Femtech is technology designed to address women's health which faces several systemic barriers that limit its integration into mainstream healthcare. Despite its vast market potential, Femtech remains underfunded due to investor discomfort and bias. Media censorship and structural funding inequities further restrict visibility and growth, while the proliferation of unregulated or misleading products undermines trust. For healthcare professionals, recognizing these challenges is essential to advancing equitable, evidence-based care for female patients.
On today’s episode of In Network's Designing for Health podcast, Nordic Chief Medical Officer Craig Joseph, MD, talks with Marina Gerner, PhD, journalist, NYU Stern adjunct professor, and author. They discuss her groundbreaking book, The Vagina Business, which explores innovation in women's health, and the cultural and financial barriers that hinder progress. They also discuss gender bias in medical diagnosis, the rise of Femtech, the stigma surrounding female-focused products, and the challenges of bringing these innovations to market. Marina shares insights from her research, including examples of transformative technologies and the importance of destigmatizing conversations around female health.
Listen here:
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Want to learn more from Dr. Joseph? Order a copy of his book, Designing for Health.
Show Notes:
[00:00] Intros
[00:09] Marina’s background and her book: The Vagina Business
[01:29] Gender data gaps
[02:52] The emergence of Femtech
[04:00] Innovation and obstacles in birth care
[05:30] Title controversy and pushback
[13:02] Femtech vs. Scamtech
[14:09] The pink tax in healthcare and global innovations
[27:03] Marina’s favorite well-designed thing
[28:52] Outros
Transcript:
Dr. Craig Joseph: Doctor Mehra, welcome to the podcast. How are you today, sir?
Dr. Mukul Mehra: I'm great. Thanks for having me.
Dr. Craig Joseph: And where do we find you today?
Dr. Mukul Mehra: Birmingham, Alabama. That of the IllumiCare office.
Dr. Craig Joseph: Awesome. I look forward to hearing more about IllumiCare and how you got there. But let's start at the beginning. You've always, since you were a small child, have always wanted to run a company. Is that true?
Dr. Mukul Mehra: Absolutely. After the Apgar score of nine, I declared that I'm going to have a company in health care one day, and they downgraded me from a nine to a seven on the Apgar.
Dr. Craig Joseph: So are we talking about the one-minute Apgar or the five-minute Apgar? It's very important. Our listeners want to know.
Dr. Mukul Mehra: You know too much. It was the five-minute Apgar.
Dr. Craig Joseph: It was a five-minute Apgar. You got a nine. Well that's good, that's good. That's how you get into some of the best schools. So let's assume that we're both being sarcastic. And that's not what you've always wanted to do. You wanted to go to medical school, I presume, and become a physician.
Dr. Mukul Mehra: I love math and physics. It still has always been my passion. And so it was really the electrical engineering route that I thought I was going to go to. I went to school at northwestern, but I found the human connective within the medical profession as the ultimate, you know, guide towards picking medical school.
Dr. Craig Joseph: And you became a gastroenterologist. How does one choose that specialty? I was just curious. Is it the procedures? Is it the disease processes that you deal with, or is it just you fell into it?
Dr. Mukul Mehra: My uncle is a gastroenterologist. The certainly I grew up with a background in gastroenterology, but you're right. I enjoy a profession where your diagnostic skills were valued and you had therapeutic interventions doing a procedure, and you were. The procedure was to our design often in gastroenterology cedars in the morning and in the afternoon in patient rounding in between. That was ideal to me. That or cardiology, I chose gastroenterology. Electrophysiology fascinated me the most. Okay. It is the ultimate compendium of an amalgamation of the physics electrical pathways and the heart stopping or going haywire.
Dr. Craig Joseph: So you were an, are a practicing gastroenterologist. How did you get into this idea of starting a company and you know, what was that? What was that process like? What problems were you seeing?
Dr. Mukul Mehra: The biggest problem I saw was a buzzword called value-based care. And it was fascinating to me that we were going into value-based care, and we thought we had a pretty good handle on at least what we consider high quality. We didn't have a grasp of cost, especially at the provider level. We were going to enter value-based care and not fundamentally expose us to the people who actually are ordering therapeutics. That was a problem, and the biggest inspiration for me came when a patient who was a patient of mine, she had colon gyrus, who had renal failure, she had pancreatitis and sepsis. So me and four other physicians ever it was about an 11-day admission. But what really happened at the end of this 11-day admission is we saved her life.
I did a New York epi with this paradigm. It was a very hard what is done? And when she came back to the office six weeks or so later, when she looked distraught, she showed me her bill. And that began the journey of deconstructing a patient bill from an inpatient stay into line item for non-charges. Even the charges appear on these bills. So what is the true cause? Or as close as we get to the true cost of the things that we did to this patient, medication ordering AB ordering in graphics study ordering. And it was fascinating to me because I, I convened this group of five physicians back and I said, look, it took me a while, but I want us to do a chart review in retrospect.
And 43% of the stuff that we did to that patient, we admitted, was probably not needed. This is the problem, because a portion of that bill now hits the patient's wallet, and we know that low value care is problematic to health systems, but it's a real problem to the patient. It was fascinating to me. I had this moment where I was like, we've always talked about iatrogenic risks. I mean, it's a Greek word. Dietro means healer. Genic means the producer. So the healer produces unintended consequences from their therapeutic decisions upon a patient. Like we know this happens. There's been a recent article on excess imaging being done, and it's radiating our patients when we do CTS or we draw a lot of blood from a patient, you know, we make them anemic. Those are after genic risks. But the real risk now in 2025 is the financial consequences of what we're doing to our patients when we're ordering meds as radiographic studies, whatever they are, and they're low value.
Dr. Craig Joseph: Let's talk about low value care. I think outside of the clinical world it's a little confusing. These are not things that have no value that you shouldn't do. Right. You hurt your foot. So I get an X-ray of your arm like, no, probably that's no value. But low value care. Some things that we do that in high, like, as you mentioned, kind of in hindsight, maybe we didn't need. Can you share what are some examples of low value care that you see in your world of things that you might have done or might still do sometimes?
Dr. Mukul Mehra: Well, like that patient who had pancreatitis and a stone in the bile duct if she had pancreatitis. So we feel that we're going to order a lipids in any amylase and come back high. We've established the diagnosis of pancreatitis. There is no forecasting of recovery based on the potential levels of amylase in lipids. So it's low value. Does it feel good when their amylase and lipids come down? Sure. That's human nature. Yet you know it doesn't in any way portend other patients. And I do, because the definition of severe pancreatitis is not based upon lipids or amylase elevation. So it's always for one, you're ordering them sequentially. Two, you're ordering both of them sequentially. Each of these lab tests have a cause, by the way. They are an extraction of blood. And it's not super comfortable getting blood drawn. That's low value care. But we don't do it with any sinister motives as physicians.
Dr. Craig Joseph: I love that example, one that I've heard is ordering EKGs routinely before non-cardiac procedures. So you're having a knee replacement and well, we'll check your EKG just to be sure. Again, for patients who have no heart disease that is known, it seems like that wouldn't do any harm. And except for the money, of course it costs money, but it does cause harm, right? Because it's not been shown in studies to be helpful. The benefit doesn't outweigh the disadvantages. The disadvantages besides cost are hey, it takes more time. Hey. Inevitable we find something, and the conversation almost always goes like, yeah, I ordered this EKG. It's slightly abnormal. I'm not sure it means anything, but now I need the cardiologist to take a look and then the cardiologist as well.
It's probably nothing, but if you're going to have surgery, we should probably make sure it's not. And then let's order some more tests which delay the knee procedure that you were trying to get in the first place. And some of those tests involve being poked with needles, and having dye injected, and people have allergic reactions and other kinds of problems sometimes. And so these things that seem like, again, we call them low value, but sometimes they're actually harmful besides the money and the time. So it getting rid of them or minimizing those low value tests. Again you perfect with well you don't need lipids and MLA should probably only need one and you certainly don't need to check them every day to see that they're going down when you can tell the patient's doing well. Otherwise we have science. This is not just our idea. Right. There are there are studies that show that whether it's going down quickly or going down slowly doesn't really matter once you've established that you have a diagnosis and you're dealing with it the right way.
Dr. Mukul Mehra: Yeah, absolutely. That's I said, in fact, you're describing a longer-term harm, which is the therapeutic cascade. Like if you take that same patient okay. So now they went to see the cardiologist. The cardiologist orders a lipid panel as part of their workup. Well, the LDL is a little bit high. But now the LDL is high. So they get put on a stat, maybe the data on using statins for primary prevention with that LDL is not that high. I'm a hepatologist too. So now three months later, that patient's Alt is 68. Now they're coming to see me for elevated liver enzyme. And so the consequences of low value care and the therapeutic cascade of future unnecessary tests, it's very hard to quantitate the financial value or, you know, loss in that case. But, nevertheless, it's not by the patient or health care system.
Dr. Craig Joseph: I have not heard that term therapeutic cascade, but I love it. It reminds me of one of the things I used to tell parents as a pediatrician. I would tell them that my job was to do as little as possible for as long as possible, and I would have used the term therapy to prevent therapeutic cascade. Right. Because, well, should we get a lap? Well, if I get a CBC, something's coming back abnormal on that CBC and guarantee it. Right. And it might be a series of letters that I'm not even sure exactly what the MCT does, but there's an MCQ, and it's off by 0.1, and now, do I need to send you to the hematologist to make sure that's not the end?
And yeah, clearly, you've established you've helped us clarify that low value care is something to be avoided. And again, there's always circumstances where you do want to get a live piece in an MLS. And you might want to repeat those because the diagnosis is not clear. And so that now no one's talking about that. But we are talking about routinely doing things that really don't have any, science to support them. And so you saw that problem. How did you go about trying to solve it.
Dr. Mukul Mehra: First of all, the first challenge was surely somebody exposing clots to providers in the acute care setting. We can talk later about why we chose the acute care setting as our area to focus on and IllumiCare, but they weren't the cost accounting system. Data does not talk to the clinical ordering system in the electronic medical record. So for example, magnesium, you're acquiring 50 bottles of 20% stock solution of magnesium. Each of the bottles is 50ml. Well that's not how we order magnesium. As a physician we order to grant Mag Run IV that translation doesn't exist because we want to get to the actual acquisition cost of the magnesium, not what shows up on this bill. Discharge, Minister Bill and that translation is very, very difficult to do for medications, especially intravenous medications and drips.
It's not as hard to do for tablets, but the cost chain and for laboratory and for radiographic studies, you know, there's some proxy measures of cost for those. So, we begin to expose flaws at the point of care. If you expose them retrospectively or in an aggregated fashion, it tends to have very little meaning to physicians. And so, we had this challenge of, well, how do we put the cost right where the physician is, the electronic medical record, they're reviewing issue. That was going to be a challenge.
Dr. Craig Joseph: So yeah, the translation between the bulk and how that actually gets delivered to the patient, that's a problem that CFOs and folks in inventory management have been having forever, right? How much does it cost to take care of this patient for heart attack? I don't know, right? How much does the room cost? How much does the nurse cost? How high? Every lab value. We seem to know, but often are paid nowadays through a DRG, through a standard number. A patient has a heart attack that's worth x thousands of dollars, and we don't really care how much it costs you, the insurer or the government doesn't really care. Obviously, the hospital, the doc from the chief financial officer on down in does care. And so what were some of the things that kind of the problems that you've had in making that come true and in terms of being able to say to docs, hey, this is actually going to cost this much money, like, how do you how do you actually do it?
Dr. Mukul Mehra: So, if you make a physician log in, put in their password, find a patient lookup something, it's not going to work. We all know that. I mean, there's enough clicking around in the electronic medical record that putting a link or a hyperlink to expose clause wasn't going to work. So, the first attempt we had at exposing was to create an EMR agnostic ribbon that would surface the insight at the point of care that, hey, you're ordering is pace. Did you know it's this much? Or here's a receipt view of the things that you've ordered and it was fascinating to see how enlightening it was to physician to clinician that they could now, for the first time, see the cost of a lab cost of the medication at the dose they were giving per day. The putative cost of the radiology study. And it was really, really cool for like two months.
Dr. Craig Joseph: One thing I just want to call out that design kind of principle, that that learning principle, the way adults like to learn versus the way kids are forced to learn is, yeah, I'm happy to learn something. As long as it's at the time that I need to learn it. Right. And that's what that was, at least for the first two months. That was key. Don't tell me how much it cost for this other patient or for this other dose. And don't tell me before or after I've already done it. I you're telling me, as I'm about to order this thing, this is going to cost the patient this much. All right, so two months, it worked great. And should we end our story there, or is there more? Sounds like there might be more.
Dr. Mukul Mehra: And so the feedback would be that it began to have very little influence in low value care ordering beyond perhaps the Hawthorne effect. So maybe the daily CBCs would go down or the BMP would go down, or the CMP would go down. But ordering a hepatitis panel or ordering lipids and amylase again and again, it was very hard to prove that we were having an effect. And honestly, the physician feedback was, well, it was neat to see cause for a month or two, I think I got it. And we don't really pay as much attention to the past. And somebody came to me and said, it's really hard to think through an algorithm of care without knowing when you may be doing something low value. And amalgamating that with the clinical literature that proves it's low value. So, what I understood was, look, we're showing you cause it's too much of a cognitive load exercise for you to think through where costs are valuable. Like it's really not valuable to see the cost of levothyroxine, but the patient has hypothyroidism, the tablets generic consent. What are you going to do with that? It's there. Tylenol acetaminophen. It's $0.02 for a 500-milligram tablet. And so we had to begin to reduce the noise and build a data set that we called clinical financial decisions for.
Dr. Craig Joseph: Before we go on, let me just call out the Hawthorne effect that you referenced that some of our listeners might not be aware of what is the Hawthorne effect and how do you think it came into play?
Dr. Mukul Mehra: I mean, the Hawthorne effect is like when my wife says she really appreciates me folding the laundry, which I hardly ever do. But then when she comes in the house, I find some laundry and just start folding. But when she's not really looking, do I go around and fold laundry? No, but I should.
Dr. Craig Joseph: I've never heard it explain that way, the way I've typically read about it. I think it was a cumbersome factory, and either it was called Hawthorne or was in a location called Hawthorne, but they started doing some experiments by changing the lighting in the factory. And they changed. They made a brighter. And they found that productivity went up like, amazing, amazing. We changed the brightness made it brighter, productivity went up. Everyone should clearly now make everything brighter in the factory. And then they lowered it, you know, they left it that way for a while, then they lowered it, the lighting. And you know what? Productivity went up and the idea was, hey, if I perceive that you're doing some research on me or my work, that's around me, I'm going to be more attentive to whatever it is I'm doing.
And so whatever it is you're checking for, you might actually find it. And so it makes complete sense to me that all of a sudden there's, hey, this is how much that costs. Well, clearly the lesson I should learn from that is that I should take this into account and be better steward of my patients’ finances and not order something. So how do you make things? How do you design to take away from the noise? And just to your point, hey, if I don't have enough thyroxine, if I don't have that hormone, I need Synthroid, like I just need it or I'm not going to survive. And so whether it cost $0.10 a pill or $10 a pill, it's really not relevant because it's an expense that has to have. But there aren't. There are things where it is relevant. And so how do you pick those out?
Dr. Mukul Mehra: That is the hardest bit. So we have close to 1100 rules around medication lab and radiology ordering that take into account the cost of the therapeutic, the cost of some alternative to that, the clinical context that makes those relevant, and then a thorough review of the clinical literature. The goal is can you choose an ergative path? There's another med, another route of that med administration, another lab not doing that lab, another radiographic study, not doing that study and quality the outcome but still be the same or improve. And if you can do that and lower the pause in that process, we call that rule set our clinical financial decision support. So clinical decision support just says well look you come in with fib, you should check for all right abnormality. That's clinical decision support. Clinical financial decision support is hey you came in here, you have a DBA.
If you don't have renal failure and the pH is at less than 7.2, you shouldn't be using I.V. sodium bicarbonate. It feels really good to get the PH. I mean, who wouldn't want somebody to put it in their blood? PH is low. Yet the outcomes if the pH is low and the kidney function is normal, is that you will raise the pH but impart no value in terms of morbidity or mortality, the patient's admission. And then there's a cost. So, in that case you don't need to use sodium bicarb. You can use a less expensive crystalloid or I.V. fluid or not use one, that's clinical financial decision support. And not every clinical value rule makes it through the final of clinical financial decision support. That then has to be imparted contextually to the right provider who's ordering it or somebody in their specialties ordering it because they've left the service.
And there's some clinical parameter inside of the patient's clinical window that says, look, this is trading on potential low value care. And we never say no value care because we're not at the bedside. And you and I have both been at the bedside. We don't like people not at the bedside or technology not at the bedside, but make absolute declaration.
Dr. Craig Joseph: So I think what you've called this and you've just kind of given us a clue is contextual nudging. So of course, most of us know what a nudge is. Just a little push in the right direction. Which to your point, sometimes it's wrong. Sometimes. Yeah. This is not a nine out of ten. This is the one out of ten. And I don't want to do that. But make it easier to do the right thing. You push me a little bit, but the key is the context. And so knowing what you know, sounds like you've written these rules to say, hey, based on the context of what's going on, this might not be the best way. I think it's fascinating that example that you gave of, well, you want to get the pH back to normal. Doing so doesn't seem to actually benefit the patient in the short term, doing that quickly. And so you're simply doing something to make you feel better, but you're not actually doing something to make your patient feel better.
And that kind of nudging is completely appropriate. And so that just works in the ear. I just get that nudge. How does that work? Because it does. Does it differ based on the kind of electronic health record I'm using or is it, does it look like it's coming from inside the EHR? Who do I feel is nudging me?
Dr. Mukul Mehra: Well, it's meant to feel like the institution is nudging you. IllumiCare uses really a black framework to nudge, because we think providers have been anchored into ignoring native EMR-looking nudges, and their ephemeral physician autonomy is super important. Clinician autonomy is super important when physicians are super highly educated, often, and been to school longer than anybody at the health system or anybody you know, on the payer world. And so we enjoy autonomy. And the nudge actually appears when you're in that patient's chart, you're the right provider to address that therapeutic because it's within your discipline. And then the nudge disappears. It fades away in seven seconds. That isn't really the mechanism that exists when you put insight into the native EMR alert window. But we know that what's important is to use all of those modality.
So with Epic and with clients, we push our clinical financial decision support insight into the Epic open architecture. We built it alongside of Epic and alongside of other clients. And when does that more heavy-handed approach occur? It occurs when the data analytics show that you succumb to low value care within that order more. You're an outlier. So we look at low value care variation. Look I think clinical variation is kind of important, but it's always going to be there. We're not all pieces of substrate for building a car, Toyota or a Honda. We just don't understand enough about different phenotypes of patients. So there's going to be clinical variation. But if you're an outlier in low value care, in ordering I.V. bicarb in patients that don't have a low pH and an elevated creatine, then you potentially will get that as a hard stop inside of the EMR architecture. Otherwise it'll just be a passive nudge.
Dr. Craig Joseph: I think most of us don't realize how complicated it is because it's not a simple rule. If you do this, then that happens. It's also looking at my past history and looking at what the patient is in front of me because, boy, your point, is well taken alert fatigue a real problem. And if I'm constantly getting pop ups and constantly getting told things, especially if I disagree with them, A, I take them wrong or, B, I agree with them. But like, I was just about to do it and you're badgering me. I'm just going to start making those things go away and they're going to be less important and not there. Explain to me about the seven seconds, I'm fascinated by this. How did you come up with that idea? I assume it just, hey, I see it on the screen. If I want to react to it, I will. Much of the time I don't want to react to it, but it's now planted in my head at seven seconds. The right amount of time is 10s better. Have you done that kind of side by side research or you just kind of picked a number and gone with it?
Dr. Mukul Mehra: We picked a number and I get to use usually make here to. So seven seconds seemed just enough time to digest the content and not feel that it's in any way intrusive, but it's configurable. We had a health system come to us and say, we think 10s allows people to not be annoyed, but they actually will read the abstract because we make a concise statement about whatever the PH. You know, sodium bicarb is only beneficial if you're acid and you have evidence of renal compromise. Otherwise it’ll potentially provide low value and can be harmful. Here's the cost per day of that. Here's a link to the abstract. And so we can track all of this. And we can track if somebody makes a change in the electronic medical record where they discontinue sodium bicarbonate, or they discontinue sodium bicarbonate but offer lactate and Ringer's, and then we look at these windows of time within the nudge for that, for that efficacy. Because that is how we measure efficacy is how do you, are you responding to them, and there's two kinds of responses. There's an immediate response. And a long-term response that our API is for learning here.
Dr. Craig Joseph: Let's talk about physician incentives. Every clinician wants to do right by the patient. It's difficult to sometimes, financially or otherwise, incentivize stocks to do less care, right? And I could totally make the argument going back to the EKG or anything else that we've talked about from a quality perspective or a low value perspective that, well, you know, once I had a patient that's a, you know, you're in trouble when I start that way. I had this patient one time, because you know, what's coming, which is they didn't fit. You know, this was one where I actually was going to harm the patient by doing knee surgery, because we didn't know that they had a heart problem. And even though, yes, you're right, only 1 in 10,000 times does that help?
But, boy, that was my patient. And so, there's the incentive for me to want to never miss anything. I'm not really seeing the forest for the trees because of that. So are there customers of yours who have figured out some way of incentivizing, either through money or other ways of, hey, you're doing the right thing? We want to call you out.
Dr. Mukul Mehra: Yeah, absolutely. And it's a poor strategy for IllumiCare when we engage a partner of system to begin to think through that. Why? Because thinking through cost as part of your clinical algorithm, that's not going to save you time. I mean, there is... IllumiCare is not a time saver. The stewardship module we're discussing and whether it's a little bit of time or more than just a little bit of time that a provider is having to think through low value care suggestion. There is some cognitive load to that. And physicians and providers should be rewarded for that. The health systems like MultiCare was really a pioneering health system for us. They recognized that one of the five quality metrics that they have wasn't being achieved by their hospitalist. And it was very frustrating. It's one that was honestly a metric that the providers didn't think they had complete control over.
The health system had a tough time tracking, so they scrapped it and they replaced it with low value care reduction. And we did data modeling on what is their low value care ordering before IllumiCare, you know, had gone live and what is the threshold that they would have to reach. And if you reach it allows the bonus. So, it is not just incentivizing reduction of care. It's really curbing low value care. And that is a real quality metric because of all of the reasons that we had discussed the consequences of low value care to the patient. And providers were like, well, I totally contract is. And by the way, in real time, I'm seeing these suggestions, and I'm not expected to follow all of them. You allow me a window of adjudication, understanding that not all of these are clinically relevant. And then there's techniques like there's a team effect. I'm a big fan of building incentives that are a team effect, because if one provider is like, whatever, I don't care. I don't care if it hurts the patient, don't care if it hurts the health system.
I'm tired and overworked. That's fine. I don't care about my bonus. Well, now you're having an effect on the whole team of hospitals. So, they're models that, look, you're part of a team. And really, honestly, the whole system in the patient or part of your team, but you're part of a more immediate team. All of your other hospital is. So if you want to take a reduction of low value care, you're actually hurting the rest of your team that is taking this scores on. And that is a fundamental model that we lead with in the engagement phase of IllumiCare. Discussing this with the health system. And they can't always pull it off right when IllumiCare goes live. But it's somewhere on the path, the happy path of fine in 6 to 9 months when it's up for negotiation. Let's do this though.
Dr. Craig Joseph: What about putting various physician ranking physicians I have found, and this might be a shocker to you. And I believe you're sitting. I found that physicians are very competitive. Is this a shocker to you? Are you still are you still with us or do you. Yeah. No, I think it's, it's a well-known fact, and I, I've, I have seen physicians who have that kind of attitude that you just described of. I don't think this is important. I don't think this is really valuable for my patient. And I'm not going to participate in this at all. And then they someone has the courage or stupidity to put up a list of, 100 doctors in the group, ranking them from most consistent with what we want them to do to least consistent with names and potentially numbers.
And, boy, I have seen physicians who are like, I still think this is dumb. I still don't see any purpose, but there's no way I'm going to let that guy outscore me on anything, because I don't think that guy's that smart. I'm going to beat him even though I don't. I don't care why. I just want to beat him. Have you used any of those perspectives?
Dr. Mukul Mehra: We do. We have an app. So after about 100 days of being live with the nudge technology, every provider can see their low value care spend for admission compared to their service. But we don't expose all the names for any one provider. But the leadership chief quality officer or chief medical officer do get a list of those providers. And like it was fascinating. There was one provider who would order magnesium the day after. One had been normal 1084 times in the last six months. He was a clear outlier, but other hospitals were doing the same thing too, just not that many times. Even when we ranked it by its mix index. We exclude patients in these detailed analysis like it couldn't have been on a magnesium drip.
They couldn't have been on, you know, an obstetrics service. So why is it still happening? And at that point, it's not IllumiCare who's going to be any more effective. It's really going to be somebody at the leadership level saying, did you know, like you are by far an outlier in repetitive magnesium load in patients, not on TPA and not on magnesium groups like, why do you do this?
Oh, and by the way, we have the stats that 97% of the time that they reordered it, it was still normal. So that's how you empower you. No change in no doubt. But I mean, one of the seminal experiments I did before IllumiCare is as an ERC physician, I knew we didn't have to. And these were outpatients. Use a stent pusher to push a stent up when you do a thing. I mean, you cut the sinker so that you can extract a stone. You just saved your sinker toe. Don't throw it away. And then when it's time to push a stent up, you just use the sphincter tone, but the stent on top of it and push the stand up.
Well, the stent pusher from the manufacturer. I looked up as I was curious, what is a stent pusher cost? It was $104. And so I began to create a list of $104. Who's using stent pushers? Who uses them the most? So I of course use none. And within six months we stopped ordering stent pushers in the GI line. None of this savings goes back to the physician. But people would come up to me and say, well, how do you, what is that? If you're not using a stent pusher? And I would show them, I'm doing any RCP, I'll show you, because nobody wanted to be the physician that was now responsible for ordering stent pushers. And when we go back to the GI lab, we reduced that pusher ordering and the expensive stent pushers so much that we felt comfortable asking the finance team for a collegiate scope. Oh, look, if we're saving $60,000 a year on stent pushers, we didn't need them. And the college's system is $40,000. You know, we felt empowered to asking for that. And these are the alignment and synergies that are needed in healthcare or propagating stewardship or low value care reduction so that all the entities involved, it's a win, the health system, the patient, and then the providers. So these are the ways that we model incentives even for subspecialists to like if you do these things, look, the next time you need something, the finance committee will say, well, look, you want this, you want another AP. We need to see some more efficiencies here. Perhaps we can get you an inpatient hospitalist AP down the road. And this is called alignment, which, you know, we've always been a misaligned health care system.
Dr. Craig Joseph: Alignment is essential to get everyone kind of rowing in the same direction. It sounds easy often, but boy, when you understand how the health care system works in the United States, when I say health care system with air quotes to get everyone kind of working as a team and making sure that people are paid and recognized for their good work and good deeds is complicated.
We could talk about this for another hour or two, but we have unfortunately run out of time. We like to always end with the same question, are there things that you deal with every day that are so well designed, it brings you joy when you deal with it?
Dr. Mukul Mehra: Something I use every day that is super well designed is honestly, it's the swimming pool.
Dr. Craig Joseph: The swimming pool.
Dr. Mukul Mehra: Yes. It is not technology. I don't know if the answer is supposed to be technology.
Dr. Craig Joseph: Oh no. But go on, I'm not stopping you. I want to hear.
Dr. Mukul Mehra: So this beautiful construct, which in America tends to be 25 yards long. And in some parts of America and in Europe, it's 25 to 50 m. If you're lucky, it has this black line and it is so consistent. It has four walls. And to me, I took up swimming as a way to break the cycle of overthinking when you just needed moments of mental relaxation. And it was very hard for me as a physician, you have your cell phone and IllumiCare book and get ahold of you all the time. And underwater nobody could get ahold of me. And during that hour I just find the ultimate therapeutic exercise to me is to go jump off the blocks, swim the 25 yards, do a flip turn which I didn't know how to do eight years ago. But I learned and it's a very consistent experience. The walls, the same, water buoyancy is the same and you can make it as challenging as you want. You can swim butterfly and you'll get short of breath pretty fast. Insulin breath stroke and breathe out of water all day long. But it's therapeutic. It's consistent. And it was a challenge I took up and I never grew up swimming.
Dr. Craig Joseph: But I love it. And what the black line you mentioned a black line that's at the bottom of the pool.
Dr. Mukul Mehra: It is. It's the center of the lane. Your goal is to swim center. You come off the wall and you're not center. So if you swim 25 yards and swim 25 back and you got off of that black line, you may swim 50.1 yard. If you're shooting for time and efficiency and consistency, the black line’s consistent. You weren't consistent because you didn't stay down the middle.
Dr. Craig Joseph: Yeah, obviously I'm not a swimmer because I'm asking what the black line is, but, no, that's great. I love that this has been great and what a great conversation. Thank you for teaching me and kind of explaining some things about how you've done your work, and I wish you only more success. And we'll have to check back in with you in a couple years to see what new things you've learned and how you've changed people to make it easy to do the right thing.
Dr. Mukul Mehra: But I learned from you, Craig, too. And thanks for having me on.
READ THE TRANSCRIPT
Show Notes:
[00:00] Intros
[00:09] Marina’s background and her book: The Vagina Business
[01:29] Gender data gaps
[02:52] The emergence of Femtech
[04:00] Innovation and obstacles in birth care
[05:30] Title controversy and pushback
[13:02] Femtech vs. Scamtech
[14:09] The pink tax in healthcare and global innovations
[27:03] Marina’s favorite well-designed thing
[28:52] Outros
Transcript:
Dr. Craig Joseph: Marina Gerner. Welcome to the podcast. Where do we find you today?
Marina Gerner: Thank you so much for having me. I'm sitting on my chair in London in the UK.
Dr. Craig Joseph: We are talking today because someone connected us about your book. And so, you put out a book recently, The Vagina Business.
Marina Gerner: That's right. And the subtitle is The Innovative Breakthroughs that Could Change Everything in Women's Health.
Dr. Craig Joseph: So, give us the backstory. Why don't you kind of give us a little introduction as to how you got to where you are and how you got to write a book that's called The Vagina Business.
Marina Gerner: My background is that I'm a journalist, and I also have a side hustle as an adjunct professor at the NYU Stern School of Business, and I've always been interested in the stories of women, whether that's in, you know, technology or health or business. So that's been my focus for a while. And then a few years ago, I learned that if you ask most people to imagine a person who's having a heart attack, most people tend to picture an old white man and the symptoms they think of is pressure on the chest and then pain radiating down the left-hand side.
And I learned that those symptoms are typical for men, but they're not typical for women. And I thought that was so shocking. You know, and as a result of that, women are 50% more likely to be misdiagnosed after having a heart attack. We also wait longer to seek help. Our symptoms are considered atypical. They're more likely to include things like jaw pain and long-term fatigue, for instance.
And women also experience that pain and the pressure on the chest but were more likely to describe it as discomfort. And so, I learned there was this issue. And I also met the founder of a company called Bloomer Tech, and the founder is called Alicia Chong Rodriguez. And what her company has created is what I thought is the coolest thing. It's a smart bra that can help women who are at risk monitor their heart health. And I thought, this is wonderful. You know, not only is there this huge problem, but there are also people who are creating new things that might be part of the solution, and that might help us fill that particular gender data gap. And I approached her about an interview.
I messaged all of my editors about this story of the smart bras, and then I kept looking at my inbox and there was just tumbleweed. Nobody was interested. And there it was this. Yeah, it was really surprising because I've written for lots of different places. You know, I've been a journalist for 15 years, and there was the sense that the topic was a bit niche. That made me wonder, how can something that could potentially help over 50% of the population, how can that be considered niche? And then I held on to this story. Even though I didn't manage to place it. The story stayed with me, which doesn't happen with many other stories in journalism, you know. But this story stayed with me. And then the pandemic happened. And I think that changed a few things, because power dynamics shifted between the doctor's office and the patient's home, because we trusted people to test themselves for Covid. And, initially, when you think back to the start of Covid, men had worse symptoms than women. So, if you wanted to be cynical, you could say we started to pay attention to sex differences in health because men were more affected by Covid.
And that's when I finally managed to place the story. But the smart bras came out in the Guardian. It did really well, and I was invited as a result of that, to chair a panel at one of the first ever conferences focused on Femtech, which is female technology. So that's technology focused on female bodies. And I was completely blown away by this conference. I was drawn into this space. I was in my early 30s at the time. I'm in my mid-30s now and I have a child now, but at the time I knew that I wanted to have children soon. So, I was preparing for this, and I knew that the vast majority of first-time mothers experienced birth injuries, unfortunately.
So, I wanted to prevent that. And I was looking for solutions. And I found a company in California called Maternal Medical that's creating a preventative device for birth injuries. And I thought that was so fascinating. I spoke to the CEO, Tracy McNeil, and she told me that the last big innovation in the standard of care at birth, mostly epidural, which was popularized in the 1950s, and that was that just blew my mind because I was thinking, there's no other area of society or technology where we bring something out from the 1950s and we say to people, hey, look, this is the best we got. Look at this cutting-edge floppy disk over here. But in birth, that's exactly what we do. And I thought that was shocking. And the more I looked into the space of what I describe as vagina-centric innovation, the more I realized that one of the biggest or perhaps the biggest obstacle is that most investors are male, and they don't want to invest in these companies because there's so much stigma around these topics.
And I have a quote from one investor who says in the book, “I don't want to talk about vaginas at my Monday morning partner meeting.” And that's the kind of attitude that stands in the way of innovation focused on female bodies. And that just made me so angry. Yeah, I wrote an article called “We Need to Talk about Investors Problem with Vaginas”, and that went viral, came out in Wired magazine. And then I took this as my what they call a proof of concept in the business world, to then write a book and look at this movement and, you know, tell the story of the Femtech movement.
Dr. Craig Joseph: So, I love everything about that. What I wonder about is what is the right response to that. That partner who said, I don't want to talk about vaginas at my Monday morning partners meeting, right? It would seem to me in hindsight, the best response is, you know, would you like to talk about money?
Marina Gerner: Yes. Would you like to talk about the unmet need? Would you like to talk about the total addressable market? Would you like to talk about why these matters? And you know, if you don't want to talk about vaginas, maybe all the others also don't want to talk about vaginas. So, wouldn't you have an advantage if you were the odd one out?
Dr. Craig Joseph: Yeah, that makes sense. Is that message being received now because of some of these conversations, because of some of the female founders that you're referencing?
Marina Gerner: I sure hope so. I mean, my goal with the book is to change that conversation and to normalize that conversation, and that's why it was so important for me to have the word vagina on the cover, because I could have called this book lots of other things. And I actually, you know, faced lots of obstacles with that particular title, and I had to come up with 16 alternative titles at one point. All of those titles were tested on a target audience in A/B testing by my publisher. And then The Vagina Business won. So ultimately, this title won in the market research. But there's been a lot of resistance to it. But the point of the book is to destigmatize the conversation. So, I figured if I put the word vagina right next to the word business, you know, and the book can sometimes be found in the business section, sometimes it's in the social sciences section. It depends on the bookstore, but it stands out wherever it is.
Dr. Craig Joseph: I love it. And did you get pushbacks from someone other than the publisher?
Marina Gerner: Oh, yes. Yeah. So, the publisher also had feedback from independent bookstores who said that they wouldn't display it, and they wouldn't promote it. I had pushbacks from when I was reaching out to other authors to write endorsements for the book. One author said to me the title is too much for her, so she wouldn't write me a blurb. I had a venue turn me down when I wanted to have a book launch there, just purely based on the title. Some people who've written reviews for the book on Amazon have used the word vagina in the review, and then that was flagged as violating community guidelines. So, they've sent me screenshots of their reviews being censored. And I think there's a lot of censorship that happens behind the scenes where people wouldn't necessarily tell me, you know, nah, I think your book titles are too much for us, but they simply don't reply.
Dr. Craig Joseph: Wow. I'm just honestly shocked.
Marina Gerner: Yeah. No, this book was published a few months ago and it continues to be an obstacle. So, the book has already won two awards, which is amazing. And one of them was supposed to be announced in Dubai. So that didn't happen because they couldn't have mentioned the title on the stage of this big conference. And you know, that continues to be back. It keeps happening and it is shocking, but it's not too surprising because all of the founders I've interviewed in this space, whether that's menopause-related, UTI-focused, sex education, all these companies and nonprofits experienced censorship online. All of them.
Dr. Craig Joseph: Wow. I'm at a loss for words, and that's not typical for me. So.
Marina Gerner: I can believe that. Yeah.
Dr. Craig Joseph: It's just I get it in certain areas of the world maybe or but boy, widespread.
Marina Gerner: Yeah. Including things like lactation cookies, you know really things where you just wouldn't expect it.
Dr. Craig Joseph: You said that you were a professor at Stern as well. How did that come about?
Marina Gerner: So, I have these, some people call it what, my multi-hyphenate or, you know, portfolio career. I have these two tracks in my career. I've been a journalist from the age of 19, I think that is when I published my first article in a vague newspaper, and I also did a PhD in my early 20s. And so, I just continued doing those two things at the same time. I left academia for about five years to be in journalism full time as a staff writer. I returned to academia with this. It's an adjunct professor role, so it's part time. Yeah. It's wonderful. I teach a course called Commerce and Culture, which is very unusual because it combines, you know, business and society, business and culture.
And it's also what I'm doing with the book because I think women's health innovation is the perfect case study for that, because if you only looked at it from a business perspective, you'd think, hang on. This is our $1 trillion market opportunity, you know? Yeah. And you wouldn't understand the stigma and the cultural side of things if you only looked at it from the cultural side of things. You wouldn't understand the financial underpinning of everything. So, I think with a topic like that, my very idiosyncratic choice of subjects has come together in a way that's really helpful.
Dr. Craig Joseph: Some of the female founders that you talked about in the Femtech area, they all seem to be female.
Marina Gerner: Not all of them aren't.
Dr. Craig Joseph: Yeah. I was going to say, tell me about that.
Marina Gerner: About 80% are estimated to be female. But then there's a, you know, a fair amount of both founders and researchers and investors who are men. And I've included plenty of them in the book as well, because I think everybody needs to be on board with this subject. And it's an opportunity for everyone, really. Where it gets a bit complicated is when you look at the data on how much money different teams raise and unfortunately, most money, even in the Femtech space, is raised by all male teams. And that's where it becomes a structural issue because there's a company over here called Flo Health, which is a period tracker, and they've become the first European Femtech unicorn. And they were founded by a group of men. And so, when they became a unicorn, people were asking, you know, is it what do you make of it?
Is it a problem that it was set up by guys or is it a victory for all of us because they've raised all this money and they've achieved this unicorn status? And it's complicated in and of itself as a case study or as a one-off example. It is a good thing for the Femtech industry to have such an example, such an example of success. But if you look at the structural side of things and you realize, well, if it was led by a group of women, they wouldn't have raised that money. And so that's where it becomes difficult.
Dr. Craig Joseph: Tell me about that. We like to talk about design. The stat part of the part of the podcast designing and healthcare. And so Femtech design, are there any kind of overarching concepts that people just generally get wrong when designing for Femtech from? Not just the product itself necessarily, but maybe the, the, the conceptualizing of it and marketing of it and financing of it. Are there design flaws that you've seen that are common?
Marina Gerner: Yes. Let me just pull up a certain chapter in my book. What I do is I distinguish between Femtech and scam tech, and so Femtech is technology focused on female bodies, everything from periods to menopause, but also going beyond like cardiovascular health and bone health. And then you have scam tech, which is technology that monetizes insecurities and that, you know, mis-sells things. And so that's where we get to the insidious side of things. So, for instance, vagina steaming devices, you know, are harmful devices and those still exist. They're not banned. But we know that they can lead to all sorts of damage. There's also a range of intimate wash products that are potentially quite harmful. And then I've also found that there is a new version of the pink tax in health care.
So, you know, when we think of the pink tax, traditionally we would think of razors. And so pink razors that are marketed to women are more expensive than blue razors that are sold to men. And in healthcare we have generic drugs like ibuprofen being repackaged, put into pink packaging, and they're being called feminine acts or Midol. And those are then sold at a premium or period pain relief. So those are three categories. Kind of the actively damaging, the useless, potentially damaging and a new version, of the pink tax. And so, the questions I recommend asking are, does this product monetize shame in any way? So, does it imply that your body is dirty? Does it sell?
But is it painful? You know that that old idea? Does it provide a full sense of safety? Is it under regulate it for what it is? What data does it collect? You know, what claims does it make? What's the evidence and what emotions does it trigger? Because in the fertility space we sort of messaging that sounds, like you're running out of eggs, you know, quick, quick, quick. You're running out of eggs. You're almost 35. Your fertility is about to fall off a cliff. And so, whenever you have something that triggers your emotions so strongly, it's kind of worth pausing and asking, you know, what? Am I being sold here?
Dr. Craig Joseph: I'd say I've never heard of the pink tax, but it totally resonates.
Marina Gerner: Yeah, it applies. So, I usually use the example of razors. But you could also look at haircuts. You know, haircuts for women are so much more expensive or rain jacket all sorts of things. Once you start looking into them, you'll see the pink tax in them.
Dr. Craig Joseph: That is fascinating. How do you draw attention? You know, you've said some of the media of which you are somewhat a part of the media is not helping, right? Sometimes even in trying to advertise your or market your book.
Marina Gerner: Yeah, absolutely.
Dr. Craig Joseph: How do we get the folks in the media to be more comfortable, or is it just part of the overall culture of the area that they live in?
Marina Gerner: I think it's about shifting the conversation, and not just by making people more comfortable with certain terms, but also by just using certain terms, without using euphemisms, for example, because, you know, if people don't want to use vagina at a doctor's office and there are some surveys that show that I don't remember the exact percentage, but a really large percentage of young women don't want to use the word vagina at the doctor's office, and that has really terrible consequences further down the line.
How do we get people to use those words, and how do we get people to use words like perimenopause or endometriosis? And I think because if you don't know that something might happen to you or your friends or your family members, how are you supposed to address it? And there are still lots of people who think, okay, menopause is when your period stops one day and they're not really aware of perimenopause and the various symptoms, the 34 odd symptoms that can come with that. And the same goes for endometriosis. 10% of women are estimated to have endometriosis, but historically we've normalized female pain. Right? So, women were always told, oh, you've got period pain. Extreme period pain. Well, that's normal. And in reality, there could be an underlying issue there like endometriosis.
Dr. Craig Joseph: You're going back to your first example of heart attacks with women too. This has real world implications as you know, even if the signs of a certain disease are slightly different, it's on the healthcare side of being able to think about some of these things. And yeah, you're right. The average female having a heart attack doesn't have the same symptoms as the average man. And yet we only assume all heart, we kind of, most of us assume all heart attacks are, you know, chest pain feels like an elephant standing on my chest, that sort of thing. And that shows in the morbidity and mortality results of cardiac problems in women. Let me pivot a little to the concept of Femtech that term.
Some folks have a problem with that in saying that. Well, why does it? Why is it Femtech? Isn't it just tech?
Marina Gerner: Yeah.
Dr. Craig Joseph: Femtech, why does it need its own category?
Marina Gerner: I have lots of thoughts on this. I think the first funny thing is with term Femtech is whenever you use it, people hear fintech, financial technology. So, you know, oftentimes people think you talk about online banking when obviously that's not what we're talking about here. The term was coined by Ida Tin, the founder of CLU, in 2016, to bring together all these different kinds of companies that are innovating in women's health.
And so, what's special about it is that 80% of founders are female, and it's estimated to be a $1 trillion market opportunity. Obviously, I hope that Femtech will only be called tech one day, just like health tech, but will simply be health, right? Because tech will be a normal component of health care. And I think with Femtech, some people prefer to use the term women's health innovation. But I think the success of the movement does not really depend on what term we use exactly. And I think the term might evolve in the future as well. But right now, it's really helpful because people find each other by using that term as a hashtag on LinkedIn, on Instagram, there are conferences that are organized that are specifically called Femtech conferences, Femtech webinars, Femtech accelerators.
So, it's a term that has energized people and that has brought people together. And I think for that, it's really helpful. And a parallel example is, you know, feminism, you could say, well, isn't it simply equality or human rights? But we still have feminism for a certain reason, and hopefully we won't need feminism one day. And the same way I would say, hopefully we won't need the term Femtech one day it will all be tech because tech will serve us all equally.
Dr. Craig Joseph: So, are there any good examples or particularly interesting founders or companies that you've encountered in the writing of the book that you think deserve highlighting?
Marina Gerner: Absolutely. I could give you so many examples. It really depends on what part of women's health you're interested in. But there's for instance, in Copenhagen, there's a new form of contraception that's being developed called V, and it looks like a laundry capsule. It's transparent. And so, it's something you dissolve in the vagina, and it works together with the cervical mucus to keep sperm out. So, it's a non-hormonal form of contraception. And I think in the future we will have more non-hormonal choices. There's also contour line, which is a long-term contraceptive for men. It's a reversible vasectomy that uses hydrogel and that's being developed at the moment. So, I think there's a lot that will happen in the non-hormonal contraceptive space. Then there's also a device that's just come to the market in Ireland, which is a smart nipple shield.
So, you know, nipple shields are usually used when you're breastfeeding to either help with a latch of the baby or to protect the nipple. And historically, they've been made out of lots of different materials, like glass and pewter and plants even. I think this one is different because it has a sensor in it that can measure the amount of milk a baby is getting. And that could potentially be really helpful if you have babies with a low birth weight or, you know, if you have mothers who would like to breastfeed, but they're too worried about how much milk the baby's getting, you can also then use that information for research purposes. And that's the case with a lot of Femtech companies, is that they collect so much data we've never had before, that if you partner with researchers, you can get some incredible insights into how somebody's milk supply correlates with other aspects of their health.
Dr. Craig Joseph: That's amazing. As a pediatrician, all we could do was measure the number of minutes the baby was nursing and then the output. Right. We you could never really know what the baby was getting. So that would be incredibly helpful, especially for kids who are somewhat sick. And we really need to know about their fluid intake.
Marina Gerner: So that one's called the Coro. That device. Yeah.
Dr. Craig Joseph: That's awesome. So those are just a few of the kind of examples that are.
Marina Gerner: Yeah, I've interviewed over 100 people in the book. So, you'll find many, many, many more examples there. And I've interviewed people across 15 different countries because I wanted to show people the range of innovation there is.
Dr. Craig Joseph: If you could wave a magic wand and change just one thing about women's health care, how it's designed, how it's delivered, what would that be?
Marina Gerner: Oh, yes. I think there's something really universal, which is the normalization of female pain. I think if we reverse that, that would be a huge and revolutionary thing to do, because right now we still say to women, you know, extreme period pain, oh, that's normal pain with breastfeeding. That's normal. Oh, you're giving birth. Well, there's no birth without pain. IUD insertion. Well, you can't possibly expect pain relief, although that's slowly changing. But I think if we completely reverse that attitude across the world, that would be revolutionary.
Dr. Craig Joseph: Is there any specific advice that you'd give to aspiring entrepreneurs who are looking to break into Femtech? What can they learn? Besides reading the book for sure, what can they learn, to either avoid or make sure that they do?
Marina Gerner: Well, of course I was also going to say, read the book. All of my wisdom, all my treasures, contained in the book. And, you know, I'm giving them to the world. I think it's really important to if you're not a researcher, if you're not a medical professional, to assemble a team that you know, includes medical professionals, that includes researchers, and to make sure that whatever you're doing is evidence based. I think we see a lot of snake oil. Unfortunately, there are a lot of things that are not evidence based, especially in the area of supplements or apps or, you know, things that aren't regulated to a high standard. Always make sure that what you're doing addresses an actual problem, because I see companies that are addressing issues that aren't actually issues as well.
So, I've seen apps that will analyze your menstrual cycle and tell you if you're supposed to have a meeting or if you're particularly creative on that day. And that's just reductive. And it's just unhelpful. It's not constructive. So, make sure that you're addressing an actual problem that you find a, you know, solid unmet need. Make sure that there's a business model for your venture, that it can exist in a commercial frame, because not everything can exist in a commercial frame, even if it's a good idea, even if it addresses an unmet need. Put together a good team and think about how it will get funded. And you know, venture capital is not right for every company. And in fact, I think we need many, many other sources of funding in women's health.
Dr. Craig Joseph: Excellent. Well, we always like to end with the same question and the of all of the folks that we interview. And the question is this, is there something in your life that is so well designed that it brings you joy whenever you interact with it?
Marina Gerner: I would say my hands free and smart breast pump. So, I have a baby. I'm breastfeeding, and I also launched a book at the end of last year. So, I've had speaking engagements all over the world, and I always travel for the shortest possible amount of time. You know, a day and a half, maybe two days and one night. And I'm traveling with this breast pump that is quite small that I've used on the plane that you simply pop into your bra, and it doesn't have any wires that are, you know, attached to anything. It's relatively quiet. It's convenient. And on these trips, I always find myself thinking, wow, I'm so dependent on this device because, you know, without it I would risk having a clogged milk duct.
I could risk having mastitis, I could risk my milk supply going down and so on. But with this device, I've got the freedom to be away for a day or so. I used a breast pump on the plane, and I asked the flight attendant on the way back from San Francisco, I said to them, have you ever seen anyone else using a breast pump on the plane? And they said to me, oh yeah, actually, there was a woman there on Friday who used a breast pump. And I said, yep, that was me, because I was flying on the same schedule as the flight attendants. So, it's still quite rare, I guess. And there are certain suggestions I have on how they could improve that design. But I think compared to all the breast pumps, it's a much more convenient tool right now.
Dr. Craig Joseph: That's amazing. Doctor Marina Gerner, thank you so much for educating us about Femtech. And I would encourage everyone to check out your book, The Vagina Business, and to prominently display it in their front window.
Marina Gerner: Yes, that would be great. And please post about it on LinkedIn or on Instagram and feel free to tag me and I will reshare your posts.
Dr. Craig Joseph: Excellent. Well thank you again. I really appreciated the conversation.
Marina Gerner: Thank you so much for having me. It was great talking to you.