Longevity clinics and executive health in San Francisco, what is worth paying for

What the programmes cost

My Doctor, a medical group in downtown San Francisco, prices its executive health evaluation from $12,500 [1]. It runs over 3 to 4 weeks, with a video intake, one day of tests in the city and a 60 minute wrap-up visit. It includes at least 4 hours of physician time, 100 or more biomarkers and data points, a 163 gene panel, a coronary calcium score, a Galleri blood test and a home sleep study, and the practice says this testing is not billed to insurance [1]. A full body MRI, whole genome sequencing and a VO2 max test are among the add-ons it charges for separately [1].

Human Longevity sells its Executive Health programme at $8,000 a year for people under 65, with whole genome sequencing, a whole body MRI, a brain MRI, hundreds of blood markers, an echocardiogram, a DEXA scan and a calcium score [2]. Its most complete year of care, 100+ Concierge, costs $19,000 [2].

Prenuvo's Whole Body scan costs about $2,500 and takes about 50 minutes, at its Redwood City location [3] [4].

What a general health check can and cannot do

A Cochrane review pooled 15 trials with outcome data from 251,891 adults, comparing people offered general health checks with people who were not offered them. The checks made little or no difference to deaths from any cause or from cancer, and probably little or no difference to deaths from heart disease [5].

The review concerns broad checks offered to everyone. A single test chosen for your own risks is a separate question, and the useful habit is to ask what each test in a programme would change.

Tests that change what a doctor advises

A coronary calcium score measures calcified plaque in the arteries of the heart on a CT scan. In 6,722 adults without heart disease, 11.9% of them Chinese American, a score above 300 carried almost ten times the risk of a coronary event of a score of zero [6].

The US Preventive Services Task Force has judged the evidence insufficient to say whether adding a calcium score to standard risk assessment prevents heart attacks and strokes in adults without symptoms [7]. Ask your doctor what a high score or a zero would change before you have the scan.

An HbA1c measures average blood sugar over recent months. Among 11,092 adults without diabetes, a level of 6.0% to 6.5% carried more than four times the later risk of diabetes of a level of 5.0% to 5.5% [8]. The task force recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 who have overweight or obesity [9].

The screening with a task force recommendation

The task force recommends screening for colorectal cancer in adults aged 45 to 75 [10]. It recommends a yearly low dose CT of the lungs for adults aged 50 to 80 with a 20 pack-year smoking history who still smoke or stopped within the past 15 years [11].

These recommendations rest on trial evidence. A programme you pay for should include them where they apply to you before it adds anything else, and these questions help you check.

• Which of these tests has trial evidence that it helps people live longer?
• Is the screening the task force recommends for my age included?
• If a result is abnormal, what happens next, and who arranges it?
• Who goes through the results with me, and how long will we have?
• What happens in the months after the day, and does follow up cost extra?

Whole body MRI and cancer blood tests

The American College of Radiology does not recommend total body screening for people without symptoms, risk factors or a family history of disease. It states that no evidence yet shows such screening prolongs life, and that the many nonspecific findings it turns up lead to further tests and significant expense [12].

The Galleri test looks for a cancer signal in the blood. GRAIL states that the test has not been cleared or approved by the Food and Drug Administration, that it does not detect all cancers, and that it should be used in addition to routine screening [13]. GRAIL recommends it for adults at raised risk of cancer, such as those aged 50 or older, and not for people who are pregnant, aged 21 or younger, or in active cancer treatment [13].

In the PATHFINDER study of 6,662 adults aged 50 or older, a cancer signal was found in 92 people, 1.4% of those with results [14]. Of those 92, 35 people, or 38%, had cancer. The 57 people whose signal was a false alarm waited a median of 162 days before testing settled the question [14].

What our assessment and longevity care cost

Our executive health assessment in San Francisco costs from $14,000, and a year of longevity care from $21,000. Your doctor will choose each test for your own risks, keep you up to date with the screening the task force recommends, and go through every result with you in person.