Cancer Medicine

NBC News and false balance on whole body MRIs

A week ago, NBC News aired a story on whole body MRI scans. Although it did include the usual cautions about false positives and the harm they cause, the caution was diluted by the story’s focus a rare case of a woman who had a brain tumor detected. Overall, it was false balance that reminded me of vaccine/autism stories 20 years ago.

I hadn’t intended on writing about the profit-driven and non-evidence-based product that is “whole body scanning” again so soon, given that I just wrote about this perennial money-making medical venture last summer in the context of companies offering newer products that add artificial intelligence to the scanning analysis without demonstrating that AI actually improves specificity and/or sensitivity. Of course, the AI is always proprietary, which doesn’t allow independent investigators to determine how and if it works, and the companies promise to do clinical trials, while continuing to charge customers up to thousands of dollars per scan. At the time, I noted that various “whole body scanning” products had been hyped for at least 20 years before and that one of my earliest forays into medical skepticism occurred in the early 2000s when I was faculty at a cancer center in New Jersey and noted radio ads for AmeriScan, Dr. Craig Bittner. The overblown claims being made for the scans, which included breast MRI and various whole body CT scans, being able to “catch cancer early” and save lives led me on a bit of a crusade that I wrote about back in 2005. Ultimately, AmeriScan went out of business, as whole body scans of the type it sold went out of favor, but bad ideas in medicine are evergreen. It was thus inevitable that, as the technology progressed by leaps and bounds over the next two decades, other companies would see profit potential selling old wine (whole body scans) in a new bottle (AI-augmented CT and MRI).

And so it was, with companies like Prenuvo seemingly thinking that whole body MRI + AI = profit. I was wondering whether there was room for the “old fashioned” sorts of whole body scanning. I need not have worried. As I was idly flipping channels a week ago while waiting for our dinner companion to be ready so that we could go out and get some food, I came across NBC World News Tonight and a story entitled Medical professionals weigh in on growing trend of people getting full-body scans to screen for cancer.

On second thought, maybe there isn’t room for old-fashioned MRIs without AI, because I learned as I watched the story that—spoiler alert!—Ezra, the company selling these scans and whose CEO is interviewed in the story is selling an AI-augmented whole body MRI scans that is claimed to reduce screening time to 30 minutes.

The NBC story on whole body scans was practically an infomercial

As this story appeared on my TV, let’s just say that I immediately got a vibe similar to what I used to get watching stories about autism 15-20 years ago, when reporters routinely seemed to think that they had to interview parents convinced that vaccines had made their child autistic whenever they did a story about vaccines or autism. In these stories, reporters would focus on the human interest story about the parents and the child and then include a couple of doctors almost as an afterthought as the token skeptics to tell the audience that the science overwhelmingly shows that vaccination is not associated with an increased risk of autism and autism spectrum disorders (ASDs). Overall, it was false balance in that science had no chance against the sympathetic human interest part of the story about a family dealing with autism. The very best impression left by these stories was that there was a real scientific debate going on over the topic—there wasn’t—while the worst impression coming from this stories was that vaccines really did cause autism. Fortunately, over the years, the press learned, particularly after Andrew Wakefield was disgraced due to losing his medical license in the UK, the retraction of his 1998 Lancet case series that had sparked the 21st antivax movement, and Brian Deer’s devastating exposé on his scientific fraud, and false balance became much less common, although sadly it’s not gone.

This story reminded me a lot of that. Here’s what I mean.

The story was bookended with the story of a woman named Andrea Schaffer. Ms. Schaffer, we’re told, had purchased a whole body MRI scan as a “present to herself” last June. When NBC reporter Vicky Nguyen asked Ms. Schaffer why she had purchased the scan, Ms. Schaffer mentioned that she was a 44-year-old woman whose mother had been diagnosed with breast cancer when she was about her age. We then learned that the scan had found a cancerous lesion in her brain, shown here:

Whole body MRI success
Yes, that’s a big brain tumor.

Ms. Nguyễn then asked Ms. Schaffer, “Do you think the scan saved your life?”

Ms. Schaffer, of course, replied, “Yes.”

First off, let me just say that I’m very happy that this tumor was found in time to do something about it with surgery and whatever other treatments were offered to Ms. Schaffer. I never want to see patients die of cancer when that can be prevented.

My good wishes to Ms. Schaffer notwithstanding, though, no matter what the rest of the story would go on to say, who might be interviewed, or what studies might be presented, I knew upon seeing how it started that the story was going to be hopelessly slanted. Here was a woman who, concerned about her health given her family history of breast cancer, had purchased a whole body MRI scan, which then found a “cancerous brain tumor.” We were not told what kind of brain tumor—which is actually rather important information given that different types of brain cancer have different prognoses—only that this woman clearly believes that the scan had saved her life. And why shouldn’t she believe that? From the perspective of the patient, surely finding the tumor must have saved her life! True, the tumor was only found about a year ago; so she isn’t that far out from her treatment. But surely she would have died, right? Maybe. Probably, even.

So what’s the problem?

Ms. Nguyễn, in fairness, did follow up the brief snippet of her interview with Ms. Schaffer with a quote from authorities trying to tell us what the problem is. However, watching such a story constructed in this manner, by the time audience hears from those authorities, it’s too late. Ms. Schaffer’s belief had been conflated with actual cause-and-effect, leading to the message being indelibly imprinted that a whole body MRI scan had saved her life.

From there, went on to note that these scans have proliferated, promoted by celebrities like Kim Kardashian and Maria Menounos, the latter of whom had a stage II pancreatic neuroendocrine tumor discovered (PNET) on a Prenuvo scan. It is important to note here that PNETs are much less aggressive and deadly than the more common run-of-the-mill pancreatic cancer, although in fairness I also need to point out that it was a PNET that ultimately claimed Steve Jobs’ life. You might read stories about Maria Menounos and see this story about Andrea Schaffer and then ask again, “What’s the problem?” Didn’t these scans save these women’s lives?” The question of screening asymptomatic people for disease, be it cancer or whatever, is, unfortunately, a much more complex question than that, and there are, in fact, harms from such screening that have to be balanced against the rare cases like those of Ms. Menounos or Schaffer, something this story did in such a perfunctory fashion that it almost might have been a brief infomercial for Ezra scans. Yes, Ms. Nguyen quoted the American College of Radiology’s statement that these scans are expensive, not covered by insurance, and can result in unnecessary medical tests and procedures, all of which is totally true, but sounds a lot less convincing coming hot on the heels of an interview with someone like that of Andrea Schaffer.

Any consideration of the potential harms of such scans was then undermined even further by what followed next, an interview with the founder and CEO of Ezra, Amit Gal, described on the Ezra website as a “software engineer and entrepreneur with a 15-year track record for building successful technology companies, and bringing them to a worldwide stage.” Mr. Gal, predictably for one of these stories, enthusiastically hyped how his company “has helped our members find numerous types of cancer,” which is all well and good but rather useless information without knowing which cancers, how many, and the denominator of how patients were screened. In other words, how many is “many of our members” and how many members underwent the scans to detect those cancers? It would also be helpful to know how many required additional workup and tests, particularly additional invasive tests, to rule out disease and were ultimately found not to have anything requiring treatment, as well as the complication rates for those additional tests.

The overall impression given was that early detection is always good. Of course, doctors serious about developing screening tests for asymptomatic populations know that this is not always the case—and often not the case—and that there are harms involved with any screening test. None of this stopped Mr. Gal from noting that his test “might find cancer, or any of 500 other diseases” and that “the vast majority of Ezra scans” don’t find anything but do give you “peace of mind.” That made me wonder: What’s the false negative rate of the scans? Every test has false negatives? In other words, how “peaceful” is the “peace of mind” provided by these scans? After all, MRIs are great at detecting some cancers and diseases, not so great at detecting others. Of course, Ezra had an answer for that, as the next shot showed Dr. Dan Sodickson, Chief of Innovation at NYU and Ezra’s chief scientist, saying that the Ezra scans are best if you get one every year. (Of course they are. Ezra needs a steady, predictable income stream, after all.) Sadly, Dr. Sodickson didn’t even present anything resembling a scientific rationale for saying this. Then, when Ms. Nguyen asked him whether it’s realistic to expect someone to pay several thousand dollars a year for these scans for “peace of mind,” his response was telling: “I think it is, if it provides that confidence about health.

After that avalanche of promotion, the story finally brought out the token skeptic, Dr. Matthew Davenport, a professor of radiology at the University of Michigan, who tried valiantly to say the things that needed to be said about a test like Ezra’s. For example, when Ms. Nguyen asked him if he thinks that the result of these scans will be more tests and medical procedures that will cause harm to patients, Dr. Davenport, to his credit, answered that “unquestionably” that will be the result, citing more testing, biopsies, procedures, and operations as potential harms and concluding that you should check with your doctor before shelling out $1,350 for the most basic Ezra scan (or $2,500 for the “advanced” scan). (I also couldn’t help but note that Ezra offers financing options with no-interest monthly payments, so that you can go into debt to get a scan.)

Of course, this being a story with false balance, Dr. Davenport’s valiant attempt to inject some evidence and science into the discussion was immediately undercut by how the story was bookended, with a shot of Ms. Schaffer walking next to a pond, with a voiceover saying that she plans on getting another full body scan this year, after which she said, “You can’t put a price on it. This saved my life.”

See what I mean? NBC News and Ms. Nguyen can defend themselves by saying that they did quote the American College of Radiology and did interview radiologist who has a different view of these scans. Unfortunately, the way the story was bookended by a compelling anecdote of an appealing woman who was fortunate that a whole body scan spotted her brain cancer in time for her to have it surgically removed and, even more pointedly, got the final word, that final word being that you “can’t put a price on” the scan and that the scan “saved my life” gave a message that was anything but balanced. Let’s put it this way. Even if the story had not been bookended with the story of Andrea Schaffer and concluded with her saying that the test had definitely saved her life, placing her story instead somewhere in the middle, this story would still have been false balance, anecdotes against science.

Anecdotes, not much science

Whenever I see a story like this, I immediately become curious about the company, its product, and what, exactly, the product is claimed to be able to do and then compare all that with current scientific recommendations. The Ezra website immediately struck me as being long on anecdotes and hype but but very short on science. Sure, it says, “Our Scientific Advisors participate in authoring and publishing research papers with our Ezra team to maintain the highest scientific rigor within our work.” Yet, there’s no link to the article shown, and when I looked it up I didn’t see how it was evidence for the utility of scanning asymptomatic individuals at average risk of cancer because it was an article about identifying areas suspicious for cancer in the prostate using MRI. In fairness, it’s likely a perfectly fine article on one of the techniques developed by Ezra, but it is not evidence that their products do more good than harm. Also in fairness, I found other such articles by searching PubMed for “Ezra” and “MRI,” but none of them address the elephant in the room, the question of whether scanning asymptomatic people for cancer improves survival or even just the question of whether it does more harm than good.None of that stops Ezra from claiming on its website landing page without evidence, “Our annual scan catches potential cancer earlier, making it easier to beat.” On another page, the company states, “Screening is our best defense against cancer. And we’ve perfected it.” Is it, though? And have they, though?

Unsurprisingly and typically, in lieu of studies Ezra does have a fair number of anecdotes like that of Ms. Schaffer, although, oddly enough, I could not find her story on their website. That led me to go back and see if it was an Ezra scan that she had actually gotten. I’m glad I noticed that her story wasn’t on the Ezra website, as I did some additional Googling and fairly quickly found Ms. Schaffer’s website, Not Just Broccoli. It turns out that she is a “nutritional oncologist” who offers “terrain testing” that looks at the “The Terrain 10”:

  • Circulation
  • Inflammation
  • Oxidation
  • Microbiome
  • Blood Sugar
  • Toxins & Detoxification
  • Hormones
  • Immunity
  • Stress & Biorhythms
  • Epigenetics

“Toxins and detoxification”? Uh-oh. Ms. Schaffer also notes:

As we take a deep dive to find out why your body is cancering, we individualize your nutrition plan based on your health history, biology, environmental exposures and DNA. In order to have a complete picture of which areas of your terrain need work, we must do extensive testing. 

 The types of testing we recommend are genetic testing, extensive blood marker panels which include cancer drivers and inflammation markers, as well as home glucose and ketone testing. 

Why your body is “cancering”? She turned “cancer” into a verb?

She also offers food sensitivity testing, which is generally a bogus test. She is also treating her cancer with unproven, non-science-based dietary interventions:

In February 2023, I did a preventative full body MRI at a company called Prenuvo, and it found that I had a 2.3 by 2.4cm mass in the right temporal lobe of my brain. About the size of a walnut. I had no idea, I was asymptomatic. I have been on a journey through the medical system since, culminating with surgery at Barrow Neurological in Phoenix, Arizona on April 5th, 2023. After surgery, I was released from the hospital and returned to mostly normal function remarkably fast. I credit that to the talents of my surgeon, Dr. Smith, and all the work I did preparing for surgery. As soon as I found out about the tumor, as my training instructs, I immediately went on a therapeutic ketogenic diet (also known as therapeutic carbohydrate reduction- very different from internet keto), and worked to mitigate any other contributing factors I could identify.  Two weeks after surgery, once pathology came in, we found out that it was a malignant grade 3 oligodendroglioma. While this is shocking news, my surgeon luckily was able to remove the full tumor and we are utilizing my diet, while monitoring labs (and using them to know where I need to work on my health), to avoid recurrence. The goal is to avoid chemo and radiation in my case, due to my cancer being of the brain. 

And on her Instagram page:

Fortunately for Ms. Schaffer, nothing heals like surgical steel—as we surgeons like to say—and a skilled neurosurgeon was able to completely remove her malignant brain tumor. Again, despite my pointing out her “alternative” and “integrative” nutrition practice, I really am happy for her. I also note that, while she was one of the lucky ones for whom a whole-body MRI did more good than harm, her anecdote doesn’t let companies like Prenuvo and Ezra off the hook for making grandiose claims for their scans and recommending them yearly, as Ezra apparently does. It’s the companies whom I blame, not Ms. Schaffer, as well as NBC News, which left out a lot of relevant information in its story and constructed it so that it came across to me as a two and a half minute commercial for Ezra. This struck me as odd, given that it was just in October last year that NBC News medical correspondent Dr. Kavita Patel did a decent story cautioning against the hype for these tests, in which she brought up a good point that “full body MRIs” often use fewer “slices” and less detailed images than targeted MRI imaging a specific organ or area of the body.

It’s true, too. Targeted MRI scans generally take much longer, more detailed scans of limited parts of the anatomy based on the clinical indication, thus producing more detailed images. For example, a targeted pancreas scan takes around 30-45 minutes to do. In comparison, Ezra’s “Whole Body Flash” scan (the least expensive scan at $1,350) takes only 30 minutes to scan the whole body (except lungs, which do not visualize well on MRI because they are filled with air). Its images can’t possibly be as detailed, AI or not. Moreover, Ezra does not use gadolinium contrast, which is used for most MRI scans in order to outline the blood vessels more effectively and provide more detail. In fairness, I understand the desire not to use gadolinium, particularly when there’s a concern about potential cumulative gadolinium toxicity with repeated MRI scans done over many years (although the risk appears to be low), but there’s a price to be paid in terms of less resolution and less ability to pick up abnormalities. I also can’t help but note that the more expensive ($1,950) Full Body Scan takes 60 minutes, and the most expensive ($2,500) Full Body Plus Scan adds a screening CT scan of the lungs.

But what about the actual evidence, rather than corporate hype? First of all, a recent review article on whole body MRI (WB-MRI) states these recommendations succinctly in its conclusion:

The use of WB-MRI for cancer screening is recommended by current guidelines for subjects with cancer predisposition syndromes, including Li–Fraumeni syndrome, hereditary pheochromocytoma–paraganglioma syndromes and constitutional mismatch repair deficiency.

I note that these are all hereditary cancer predisposition syndromes in which affected patients have a very high lifetime risk of developing a number of different cancers. But what about patients at average or low risk of cancer, which is the general population targeted by ads for whole body MRI scans? The review notes:

…all the reports provide the number of subjects in which a malignant tumour was suspected, with cancer detection rates from 0% up to 10%. This wide range is probably a consequence of the small sample sizes of many studies, and the above-mentioned technical heterogeneity. Taken together, findings suspicious for malignant cancers were reported in nearly 2.0% (119 of 5809) of the screened subjects. Unfortunately, the number of studies in which follow-up and verification of findings was performed is lower, comprising 3287 screened asymptomatic subjects, in whom there was a 1.5% overall rate of histologically confirmed malignant cancers. This rate of malignant tumours detected with WB-MRI in asymptomatic subjects of the general population should not be ignored, justifying further studies. However, critics highlight the high rate of indeterminate incidental and false‐positive findings, which can lead to unnecessary additional examinations and treatments, with potential negative psychological impact [7475]. Therefore, the clinical utility of WB-MRI for cancer screening in the general population remains a matter of debate.

Last summer, the Dana Farber Cancer Institute blog published an article bluntly stating:

There is no evidence that full-body MRI scans are beneficial for people of average risk. If there were clinical evidence that they were effective, such as a clinical trial showing that many people benefitted from these scans, then they would be incorporated into standardized screening protocols. The United States Preventive Services Task Force (USPSTF) recommendations and the National Comprehensive Cancer Network (NCCN) provide excellent, meticulous analyses of screening technologies, and neither entity currently recommends full-body MRI for average-risk screening. 

Regarding some harms:

If a full-body MRI finds a suspicious signal on the pancreas, the next step is to do an endoscopic ultrasound. A doctor will put a little camera down your esophagus and into your stomach to look at the pancreas. If they see something suspicious, they’ll take a little piece, a biopsy, for investigation.  

These procedures introduce a risk of complications, even when performed by experts with low complication rates. In the average risk population, the risk of pancreatic cancer is low enough that many of those biopsies would be false alarms. It’s a lot of potential harm, possibly even the risk of death, that isn’t necessary for most of those people. 

That is exactly what I’ve been saying all along, going back over 20 years and going back to the days of my blogging about AmeriScan. I can also understand someone like Mr. Gal, who has no background in medical screening, being well-meaning and thinking he’s saving people by offering them these AI-enhanced scans. However, radiologists really should know better. Most do, but not all. They’re the ones who sell products like whole body MRI scans, even though there’s no evidence of benefit for people at average risk, they aren’t covered by health insurance, and they have the potential for causing more harm than good, exceptional cases like Andrea Schaffer notwithstanding. Even the presence of Siddhartha Mukherjee, M.D., D.Phil., author of the excellent book about the history of cancer Emperor of All Maladies, on Ezra’s list of scientific advisors does not change that.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

38 replies on “NBC News and false balance on whole body MRIs”

I’ll just leave this here:
Attack from Within: How Disinformation is Sabotaging America, a new book by Barbara McQuade. It’s mostly about politics but her evaluation holds for a wider array of disinformation.

Orac, this was well-researched and very interesting. Low accuracy testing for rare conditions does not seem to be useful. Thank you.

To what extent do your above thoughts apply to mammograms? I read some recent studies that mammograms suffer from the same exact problems (also adding exposure to X-ray radiation to the cost side). They are not accurant, often when they find cancer it is too late anyway, etc.

Are mammograms fundamentally different from “whole body AI scans”?

Oh man…it never ends…

75% of breast cancers are caught by mammo in women 40-59. That jumps to 90% at age 60.

Stop “questioning” things and sewing doubt. This has been established since the seventies. If one poor, misguided woman reads your bs and skips screening? Well, Orac can explain better what you would potentially be responsible for. You really have no morals or shame, do you?

Lee CI, Elmore JG. Breast cancer screening. In: Harris JR, Lippman ME, Morrow M, Osborne CK (eds). Diseases of the Breast. 5th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2014: 90-105.

“Oh man…it never ends…”

Because they never learn and always find a way to stir engagement through fear mongering/ inciting worry and mistrust.
The reason they ( Substackers and bigger hucksters like Mercola et al) do this is because they can’t serve as legitimate educators and informers to the public: instead, they misinform/ disinform to get attention and ego gratification. It’s all they’ve got.

Orac actually has several articles about mammograms. You could use the search box or look at his other not so secret blog for his views there. I think it’s fair to summarize his opinion as “it’s complicated,” but he can correct me if not.

There seems to be no useful medical intervention that antivaxers won’t attempt to trash, no matter how many lives are potentially lost.

No surprise that Iggy is trying to steer women away from mammography.

it will come as a shock to no one that Igor has been spreading the false claim that the Red Cross is concerned about accepting vaccine-“tainted” blood (it’s been making the rounds on Igor’s and other antivaxers’ X accounts).
These “truth-tellers” will slurp up any nonsense if they think it advances their slimy agenda.

Thank you for your interesting comment! I did not know that one mammogram delivers X-Ray dose equivalent to 7 WEEKS of background radiation. Wow.

Regarding your comment on blood donations: I recently donated a pint of blood on Feb 19. Perhaps it will save a life of two suffering vaccinated persons! (Red cross person told me I saved two lives) Fortunately my blood is not contaminated with nonhuman DNA, IgG4, Covid vaccine mRNA, lipid nanoparticles etc.

Anyway, regarding mammograms: Cochrane collaboration explains how lots of women have their precious breasts cut off due to misdiagnosis, whereas no positive effect on overall mortality is seen:

“We found that breast cancer mortality was an unreliable outcome that was biased in favour of screening, mainly because of differential misclassification of cause of death. The trials with adequate randomisation did not find an effect of screening on total cancer mortality, including breast cancer, after 10 years (RR 1.02, 95% CI 0.95 to 1.10) or on all-cause mortality after 13 years (RR 0.99, 95% CI 0.95 to 1.03).”

Not a subject I deeply care about, but Orac’s insightful post made me ask a question about mammograms, a procedure in some similar to “whole body scans”.

I did not know that one mammogram delivers X-Ray dose equivalent to 7 WEEKS of background radiation.

It’s become clear that you don’t know much of anything and are incapable of understanding most of what you do know. You can, however, state things that are unconcerning in ways meant to appeal to the fools who follow you, as your comment above shows.
That amount of radiation is about what one gets flying cross-country: I look forward to your unhinged ranting about the danger of being irradiated in planes and telling people they should not fly, that driving is much safer. (Except then you’re closer to the ground and the radioactivity from that: perhaps people need to line the bottoms of their cars with lead?)

Fortunately my blood is not contaminated with nonhuman DNA, IgG4, Covid vaccine mRNA, lipid nanoparticles etc.

It’s a good thing your stupidity can’t be transferred with your blood: that would put people in danger.

“Although the ACS acknowledged that there is a high likelihood that breast cancer overdiagnosis occurs at some level, its authors concluded that “Regardless of the study design, practically all estimates [of overdiagnosis] require unverifiable assumptions or use methods that are biased by inadequate follow-up or failure to properly adjust for trends in incidence and lead time, leading to inflated estimates””

Unverifiable assumptions? Bias? Sounds right up your alley. Per usual, you have no clue what you are reading, referring to, talking about, or even what planet we are on.

Also, NO ONE gets an inappropriate mastectomy you ghoul. Surgeons don’t just cut shit off because someone asks. Orac, as before, is much more able to explain why (for obvious reasons) than I am.

Though, if ever a boob needed to be removed you needn’t look further than the mirror…

Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, Shih YC, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society [published erratum appears in JAMA 2016;315:1406]. JAMA 2015;314: 1599–614. (Level III)

It’s also not as though I haven’t written a lot about mammography, screening, and overdiagnosis over the years, as Igor could easily find if he were to use the search box for this blog. I’ll grant you that it’s been a while since I’ve written anything on this topic and maybe I should do an update, but there are several long posts dating back probably to 2008 or 2009 right here on this blog on the topic.

Should have read the rest of the comments before posting, Orac already said this. 😊

Concerning what Orac said at 8:14 :

Isn’t it amazing that alt med/ anti-vaxxers who scour the internet and periodicals for proof can’t find simple everyday general information about issues in medicine that Orac writes about?

A few examples:
–RFK jr and other brave rebels never found volumes of studies that destroy any chance that vaccines cause autism because it is primarily of prenatal origin:
that’s a lot of research in several related fields to miss as well as huge studies like KiGGS and Jain .

–Anti-Covid vaccine warriors manage to disregard loads of studies after new vaccines’ releases that show no tsunami of death and disability attributed to their self-assembling nanoparticles or whatever**

–New wave conservative sympathisers like Naomi Wolf in their praise of CPAC/ retro lifestyles entirely miss frequent anti-semitism, sexism and racism.

–Vegan polemicists who rage against meat and dairy products fail to observe that Dutch people and Swedes live quite long lives.

** but I suspect that there are really self-assembling conspiracy theories since 2021

Orac, I would be very much looking forward to hear your opinion on mammograms (and perhaps colonoscopies). It is a non-ideological question that is of interest to most people who reach middle age. Thanks

“my blood is not contaminated with nonhuman DNA”

Unfortunately this isn’t true. During your life you’ve eaten food, been injured, bitten by insects and breathed air (presumably). You are now a veritable swamp of nonhuman genetic material.

Don’t tell your friends though. You know how those sort of people react to impure blood.

If only there were some mechanisms by which the body protects itself……

Because of deceptive nonsense spread by fearmongering antivax dipshits about a question on the Red Cross’ RapidPass form, the Red Cross felt it necessary to reiterate its policy on accepting blood from donors vaccinated against Covid-19, .

“COVID-19 vaccine does not impact donor eligibility”

“The American Red Cross wants to remind the public that receiving a COVID-19 vaccine does not make you ineligible to donate blood and blood donations from those who have been vaccinated for COVID-19 are safe for transfusion.”

“The Red Cross, like all blood collectors in the U.S., is required to follow the eligibility guidelines set by the Food and Drug Administration (FDA), including guidance regarding blood donor eligibility related to those who receive vaccinations, such as a COVID-19 vaccine and others.”

“The FDA permits individuals to donate blood with no wait period after receiving a COVID-19 vaccine as long as they are feeling well and symptom free, and the vaccine they received is one approved by the FDA for use in the US. Those who report they have received a COVID-19 vaccine are asked to provide the name of the manufacturer to ensure it is an FDA approved vaccine. If the donor cannot remember the name of the manufacturer, they are asked to wait two weeks from their vaccination to give blood.”

“To help donors save time at their next donation, the Red Cross offers a RapidPass, where donors can complete their pre-donation reading and health history questionnaire online, on the day of their donation, before arriving to the blood drive.”

“It’s important to note the RapidPass is not able to determine blood donation eligibility, so our phone number, 1-800-RED CROSS, is listed alongside many of the questions to allow donors to get additional eligibility information prior to making a trip to donate. For example, this note displays on the question about if you have received a COVID-19 vaccine because those who indicate that they have received a COVID-19 vaccine are then asked to provide the name of the manufacturer to ensure it is an FDA-approved vaccine. Those who have received an FDA approved COVID-19 vaccine may be able to donate as long as they feel well and meet all other donor eligibility criteria.”

“Blood donations from those who have been vaccinated for COVID-19 are safe for transfusion.”

Igor claims he “doesn’t care deeply” about vaccination or mammograms, but that doesn’t stop him from doggedly spreading falsehoods about both.

Cite,cant you understand that ? Then the paper could be evaluated:
Lots of misclassification of deatha, claims Goetzsche (for it is him),
On the other hand:
Those misclassifed deaths would be interesting This study has:
Coding of breast cancer as the underlying cause of death by Statistics Netherlands has been shown to be reliable in 95% of the investigated cases [17]. In addition, the Health Council of the Netherlands concluded in 2002 that the use of death certificates is valid for use as an end point for the evaluation of the screening program, as the misclassification rate is modest and is not affected by mode of detection [18], [19], [20], [21].

Right, the problem is, let’s say the woman has breast cancer detected, undergoes mastectomy, and three years later dies from “cancer of unknown origin” that is in fact an early B.C metastase.

It is not recorded as a breast cancer death, but it is. I hope Orac will shed more light on this

Right, the problem is, let’s say the woman has breast cancer detected, undergoes mastectomy, and three years later dies from “cancer of unknown origin” that is in fact an early B.C metastase.

This is a ridiculous scenario that simply would not happen. As if her medical record and an ABSENT breast would be overlooked! And biopsy not done on metastatic lesions before diagnosing “cancer of unknown origin”?
It does, however, serve as a demonstration of your penchant for shooting your mouth off about subjects of which you are completely ignorant.

let’s say the woman has breast cancer detected, undergoes mastectomy, and three years later dies from “cancer of unknown origin” that is in fact an early B.C metastase(sic).

Apparently the doctors who looked after this woman during her terminal illness:
– didn’t ask her about her previous illnesses
– didn’t review her medical records
– didn’t notice her absent breast
– didn’t biopsy her metastatic tumours

Igor, you will appear much less foolish if you stop shooting off your mouth about subjects you know nothing about.


Igor, you will appear much less foolish if you stop shooting off your mouth about subjects you know nothing about.

But then igor would never post and…., oh, I see what you did. Very clever.

@ TBruce:

Isn’t it interesting that brave maverick supersleuths/ contrarian tech bros who scour the internet/ public records/ research results and present their followers with startling discoveries about SBM
FAIL to incorporate, or misrepresent, basic facts?

a la Naomi Wolf since early in her career, Del Bigtree at nearly every broadcast, RFK jr or Gary Null?

One of the funniest was when an anti-vaxxer railed about mercury contaminating a vaccine that never had it for obvious reasons!

I’m no pathologist but I’m pretty sure they mount those cancers and can tell you the primary tissue type/source. Sometimes we really only need to know the receptors to guide treatments and you can directly infer the primary tissue from that. I’ve never heard of a cancer of unknown origin but Bacon or Orac should weigh in.

@Medical Yeti:

As a pathologist, I can provide some insight into “Cancer of Unknown Origin”.
It does occur, but is more and more uncommon. Some cancers with a specific microscopic appearance can have multiple possible origins. Also, high grade malignancies have an undifferentiated appearance so that the primary histologic features of origin are obscured. Traditionally, the pattern of spread and other clinical clues were used to try to identify the primary origin. Over the past 40 years or so, immunological stains allow many of these tumours to be sorted out. Newer genetic and molecular investigations can also help.
Still, occasionally we can only provide a differential diagnosis of probable origins. A frustrating situation.


I remember about 20 years ago my father had a coloscopy and they identified two different types of cancer. They had removed the polyps and he did several rounds of radiation and chemo.

He lived for another 10 years before dying from an infection.

What is so “precious” about a breast? Do tell. It’s a body part that thankfully can be removed when needed to SAVE YOUR LIFE. I’m glad I had mine for breastfeeding but would have used formula if it I’d had to remove one or both in the reproductive years. You sound like some guy who thinks breasts are sex toys for men to ogle and salivate over.

Exactly! What is this misogynist nonsense out of Igor? (Not that I am surprised.)
It’s just plain gross.

Misogyny- frequently cleverly disguised- is often expressed by alt med/ contrarian / alt right-adjacent proselytisers.

There are two problems with the story, and you rightly concentrate on the medical issues. As a former reporter who left the profession decades ago, my concern is with the abysmal quality of reporting. It’s lazy and careless, and it reeks of ignorance. You say it sounds like an infomercial, and it may well have been inspired by an infomercial or by a mailed solicitation like we receive every so often. It’s simply inexcusable that the reporter didn’t look further into the person whose brain cancer was detected, especially given the resources available to everyone today.

A few thoughts…

Incidentalomas are often a curse. I’m convinced I can scan a newborn and “find” something. People get hung up on them. You have to follow some of them, etc. you call the specialist about a weird one and they get angry at you. The list goes on. I’ve seen plenty of unnecessary biopsies from them but most were of possible breast lesions caught on a ct done for some other reason.

That said-I’ll be fair-sometimes scans done for other things can be useful. Had a young pt who got a ct to rule out appy that found PCOS we could do something about.

I’ve moved to doing prostate mri in guys with equivocal or long-standing PSA elevations. You get way more info and it guides biopsy. I’ve saved a dozen or so from biopsy who didn’t need it and those biopsies are NOT benign procedures.

If, in the future, we develop a “cancer panel” that detects a “risk” with reasonable SP/SN via labs I’d be happy to send that person for a pan scan. Maybe we’ll get there. As you note, that prostate mri is getting a very detailed, targeted look compared to a pan scan.

I heard that Fuji or one of the other PACS makers is already fielding an AI based system that does wet reads of imaging studies. For now, those have to be reviewed by a rads doc but their AI then learns from that, and so on. The goal being it does reads and you have to request a radiologist review if you think it’s wrong. I guess we’ll see if this comes to pass…
“Number needed to scan” should be a thing haha

My experience has almost always been – over several kinds of tests and issues – that the PCP/Radiologist sees something and refers you to a specialist, and you can almost see the specialist roll his eyes and says not to worry about it.

Yep. Partially because I work rural/critical access most of the time I tend to be someone who doesn’t refer unless I’ve gotten to the point I’ve had to throw my hands up in the air.

Often it’s a matter of cover your behind at that point-I can’t explain this, better have the pro look once. I get a two-line note back six months later that says something to the effect of “This is a nothing burger, thanks for allowing me to participate in care”

Yes! Only for me, it happened AFTER the unnecessary biopsy. Radiologist (different one) said WTF; you did a biopsy for that little smudge or whatever? Never mind my three days of terror.

Yeah that’s the worst. Like prostate cases that are equivocal, I’ve moved to breast MRI when a woman has already had a biopsy or is going to have to wait weeks and weeks to get a biopsy. Three biopsies have been cancelled as a result to date. Also, mri gives vastly more info and puts it in context.

I suspect this is where things are headed but we shall see…those studies probably only got paid for because they were coded as “guide or determine need for biopsy.” Last I checked those biopsies cost insurers around $2500, the mri is around $600.

Siddhartha Mukherjee should have declined to serve as one of Ezra’s scientific advisors, but I imagine he just couldn’t turn down the easy money. And why did NBC carry this story? It is all about scintillating “news storys” so that they can make more advertising dollars.

Want to respond to Orac? Here's your chance. Leave a reply! Just make sure that you've read the Comment Policy (link located in the main menu in the upper right hand corner of the page) first if you're new here!

This site uses Akismet to reduce spam. Learn how your comment data is processed.


Subscribe now to keep reading and get access to the full archive.

Continue reading