Talking about women’s health has been a taboo subject for some time, contributing to a lack of innovation in the sector. Still today, many are uncomfortable discussing the topic. Consequently, only 2% of medical products in the pipeline are for women’s health and only 2% of all venture capital dollars go into developing these products. In this episode, we talk with two women in biotech who are trying to change that narrative and infuse more investment in innovations that meet the needs of half the population.
Talking about women’s health has been a taboo subject for some time, contributing to a lack of innovation in the sector. Still today, many are uncomfortable discussing the topic. Consequently, only 2% of medical products in the pipeline are for women’s health and only 2% of all venture capital dollars go into developing these products. In this episode, we talk with two women in biotech who are trying to change that narrative and infuse more investment in innovations that meet the needs of half the population.
Sabrina Martucci Johnson, CEO
Daré Bioscience
Elizabeth Baily, Managing Director
RH Capital
Archie Bunker (00:05):
I know all about your women's troubles there, Edith, but when I had the hernia that time, I didn't make you wear the truss! No, no, no, no, Edith. If you're going to have a change of life, you got to do it right now. I'm going to give you just 30 seconds! Now, come on. Change!
Theresa Brady (00:36):
What you just heard was a clip from an episode of the iconic 1970s sitcom, All in the Family. The well known and socially clueless Archie Bunker is reacting to changes happening to his wife Edith due to menopause. As was typical for the show, the episode broke new ground talking about something most people had considered out of bounds.
(00:58):
While some things have changed since the early 1970s, when talking about women's health was considered taboo, you may be surprised to learn that those perceptions haven't changed much since then. 2%. That's the total percentage of products in the development pipeline that are women's health products. And overall venture capital investment dollars in the space, the same. 2%. That leaves a huge gap. Today we talk with two women in biotech who are trying to change the narrative and improve the numbers around women's health. I'm Theresa Brady, and you are listening to I AM BIO.
(01:54):
Have you ever been at a party when someone said something that made all the other guests cringe and look away? Well, that used to be the standard reaction when it came to women's health. Many were uncomfortable acknowledging certain conditions that affect women, and even shunned any discussion of women's anatomy. Today we discuss if this landscape has changed. Are biotech and pharma paying more attention to the health needs of women? What can spur innovation in this sector? And just as All in the Family created a space to talk about taboo subjects, our guests say their job is to bring a comfort level to the discussion around women's health.
Elizabeth Bailey (02:34):
I'm Elizabeth Bailey, the managing director of RH Capital.
Sabrina Martucci Johnson (02:39):
I'm Sabrina Martucci Johnson. I'm the CEO of Dare Bioscience.
Theresa Brady (02:44):
Sabrina says The best way to start a conversation about women's health is to dive right into what people may find uncomfortable.
Sabrina Martucci Johnson (02:52):
The way to get people more comfortable talking about women's health is frankly just to make sure those conversations are happening everywhere, and using the appropriate language. My favorite, over the years of working now on women's health and at Dare, is being in a room with a group of men, and almost doesn't matter which product in our particular portfolio I'm talking about, I just try to get "vagina" in pretty much the first sentence. It's disarming. It's shocking sometimes for people, but then it just gets it out there, and then we're just having the conversation, just like we would about any other therapeutic category.
(03:26):
Vagina is not a four-letter word. It is a body part. It is part of the anatomy, and using the right language right away, just like we do in any other therapeutic category, really makes the whole conversation more accessible. It makes it more comfortable in mixed company if you're using the appropriate language immediately, unashamed, and just dealing with it head on.
Theresa Brady (03:49):
Elizabeth agrees.
Elizabeth Bailey (03:51):
I think for a very long time, maybe forever, people didn't want to talk about women's health. There's such stigma associated with things related to menstrual health and menopause. Until we actually are able to talk openly about our health issues and engage others to talk about our health issues, we won't be able to move the needle in this space. I think normalizing the conversation around women's health is essential. Removing the stigma associated with talking about things that have historically made people really uncomfortable, having women in decision making roles, whether they be at venture capital funds, in industry, in research and clinical organizations, in academia, we need those voices at the table. We need them in every room where decisions are being made. I think that narrative change of women's health matters to all of us.
Theresa Brady (05:05):
Sabrina founded her company, Dare Bioscience, in 2015, because she saw a gap in existing treatments for a host of conditions faced by half the population. She talks with us about this unmet need.
Sabrina Martucci Johnson (05:18):
One of the things that we're trying to do as a company is bust those myths, and one of the myths that has been out there is that there are no unmet needs in women's health. Hopefully we can adequately address that simply through education, of making people aware of the healthcare conditions that uniquely affect women, and the unmet needs in those sectors. Our development candidates encompass everything from contraception, vaginal health, sexual health, through to fertility. We are always looking at enhancing our portfolio, and looking for the next unmet need to address. Our portfolio is very differentiated, in that every single product has come from another innovator. We did not invent any of these products ourselves. As a business model, we start with the unmet need. In women's health, we develop a target product profile of what would be a great product to address that if we were designing that product from scratch.
Theresa Brady (06:13):
Elizabeth has the same goal, but she uses the power of money to change the narrative. RH Capital uses the venture capital model to invest in women's health companies that are advancing health equity in the United States.
Elizabeth Bailey (06:27):
We are 50% of the population, and we birth 100% of the population. Our health really does matter. It matters to everyone, and normalizing that, destigmatizing is the way that we change the conversation. We need to start talking about the business case in women's health. We are an enormous market with unmet needs, and when you look at how investment decisions are made, we should be a great investment bet. Venture capital backed companies get products to market three times faster. We know the incredible impact that venture capital backed companies can have in healthcare. There has been little to no investment in the women's health space over the last 20 to 30 years. We look at health equity along both gender and racial lines, and there are huge disparities in the US, in terms of the access to healthcare and health outcomes. Our fund is really looking to invest in innovation and startups that are looking to improve health equity for all women in the US.
Theresa Brady (07:44):
Sabrina believes that Elizabeth's model, growing venture investment in women's health startups, will yield both health and financial returns.
Sabrina Martucci Johnson (07:52):
The other myth out there in women's health that has frankly hindered development in some ways is the misconception about the sector in terms of its ability to deliver products that are financially accretive. Women's health represents about 2% of the pipeline of products that are in development, whether we consider preclinical, phase one, phase two, or phase three. Products in development, about 2% of those products are women's health, and that's been true for quite some time.
(08:22):
But now if we look at what happens when products get approved, what proportion of products do women's health represent in terms of products that achieve over $500 million in annual revenues, well, you know what? Women's health products are 27% of the products that generate over $500 million in annual revenues, and those 27% of the products that are women's health, in that bucket of products that are over $500 million in annual revenue, they contribute 35% of those dollars. We would love to turn that myth around and get some of those facts out there. We believe that investment in women's health is actually disproportionately impactful. There just simply isn't as much awareness about the opportunity here.
(09:08):
I think also it is one of those therapeutic categories that it can benefit from having more women in leadership roles, in industry, to help build awareness. We haven't required that in other therapeutic categories. Frankly, we don't often feel the need that someone working in oncology, for instance, has had a personal experience with cancer.
Theresa Brady (09:39):
When we think about women's health, we often think about fertility or reproductive health and breast cancer, which are all very important areas of research, but it really is much more, as Sabrina explains.
Sabrina Martucci Johnson (09:52):
Women's health is a really broad category that definitely includes the areas that we most typically associate with women's health, which are those conditions that solely affect women. So think contraception, fertility, maternal health. But women's health is actually a lot broader than that. It includes any conditions that not only solely affect women, but also conditions that disproportionately affect women. And there's even a school of thought that women's health should not only include those two categories, but also include conditions that differentially affect women, so think cardiovascular disease, which presents very differently in women than it does in men.
(10:34):
In terms of the unmet needs in women's health, really across all of those categories, there are conditions that have not been adequately addressed. If you think about menopause, there are a number of aspects of menopause that are still not adequately addressed. We know what we need to do to address the hot flashes or the vaginal symptoms of menopause. We just simply need to do that as an industry, and deliver drugs that make more sense for her. Menopause, no one talks about menopause, but it affects 45 million new entrants every year. And so therefore, unlike other therapeutic categories, women's health is also a sector where it can benefit from having more women in the room, simply just to make sure the conversations are happening. I look forward to a day when that's not required, when the men will all speak as openly about some of these women's health issues as people do about other therapeutic categories, where we don't expect them to have had a personal experience with the condition in order to lead.
Theresa Brady (11:35):
Elizabeth agrees that representation is key to advancing innovation, and she has witnessed a sea change since the COVID pandemic.
Elizabeth Bailey (11:43):
When we started back in 2018, discussions about health equity were really not happening as much as they are today. But fast forward to 2022, in part because of the COVID-19 pandemic, there was a big, bright light shown on health disparities in the US, and so companies really started to pop up all over the place, and there was a recognition that women's health was really underserved by venture capital. There was this huge mobilization across the entrepreneurial ecosystem, and women in particular saying, "There are not companies that are serving my needs, and I'm going to start them."
(12:30):
When we look at the pipeline over the last few years of opportunities, we have tons of new founders, new CEOs entering the space. We can do so much better. We need to look to the private sector to develop solutions to serve these women, and we need to include them. It goes back to this issue of making sure that you have the right voices at the table at all levels. In addition to women being decision makers and making investment decisions, you need to have the voice of the community in the room to listen to what is needed, what is acceptable, because without that kind of buy-in, it's really hard to improve adoption of solutions.
Theresa Brady (13:28):
Elizabeth also points out that we have a long way to go in the US to better serve women of color.
Elizabeth Bailey (13:34):
There is a very dark and ugly history in the United States with respect to scientific research on women of color, and that history and that backdrop has made communities of color, rightly so, incredibly skeptical and suspicious of the healthcare system, which has not served them well, and yet has exploited them to conduct scientific research. We have a huge task in front of us to make sure that the system works for these underserved and marginalized communities. I think that innovative startups, many of them led by women of color, hold so much promise, but we need to make sure that we have investment in those types of companies.
Theresa Brady (14:33):
When we come back from our break, we'll delve deeper into the importance of including more women in clinical trials, and what our guests are doing about it.
(14:54):
As we head into the winter months, BIO is preparing for some great events in 2023. Visit bio.org/events to find out more, and don't forget to check out bio.news. Bio.news is a daily news website exploring the intersection of biotech innovation, and US and international policy. Visit now by typing bio.news into your browser.
(15:30):
Another myth that hinders innovation in women's health is that women are reluctant to be in clinical trials. Here's how Sabrina refutes that claim.
Sabrina Martucci Johnson (15:39):
Working in women's health is also fascinating in that women are very enthusiastic participants in the healthcare system. Many people are aware of the statistics that women control 80% of the healthcare decisions in their household, and that ownership of their health and healthcare decisions has definitely been visible as we've conducted clinical trials. Every single one of our patients in our clinical studies is a woman, and we have found that women have been, to date, overwhelmingly interested in participating in this research. Our female sexual arousal disorder study, we had over 10,000 women complete the online screener for the study just within the first few months of posting that trial on social media.
(16:28):
This is another area where there are myths. There are myths out there that it's hard to conduct research in women, or that women are unwilling to participate in clinical trials, or that it's difficult to enroll women in clinical trials. And we have absolutely not seen that to be the case. Now, you have to be thoughtful when you are going to enroll a woman in a clinical trial. They are often disproportionately responsible for child care, and healthcare, and other aspects in their household, and designing trials that are thoughtful about their time, that minimize an unnecessary number of office visits that they would have to make, that operationalize remote tools like telehealth, and electronic diaries for data capture, those are definitely very important when you're innovating in women's health.
Theresa Brady (17:15):
Elizabeth says the FDA has stepped in, but for years, government policy held back progress in medical advances for women.
Elizabeth Bailey (17:22):
The women's health innovation ecosystem is really still in its nascency, which feels funny to say, actually, given that women have been around for quite a long time, and we've seen incredible medical and scientific advances in other fields.
(17:40):
There are a number of reasons why women's health has not advanced to the same pace as some other areas. It was as recent as 1993 or 1994 when the FDA made policy changes to actually facilitate inclusion of women in the earliest stages of clinical trials. Before that, they had been left out. We're talking about not so long ago that women were actually excluded from clinical trials. Back in 1977, pregnant women were actually banned from clinical trials, I think with good intention, because of some adverse events in things like the thalidomide trial. The overhang of that has really been a disadvantage to drugs and medical devices actually being tested on and having women factored into medical advances. I think there's a real history of disadvantaging women, not including them, not including their voices, certainly, and definitely not including their bodies in medical research. That alone puts us way behind men in terms of scientific advances.
Theresa Brady (18:59):
Two of the areas that RH Capital focuses on are maternal health and contraception. Elizabeth tells us why.
Elizabeth Bailey (19:07):
Almost half of all pregnancies in the US are unintended. Part of the reason for that is the lack of options for women who don't want to use hormonal birth control. One of the focus areas of our fund is really to invest in the next generation of non-hormonal contraceptives for both men and women, because we actually think that male options also benefit women's health.
(19:34):
One of our companies, a company called Circle Biomedical, is actually focused on a new option for women's contraceptive, and specifically non-hormonal, on demand, something that really doesn't exist right now. We are really excited about the science. We think that it promises to create a really important option for women who are looking for alternatives to hormonal birth control. We also think things that are controlled by women can be used on demand, are very low cost, and yet they have to be as effective as the pill, hold great promise for reducing unintended pregnancies in the US.
Theresa Brady (20:24):
A lack of options for women extends beyond reproductive health. For example, 40% of women experience female sexual dysfunction, yet only a small percentage of women even seek medical attention for it. It is something you just don't hear or talk about. Sabrina says it will take a concerted effort to shake the stigma and move towards normalizing the needs of women.
Sabrina Martucci Johnson (20:48):
To have that conversation, you just got to get the words out there right away and normalize it, and that's what's going to happen. And we've seen that in some of our clinical trials that we're running as well. We're running a study right now in female sexual arousal disorder, and how shocking it has been to learn that almost to a woman, the participants in this study have not talked about the condition with their partner until they enrolled in our study, and we helped give them some of the tools to communicate with their partner about the condition and its physiology, and that it's not her lack of interest in the partner, and it's not her boredom with the relationship, but this is a medical condition.
(21:29):
And so even doing more clinical research in women's health, and getting into the communities, and giving people the tools when they participate in the trials to have the conversations, and with social media, hopefully they'll get on and talk to other people, five other people, and share the knowledge, and that's how we're going to make a difference, is by normalizing some of these conversations so that people can be more aware, and can take more ownership of their own healthcare decisions.
Theresa Brady (21:54):
Sabrina points out the obvious disparity between addressing men's versus women's sexual dysfunction.
Sabrina Martucci Johnson (22:01):
It's female sexual arousal disorder, which is a condition that is very analogous to erectile dysfunction in men. It's a lack of physical arousal response. In men, we figured out how to address it with an active agent. Most popular brand historically was Viagra, that has sildenafil in it. And the actual pathophysiology, the condition in women, is very analogous. We simply don't have a drug that's been FDA approved to treat the condition in women, and the oral dosing in women probably is not the way to go, simply because of the side effect profile.
(22:34):
So that's a great example, like some other conditions in women's health, where we know what we need to do. We just haven't addressed her version of a condition that has already been addressed on the male side, and that's the kind of difference we can make as an industry, and that's a great example of a place where we understand the type of drug that makes sense. It's simply a matter of actually studying it now in women, in her version of the condition, and making it available as a prescription product.
Theresa Brady (23:08):
Clearly, we are not meeting women's health needs. In the end, it comes down to normalization, representation, and just recognizing the huge untapped market potential. It will take years to close the gaps in developing medical treatments for women, but things are changing. As more women speak up about their health needs, and as the number of female leaders in biotech and venture funds increases, we will see more innovation in women's health.
(23:36):
I want to thank Sabrina and Elizabeth for talking about this critical issue. Make sure to subscribe, rate, and-or review this podcast, and follow us on Twitter, Facebook, and LinkedIn at I Am Biotech, and subscribe to Good Day Bio at bio.org/goodday.
(24:06):
This episode was developed by executive producer Theresa Brady, and producers Lynn Finnerty and Rob Gutnikoff, and was engineered and mixed by Jay Goodman, with theme music created by Luke Smith and Sam Brady.