While startup Ezra and biohackers are trying to make MRIs mainstream, medical experts are concerned the full-body scans could do more harm than good — setting up people who have no specific risk of cancer or another illness for overtreatment and overdiagnosis.
By Rashi Shrivastava and Katie Jennings, Forbes Staff
Bryan Johnson is the self-proclaimed “most measured person in human history.”
Johnson, who became a millionaire selling his online payments startup to PayPal for $800 million, is the new poster boy for an old Silicon Valley obsession: “biohacking” your body to extend your lifespan. He takes routine measurements of everything from his blood to his stool as part of his anti-aging quest.
But Johnson told Forbes he believes there is one “gold standard” measurement tool to rule them all: the full-body MRI.
The medical imaging technique uses powerful magnets to generate highly detailed pictures of your insides, including organs, bones, joints and blood vessels. Johnson loves them. “I just did an MRI on every joint in my body in preparation for stem cell therapy. I’m doing one on my brain. I’m using it to quantify my body muscle and fat,” he said. “In the next month, I’ll be doing six MRIs.”
One of his go-to providers of the service is New York-based startup Ezra, which uses artificial intelligence to speed up the process, with the goal of making full-body scans accessible enough that people get them regularly.
Usually MRIs are done for a specific reason, targeting a specific area of the body. But for Ezra’s founder and CEO Emi Gal, a biohacker and longevity enthusiast himself, regular full-body scans should be a universal pre-screening tool, a way to catch any potential condition you might have, from cancer to bladder stones, early enough to treat it. Now, Ezra has announced a fresh $21 million in venture funding to take full-body scans mainstream. With $41 million in total funding, Ezra is now valued between $100 million and $150 million, according to a person in a position to know.
“It was life changing to do it,” Johnson said of his first Ezra scan a few years ago, which revealed that two veins in the side of his neck were narrowed. “I wasn’t getting enough blood flow out of my brain,” said Johnson, adding that his “bad posture” exacerbated the problem.
Gal said that since Ezra was founded in 2018, 7,000 people have done its full-body scans, which cost $2,500 a pop and aren’t covered by insurance. About one third of them are “the Bryan Johnsons of the world” — wealthy biohackers who work in tech. The rest are what he calls the “cancer conscious.”
But medical experts are concerned that full-body MRI scans could do more harm than good for the majority of patients — setting up people who have no specific risk of cancer or another illness for overtreatment and overdiagnosis. Not to mention the skyrocketing costs of a bunch of unnecessary follow-up procedures.
“It makes me sad, because I think these companies are preying on people’s vulnerabilities and fears.”
Gal said Ezra offers a screening full body scan and if it shows any indication of cancer or one of 500 conditions Ezra looks for, there would be a follow-up diagnostic exam outsourced to the patient’s regular doctor. “If you ask ten people on the street, would you like to do a scan that might require you to do a follow-up scan or would you like to die of cancer? Pretty much all of them will say give me the follow-up scan.”
While this argument is logical and appeals to the average person, it’s not grounded in science, Matthew Davenport, a radiologist and professor at the University of Michigan, told Forbes. “Not all cancer is the same,” he said. Depending on the organ, anywhere from 15 to 75 percent of cancers are “indolent” – a medical term meaning that the cancer has a very low likelihood of spreading or shortening their life expectancy.
This is why medical guidelines around screening for cancer always take into account the patient’s probability of getting cancer in the first place. For example, does this person have a family history of cancer or live or work in an environment where they might be exposed to toxins? Otherwise, this leads to what Davenport calls a “cascade of care,” meaning workups, diagnoses, biopsies and treatments that the patient might not even need in the first place. “It makes me sad, because I think these companies are preying on people’s vulnerabilities and fears,” he said. “Now they start living with this idea that they have something lurking in their body, which never would have harmed them in the first place if it hadn’t been detected.”
Gal admitted his own experience involved one such false positive finding when he was acting as “the guinea pig of Ezra,” he told Forbes. In the company’s early days, Gal said one time he spent three and a half hours inside an MRI machine as they worked on building out the product (he took bathroom breaks). The radiologist found a lesion on his liver. A follow up diagnostic scan revealed the lesion was benign. “It’s now been stable, meaning the same exact size, for many years,” said Gal, adding he gets an Ezra scan every six months. “I know that this is not anything of concern.”
For Gal, the benefit of knowing and the cost of monitoring outweighs the risk of false positives. “As a culture we’ve been afraid to image more because of false positives but the best way to rule out false positives is to image more,” he said.
A software engineer and former advertisement tech entrepreneur, Gal said he transitioned into the healthcare space because of his past run-ins with cancer. His mother passed away from cancer and he is also at high-risk for melanoma, a type of skin cancer. Born in Romania the same year as the nuclear disaster in Chernobyl, Gal said he has over 250 moles on his body, which made him concerned about exposure to radiation and led to frequent visits to the dermatologist. “I was probably more aware than most young people of the importance of screening,” he said.
But for now Ezra has a limited clientele: people who are willing to pay thousands of dollars out-of-pocket. A 60-minute full body scan plus lungs is currently priced at $2,500, whereas a 30-minute scan without lungs and spine runs $1,350. The ultimate goal, Gal said, is to get the cost to around $500 for a 15-minute scan, which he expects to reach in about two years. And that’s where artificial intelligence comes in.
“To date, there is no documented evidence that total body screening is cost-efficient or effective in prolonging life.”
Ezra does not build any hardware. In fact, the company doesn’t own any MRI machines at all. It partners with existing radiology centers, such as Radnet, and pays those clinics for scanning slots on machines manufactured by GE, Siemens and Philips. The plan is to offer Ezra’s AI at more than 50 locations throughout the U.S. by the end of this year.
“It’s a great business model,” former One Medical CEO Amir Dan Rubin, whose new venture fund Healthier Capital co-led the investment in Ezra alongside FirstMark Capital. Rubin said the key differentiator is “reducing the time in scanner.” He described it as a win for patients who spend less time trying to lie still in a giant metal tube and a win for the clinics who can now run more scans in a shorter amount of time.
Ezra’s innovation is all in its software. The startup’s AI is a neural network, built on a database of 10 million MRI images as well as anonymized data collected from a third-party data provider (which Ezra declined to disclose). The company trains radiologists and MRI technicians at existing clinics how to use it.
For a typical MRI screening, multiple images are needed to produce a high-quality readout. That’s because there tends to be a lot of “noise” or graininess, while the machine bounces radio waves off the protons in your body in a manner similar to radar. With Ezra’s software, fewer images are required because the AI cleans up the scans and increases sharpness. This technology, called Ezra Flash, was cleared by the FDA in July 2023 to speed up scans of the brain.
After the scan is done, the radiologist applies another AI tool called Ezra Assist, which has been FDA cleared to help analyze the prostate – in the future Gal hopes to get clearance to use the AI for the entire body. When it comes to communicating the findings to customers, Ezra has built another AI tool to convert complicated medical terms in the radiology report into simpler language. “We joke it’s like ChatGPT for radiology reports,” Gal said.
However, he confirmed a human – either a primary care doctor or nurse practitioner – reviews the AI-generated report before it’s sent to the patient. Any patient with suspected cancer is contacted by Ezra’s medical director or a nurse practitioner on staff to go over the findings.
Gal said one of the most common findings among Ezra customers is prostate cancer, which he said most of the time “should just be monitored” because it’s slow going. The second most common finding, he said, are thyroid nodules, most of which are benign. “We’re helping people get this data and then only act upon the findings that look problematic,” said Gal. “But you can only do that if you do more scanning.”
Or, you could just not do the scans in the first place, said Davenport, the radiologist. He said the thyroid findings are particularly troubling based on long-term data from South Korea, which found that increasing screenings led to an “epidemic of thyroid cancer” in the country. However, even as the country saw the highest number of thyroid cancer cases in the world, there was no increase in the number of deaths, according to a study published in the New England Journal of Medicine. This resulted in tens of thousands of people getting their thyroids removed and being treated for a cancer that was essentially harmless and was not going to kill them. “Have we not learned our lesson?” asked Davenport. “It’s like a Greek tragedy.” (Gal said Ezra only recommends monitoring for thyroid nodules detected on scans and not biopsies or follow-ups.)
Even if Gal succeeds in his vision of a $500 MRI scan, there’s still a looming question: who will pay for it? Generally health insurers are sticklers for only covering what’s medically necessary – and currently there is no medical society in the U.S. that advocates for these full-body MRI screenings. That includes the American College of Radiology, the association that represents doctors who interpret MRIs, which wrote in a statement last year that “to date, there is no documented evidence that total body screening is cost-efficient or effective in prolonging life.”
While health insurers probably won’t pay for the scans, it’s possible that self-insured employers, meaning companies that are on the hook for their employee’s overall healthcare costs, might, said Ge Bai, a healthcare policy and accounting professor at Johns Hopkins University. Gal told Forbes that Ezra already has deals with some employers to provide scans to certain employees. For Bai, the proposition is still net negative financially. “An individual person might get their life saved, but there’s no evidence at population scale that this kind of a test will help.”
This was echoed by Davenport. “My expected value of that test is negative from a health standpoint, even if I’m a millionaire,” he said.
Bryan Johnson won’t be swayed by the doctors or economists. “I understand people’s arguments that it can kick up a bunch of other stuff. On the flip side, there’s a possibility that we are not preventative enough in our screening protocols,” he told Forbes.
“In an ideal world, everybody would have them,” he said about full-body MRI scans.
Gal believes data about the rate of false positives, which the company plans to release in the next few years, will shift the mindset of detractors and also get insurers on board. In the meantime, he said most of Ezra’s new customers – nine out of ten – are from referrals of existing customers. “I’m very happy that there are competitors and that Kim Kardashian is getting scanned as well,” he said, referring to a now viral Instagram post where the reality TV star gushed about how much she loved rival full-body MRI scanning startup Prenuvo. “It’s helping grow the market.”