The FDA is dragging its feet on Grail’s ineffective new cancer screening tool, depriving millions of perfectly healthy biohackers of the ultimate longevity metric: pure, unresolvable existential dread.
I have decided we are being entirely too hard on the concept of ineffective medical testing.
For months, the FDA has been dragging its feet on approving Grail’s Galleri test, a multicancer early detection screening tool that promises to scan your blood for fifty different types of malignancies. The criticism, led by entrenched medical traditionalists like Dr. H. Gilbert Welch, is that the test is notoriously inaccurate, generates massive numbers of false positives, and routinely identifies indolent cancers that would never actually threaten a patient’s life. Welch recently summarized this dinosaur mentality by arguing that telling more people they have cancer is not progress unless it actually prevents them from dying.
This is, frankly, a breathtakingly narrow view of human optimization.
If we restrict our healthcare system to only treating people who are actually dying, we are ignoring a massive, untapped demographic of perfectly healthy individuals who possess both severe hypochondria and vast amounts of disposable income. As someone who has spent the last decade tracking my resting heart rate, my deep-sleep phases, and the continuous glucose spikes caused by looking at a carbohydrate, I can tell you that the wellness community is starved for a new metric. We have cold-plunged our way to baseline. We have optimized our microbiomes. What we need now is the sheer, unadulterated adrenaline of being told we might have a mysterious, untreatable stomach tumor.
The Galleri test works by detecting fragments of cell-free DNA shed by tumors into the bloodstream. When it works, it is a marvel of modern pathology. But when it fails—when it triggers a cascading series of frantic, out-of-pocket radiological scans to locate a cancer that simply does not exist—it is a marvel of lifestyle motivation.
What the studies won't tell you is that a false positive is the ultimate catalyst for personal growth. Nothing makes you appreciate a Tuesday morning matcha quite like a highly credentialed oncologist telling you they found a suspicious methylation signature that they can neither locate on an MRI nor offer any clinical protocol to treat. You will never be more present in your life than during the six-to-eight months of watchful waiting, wondering if the phantom signal in your blood is a statistical artifact or a silent assassin.
We aren't just selling you a high probability of a grueling, unnecessary exploratory biopsy. We are selling you the gift of profound, life-altering hyper-vigilance.
The FDA’s reluctance to approve this technology stems from a paternalistic desire to protect patients from psychological harm. This fundamentally misunderstands the modern consumer. We are paying thousands of dollars to be electrocuted at longevity retreats in Costa Rica. We are injecting ourselves with untested peptides sourced from a guy named Brandon in a Telegram group. We do not want to be protected from harm; we want to meticulously document our proximity to it on a dashboard.
Consider the downstream economic benefits that Welch so casually dismisses. An ambiguous cancer screening does not just benefit the patient’s sense of urgency; it acts as a massive stimulus for the broader wellness ecosystem. The moment you receive an unverified signal for an obscure neuroendocrine tumor, you immediately require a holistic support team. You need a somatic breathwork coach to manage the panic attacks. You need a functional medicine doctor to prescribe eighty-four daily supplements to alkalize your blood. You need a spiritual guide to help you make peace with the fact that your insurance will not cover the $15,000 full-body MRI required to chase a diagnostic ghost.
This is job creation in its purest form.
I recently flew to a private longevity clinic in Zurich simply because they promised to run my blood through an unapproved, highly experimental assay that screens for cellular anomalies that have not even been classified by the WHO. For three glorious weeks, my entire cohort operated under the assumption that our mitochondria were aggressively turning against us. We immediately initiated a regimen of hyperbaric oxygen therapy, intravenous glutathione, and sensory deprivation. We bonded over our shared, completely unverified mortality. When the clinic finally admitted that the machine had simply not been calibrated correctly and we were all completely fine, the disappointment in the room was palpable. We had to go back to worrying about our cholesterol like commoners.
Welch’s assertion that progress means fewer people dying from cancer is exactly the kind of outcome-oriented thinking that is holding back preventative medicine. Death is a lagging indicator. If we wait to diagnose cancer until it actually presents a physical threat to a patient’s life, we have robbed them of years of frantic, highly monetizable preventative action.
If we only intervene when a disease is biologically capable of killing someone, we are leaving millions of perfectly healthy, terrified consumers entirely un-optimized.
The truth is, having a non-actionable, clinically insignificant cancer diagnosis is rapidly becoming a status symbol among the coastal elite. At a dinner party in Malibu last weekend, I sat across from a tech founder who casually dropped that his liquid biopsy revealed an elevated risk for an unspecified sarcoma. He could not do anything about it. His doctors told him to go home and forget it. But the sheer cachet of possessing a microscopic, undetectable flaw elevated him above the rest of us perfectly healthy attendees. He was carrying a secret. He was a biological mystery. He took the last piece of branzino, and nobody dared stop him.
The FDA must realize that the era of doing no harm is over. We have entered the era of demanding the data and ruining our own weeks.
If Grail’s multicancer test is ineffective at saving lives, so be it. Let it serve its true purpose as a luxury existential threat. I am calling on the regulatory agencies to not only approve the Galleri test, but to mandate that it become less accurate. I want a screening tool that flags my pancreas every time I eat a non-organic almond. I want a smartwatch that vibrates to inform me that a rogue cell just mutated, even if my immune system resolves it five seconds later.
Awareness is the only currency that matters in the longevity space. And right now, the FDA is hoarding all the panic for themselves. I, for one, will not stand for it. I am currently refreshing a patient portal for a mail-in blood test that I bought off an Instagram ad, and if it does not tell me I have at least three phantom diseases by morning, I am demanding my money back.