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A research-based protocol for longevity

According to the CDC, the main causes of death for a 35 year old (my age) are unintentional injuries (poisoning through narcotics and psychodysleptics or motor vehicle accidents), followed by cancer, coronary heart disease, suicide or homicide [1]https://wisqars-viz.cdc.gov:8006/lcd/home.

If you fast forward to 65 years+, the main causes of death change to coronary heart disease, cancer, lung disease, stroke, and Alzheimer’s for both men & women [2]https://wisqars-viz.cdc.gov:8006/lcd/home.

So, what should I do in order to minimize risk of death at 35, while optimizing for longevity – aka do things now that will have a positive impact on my health for when I’m 65 years old?

Before I start, two disclaimers:

  • This post summarizes my opinion on the topic, backed by research papers with large effects on (mostly) large sample sizes. That said, I am not a medical professional, and this post is not intended to diagnose, treat, cure, or prevent any disease. The content below is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
  • I’m the CEO & co-founder of Ezra, a healthcare startup that’s created a new way to screen for cancer everywhere in the body using a full body MRI powered by Artificial Intelligence. I’m including an annual full-body MRI in my recommendations below. While recent research supports an annual full-body MRI, I’m also slightly biased, hence the disclaimer.

Every day:

  • Sleep well (7-8+ hours / night)
    • Lack of sleep has been shown to significantly increase risk of all-cause mortality, diabetes, hypertension, cardiovascular disease, and obesity [3]https://pubmed.ncbi.nlm.nih.gov/27743803/. I try to sleep 8 hours a night. To sleep well, I set the temperature around 65 Fahrenheit and make my room as dark as possible.
  • Exercise
    • Exercise decreases blood pressure, inflammation, and reduces risk for cancer [4]https://pubmed.ncbi.nlm.nih.gov/28718417/ [5]https://pubmed.ncbi.nlm.nih.gov/28324125/. The ideal exercise protocol should include a combination of cardio and resistance training. Resistance training has been shown to improve muscle mass, bone density, and reduce blood pressure (more so than cardio alone) [6]https://pubmed.ncbi.nlm.nih.gov/32422599/. I’m personally partial to compound weightlifting exercises (squats, deadlifts), as they’re a very efficient way to train. I also recommend low-impact cardio such as swimming, cycling, or rowing. I’m a big fan of running, too, but my empirical evidence from a dataset of one shows that running is not that great for my knees.
    • I’ve also found that exercising in the morning is best for compliance.
  • Practice meditation and yoga
    • Meditation and yoga have been shown to reduce blood pressure, which lowers the risk for stroke and coronary heart disease. Meditation also reduces stress, which is a cause for high blood pressure and high cholesterol [7]https://pubmed.ncbi.nlm.nih.gov/28384004/ [8]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923750/. Thus, meditation and yoga have a double whammy effect on lowering blood pressure and risk for heart disease.
  • Eat healthy food, not too much, mostly veggies
    • Focus on eating mostly a mediterranean diet – veggies, nuts, fruit, fish. It’s been shown to decrease the risk of cancer and cardiovascular disease, and increase overall life expectancy [9]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5352455/.
    • For the most part, avoid carbs, sugar, fructose, and alcohol. These all lead to insulin resistance, Type 2 diabetes, and increase fat deposition [10]https://link.springer.com/article/10.1007/s00394-016-1340-8. Also, unbeknownst to me until I started doing this research, fructose has the worst impact on health, and it’s found in pretty much everything you crave – sugary soft drinks, burger buns, ketchup, etc.. I don’t want to completely eliminate these from my diet (I don’t want to live like a monk), but I treat them as rare treats and consume sparingly.
  • Skip breakfast (you can still have black coffee, I’m not crazy) or dinner
    • If you can, start doing intermittent fasting (which basically means skipping breakfast or dinner). It helps reduce caloric intake, which helps you lose weight. There’s also some evidence that a caloric deficit increases longevity by reducing blood pressure, and by decreasing risk for cancer and other diseases [11]https://pubmed.ncbi.nlm.nih.gov/28202779/. And it allows your gut to take a break.
  • Be careful when crossing the street, and don’t text and drive or walk
    • Motor vehicle accidents are a leading cause for death in young people. Look three times before crossing any street (yes, three times). Don’t jaywalk (if you do, look three times before doing it). If you drive, put your phone on sleep mode while you’re driving, so you’re not tempted to text or even speak on the phone.
  • Take precautions to stay physically safe
    • Homicide is a leading cause for death in young people. Luckily – I live in New York, the safest large city in America, but even so I try to be vigilant about what’s going on around me.
  • Get a cold shower in the morning
    • Exposure to cold is known to activate the sympathetic nervous system and increase the blood level of beta-endorphin and adrenaline. Additionally, due to the high density of cold receptors in the skin, a cold shower is expected to send an overwhelming amount of electrical impulses to the brain, which could result in an antidepressant effect. A large study (3,000+ people) has shown a 29% decrease in self-reported sickness after a 30-day cold shower regimen [12]https://pubmed.ncbi.nlm.nih.gov/27631616/.
  • Spend time with people you love
    • An active social life and time spent with friends & family leads to less stress, which is good for health. Recent research has shown a direct correlation between social factors and healthy aging [13]https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232017000600878.

Once / week:

  • Eat meat sparingly
    • If you like meat (I do), try to limit meat intake to once or twice per week, and eliminate consumption of processed meat completely. Processed meat has been shown to increase risk for cancer, heart disease, and type 2 diabetes [14]https://www.sciencedirect.com/science/article/abs/pii/S0278691516301144?via%3Dihub. Unprocessed meat seems to be neutral but further evaluation is needed, so I’d err on the safe side and try to minimize consumption.
  • Don’t drink too much alcohol
    • I like red wine, but try to limit consumption at once per week. Drinking too much alcohol decreases sleep quality, negatively impacts cardiac function, increases risk of liver disease, and may lead to dementia and depression [15]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821259/ [16]https://pubmed.ncbi.nlm.nih.gov/25880513/ [17]https://pubmed.ncbi.nlm.nih.gov/29041989/ [18]https://pubmed.ncbi.nlm.nih.gov/28950395/ [19]https://pubmed.ncbi.nlm.nih.gov/21382111/.
  • Measure your weight
    • I don’t believe in measuring your weight every day as weight fluctuates quite a bit, but weighing yourself every week is very useful to observe trends. I use a scale that connects to my wifi and uploads weight data into my Apple Health.
  • Do a 24-hour water fast
    • Fasting has been shown to reduce body weight, cholesterol, and blood pressure [20]https://pubmed.ncbi.nlm.nih.gov/26374764/. My 24-hour fasting protocol is basically have dinner, then don’t eat anything until the next dinner. It’s pretty easy, especially on a busy day. It’s gotten even easier since I started doing intermittent fasting a few years ago. I basically skip breakfast and lunch on the days I’m doing a 24-hour fast.

Once / month:

  • Measure blood pressure.
    • While the probability is low that a healthy 35 year old male (that’s me) would have high blood pressure (currently 117/70), I want to see how trends evolve over time. I have an Omron wireless blood pressure monitor that automatically uploads the data to my Apple Health, and I have a monthly reminder to take my blood pressure on the last Sunday morning of the month, before having coffee.

Once / quarter:

  • Get blood tests
    • At the bare minimum, a good panel will include cholesterol, fasting insulin, testosterone (for guys), inflammation markers, iron, and vitamins. A good primary care physician should be able to design a good panel. I may publish mine at one point (you can email me for a sample, in the meantime).
    • Some people might prefer doing blood tests every 6 months. I think quarterly is better, as it gives you more immediate feedback on changes you’re making (or that you need to make).
  • Do a multi-day fast. It’s excellent for weight-loss (you can easily lose 10-12 lbs in a 3-5 day fast), and some doctors have used multi-day fasts as a way to reverse Type 2 diabetes. I found this book very useful to plan for multi-day fasts.

Every 6-12 months:

*Note: a lot of the recommendations below err towards aggressive cancer screening. More data is needed to support these, but I’m in the “more is more” camp on this one, due to how aggressive cancers in young adults are.

  • Get a full-body MRI
    • A full-body MRI is a safe and effective way to check for cancer, or other life-threatening diseases (e.g. aneurysms) [21]https://pubmed.ncbi.nlm.nih.gov/29627288/ [22]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248944/ [23]https://pubmed.ncbi.nlm.nih.gov/28091804/ [24]https://pubmed.ncbi.nlm.nih.gov/25810696/. You can sign up for a full-body MRI scan through Ezra, a startup that offers full body MRI scans powered by AI across New York, San Francisco, and Los Angeles (Disclaimer: I’m the co-founder & CEO of Ezra). Some folks believe you shouldn’t be worried about cancer before the age of 40, but the reality is that in 2020, there will be approximately 89,500 new cancer cases and 9,270 cancer deaths in adolescents and young adults (AYAs) ages 15 to 39 years in the United States. You don’t want to be a statistic [25]https://www.cancer.org/cancer/cancer-in-young-adults/key-statistics.html. There is some legitimate concern around over-diagnosis caused by incidental findings in full-body MRI. At Ezra, we use multi-parametric MRI (functional and anatomic imaging) to minimize over-diagnosis, and have a medical team on staff trained to guide you through any abnormal findings.
  • Get a DEXA scan
    • This will give you bone density and muscle mass data, which is especially important as you get older. You want to increase muscle mass and maintain or increase bone density as you age. An MRI and a DEXA scan will influence what type of exercise you should do (e.g. low bone density -> weightlifting).
  • Get a pap smear every 12 months
    • If you’re a woman, do a pap smear and an HPV co-test every year, as it’s been shown to reduce death rates from cervical cancer. This is especially valid if you’re under 40 years old [26]https://pubmed.ncbi.nlm.nih.gov/27598026/.
  • Get a mammogram and / or a Breast MRI
    • If you’re a woman over 40, do a mammogram every year. I personally think women should also get a baseline mammogram when they’re 35; this will also show if a woman has dense breast tissue. If you have dense breast tissue, a Breast MRI has been shown to increase early-stage clinically significant breast cancer detection [27]https://pubmed.ncbi.nlm.nih.gov/31774954/. If you decide not to get a baseline scan in your 30s, definitely start doing a mammogram and / or breast MRI every year starting the age of 40.
  • See a dermatologist
    • If you have moles and / or live in an area with a lot of UV exposure, do a dermatology skin check every 6-12 months. It’s quick and it will help detect melanoma or other types of skin cancer early. Further evaluation is needed to determine whether this practice will decrease skin-cancer mortality [28]https://pubmed.ncbi.nlm.nih.gov/27583318/, but the probability of over-diagnosis is low, and I’d rather err on the cautious side.
  • See your dentist
    • Seriously. Teeth and gums are important, and you’ll only realize how important they are once you start having issues. Floss. See a dentist every 6 months, and get an X-ray every 2 years. It will help you discover issues before they become serious. If you’re in New York, I strongly recommend you go here.
  • Donate blood
    • If you’re male, donate blood every 6-12 months to reduce iron stores, which has been shown in some studies to decrease risk of heart attacks [29]https://pubmed.ncbi.nlm.nih.gov/9326996/ [30]https://pubmed.ncbi.nlm.nih.gov/9737556/.

Every 5 years:

  • Get a low-dose chest CT with calcium scoring
    • A LDCT with calcium scoring is the best way to detect heart disease and lung cancer (especially if you’re at risk of lung cancer due to smoking) [31]https://pubmed.ncbi.nlm.nih.gov/31995683/ [32]https://pubmed.ncbi.nlm.nih.gov/31754800/. Those at very high risk of lung cancer should consider doing a lung scan every year / every two years. We offer LDCT scans at Ezra.
  • Get a colonoscopy
    • The American Cancer Society recommends colon cancer screening using a stool test or colonoscopy starting the age of 45, for those at average risk [33]https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html. However, there’s increasing evidence of colon cancer in young adults [34]https://pubmed.ncbi.nlm.nih.gov/30659375/, so I personally think colon cancer screening should start at 40 for those at average risk, and 35 for people with high risk (due to family history).

Other considerations:

  • Avoid hospitals, especially the Emergency Room
    • Almost 50% of poisonings are caused by drugs mis-administered during surgery, or inadequate prescription drugs [35]https://wisqars-viz.cdc.gov:8006/lcd/drill-down?causeLabel=Unintentional%20Injury&agegrp=35-44. Furthermore, avoidable medical errors are a leading cause of death in the United States [36]https://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx. In the ER, as much as 40% of emergency room nurses have witnessed or caused medical errors [37]https://pubmed.ncbi.nlm.nih.gov/29076206/. Try to stay out of the ER. While there is no guarantee, adhering to the list above will decrease your risk of landing in the ER.
  • Get a genetic test to check for genetic predisposition to heart disease or cancer. I really like Color Genomics.
  • Regardless of whether you’re male or female, get an HPV vaccine. It’s been shown to substantially reduce risk for cervical cancer [38]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4992181/.
  • You’ll notice I have not included any nootropics in my recommendations (i.e. resveratrol, metformin, NMN, rapamycin). I haven’t yet tried any, but I intend to. David Sinclair takes them, and a recent small trial has shown that they can potentially reverse aging in humans [39]https://www.nature.com/articles/d41586-019-02638-w [40]https://www.amazon.com/dp/0008380325/ref=cm_sw_r_tw_dp_LLEdGb4D2PFX0.
  • Don’t stress about that Apple Watch data
    • Wearable sensor data is useful, but not super actionable. Sure, walk more steps.
    • Resting heart rate trends are interesting (lower is better), and heart rate variability is useful to avoid overtraining. But IMHO the most useful wearable sensor data is knowing how much you sleep every night, and optimizing that. The Oura ring and the Whoop are both great at tracking sleep. The Apple Watch tracks sleep as well but I find it too bulky to sleep with.
  • If you can afford it, I recommend investing in some technology to help you sleep better. This tweetstorm from Nat Eliason is pretty good.

This article covers a lot, and it does take a certain amount of discipline to do all the things I recommend above consistently. What’s important is to just get started, and if I were to choose the things to start with, I’d say: exercise, get weight under control (if you’re overweight), and get screened for cancer.

A final thought: don’t smoke. If you smoke, the only takeaway from this article should be to stop smoking. Lung cancer kills more people than all other high incidence cancers combined [41]https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2020.html. Quitting smoking will decrease your risk of cancer, heart disease, Type 2 diabetes, and stroke more than everything else in this list combined. Don’t smoke.

Thanks to Michael Chen MD, Esther Dyson, Balaji Srinivasan, Sabina Gal, and Kim Scott for reading drafts of this.

References

↑1, ↑2 https://wisqars-viz.cdc.gov:8006/lcd/home
↑3 https://pubmed.ncbi.nlm.nih.gov/27743803/
↑4 https://pubmed.ncbi.nlm.nih.gov/28718417/
↑5 https://pubmed.ncbi.nlm.nih.gov/28324125/
↑6 https://pubmed.ncbi.nlm.nih.gov/32422599/
↑7 https://pubmed.ncbi.nlm.nih.gov/28384004/
↑8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923750/
↑9 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5352455/
↑10 https://link.springer.com/article/10.1007/s00394-016-1340-8
↑11 https://pubmed.ncbi.nlm.nih.gov/28202779/
↑12 https://pubmed.ncbi.nlm.nih.gov/27631616/
↑13 https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232017000600878
↑14 https://www.sciencedirect.com/science/article/abs/pii/S0278691516301144?via%3Dihub
↑15 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821259/
↑16 https://pubmed.ncbi.nlm.nih.gov/25880513/
↑17 https://pubmed.ncbi.nlm.nih.gov/29041989/
↑18 https://pubmed.ncbi.nlm.nih.gov/28950395/
↑19 https://pubmed.ncbi.nlm.nih.gov/21382111/
↑20 https://pubmed.ncbi.nlm.nih.gov/26374764/
↑21 https://pubmed.ncbi.nlm.nih.gov/29627288/
↑22 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248944/
↑23 https://pubmed.ncbi.nlm.nih.gov/28091804/
↑24 https://pubmed.ncbi.nlm.nih.gov/25810696/
↑25 https://www.cancer.org/cancer/cancer-in-young-adults/key-statistics.html
↑26 https://pubmed.ncbi.nlm.nih.gov/27598026/
↑27 https://pubmed.ncbi.nlm.nih.gov/31774954/
↑28 https://pubmed.ncbi.nlm.nih.gov/27583318/
↑29 https://pubmed.ncbi.nlm.nih.gov/9326996/
↑30 https://pubmed.ncbi.nlm.nih.gov/9737556/
↑31 https://pubmed.ncbi.nlm.nih.gov/31995683/
↑32 https://pubmed.ncbi.nlm.nih.gov/31754800/
↑33 https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html
↑34 https://pubmed.ncbi.nlm.nih.gov/30659375/
↑35 https://wisqars-viz.cdc.gov:8006/lcd/drill-down?causeLabel=Unintentional%20Injury&agegrp=35-44
↑36 https://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx
↑37 https://pubmed.ncbi.nlm.nih.gov/29076206/
↑38 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4992181/
↑39 https://www.nature.com/articles/d41586-019-02638-w
↑40 https://www.amazon.com/dp/0008380325/ref=cm_sw_r_tw_dp_LLEdGb4D2PFX0
↑41 https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2020.html

“Ezra saved my life”

[Originally posted on Medium]

Two and a half years ago, we set out to create a new way to screen for cancer that is fast, accurate, and affordable. Eighteen months ago, we launched Ezra, with the mission of detecting cancer early for everyone in the world. And nine months ago, this email landed in my inbox from one of our members:

“So, Ezra saved my life. That’s the simple statement. I had surgery Sep 25 and today, Oct 1, I got the pathology back, and am now cancer-free. I’ll go into a regimen of surveillance against recurrence instead of chemo or further treatment. This particular kind of cancer is usually not discovered until late, and so even though it’s particularly operable, it’s also particularly deadly. But here I am, because my Ezra scan served as my early warning system against problems.”

Our year in review

Around the time I received this email last year, the Ezra team was just 12 people across our two offices in New York and Toronto. We had just launched our full-body MRI scan, and we were live in one facility in New York.

Fast forward to today — we are now a team of 30 people with offices in New York, Toronto, and Los Angeles. We are scanning Ezra members in 11 imaging facilities across New York, San Francisco, and Los Angeles. We are live with our full-body MRI, prostate MRI, and low-dose CT (LDCT) lung cancer screening programs across all our partner imaging facilities.

Most importantly, since going live in January 2019 we have helped 4% of our members — all of whom were asymptomatic — detect cancer early.

It has been incredibly rewarding to receive emails and letters from our members thanking us for helping them detect cancer, pre-cancer, and other significant health conditions, and I am grateful for all the hard work my colleagues have put in to make this a reality.

The Ezra COVID 360

Our mission at Ezra is to help everyone in the world detect cancer early, and we do that by giving our members a look inside their body through our proprietary, full-body MRI.

As coronavirus took New York City (our home) and the world by storm, we started thinking about how we could use our technology and expertise to help people who’ve had COVID-19 better manage their health. More than 1.5 million people in the US have been infected with the coronavirus, and many of them may have long-lasting lung damage caused by the virus.

So today, I’m excited to introduce the Ezra COVID 360, a low-dose CT scan of the lungs to look for damage caused by COVID-19, paired with an antibody blood test to check for igG and igM antibodies. This new plan is designed for individuals who want to understand the potential long-term impact of COVID-19 on their lung health, and check their antibody status.

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Ezra COVID 360 will be available for $390 in New York City starting June 1st, and we’re working tirelessly to bring the plan across California in the upcoming weeks.

We’re also offering 50 free plans to medical providers and first responders who have been on the frontlines of COVID-19. If you’re a first responder and would like to sign up, please email hello@ezra.com and our team will get back to you within 24 hours.

A great new partner

To support the Ezra COVID 360 launch and continue building our medical imaging AIs to make MRI-based cancer screening more accessible, today we’re also announcing that we have raised $18M in new funding.

The round was led by Rick Heitzmann at FirstMark Capital, alongside new investors Jeff Raider and Dave Gilboa (co-founders of Harry’s and Warby Parker), Vlad Tenev (co-founder of Robinhood), Fred Destin (co-founder of Stride VC), and Andrei Dunca (co-founder & CTO of LiveRail). Existing investors Accomplice, Seedcamp, Credo Ventures, Founders Future, LDV Capital, Esther Dyson, Taavet Hinrikus, Daniel Dines, Dave McClure, and Jeremy Arditi also participated.

I’m excited to become part of the FirstMark family and to add Rick Heitzmann to our board of directors. Rick is an extremely smart and thoughtful investor with a strong thesis on empowering people with their own health data and takes a long-term approach to his investments. He will be joining our board alongside Ryan Moore, partner at Accomplice (who led our Series A).

A paradigm shift in technology

Every few decades, a technological paradigm shift opens a window of opportunity to create what we previously thought was impossible. Artificial intelligence represents one of these paradigm shifts, and I am excited about applying it to democratize cancer screening and make it widely available to the world.

Aside from investing in the Ezra COVID 360, we’ll also use the fresh funding to expand our medical imaging AIs to make MRI-based cancer screening more accessible. Ezra’s first AI product will assist radiologists in their analysis of prostate MRI scans, helping them work accurately and more efficiently. The Ezra prostate AI is currently under FDA review, and we are working on more AIs to help decrease the cost of MRI-based cancer screening.

Join our mission

I’m fortunate to be working with an extraordinary group of team members, investors, and advisors toward our mission of detecting cancer early for everyone in the world. If you’d like to learn more about us or join our team, please visit our website or send me an email at emi@ezra.com.

Stay healthy and safe,

Emi Gal
CEO and co-founder
Ezra

Introducing the Ezra full-body scan, covering 13 cancers in women and 11 in men

[Originally posted on Medium]

We started Ezra with one mission: help everyone in the world detect cancer early. In 2018, 18.1¹ million people worldwide were diagnosed with cancer². Of that number, almost 50% were detected late, and only 2 out of 10 of those individuals are likely to survive longer than 5 years³.

The numbers tell a compelling story: early detection could save more than 7 million lives each year.

A promising start

In January of this year, Ezra launched our first MRI-based cancer screening program, for prostate cancer. We chose prostate cancer because it is the highest incidence cancer in men (1 in 9 men will get prostate cancer during their life), and because the current standard of care (PSA blood tests) is highly inaccurate and often results in unnecessary prostate biopsies. In the U.S. alone, 1 million prostate biopsies are done every year, and the majority of them could be avoided. A study published in The Lancet⁴ in February 2017 showed that a prostate MRI can detect 18% more clinically significant cancers, while decreasing the number of unnecessary biopsies performed by 27%.

Since launching our MRI-based prostate cancer screening, almost 1,000 individuals have signed up, hundreds of men have been scanned, and Ezra has successfully helped our members find prostate cancer early and avoid unnecessary biopsies.

Move fast and try not to break things

From the beginning, our goal at Ezra has been to offer a way to screen for cancer everywhere in the body that is fast, accurate, and affordable. For the past year, my team and I have spent countless hours testing MRI sequences in order to build our proprietary full-body MRI scanning protocol.

Image for post

Today, having a full-body MRI scan in a typical clinical setting takes 2 to 3 hours. Together with an incredible team of physicians, radiologists and MRI specialists, we have reduced the scanning time for the Ezra full-body protocol to approximately 60 minutes for men and 75 minutes for women. In just about an hour, we cover up to 13 cancers in women and 11 in men (full list in Table 1 below). It is the most advanced scan of its kind, and it is now available at our Manhattan facilities.

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Table 1 — cancers covered

The imaging modality of the future

For those who don’t know much about MRI, the acronym stands for Magnetic Resonance Imaging, and the modality has been around for 30 years. An MRI scanner uses the magnetization properties of the protons in the water in our cells to create internal images of the body. In essence, MRI uses magnets to take photos of your organs.

That said, while an MRI scan is non-invasive, accurate, and painless, it’s also very expensive. Unlike other imaging modalities such as X-rays or CTs, MRI scans take a longer time — an average prostate scan, for example, takes about 30 minutes. They also require significant training to accurately analyze — an expert radiologist spends, on average, 15 to 20 minutes per scan to analyze a prostate MRI versus 1.5 to 2 mins for an X-ray.

That’s why, at Ezra, we’re building Artificial Intelligence to decrease analysis time while increasing radiologist accuracy. By building organ-specific AIs, such as our Prostate AI, we help radiologists become more accurate and more efficient when analyzing scans. Our prostate AI, currently undergoing the FDA clearance process, helps radiologists automate the functions of their job that are most arduous — measuring the volume of the prostate, the size of lesions, and segmenting lesions for Magnetic Resonance-Ultrasound guided biopsy preparation.

A plan for everyone

Making MRI cancer screening available to everyone means making it as affordable as possible. Right now, our full-body scan is $1,950, the torso scan is $1,350, and a pelvic or abdominal scan is only $675. We also offer affordable installment pricing options, where members can pay for their scans in 12 monthly installments.

As we build our collection of AIs to optimize image acquisition and analysis, our goal is to bring down our prices as quickly as possible in order to make MRI cancer screening available to everyone.

Backed by world renowned medical experts

Ezra is headquartered in New York City, the epicenter of oncology innovation. Over the past few months, we have been fortunate to add a number of world-class medical experts to the Ezra Medical Advisory Board: Columbia University Medical Center doctors Azra Raza, Siddhartha Mukherjee, and Joseph Alukal, as well as Dr. Oguz Akin from Memorial Sloan Kettering Cancer Center and Radnet’s Dr. Lawrence N. Tanenbaum, Dr. John Melnick, and Dr. Charles Fiske.

Join our mission

Our mission at Ezra is to detect cancer early for everyone in the world. We plan to do so by offering fast, accurate, pain-free MRI-based cancer screening; provide access to expert radiologists, assisted by the Ezra AI (once we obtain FDA clearance); and deliver compassionate, ongoing support from our team of Ezra Physicians and Ezra Guides. Our goal is to remove the stress, anxiety, and human error from the cancer screening process, and give people a better way to take proactive care of their health, year after year.

To learn more about our full-body cancer screening program or sign up, visit ezra.com. If you’d like to join us on our mission and help build cancer screening solutions that are fast, accurate, and affordable, visit our Careers page and join us at our offices in New York City or Toronto.

[1] https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21492
[2] https://seer.cancer.gov/ – 46.8% of cancers are detected in stages with disease spreading outside of the original tumor.
[3] https://seer.cancer.gov/ — calculated based on 5-year survival rates for individuals with distant metastatic disease.
[4] https://www.ncbi.nlm.nih.gov/pubmed/28110982

Meet Ezra, a new way to screen for cancer

[Originally posted on Medium]

18.1 million¹ people across the world will be diagnosed with cancer this year, and over half will be diagnosed late². Of the 9 million people who will receive a late diagnosis, only a third will survive longer than 5 years³. If their cancer had been detected earlier, more than 85% of these men and women would survive. That’s 5 million lives that could be saved by early detection every year. So why isn’t everyone having their cancer detected early?

Screen for cancer, save more lives
I’ve been interested in cancer screening my whole life. As a child, I developed hundreds of moles over my body that put me at increased risk of melanoma. Having annual dermatology check-ups to screen for abnormal moles has always been part of my life. Then, in 2015, a friend introduced me to Hospices of Hope, a non-profit in Romania that builds and operates hospices for terminally ill cancer patients. Speaking to patients and their doctors helped me learn that one of the biggest problems in cancer is the lack of a fast, accurate, painless way to screen for cancer anywhere in the body. So I embarked on a personal quest to see if we could use technology to help everyone in the world detect cancer early.

Inspiration and a new idea
I spent the following two years reading about cancer, meeting with doctors, speaking to scientists, and trying to learn everything I could about the disease. I cycled through a dozen different ideas, ranging from DNA nanobots to digital microfluidics biochips (neither technology is ready for clinical use), with the goal of finding a way to screen for cancer anywhere in the body with a single test. And then, while reading research papers on my honeymoon (I know!), it hit me. One morning I asked my wife, “What if you could get a full-body MRI scan and have it analyzed by AI in order to detect cancer anywhere in your body? Would you sign up for that?” She loved it, and that’s how Ezra was born: a direct-to-consumer membership that offers cancer screening using a full-body MRI analyzed by AI.

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Validation
I returned from my honeymoon and started reading everything I could about MRI. My previous company, Brainient, had just been acquired by Teads, and I had been promoted to CEO of Teads Studio and Global CMO. But I devoted my nights and weekends to researching this new idea. Then, in January 2017, a study⁴ published in Lancet convinced me that I was on the right track. The study compared the current standard of care for prostate cancer screening — a PSA (prostate-specific antigen) blood test, followed by a prostate biopsy if PSA levels are elevated — with an alternative, a prostate MRI. The conclusion? When prostate biopsies are guided by MRI findings, 18% more clinically significant cancers are detected. And there was more: using MRI to triage men decreases the number of unnecessary biopsies by 27%. In other words, MRI yields a more accurate, less intrusive test with a better patient experience. I was sold.

The right technology, the right people
I believe startups succeed or fail based on the quality of their teams, and I knew I needed a medical imaging expert to complement my computer science background. I sifted through the profiles of 2,500 deep learning and medical imaging experts across the globe. I reached out to 300 of them, 150 responded, and I conducted 90 interviews. I narrowed my search to four applicants whom I engaged in a 3-month project to train a deep learning network and validate their skills. That’s how I found Diego Cantor, PhD, my co-founder and one of the smartest people I’ve ever met.

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Emi Gal, CEO & co-founder (left) and Diego Cantor, CTO & co-founder (right)

Together with Diego, we started tackling our first cancer — prostate cancer. We chose prostate cancer because it is the most common cancer in men, and because the current standard of care for prostate cancer screening is broken: elevated PSA levels are often caused by non-cancerous conditions such as benign prostate hyperplasia (BPH) and prostatitis, so a lot of men undergo unnecessary prostate biopsies. For those unfamiliar with a prostate biopsy, a needle is inserted through the wall of the rectum to sample prostate tissue from 12 to 14 different locations, and requires antibiotics before and after the procedure. And most important, prostate biopsies often have side effects such as bleeding, infection, urinary issues, and erectile dysfunction⁵. That’s no fun, and while I wouldn’t expect cancer screening to be fun, I do believe it should be comfortable, accurate and safe.

A new approach to prostate cancer screening
Diego and I spent a year building the Ezra AI, and thanks to Diego’s extensive deep learning and medical imaging expertise, we created what is likely the most accurate prostate AI in the world, with over 90% accuracy when compared to an expert radiologist. (Note from our legal counsel: The Ezra AI is an investigational device that has not yet received marketing authorization from the FDA. The safety and effectiveness of the device have not been established. After further study of the Ezra AI technology, the Company plans to seek FDA clearance in 2019).

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Radiologist (left) vs. Ezra AI (right) for prostate lesion segmentation

A clear mission
Our ultimate mission at Ezra is to detect cancer early for everyone in the world. We plan to do so by offering fast, accurate, pain-free MRI-based cancer screening; access to expert radiologists, assisted by the Ezra AI (once we obtain FDA clearance); and compassionate, ongoing support from our team of Ezra Physicians and Ezra Guides. Our goal is to remove the stress, anxiety, and human error from the cancer screening process, and give people a better way to take proactive care of their health, year after year.

The Ezra launch — today
Today, we’re announcing that Ezra is available as an invite-only private beta program in New York City. We’ve partnered with RadNet, the nation’s leader in outpatient imaging, and Ezra members will be able to get their prostate MRI scans at RadNet’s Lenox Hill Radiology facility in Manhattan (61 East 77th Street, New York, NY). Additional facilities are scheduled to be enrolled through 2019.

We’re also pleased to announce a $4M seed round led by Accomplice, with participation from Founders Future, Credo Ventures, Seedcamp, Esther Dyson, and a number of startup founders and angel investors. We are humbled and thrilled to have such an extraordinary group of investors on board and look forward to building a meaningful company together.

Diego and I are very excited to finally launch Ezra, and we look forward to keeping you updated on our progress. If you’re a man at risk of prostate cancer and would like to become a private beta member, request an invite on our website. If you’re inspired by what we’re working on and want to join our team, visit our Careers page. And if you’d just like to stay in touch, subscribe to our newsletter or drop me an email.

Stay healthy,

Emi Gal
CEO & co-founder of Ezra

¹ https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21492
² https://progressreport.cancer.gov/diagnosis/stage
³ https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf
⁴ https://www.ncbi.nlm.nih.gov/pubmed/28110982
⁵ https://bit.ly/2B5DlvV

My 2016 experiment

For the past eight years, I’ve taken on a new experiment every year. I do them for three reasons: to learn something new, meet new people and get outside my comfort zone. My experiments vary – in previous years I’ve been a polyphasic sleeper, read a book per week, gone to the gym every day or trained my memory with a world memory champion.

This year, I will volunteer for a day every two weeks in a hospital or charity caring for cancer patients. I have been fortunate not to have any friends or family touched by cancer, but through my involvement with Hospices of Hope, I have seen first hand how much of a toll cancer takes on people’s lives. In whichever way I can, I want to help the charities, doctors, nurses and patients dealing with cancer.

In order to make as big of an impact as possible given my time constraints, I will choose three charities or hospitals to volunteer for, one for each location where I spend most of my time (London, New York, and Bucharest).

In terms of the actual volunteering work, I will do anything that’s required of me, but focus on three areas where I think I can add the most value:

  • advise charities & hospitals regarding their technology, digital marketing & data strategies;
  • help with fundraising and
  • offer patient care, with a focus on helping patients with sports and physical activities

Given I am already on the Honorary Patrons Committee for Hospices of Hope, I will volunteer in their palliative care centre whenever I am in Bucharest. I’m still researching which hospitals or charities in London and New York to get involved with, so if you have any recommendations please email me (emi@brainient.com) or leave a comment below.

The #elderproject – what I learned

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For the past 10 years I’ve always spent the first few quiet days of the year thinking about the past 365 days and planning for the next. This year, my introspection also turned out to be a good opportunity go through all my #elderproject interviews and gather the learnings.

My experiment succeeded and failed at the same time. It succeeded because I found answers to a number of questions I’ve been ruminating over, but it failed because I interviewed substantially less people than planned. However, I am happy with the outcome and would like to share the results with you. Here are the #elderproject questions and my summary for each question.

What makes you happy?

Three things surfaced as the main drivers for happiness: a happy family, close friends, and achieving one’s career goals. Not a single person from the ones I interviewed mentioned money as a driver for happiness. This doesn’t mean money is not important (as you will see in a question below), but it is not a prerequisite for happiness.

If you could go back in time, what would you change?

The answers to this question varied a lot and when grouping them into buckets, I discovered three different themes of “regret”: love (either not pursuing one’s true love, or not being careful enough in choosing one’s partner), education (mainly wishing they had spent more time on their education) and balance (mainly finding balance between the time spent at work vs. time with their families).

What was the most important thing for you when you were young?

No surprises here. Making money & building a career was perceived as the top priority for most of my interviewees. For a small number of people, however, the desire to build a career was only a way to achieve the level of financial stability necessary to sustain a family.

What’s the most important thing for you now?

Health, balance between work & family (or friends), and recognition from one’s peers. Dave Moore from Xaxis had one of my favourite quotes from all the interviews: “Family is very, very important in my life. To succeed in business and fail at home is to fail completely.”

Work & Family, what is more important?

Not a single person said they wish they had spent more time at work. With one exception, all of them said that work & family are equally important but that if they were to choose between them, they would choose family. Dave Moore had a wonderful quote, again: “The most important thing is to leave a family legacy so strong that generations within your family will remember you.”

How important has money been in your life?

Everyone said money is very important because it offers independence and stability. Among all the people I interviewed, I noticed a love-hate attitude towards money because they acknowledge that it can sometimes change people for the worse. My dad said: “Money is important, but not the most important. One should rather have no money if it changes his character.” And I feel the need to quote Dave Moore again, because as a proper ad-man, he gave an insanely quotable interview: “Money is a materialistic ambition, and the only way to make it immaterial is to make so much of it that it doesn’t matter.”

Is there a moment that has completely changed your life?

Out of the ones that could identify a seminal moment, two threads emerged: either moving to another country, or the death / illness of a close one (friend or family). No one mentioned a work-related event. Work is work and as it turns out changes in one’s career, losing their job, etc does not influence people long-term.

Have you had any role models in your life?

The biggest surprise for me was that almost all the people I spoke with said that their parents or partner were their role models. For those who named public figures, the most prevalent were heads of state or entrepreneurs.

What do you want to leave behind?

I would do this section no justice if I summarized it, so I’m just going to share some of their responses. They are all beautiful. “Leave a happy memory.” “A good name.”  “Be remembered by a lot of people that I’ve done something for that they’ll never forget.” “Happiness to all my family. That’s it.” “My only modest goal is that the people around me will have good things to say about me.” “I hope they would say I was a kind person. I would like for someone to say that I really made a difference for some people. That I righted some wrongs.” As you can see, all the responses are about people. All about being kind & generous. All about family.

Do you have any fears in growing old?

Without exception, health. Elderly people are afraid, for good reason, to become physically or intellectually incapacitated. Their fear springs from a desire to be able to enjoy time with their families without being “a bloody nuisance”, as Jeff Hutchinson said.

If you could live forever but keep just one of the things you currently have, what would you want to keep (work, family, health, money)?

Family & health were winners on this front. A few people said they wouldn’t be able to make this decision and would rather not live forever than having to choose.

If I were your grandchild, what would be the once piece of advice you would give me?

Be generous, kind and respectful. Go to school, educate yourself, never stop learning. And never give up.

What’s the meaning of life?

Graham Perolls summarized the views of pretty much everyone who answered this question: “Life is a struggle. There are no easy answers. I have an anchor in my faith, and feel that we are all on this earth for a purpose, and we need to find what that purpose is.” I also really liked what Princess Marina Sturdza said: “[the meaning of life is all about] living life with a certain amount of humility. Staying humble. Finding balance.” And lastly, Ewan summarized everything, for me, on this topic, by saying “What’s the meaning of life? I don’t know – perhaps, love.”

Happy New Year and I hope you enjoyed listening to my interviews and reading this summary as much as I enjoyed making these wonderful new friends and learning from them.

The #elderproject #11 – Graham Perolls

I first met Graham earlier this year, when he invited me to become a Honorary Patron on the Copaceni fundraising committee for Hospices of Hope. 

I’m in awe of Graham’s dedication to helping people in South Eastern Europe with services of palliative care, and this was one of my absolute favourite interviews. Enjoy!

The #elderproject #10 – Princess Marina Sturdza

A week ago in New York, I had the great pleasure to interview Princess Marina Sturdza. She is a member of the old, aristocratic Sturdza family, who were exiled by the communist regime in Romania when she was just three years old.

Princess Marina is best known for the charitable work she has done in Romania over the past two decades, but aside from the #elderproject questions the interview covers much more: her journey to Canada when she was three years old, her brief stint as Vice President of Oscar De La Renta and her work at the UN. It was wonderful interviewing her because she truly embodies all the qualities I’ve ever thought a princess would. And then some. 

The #elderproject #9 – Andrew

Smart, modest and wise are the first attributes that spring to mind when I think of Andrew, my 9th interviewee for the #elderproject.

A Romanian 71 year old that fled to the US during the communist regime, he lived in the US for 20 years and is now living in the UK. This was one of my favourite interviews so far, and I hope you enjoy it as much as I did. 

The #elderproject #8: Aida

My next interview is in a combination of Italian & Spanish because Aida, the first woman I interviewed as part of the #elderproject, was not comfortable in doing the interview in English. She works for Franco, whom I hope you’ve already listened to as he’s an amazing human being. 

Albeit somewhat expectedly, what struck me the most about my first interview with a woman was how sharp and clear the importance of family was to her compared to anything else. As you’ll see from a few more interviews with women her age, life is clearly mostly about family. Which is nice to see.