An Open Discussion on the State of Women's Health | LSI Europe '24

Yahel Halamish 00:05  
So good afternoon everyone. Hope you had your post-lunch coffee and you are ready to kick in with some talks about women's health. So it is important; we're 50% of the population. I hope everyone in the room remembers that, even though the representation here is not a representation of actual society. So I'll start with a brief intro about myself. So, super briefly, I'm Yahel Halamish. I'm from Nina Capital, a principal at the fund. We are a VC fund based in Barcelona, but investing across multiple geographies, at pre-seed and seed stages. In the past four and a half years, I saw a lot of companies solving healthcare needs because healthcare is all we do. But I became a bit obsessed about women's health and why it is not solved, and why are there so many gaps that we're not filling in? And this is what we're going to talk about: gaps. Specifically, because there are so many of them, we'll start with preventative care and maternal health because of the amazing representation of our panelists here. And to kick it in, because we like to talk about facts, the facts in women's health are really bad. So Andrew, if you can please introduce yourself and Hologic and share some facts.

Andrew Pieprzyk 01:37  
I'll do my best. It's a pleasure to be up here with you guys today. For those of you that know Hologic, it's a med tech, med device company. We are focused on women's health, but we've got a broad portfolio. What I'm going to be talking about today is actually a program we launched four years ago in partnership with Gallup, and that's the Hologic Global Women's Health Index, where we're surveying men and women across 143 countries on the state of women's health. Those five pillars are attributed to about 70% of the factors that impact a woman's lifespan at birth. When you go into those, and I'm going to use my notes because we took a specific cut of the European data given the audience, those five pillars, as we talked about, are preventative care, emotional health, individual health, basic needs, and opinion on health and safety. And underneath those, there are lots of questions. Now this is all publicly available data. You guys can go on the web and find it. We use this to raise awareness around the gaps. So part of my role in strategic development isn't just running a portfolio for the business, but we also have multiple public and government affairs programs working at the EU Commission level to put a women's health agenda on the radar, into the legislation. So that's really where we're starting to carry the awareness, desire, and the capabilities around some of these gaps. So let me start with some of the facts or the data. This is our third year of data. We are now crunching our fourth year of data, so there is a little bit of trending in here. So if you bear with me, I'll go through some of this to kind of ground us in those pillars of preventative care. In the year three survey, there were over 78,000 respondents, women only, covering the age of 15 and above, across 143 countries and 140 languages. In the EU member states, there were over 14,000 respondents. So thinking about the power of the data set and what we all look at as innovators, entrepreneurs, or strategics, looking for problems to solve, we have a very large data set that's documenting this across the EU. In the year three findings, Taiwan was actually the highest at 72 out of 100. The average score in the EU was 61, and the average global score was 54. So on a total level, the EU is not doing too bad, but there's a lot of room when you think about that preventative care. What is the definition of this relative to the index? What are the aims that help people avoid illness and detect health problems early, before the onset of symptoms? So in the survey, that is the definition of preventative care. The right test at the right time helps make it more possible for women to be treated and live healthier and potentially longer lives. Now I'm also, by design or not, the only male member of the panel, right? And this is also important to me. As a son, a husband, and a father of daughters, right? Thinking about these gaps that we'll get into, especially when you start getting into taboo topics around health and safety, because there are some dimensions in here about domestic abuse that I think we don't talk about enough. But let's go back into the preventative cares, and this is really around screening. Okay, so in the EU, 47% of women were tested last year for high blood pressure—less than half. Only 24% were tested or screened for diabetes, 20% were tested for cancer, and only 8% were tested for STDs or STIs. And that last one is important because we're going to go into maternal health. The long-term effects of an undocumented, undiagnosed, and lingering STI could lead to infertility and then troubles later on down the line, so that's where these measures become important. And when we start talking about how the countries rank in these, particularly where my business helps is in cancer and STI screening, and that's kind of where Hologic plays in that one. But as you all look into the market, women's health is a massively unserved need, and there are dimensions across all of preventative care that we can absolutely focus on.

Sharon Handelman-Gotlib 06:33  
Well, Sharon, your work at Shela Health is actually improving maternal health. And the measurements that Andrew just mentioned are substantially impactful for what you do. So maybe, can you walk us through the innovation that you're taking in order to bring this preventative measurement into women's lives and how we can improve access to care by adoption? Sure.

Sharon Handelman-Gotlib 07:01  
So first, by means of introduction, I'm Sharon Handelman-Gotlib. I'm the co-founder and the CEO of Shela Health, which provides prediction and precision health recommendations in the maternal space. Our current focus is that we have prediction models and algorithms to predict the leading pregnancy complications such as preeclampsia, preterm birth, and gestational diabetes. I think the numbers and the data that you just shared are, for me, always, as a FEM tech and women's health advocate, mind-blowing. I'll start with that—they're sad, they're sad, they're sad, they're mind-blowing in a bad way. And that's, by the way, why I became what I am today. I was many years in the health space; that's my background, coming from innovation, leading the innovation at the second largest HMO in Israel, which is one of the largest in the world. Somewhere down the road, I came across the notion of FEM tech, and that kind of was an eye-opening moment for me, an aha moment that I knew that that's the area that I wanted to make a shift to move the needle. So I became very active on a global basis in the FEM tech space, specifically in Israel, bringing the FEM tech notion to life and establishing the ecosystem. What I wanted to do was create a company, a startup, a platform based on data, deep tech, and deep science. And that's exactly what we're doing and trying to create. So that's kind of, I'd say, where we are today. We're closing the gaps. We're doing a better job, but we're only in the baby steps in the beginning. So data screening, preventative in Shela's perspective and landscape, 25% of pregnancies lead to a severe pregnancy complication. Very severe, as I mentioned, preeclampsia is one of those severe for the mother and for the newborn, and it affects not only the short term but also the long term because pregnancy is really a stress kind of test for a woman's long-term health—like a crystal ball. And we as women, and I say also men, are very unaware of the outcomes and results of what can happen, what can occur from not preventing a condition at the right spot and at the right timing. So that's why I'm here to make that shift. What we do is provide an early prediction capability and a precision care pathway for each woman on a personalized basis, excuse me, to provide and prevent pregnancy complications from even occurring. The fact is that if you're able to identify the condition early on, you can, surprise, surprise, prevent. Right? So it's very important, and the fact that pregnancy, I'd say, is an easier hook for women to join, as opposed to blood pressure, breast cancer screening, and others that we often just ignore because we're too busy with others to deal with than ourselves. Pregnancy is the potential hook for a woman to finally meet a clinician and ask herself health questions. That's where we believe, at Shela, that we can also start this companionship for the long term. So that's from a prevention standpoint—a very important point in the health journey of a woman—to say, hey, let's start talking about health. Let's start talking about how your future health can look like and preventing those from occurring. Preeclampsia, long-term cardiometabolic diseases, preterm birth also entails those complications, gestational diabetes, and a higher ratio for type 2 diabetes. Why not connect the two data, facts, conditions, prevention?

Yahel Halamish 11:13  
Maybe just a follow-up question there, because we're talking about awareness. Many of the preventative measurements overall need awareness, and adoption has historically been very challenging with everything that is maternal health, partly because of lack of awareness, but partly because the incentives, unlike other spaces in the healthcare space, are very much misaligned. So how do you view this situation, and how can we improve it to make physicians maybe adopt more of the solutions like Shela to improve care overall?

Sharon Handelman-Gotlib 11:57  
So I'd say it's a great and very broad question, and we're seeing it also outside of maternal health, of course. I'd say that once the physicians, the OB-GYNs, want to use that and want to embrace it, it depends on the health system—if it's a US one or a European or non-European, others; they're all different. But in the US, you have to understand the right incentive in how to incentivize the physicians, the OB-GYNs, and clinicians to use and embrace that. How to incentivize the health insurance, the employers? It's a broad question for them, but if you present the ability to also not only improve health but also provide cost savings, to some extent, short and long term, it makes our, I'd say, our opportunity bigger, and we're able to convince others to use it. I haven't seen an OB-GYN say no to technology or no to having better health outcomes per pregnancy, for sure. Nobody wants to see that, and I haven't seen health insurance that wants to have a newborn with challenges from day one. So these are also areas that everybody wants to see the best outcomes, and I'll say that embracing that also saves a lot of liability issues and so many other issues and angles that are part of the discussion and are part of the ecosystem. The way we can support that and accelerate the embracing of technologies is proof, first of all, is providing validation, showing that it works. Having those discussions, the awareness policies, bottom-up and top-down as well. These are the kind of activities that we're also working on—getting women to be aware. I'd say again, in the larger magnitude, that's something that we're seeing change. If two or five years ago, there wasn't a discussion around menopause or around conditions and diseases like endometriosis, which affects a very large female population, that's not the case today—in a very good way—because we are having that discussion. Women are louder and demand the solutions for that, which makes all the difference, and we're hearing that. And not only that, there are women like the ones on stage and so many others who are trying to create a new future, a different one. So identifying the challenge—that's one—talking about it, and making our own future and taking it into our hands and providing the solutions and technology.

Andrew Pieprzyk 14:57  
I think it's a really important lens. How many of you are in healthcare? I'm expecting everybody in the room to raise their hand. We have a perspective; we are highly informed, right? Yeah, where I think the other part is, yes, it's access to the ecology; it's the provider being able to offer it, but it's the agency of the patient. They might not even be a patient yet, and then it becomes education and awareness for them to ask the questions. So how do we use our perspective, right, in our lens? Because you're an advocate, because you see it. If you're a busy mom or you're a busy family and you're taking care of school and you're doing a run and you miss a doctor's appointment, you might not think about all of the things that we do when you miss that appointment and why we put it at the top. My perspective, being in healthcare, has actually led to some very, I would say, amusing conversations with my wife. She's like, "Why are you asking me this?" I'm like, "Because I want you to go to the doctor," right? You know, and that's important. I think the empowerment piece and making sure women can ask those questions, that they're safe to ask those questions, and encouraging the men in their lives—whether it's a father, a brother, or a husband—to be able to say, "Look, I think this is important." I think that's a really big piece. We see this in screening programs today, right? It's not like the technology is there; it's paid for by the government, but the women aren't showing up. Yeah, and how do you answer that question of why aren't you showing up?

Regina Atim 16:39  
I think this ties really well for Regina to introduce herself because you are building a solution to empower women, and you're also part of advocacy groups. I think the patient perspective is very strong with what you do. So if you can introduce yourself and also share more about the patient perspective with all of it, absolutely.

Regina Atim 17:00  
So my name is Regina Atim, and I am the co-founder of Clinicians Touch Allyve, which is also a wearable plus digital platform that basically collects biometrics throughout the pregnancy of the patient and also before as well as postpartum. In terms of what we aim to do, we want women to be equal stakeholders in their health, especially in their pregnancy journey. Even as healthcare workers, even knowing and understanding the issue as a mom or as a pregnant woman, I have found that it's still very difficult to navigate that process. I am a pharmacist by trade, and I started out in the NICU and L&D, so I'm very accustomed to taking care of women and their babies. When I held my own journey, I had to heavily advocate for myself to get myself through the process, specifically my second pregnancy, where I actually had to go against medical orders and switch hospitals because I wasn't being heard and because what they were proposing was against everything I knew to be correct. That turned out okay for me, but if I was someone with less education and less understanding of the process, I may have just gone along with it, and those results could have been different. With that background, I was compelled to start. I've always been in the safety space, but during the 2000s, when the maternal mortality rates became so apparent and heavily discussed in the US specifically, I became involved with creating this device and application. In 2023, we really started our development process. What we aim to do is empower women to be able to understand the processes, give them the education that they need to then take with them to their physician's office, as well as communicate with their physicians or whatever caregivers they may have to help them understand where they are in the process. As Sharon mentioned, to predict earlier any issues that may crop up so that an intervention may take place before it turns into an emergency. While they're having the baby, we also want women to feel supported. If they have the application and device, and while they have their network, this is going to be in addition to all of their physician groups and their current medical groups, in such a way that they don't feel alone. We create a digital community of sorts for them to be able to ask those questions. It's funny because on my way here, I was scrolling through Facebook, and in one of the mom groups, there was a woman that mentioned that she just had a baby, and she was very happy. She was getting ready to get discharged, and she happened to mention that she had also been having a persistent headache, and she wasn't going to say anything about it because she just wanted to go home. She felt that she didn't want to bother the doctor with something so minor, as she mentioned it. My eyes got wide, and I inboxed her. This is a random patient, a random person, just sharing their information. I said, "Listen, you need to tell them that you're having these headaches and let them know and take it seriously, and really just don't worry about being a bother." A few days later, she did inbox me, and she said they kept her there. She had preeclampsia. These are the things that happen postpartum, and we want patients to have a community. We don't want them going to Facebook and maybe having that be missed. We want them to feel like they have a community where they can jot down how they're feeling—if their feet are swollen, say, "Hey, my feet are swollen, I don't feel good," or "I'm having pain here." That is what we aim to do at Clinicians Touch Allyve with our product. We are currently in the pre-seed stage, but we're looking forward to continuing our journey and getting this to patients as soon as possible.

Yahel Halamish 22:07  
I think something that was said before, I think Sharon said that maternal health is used as a hook for actually taking control over your health. I really like this specific sentence because I think preventative care is hard enough. But during your pregnancy, you're taking different decisions, and you're trying to be more mindful of your health. You're even taking more pills just for your iron or things that are complementary and not necessarily needed just because of preventative care measurement. In that perspective, maybe Andrew, you can kick it off—what do you see as a key area in preventative care for women that you believe tech solutions can actually provide a lot of difference in the future? How do you see the future in the next year? What will be the solution that will be able to promote preventative care more substantially in upcoming years? So trends, people trends.

Andrew Pieprzyk 23:20  
Was that a pre-replay derailing a little bit? Yeah, like—

Andrew Pieprzyk 23:26  
I think when you look at just the statistics I rattled off earlier, right? I don't know if there's a technology that can get a woman to the doctor, right? Just the basics, right? So I think education, right? Is there a platform—not Facebook? I can tell you how amazing, you know? And it says, I love my wife. She's like, "Oh, I saw this on TikTok." I'm like, "Not validated, not medically relevant," right? But okay, you know. But there are people that are good with that information, but you have to be able to trust it. So I think there's an opportunity for technology to fill in the education gaps, especially in preventative care, and that can be embraced rather uniformly and probably endorsed by most of the medical societies in these basic preventative levels. When you then specialize, I think the societies probably can then work within their specialties on what education can you give the women that are actually showing up to empower them. I go back to the education piece. You know, I know we're in healthcare, but that agency is probably the most important because if a woman isn't engaging, you're going to miss her anyway, and they need to be able to engage themselves. It's also for men, but it is one of those. If you are not engaged in your own care or you're hesitant to ask a question because someone's busy, you've got to like—this is my life, right? I would love for every woman to sit there and be like, "No, this is my life. This is my question." I've done my whole work on this platform, and doctors aren't upset by that, but they're all busy, right? But it's also where do they go for that? I think for me, that's one that's pretty universal. It's just education on the basics and how do you make that as consistent as possible?

Yahel Halamish 25:16  
So a small follow-up question here because at the beginning of our conversation, you mentioned that part of what you do in Hologic is to put women's health on the agenda of regulators. Education is something that is highly driven by regulators overall. So what’s your experience of trying to put women's health on the map for regulators from the work at Hologic? What’s the experience that you have?

Andrew Pieprzyk 25:47  
It's early days. We have now been engaged in all sorts of conversations across the EU Commission, the elections, kind of, you know, we had to navigate, right? You guys know how that goes. I would say, relative to what would be public and government affairs measures, we have overwhelming support from the incoming elected officials to really make sure this is on the docket. The data from the Women's Health Index—we are also working within the med tech communities, Med Tech Europe, and others across companies to make sure we are speaking with one voice. Because in the end, it benefits everybody. When the tide rises, all boats rise. I think that's the piece. There is a lot of interest within the regulatory bodies and the EU Commission, but it will take time. As you guys know, it's not the United States of Europe. You have to have the overarching commission and then work it in. We're also working at a country level, and this is where it can be more programmatic. Some of our countries have partners in spaces where they're a bit adjacent to us, or we're tackling more instant challenges. For instance, in Spain, there is no STI screening program, right? There's no asymptomatic screening in any of Europe except for the UK, right? But Spain and Italy, in particular, are having challenges with lower birth rates and population, and you're starting to see these linkages emerge. We're like, because you're not actually screening, and these are some things downstream. I think there are multiple levels to how we're working with those regulatory and guideline bodies to help bring that awareness. So using the change management model, there's awareness. We're uncovering a high level of desire to put a women's health agenda across the European Union. With this data, there's a lot more knowledge coming, right? That's where I think this community needs to use your voice. Last year, at this meeting, some of the innovators actually are on technology commissions within the EU Council, right? So they're already around. It's connecting the dots, and that's really what we've started to do the last couple of years with this data.

Sharon Handelman-Gotlib 28:15  
Right? So connecting the dots, I think this question goes to both of you, actually, because both of your solutions are based on a lot of data that requires partnerships with regulators, with other tech companies, with providers. This entire collaboration and basically putting the dots together are essential to delivering the product that you're building. So how do you see partnership impacting your development, and where do you think we can improve in that, taking regulators in as well? Because I think it's a big piece in the puzzle.

Sharon Handelman-Gotlib 28:58  
Absolutely. So I'll go ahead and start, and I'm just speaking from a US perspective at this point. I do think that it is important to partner with as many agencies and as many organizations as possible to bring all the ideas to the forefront for the gain of the woman. We need to center women, and we need to come up with the best solutions. In order to do that, we do need to partner with our regulatory agencies, find out exactly what milestones they're looking for, and exactly what we can do with this data to keep the process improvements going so that the data isn't stagnant. We need to be able to make updates without having to do a new submission. In doing so, I think engaging with our regulators early and coming up with a process together is going to be essential to ensuring that we can have the advancements that we want, and we can move fast while still maintaining the credibility and accuracy that they're looking for and the safety that they're looking for, but allowing us to not be stuck with a solution that we can innovate and do an even better job on simply because it would have to go through a new regulatory process. I think that's probably the challenge with technology in general. But I think that working with them and helping them to understand where they can stage gate in a way, and help us to find these different solutions so that once we do get approval, maybe an annual report will be good enough for advancements or things of that nature.

Regina Atim 30:45  
I agree with that, and I would like to add, again, to what Andrew also said. First of all, it's around data and not only education but the publicity of that, and getting everybody around the table to talk, to discuss, and demand. So it's the women, it's the regulators, it's the providers, it's the clinicians, the key opinion leaders—everybody. Once we emerge all these forces together, we can make the change. I'd say as early as possible, and as data-driven and science-driven as possible, that kind of gets everybody to get together. Not only in the EU; you see it also as a heated discussion in the elections today in the US. Women's health and reproductive rights for women are leaping onto the agenda for many reasons. We're not going to go into all of that; it's super complicated, but it's there, and we deserve that right as women and also as men because we are all impacted by that. Once we have the discussion, from a regulation standpoint, as early as possible, as partners, we shouldn't be fighting around it. It's not something that we should contradict and disagree on. Let's find where the common base is, what you want to see, what we can provide, and let's find the common ground to work on that and then expand. That's one. The second one is where we work to identify also early adopters, KOLs, the strong key opinion leaders, to say, "I believe in this technology. I embrace that. I will implement that technology." If we have, for example, Shela's screening process as part of our platform, this will make a significant change. These are the people that we're looking for—identifying and working together and also identifying those populations that we can serve best, which are in more crisis or at higher risk. To identify those and prove our thesis—that's kind of in general. I'll say also to what you addressed before is the fact that women are not showing up for many reasons. Let's find the technology and tools to meet them where they are, either at home. For example, Shela's first step of our platform is a digital intake. Everybody can do that anywhere. I don't have my mobile phone, but imagine I have that through my mobile app. That's doable. If a woman spends her time with, I don't know, the salon getting her hair done, why don't we have that kind of awareness or some kind of tool or technique? Those things are applicable and done today because oftentimes, and very sadly, in the US, pregnant women will not see an OB-GYN and not see anybody until she gives birth for crazy reasons, which is unacceptable. But let's make the difference. She's unaware, she's afraid, she's not being heard, and she's being dismissed. So why bother? These are things that we hear, we echo that. Where can we meet the woman where she feels most comfortable? Find those hooks again and work on those to improve health. These are the types of things that we're thinking of. It's not only about the innovation; it's not only about the technology; it's where a woman feels comfortable and well, where we can see that it fits in smoothly. That's going to make the change. Okay?

Yahel Halamish 34:53  
Maybe a last question for everyone because it's all about incentives, right? At the end, we're talking about connecting the dots. Regulators, they all need incentives. Bottom line, they're spending more money on research for erectile dysfunction than menstruation—one affecting 20% of men, one affecting 50% of the population. What incentives are missing, and is there a way to gap the incentive using technology? It's a big question, and we have three minutes.

Andrew Pieprzyk 35:24  
I'll go really fast just to start. I think one of the incentives is really to showcase the decreased length of stay within the hospital systems. I think that's a big one where technology can really bridge that gap and help everyone to see that it's in everybody's benefit to really utilize this technology as an adjunct to whatever else we're doing. I would say that was one big thing.

Sharon Handelman-Gotlib 35:50  
I'd say proving also from whoever pays the checks is the incentivized would be always cost—driving costs down, improving health, and making sure if you're an employer and you're self-insured or what have you, one presents the perks is showing that and understanding the ratio and what you get from that. That would make, again, the incentive of others to embrace that change. I always look at that again—meet the people where it really will hit them and make the change. It's money; it's the dollars.

Andrew Pieprzyk 36:28  
I want to extend your social care. Even in the US, you pay per instance. You have this; we do this, right? It's the innovator's dilemma. If you go upstream and you incentivize the woman to go to the doctor when she's 21, you get that. But governments aren't putting that in place, right? You come out of COVID, and people might be struggling for a job, and I can't miss a day at work. If I miss a day at work, I'm not going to be able to pay my bills. When you think about all the incentives that are possibly keeping women from showing up, how do you diffuse that and get them in at that early age to start that conversation before they get pregnant? I think that diffuses it, and that goes to the incentive of total cost of care over a lifetime, not on an episodic level, right? Particularly when we're diagnosing what is not preventing what could have been. That, to me, is the major shift. It goes back to regulators, but it's also a reconfiguration of the whole system. For me, there is a sense of urgency in this because our CEO said women are the cornerstone of society and civilization. My add to that is it's known in healthcare that it takes 17 years to change the gold standard of practice. We don't have that time, right? The clock's on, yeah. Pun intended, but, you know, this is the complex environment we live in. So that's a great question: what's that one piece that can get there? I fundamentally believe in a lot of social care systems; it's the incentive on the front end to help the women at an early age trust the system, right, to get in and be educated early. I think that cuts through a lot of it.

Yahel Halamish 38:27  
Okay, and with that note, thank you for being here. I think we had—thank you for talking, all of you. I think we had a lot to say, and sadly, we couldn't fix the system yet. What we can take from this discussion is that each one of us is a hook. Each one of us is someone who can actually make a difference. So next time, bring your colleague with you who is a man for a change because I think it's the biggest amount of women I've seen throughout this conference in one room. So thank you for being here. Thank you for speaking. Thank you. I appreciate you all.

Andrew Pieprzyk 39:10  
Yes. Thank you.