The use of MRI body scanning as a preventative tool was highlighted by the president’s recent rope-a-dope with the media. Community practice whole-body MRI businesses now exist, local entrepreneurs directly marketing these services to the public. These scans are not reimbursable by traditional health payers.

The attraction of MRI is its lack of ionizing radiation, as well as its proven sensitivity to a variety of pathologies. Example: Detection of breast cancer in women is more sensitive with MRI than any other tool. Likewise, most brain pathologies. MRI screening for brain aneurysms is reimbursable if sufficient family or genetic predisposition exists. Few other accepted preventative MRI screening exams are reimbursed. The president’s screening was apparently aimed at his heart; detection of ischemic heart muscle by MRI is well documented. Why his liver was a target remains a bemusing speculation.

Almost 25 years ago, whole-body CT scanning became a popular fad, even featured in The Wall Street Journal and by Oprah Winfrey, with numerous imaging centers offering the scans to cash-paying clients, including ours. Its popularity alarmed regulators because numerous “false positives” were found leading to an escalation of health care expenses for follow-up management of such things as lung nodules (not truly a false finding, just not necessarily significant). This intersected with political targeting of runaway health care expenses leading up to Obamacare legislation. The threat of death from cancer induction by CT was used as a hammer, the FDA got involved, and professional condemnation put a damper on the practice, claiming thousands of unnecessary deaths from CT. Forget the fact that CT scans essentially eradicated routine exploratory laparotomies for appendicitis, commonly done before the CT era, or the countless millions of lives saved by CT scans compared to the theoretical risk of cancer from a single CT scan.

Subcomponents of whole-body CT scanning ultimately proved themselves. Today, coronary calcium screening, lung cancer screening with CT, and even virtual CT colonography are accepted uses; taken together they represent essentially full-body CT screening.

This flashback brings us back to whole-body MRI. Trump’s use of the technology raises questions of political privilege and wealth inequality in health care. When Obama underwent virtual CT colonography during his term, similar criticisms arose.

Consumerism in American health care is nothing new; we spend approximately $30 billion a year on complementary and alternative medicine with little evidence base, with no expected third-party reimbursement. The spectrum varies from nutraceuticals, intravenous hydration therapy, to plastic surgery. Yet paying a $20 copay for a conventional health care visit to a primary care physician or a drug prescription is anathema to those who feel health care should be free.

So will whole-body MRI scanning be outmoded, if not condemned, in the same manner that CT was? We already are seeing an uptick of patients referred for conventional evaluation of equivocal or real findings on such scans. After all, what is the definition of a “false positive”? A breast nodule on mammography is benign in the vast majority of cases, yet subjected to biopsy as a consequence of routine screening. Few decry the associated anxiety and expense of such acceptable practice.

Following the science is difficult in an individual case, as the COVID-19 pandemic taught us. In the end, individual choice may “trump” authoritative health care recommendations.

Michael Brant-Zawadzki is a radiologist and physician executive.