Social Media Posts About Medical Tests with Potential for Overdiagnosis
jamanetwork.com
jamanetwork.com
> ... an urgent need for effective regulation to protect the public.
Unlikely to happen.
It's now open season for fraud against Americans. Many of the regulatory organizations in the US Government have been downsized or eliminated, and the Department of Justice is cutting back on enforcing laws against white collar crime.
It's a great time to be a scammer. Any scam that can be made to look even vaguely legitimate is low-risk.
cough* United Health cough*
A few randomly-found pre-2020 citations to corroborate:
“I Want a Whole-Body MRI” When Patients Demand Unnecessary Tests 2019 https://www.midwestmedicaledition.com/articles/i-want-a-whol...
"Are MRI’s Being Overused?" 2015 AdventHealth University https://www.ahu.edu/blog/are-mris-being-overused
As to prior boom-and-bust waves of full-body scan business (self-correction: I shoud have said the previous wave was CT scans, not MRI), GQ 8/2023 [0] "Almost 20 years ago, there was a boom and bust of body-scanning clinics, as The New York Times [1][1-archive] covered in 2005. It was a “a sort of medical gold rush,” boosted by direct-to-consumer advertising that got thousands to cough up out-of-pocket payments -- sometimes up to $1000 ... It began as a sort of medical gold rush, with hundreds of scanning centers, with ceaseless direct-to-consumer advertising, and with thousands of Americans paying out of pocket for the scans, which could cost $1,000 or more. It ended abruptly with the wholesale shuttering of businesses."
Prenuvo's CEO, Andrew Lacy appears to have zero medical credentials and zero scientific background; however he's big in marketing startups. Here are some very dodgy statements from his podcast [2] "How I Built This with Guy Raz - Full body preventive health care with Andrew Lacy of Prenuvo" where Raz asks his to "ask you about the science behind it, and also the criticsms... overwhelming oposition from the medical establishment... I have not found any official endorsement of what you're doing... many public health experts are like: people should not be doing this, it's very expensive... unnecessary procedures, false positives" [20:30] and Lacy replies [21:52] "I don't think you've fairly characterized what they say... not true, a lack of comprehensive, long-term evidence is not... [does not finish his sentence]... I think these statements also have been made about pap smears and mamograms, so this is a very very natural point in the journey from potentially breakthrough screening technology to a point at which it is inevitably adopted, and I hope it won't take thirty years..." [23:40] "... These are very new techniques... and you really need first-hand knowledge to be able to form an opinion that is informed, and there's noone that has really spoken out against these technologies that has experienced it first-hand(!)... in fact most of those people bring their family members in and then start referring their patients" [implies that any doctor who tries it will endorse it].
Disappointing that Raz didn't cut that off "there is zero medical or scientific evidence for your claim. Where are the peer-reviewed studies? Which doctors are you claiming endorse it?".
[0]: https://www.gq.com/story/kim-kardashian-endorses-full-body-d...
[1]: NYT 1/2005 "Rapid Rise and Fall for Body-Scanning Clinics" https://www.nytimes.com/2005/01/23/health/rapid-rise-and-fal...
[1-archive]: https://archive.ph/UcahO
[2]: 12/7/2023 https://one.npr.org/?sharedMediaId=1217778389:1217778391
GQ 8/2023 "Full Body Scan: Kim Kardashian Endorses Them. But Are They Worth It?" https://www.gq.com/story/kim-kardashian-endorses-full-body-d...
r/Radiology: Explaining the whole Prenuvo mess to the layman... https://www.reddit.com/r/Radiology/comments/17sdguu/explaini...
r/PeterAttia Anyone have regrets over doing the Prenuvo scan/Full body MRI? https://www.reddit.com/r/PeterAttia/comments/1fievpc/anyone_... multiple negative reviews, including one experience by Historical-Sail-3636: "I regret getting a full body prenuvo scan ! It’s a scam ! Don’t do it. The radiologists reviewing and signing the scans are not properly licensed. They are the rejects of the medical community. Check the license of the radiologist that read your scan! You’ll be surprised."
"We Tried Prenuvo's $2,500 MRI Scan. Here's What We Learned and Why It's Not for Everyone" https://www.verywellhealth.com/prenuvo-full-body-mri-scan-76...
I know it’s very dose dependent, but typical steroid doses are 10-100x what your body produces naturally(!).
I don’t know how it compares to “clinical doses”, but think twice man…
The doctor started me on a "midrange" dose of enanthate: 75mg every 10 days. My levels shot up, at the very high end of the male range. I brought that down to 75mg every 2 weeks and it barely budged.
This is the exact same drug/formulation that a lot of these guys are taking for TRT. The highest "official" dose is 100mg every 7 days. (I'm sure some of them are taking even more than that, but that's as much as a doctor should be prescribing you.)
Obviously everyone metabolizes this stuff differently, and if you're tall/heavy you'll likely need a higher dose than someone of average stature like me. But if my T levels shot up from ~20 ng/dL* to ~900 on a very moderate dose of enanthate, how high are those levels getting for someone who's starting from ~500?
* The normal female range is anywhere from 15 to 70. The normal male range is anywhere from 200 to 1000.
Even those patients are often disappointed when the TRT doesn’t solve their problems.
The high doses used by TRT clinics shoot past that threshold and go for levels that were previously only used by people using testosterone for performance enhancement.
The really hard thing about this topic is that a lot of the negative effects don’t show up right away. It’s sometimes months or years later before people realize their testes are so shut down that they’re dependent on TRT for life, for example. People also go into loops of trying to manage high estrogen (a side effect of high TRT doses) where they crash their estrogen, going into deep depression, or get it wrong and end up growing excessive breast tissue that needs to be physically removed.
High testosterone levels (beyond normal physiological range) are also associated with lower cognition. It makes people feel more confident, though, so this also isn’t noticed. Anxiety disorders are also a common side effect of excessive dosing.
The list goes on and on. Unfortunately mainstream podcasts on this topic are woefully bad at covering it because they know listeners only want to hear about the positives. Even the supposedly good podcasts like Huberman Lab are a joke on this topic. The TRT forum people love picking apart how bad Huberman’s TRT takes are, even though he positions himself as being moderate on the subject.
Testosterone has become a favorite topic of social media influencers and podcasters. In parallel, clinics have been popping up all over the country to do nothing other than diagnose people with "low testosterone" and get them started on testosterone prescriptions.
Two important things that are always left out of the conversation:
1. Taking exogenous testosterone causes testicular atrophy. The body recognizes that there is enough (or more than enough) testosterone and stops stimulating the testes to produce more. This causes them to atrophy, gradually losing their ability to produce adequate amounts of testosterone.
2. Almost everyone who starts injecting testosterone (or creams, etc) will feel better at first. The initial change of the added testosterone on top of what your body was already producing in one sudden upswing leads to feelings of energy, motivation, and well-being. This fades over time as your body adjusts to the exogenous testosterone.
These two facts are critical to understand before starting testosterone, but they're almost never discussed on social media or podcasts. Shady TRT clinics actually benefit from those two points because the first one means customers become physically dependent on the product and the second means that they'll immediately feel like it solves all of their problems.
The really problematic TRT clinics are now doing things that make the problem even worse:
1. They offer free testosterone blood tests, but if the numbers aren't actually low they'll find another way to justify prescribing. Common techniques are to use non-standard reference ranges (e.g. claiming everyone should have 1000ng/dL levels) or having you fill out a big questionnaire of "low T symptoms" and then saying they treat the symptoms, not the blood test.
2. Advertising on the radio. There are multiple TRT clinics in my area who advertise their TRT as a way to "get an edge in the gym or at the office". They aren't even trying to hide it.
3. Prescribing enormous doses. A local TRT clinic chain has been prescribing high doses to everyone who comes in the door, resulting in some very excessive levels in patients. This can lead to many problems, including Gynecomastia (male breast growth).
It's a big topic among my doctor friends because they're seeing an increasing number of guys show up either asking to have someone take over their TRT prescriptions (the clinics usually don't do insurance), asking how they can get off TRT without crashing out, or dealing with various health problems from excessive dosing.
Feeling better immediately is a problem, but there's lots of other treatments where that's true, and that'd be a transient problem if it wasn't for it causing dependence.
It's so incredibly darkly funny to me, given how common a joke male bodybuilders on hormone supplements having withered testes is, and has been for many years, so it's not like it's a secret that this happens, or not in the public consciousness in other places.
But having had chronic issues with illness and infirmity for a bit now, I do understand, to some extent, the desperation to not feel the phantom of body rot creeping up on you, carving off thin slices of your quality of life.
By contrast, broad-spectrum tests like full-body MRI or MCED seem less prone to abuse. They may be unnecessary, but they don't have as much of an incentive to find a diagnosis, and anything they pick up will probably get reviewed (and treated, if appropriate) by someone outside the clinic.
And from the study’s conclusion:
> These data demonstrate a need for stronger regulation of misleading medical information on social media.
Absolutely not. Free speech is more important. And experts can be wrong, especially when they have bad incentives. In this case the authors are part of groups in Australia that promote overdiagnosis as a problem. And Australia is unfortunately a censorship addicted country at the moment.
Not to mention the cost of the exams themselves. Everytime someone goes through an exam that serves no useful purpose, that's healthcare money that could be put to better use.