Design in healthcare goes far beyond building layouts. It influences patient satisfaction, clinical workflows, and community health. In this conversation, we examine the intersection of design, public health, and technology, uncovering practical ways to integrate human-centered approaches into medical education and everyday practice. From sound levels to seating arrangements, small design choices can have a big impact.
On today’s episode of In Network's Designing for Health podcast, Nordic Chief Medical Officer Craig Joseph, MD, talks with Matthew Trowbridge, MD, physician, public health researcher, and associate professor at University of Virginia School of Medicine. They discuss design beyond architecture and how exploring aesthetics, including inclusivity, and how design choices influence behavior and perception. They also discuss the UVA Medical Design Program and how design thinking is integrated into medical education to teach empathy, systems thinking, and interdisciplinary collaboration.
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
[00:36] Matthew’s background
[03:28] Learning and the CDC
[07:13] Building environment health
[12:00] Evidence based design in healthcare
[17:10] The medical design program
[24:33] Utilizing AI for prototyping
[28:55] Matthew's favorite well designed thing
[30:14] Outros
Transcript:
Dr. Craig Joseph: Doctor Matthew Trowbridge. Where do we find you today?
Dr. Matthew Trowbridge: Well, it's great to be here. I am in my home office, here in Charlottesville, Virginia.
Dr. Craig Joseph: Welcome to the podcast. I'm pretty excited to have you here. When we were preparing for this, I think we went on and on for hours. And so, there's a lot of stuff that you do that is going to be very interesting to our audience. So, before we start, why don't you give us a little bit of background? I assumed you were an emergency medicine doctor, and that was proven to not be true. So, tell us what you do how you got to where you are.
Dr. Matthew Trowbridge: I'm a physician and a public health researcher. Associate professor here at the University of Virginia School of Medicine. I am well known for my work in the built environment and health. I think we'll get into that in our conversation. Fascinated with the way that the places we live in impact our health behaviors, health choices and our health outcomes. And I've done a lot of work thinking about how to design interventions at the full stack to actually try to incentivize real estate for making healthy places. Really, genuinely. I've been inspired by the work I've done with designers over my career, and I've had a lot of fun trying to pass that on to medical students. So, the other thing I'm proud of and get to do is, I've been teaching a design thinking program here at the University of Virginia School of Medicine called the UVA medical Design Program for about ten years.
Basically, if there's something going on at the intersection of health design and technology, I mean, I genuinely believe that all the things happening in health care right now, those things we need to be really thinking deeply about how to how to do things at that intersection. I was really fortunate to grow up in the 1980’s Centers for Disease Control community. My dad was a physician and a pediatrician. He was really one of the original Epidemic Intelligence Service officers. So, you know, in my youngest ages, we lived abroad and El Salvador and other parts of Central America while he was doing, global kind of child malnutrition work. And so, we came back to Atlanta when he served as the director for nutrition at the CDC for a long time. And basically, I just happened to just grow up with these public health icons. I mean, it was very normal for me, for a physician, when you ask them what they do for a living. They would if it was Jeff Copeland or Bill Fahy; they would say, well, I work on eradicating smallpox. And my dad was focused on, you know, iodized salt in South America. You know, I was like, okay, that's what a doctor does. Like you take on a massive issue at a global scale. And so, I was like, that sounds really cool. Let's do it.
Dr. Craig Joseph: That is amazing. That is an unusual upbringing. So, most of us don't have physicians as parents. But if we do, most of the time, we're generally doing things that the vast majority of physicians do, which is I go to the clinic every day or go to the office and see patients. And, and then I sometimes go to the hospital and deliver babies or do operations, and that's what physicians do. But you had told me a story somewhere about, you know, running through the halls of the CDC, which I suspect would be frowned upon nowadays.
Dr. Matthew Trowbridge: Yeah. I'd have to kind of go back to a very different era of Clifton Road in Atlanta, where it really literally was like my mom would drop me off at the front door, and I would run into my dad's office, though. And, you know, it's relevant even to my own career in the sense that you know, during medical school, I went to Emory. I literally was planning to just go right into the Centers for Disease Control. But, you know, obviously with 911, the Centers for Disease Control had to change, and did change and dramatically. And, gosh, I was recently in Atlanta, and it's unrecognizable, obviously. You know, now you've got, it's obviously it was always doing serious work, but it's a very different place now. But this was back when the Centers for Disease Control director was not a political position. It was often somebody who was, started their work there, and it kind of rose through the ranks. So it was a very different time.
Dr. Craig Joseph: And so, you were always kind of planning on doing something in public health, right, that you went you got your MPH fairly soon.
Dr. Matthew Trowbridge: I was one of the first combined MD and MPH students at Emory. And, yeah, it turned out to be pivotal. This was in the late 90s. And I think about this all the time because, you know, again, lucky, in my opinion, to grow up in the community. I did and I did a one-year master's in public health at Emory and took Environmental Health 101. And it just so happened that at that exact moment, some of the physicians that were really defining or bringing attention to the built environment as something that by every, every sense of the definition really should be treated as a public health determinant. We're there. So, we had like Doctor Howard Frumkin, he was the chair of environmental health at Emory at that moment. We had Richard Jackson at the Centers for Disease Control and people like these people are these iconic figures in the built environment, health space. And I also learned a really important lesson from them. Looking back is this was radical thinking at the time, that it was not happening anywhere. Built environment was not an established thing, but they taught us it was just included in the environmental health like syllabus, as if it was 100%.
And it worked. I just absorbed it because it held water, it was logically sound and it was really interesting. But they just taught it as like, hey, chronic disease, biggest issue of our time. You know what are actual causes of death, not heart disease. It's actually like lack of physical activity, poor diet. Guess what? Like there's a structural element of the way we're designing our lives, particularly in a place like Atlanta where we're building car dependent lifestyles, we're creating food deserts. And these are real. So environmental health is part of it. And I we all kind of said yes sir and absorbed it. And I'm like, gosh, that's powerful. I'm going to do that. And I've looked back and realized that was genius. And I'm trying my best to do the same thing with design.
Dr. Craig Joseph: I think it is genius. And it makes me think of, you know, the kind of fake it ‘til you make it. They acted because they believe that this is a major part of health.
Dr. Matthew Trowbridge: And it was also all of them have such serious chops that within a couple they were already actively building that evidence-based. But it was again, they so effectively brought in, you know, people who or their students. I've had the incredible honor to go on and actually be colleagues and collaborator with all of them. That's the other thing I've learned about teaching is that, like you blink and your student becomes your partner and your colleague too. I still continue to put a lot of energy and passion into teaching.
Dr. Craig Joseph: Probably a year or so ago, we had an architect who was also a physician. I think she calls off a doc attacked, which I believe is copyrighted. So don't try and stop. So you're when talking about built environment, you're talking to some extent about physical structures like an architect would. But it sounds like it's on a much bigger scale. So not just, hey, this is how your house is constructed or how a hospital room is constructed, but this is how the city is constructed.
Dr. Matthew Trowbridge: That's right. Well, how about this? You know, if you're a listener of this podcast and you're interested in design and health, let me just tell you this. You have to be brave. Because, yes, I work. I think about the built environment very broadly when I say what I do to my clinical colleagues; they here built environment health. Wow, that is such a niche thing, man. Well, then when I go into the rest of the world and I go into I'm a complete generalist, you know, they bring in the MD to talk about the built environment. And sometimes I'm in a room speaking to urban planners or transportation planners. So, you know, in some ways that's where I'm most comfortable, because that's where we're in, in the world of like data and statistics and coefficients. And it's very like, nerdy, kind of high, high-level stuff. But I also get into things like architecture or okay, well, now you've got to take our evidence and turn it into like really specific design guidelines and then even into things like some of the stuff I think is most interesting is things like esthetics and interior design.
You know, one of the most compelling things I ever heard was some work a consultant did for, I won't name that brand, but like, essentially a salad prep brand. That part of what it does is it comes into rapidly gentrifying neighborhoods and makes has this really cool modern esthetic and everything like that. The reality is, though, she came in and showed them like, you know, I believe you're really trying to be equitable and really have like just bare things. But by the way, your esthetic is not welcoming to a lot of people. I think that's so interesting, even thinking about like, okay, just because it might make it, you can make whatever choice you want as a business. But just know that, like, how are you? Does whatever design you put out there, it impacts people and it impacts the way they react to it impacts the way they act in that space or even if how they feel, if they're welcome in that space. It's kept my attention, this whole built environment thing, for so long, because you can never be an expert in all of it. And again, because I'm a doctor, I get invited into rooms as the interesting person that I really have no business even being in, which is great. So, you know, I try to bring some value when I can.
Dr. Craig Joseph: These aspects of design are ones that a lot of people don't consider. I was talking to one person who is responsible for operations at a hospital, and we recorded this podcast that hasn't come out yet, but he put sound level detectors around the hospital. So not picking up a voice or recording what people are saying, but just what's the decimal? How loud is it? And was looking for outliers and noticed there was one area right near a patient's room where it was regularly louder than it probably should have been. And did some actual field work. And by that, I mean walked over to where this detector was and found that it was near the nurse's station upon further investigation, found that while nurses, this is where they often did sign out to one another. It's kind of those things you don't often think about.
Dr. Matthew Trowbridge: Yes. In fact, you know, I got to do a really fascinating thing. Two years ago, I took a sabbatical from UVA, and I actually served as the chief medical officer for a building certification system called WELL, which is its companies, an international world building institute. And, they have a very robust, like many hundreds of strategies, you know, system. It's similar to lead, but for health. And to your point, it covers about ten different concepts, as they call it, all of them evidence-based. And they range from everything from like as you said, sound to light to, you know, promoting physical activity to the materials and very deterministic aspects of interior air and stuff like that. So, there's so much evidence out there and in certain areas like where there's a high incentivized structure. So, like commercial real estate, you know, there's starting to be really clear evidence that people, if they can have it, they would like to know that they're in a much in a as healthy a space as possible. Strangely, in health care, we have all kinds of regulations around things, but we really are not using like a fraction of the available evidence beyond just pure safety or things like nosocomial infections and stuff like that.
There's so much more we could be doing. And then we get stuck a little bit in the idea of like, you know, there's such a demand on space and throughput and so forth that unfortunately, I think design sometimes turns into care efficiency metrics only, you know, like eight rooms as opposed to, well, all those rooms are not the same, like some of them are loud, some of them are hot. But and yeah, that's the other thing that keeps me going with this work is that there's just kind of unlimited ability. There's opportunities to apply what we already know, just better.
Dr. Craig Joseph: Yeah. I love your idea. That concept of adding friction efficiency is great for some things, but sometimes we actually want things to be a little bit slower and adding some friction points are good. There was an article that I love to cite about a chair. You know, oftentimes in the hospital there's a chair for patients, family, or friends, and it might be out, but it's often folded and either hanging on the wall or in a closet. And someone did a study whereby they took the chair out and just put it right next to the patient's bed. And then they told physicians that they were going to be observing the physicians. Their interactions with the patients, of course, with the patient's approval, and they made up some reason, but it really wasn't the reason that they wanted to study. What they wanted to study was how long was the doctor going to stay in the room? Did they sit down in the chair? And what were the patient's perceptions of that interaction? And what they found is their caps score went up significantly in terms of patient satisfaction. And, you know, what did they do to get their caps score up?
They put a chair there. Did they tell the doctors, hey, we really want you to sit down because we find that we know that when you're standing versus sitting, when you're sitting down, you're at the level of the patient and your patients perceive that better and you slow down a little bit. You're a little bit more. At least the perception is that you're more caring and not in a rushed way. And, no one told the doctors anything, but the doctors are like, oh, there's a chair. I should sit in it. And they just did. Right? And be like, that's a little bit of friction. Like, yeah, it's much more efficient. I can get them in and out of that room faster, but boy, an extra 1 or 2 minutes. Pretty good.
Dr. Matthew Trowbridge: Okay, well, we're trading fun quotes. I think one of my favorite ones from this realm that always stuck with me is, you know, why should we care about architecture? Well, I had a quote that architecture reflects the ideals and values of a moment, but then persists for decades, even centuries. And so, I think while in health care think about that. So I think it ups the stakes when you think about it that way. We all can think about when you design a new emergency department like we did in UVA a couple of years ago, you really should think about what it is, like you said, like what are the values and the behaviors of this moment. Be very careful because it will set the tone for the next 20, 30 years, probably until you get another chance to design you know, the one I like, actually, I took my design students. We did a lot of like small scale interactions with the building. When they were designing it and building it. We went into the old emergency department that had been built in the 80s during managed care.
And guess what? It was like this very I actually think maybe purposefully not very nice place. I think it was like I think the esthetic was don't hang out here, get out of here. They were aghast at was how few electrical outlets there were for cell phones. And I was like, well, those didn't exist in this emergency department thing. So, another thing of kind of like not being forward looking, not recognizing that you're building something in a moment that will likely change, you know, like our emergency department was designed during the Obama administration. And then it finally bought it got built like right in the middle of the covet. You know, it's hard to do this, but the infrastructure we build is so much more important. And then we in health care, I think we tend to think of it very just cost per unit square footage tank. Whereas I think there's a lot more going on.
Dr. Craig Joseph: It's not just how many patients can we get in this, you know, square footage and there's so many other things. And as you pointed out, hospitals are not only being judged on some of these, other characteristics like quality and patient satisfaction. They're being paid on those things as well. And so it's super important. So tell us about this medical design program.
Dr. Matthew Trowbridge: I really had this privilege of working with all these architects. As I was kind of getting more and more, you know, I kind of got into the built environment space. Not a lot of people were working at it at the time. So, I did some early publications. I had this amazing opportunity where I actually got because I was kind of operating in my own lane. I was actually brought up to NIH. I got to work with the National Cancer Institute and their obesity prevention group, and they were interested in the idea of things like optimizing school design to promote childhood obesity prevention. And what I pitched them on was, you've got all these great programs that are really well, you know, the programmatic elements are really well evidenced, but you're treating the school facilities as a commodity. And I don't think that's actually true. I mean, so what was cool about it was we kind of leveraged into the idea of what would this optimal school environment look like from the perspective of if we think we have some software like great school-based obesity prevention programing, what would be the optimal hardware for that to run?
And so it was things like, okay, well, you know, long term food attitudes to fresh foods, okay, cool. Like what should the what should the cafeteria look like? How can we make the kitchen more functionally ready for scratch cooking? And importantly, how could we do it in a way that was actually feasible to actually do in a project? And I just thought it was fantastic. I learned so much from some brave architecture firms that signed up to kind of listen to me talk about the public health evidence and then they taught me how to translate that into like actual spatial intervention.
Eventually I was just like, I feel like we should teach this to medical students. I'm learning a lot. I think this is actually particularly in like hypothesis generation or like I think this is turning me into a better researcher, all kinds of things. And suddenly I realized, wow, they've been teaching design thinking in business school, including University of Virginia, for like ten years. I've always found a lot of success. If you're proposing in health care or in a school of medicine style of bureaucracy, it's often better, in my experience, not to be doing something brand new, but more saying, I'm adapting and you get to say these really great academic words. I mean, adapting an existing pedagogy to a new use case. By the time they figure out what you just said, they've already said yes, and you're off to the race. All kidding aside, that is how I started. What I actually pitched them on was, hey, let's look at the AMC, you know, competencies for future physicians. And in this it was a fairly recent kind of revamp of it.
And it included things like systems thinking, tolerance of ambiguity, the ability to work an interdisciplinary team. The word empathy was written everywhere, you know? And I was like, these are great. How are we doing on them? And they were like, not great. I was like, does anyone really know how to teach empathy? No, but we know it's important. Maybe there are some frameworks out there that address these things directly. And I said, oh, here's one, design thinking. I don't know what that is, let's look at this together. And I love the read. Like actually Darden School of Business here, UVA is a world leader in design thinking and business. This is cool. You know, maybe this is our thing. We're a little behind. But you know, maybe we can catch up so suddenly. Design thinking was a catch up for the people not seeing me. I'm whispering into the microphone, which is kind of design, you know, user-centered design. You know, find a pain point. Somebody cares about it. Start from that right and off instead of driving design down their throats. And there's a growing number of us trying to teach these courses across the US. So it’s something I really deeply enjoy. I hope you can hear that in my voice. It's a pleasure to talk about.
Dr. Craig Joseph: It's amazing. As physicians, as clinicians, just in general, the ability to kind of learn the language of a different group of people. In my world, it's often been technical people. Some of the EHR vendors have started these programs, called physician builder programs, where they'll take it practicing physicians and give them just a smidge of knowledge about how the electronic health record or other technology works underneath the hood. Are they competent to do a bunch of things by themselves? Absolutely not. They're competent to do a few things, but not a lot of things. But what I really think is impressive and has been helpful, is that they now have a language that they can use to talk with the more technical people and then, you know, like the architect or the designer, oh, I know what to draw now because you said these words and I can now solve the problem. You're never able to solve the problem. But because of the words that you've used, now I know how to solve the problem. Sounds like the first rule of a design program in a medical school is that there is no such thing as a design program at the medical school. It's something else entirely.
Dr. Matthew Trowbridge: That is actually what I always say in a little stump speech. If I'm asked to come ask, hey, how could we get this started at my school? And my pause for laughter moment is the first rule of getting a design thinking started at your school is not to say you're trying to do design thinking, and you already heard my pitch. It's to start with an existing pain point, tie it to a national agenda, and then also like look for existing curriculum like where there's already something in the curriculum, and then just show that design thinking can really add value to it. Because there's usually going to be something like social issues in medicine, or there's going to be something even just pure patient interviewing or, you know, kind of innovation courses. There's usually some place where you can put it and you don't have to make a huge deal about it. Because I do feel when you say design thinking people, they hone in on the graphic design kind of mindset and like, oh, well, I mean, graphics don't get me started. Graphic design actually is a bigger deal than you think.
But no, I'm actually talking about a core set of like a structured approach to keeping yourself in a mindset of learning about users of a product or service that have a different lived experience than you. That sounds ideal, right? Like, isn't that what we're all supposed to be doing as doctors? Actually, yeah, that does sound good. Yeah, cool, you know. Well, I'm also going to do a structured approach to keeping yourself in a learning mindset as opposed to going right to the first solution that comes to your mind. Doesn't that sound like a good thing we should all be doing as clinicians? Yeah, that's actually sounds really good.
Dr. Craig Joseph: What about those folks who are out for a decade or two? Have you approach that kind of a group? Are they interested in learning about this, or are they all dogs that are not interested in new tricks?
Dr. Matthew Trowbridge: No, I think there's a lot of interest in that. And that is something we're exploring. I'm exploring both within my role at UVA and developing kind of other types of digital content, because I think this is particularly relevant in the era of AI. You know, I, I actually I recently launched a classic version of my design program is for first year medical students, which I just really enjoy. But now I'm doing a fourth-year elective, which is a lot of fun. It often ends up being alumni of my first year and they've but now they're bringing clinical ideas. But I've renamed that one Health Design Thinking and Building because I think what AI does is it solves a big problem in this kind of teaching, you can prototype things so much faster because that's actually ends up being the hardest thing to do, like a classic design studio, right, is like in an architecture school or something. It's like you live and breathe this in a studio for like a whole semester and stay up all night and just constantly. Because as again, my friend Dina has been very seminal in my career, she's a good, dear friend. She always talked about the real design is the unsexy middle bits. You know, it's the iterative, it's the endless iteration on things.
It's the hard work of creating stuff. And so, we don't get to do enough of that. In the design program. I'm in the elective, we're going to do a little more, but it helps you. Now there's really no excuse not to like, let's build a quick digital prototype or something. Well, it doesn't have to take a month. You can get a pretty significant workshop done in a day or even less. So yeah, I'm starting with the fourth year students, but we I think, again, there is no time at which this isn't something you can pick up and learn and make the day-to-day practice of medicine and health care more fun. And I think, I think it's more effective.
Dr. Craig Joseph: I love your perspective of just leveraging AI to prototype things much faster. And even if it only works a little, I mean, I've seen, I think it's called vibe coding, right? I don't really understand how to program, but I told it what I wanted to do and I have no idea how it's doing it, but it seems to be doing it. And even though that's, you know, you're not going to start a company that way with that kind of software, you have something that you can show to people and get feedback. And yeah, that's something I would love. You know, that's the thing.
Dr. Matthew Trowbridge: And, yes, you can definitely jump into the vibe coding things like Cursor and stuff. But as you said, honestly, like using programs like Figma and stuff like that, where in the context of a design sprint actually just getting like a workable clickable prototype of the front end, that just kind of gets people thinking about what might happen. You kind of more of a Wizard of Oz type prototype that can be more than enough, and that is suddenly in the realm of easy possibility within a course. And I think that's really empowering the students. Part of my goal of these courses is to not just sell them on the big theme, but leave them with extremely tangible little workshops.
They can run a lot of the things I do, they are designed to be very easily picked up and used again, by a student after they've been used once. And so, that's why I'm very excited and just getting started, really developing coursework that really leverages AI. A lot of what we trade back and forth is like, how do you how do you rapidly distill down the concepts of human-centered design thinking for a medical education audience, where time is always too little, and at any point the dean of the medical school could walk in and be like, what's going on here?
Is this clinically relevant? And also the students themselves, I always warn people on like, there is nothing more like intense about protecting time than a med student. They can sense if they're not extracting maximum value out of this time, they're with you, they're out. So you've got to deliver on a two-hour workshop that teaches them something new, doesn't take too much prep work. I try this, you know, it's a lot of fun to try to take up that challenge.
Dr. Craig Joseph: I'm tired, just contemplating all the work that you're doing, keeping up with those young, young medical students. We are almost out of time, and we always like to end with the same question. And as someone that teaches design, this is a great question for you. And here's the question. What is something that's so well designed that you use that brings you joy whenever you interact with it?
Dr. Matthew Trowbridge: About a week ago, it would have been my Waterfield black backpack that I've had for about ten years, because it just never breaks. And it's like the little, all the pockets are just the right size for everything. And it just looks better the more used it gets. So that's one thing, but I bought a new electric bike. It's a specialized globe haul short tail. What I love about it is that I'm a huge cyclist. But what I love about this bike, particular to your question, is it knows exactly what its role is, and it has a point of view. It's heavy. It's not the most nimble, but it can carry like 400 pounds of cargo if you need to. So, it can. It's super stable. Do you hit bumps? It doesn't care. And it makes every day like I live about two miles or so from the university, and that one bike means that now when I load up all my supplies for design, I don't have to drive. And now suddenly I get this little ten-minute bike ride and right into the center of university. And I don't know, it's like you pull up, it's got this burly kickstand. Boom. Every single part of it is like, I am a cargo bike. That is what I am, and I love that about it.
Dr. Craig Joseph: Well, that's great. What fun it has been to talk with you. A real leader in design and health care. I'm so impressed by the work that you're doing. Can't wait to see it. I want to sign up. I'm thinking of going back to medical school at UVA, so I might just reenroll just so I can take your class. I'm not sure how UVA would feel about that.
Dr. Matthew Trowbridge: We'd welcome you with open arms.
Dr. Craig Joseph: Well, thank you so much. I feel like there's another show comment we could interview about a bunch of other topics, and I think we'll do that. But I'll let you off the hook for right now and say again, thank you so much. Really appreciate it.
Dr. Matthew Trowbridge: Thank you for having me. And I really appreciate what you're doing with this podcast. I genuinely believe that design offers something that brings a lot of joy to practice, but then it also has a real set of skills that can really advance health care.
Dr. Craig Joseph: Well, that's two of us that believe that.
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.