In today’s fast-changing healthcare environment, the fusion of clinical expertise and technology has never been more essential. Adopting a systems-oriented mindset offers transformative potential across medical education, electronic health records (EHRs), and clinical workflows, and helping to address both longstanding challenges and emerging innovations. From the early days of EHR implementation to the rise of AI-powered ambient documentation, this conversation provides meaningful insights for healthcare professionals committed to enhancing patient care through thoughtful, tech-driven solutions.
On today’s episode of In Network's Designing for Health podcast, sits down with Will Morris, Chief Medical Officer at Ambience Healthcare. They discuss Will’s educational journey and early career choices that led him into the world of EHR design. They examine the evolution of electronic health records. From the limitations of early systems to today’s focus on usability and clinician engagement. Their discussion also delves into the importance of designing for clinical context and education, highlighting how AI can enhance medical training, support contextual decision-making, and reinforce the vital role of human judgment in patient care.
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
[01:30] Will’s educational background
[04:00] Speaking up for career growth
[05:10] The evolution of EHRs
[09:40] Systems of engagement vs. systems of record
[12:00] Accessibility in healthcare
[18:00] The role of note writing
[21:00] Data accuracy
[38:09] Will’s favorite well-designed things
[39:56] Outros
Transcript:
Dr. Craig Joseph: Doctor, Will Morris. Welcome to the pod. Where do we find you this morning?
Dr. Will Morris: I am in the illustrious Leland, Ohio. Yeah. It is sunny outside. It's gorgeous, as it always is. You know.
Dr. Craig Joseph: I'm going to let you kind of give us a little run through your life so that we understand where you're coming from. I want to prepare the audience. Most of the places that you have worked at, no one has ever heard of before. So, I just want to make sure that everyone is kind of set for that. Let's start with medical school.
Dr. Craig Joseph: Why did you go to medical school?
Dr. Will Morris: I went to actually Case Western Reserve. So, I was born and raised in Boston. Came here for the weather, but went to Case Western Reserve and then trained in Boston.
Dr. Craig Joseph: And then where did you end up working?
Dr. Will Morris: The story is about the ping pong between the East Coast and Cleveland. There was an opportunity at the Cleveland Clinic. They had just opened their medical school. And so Toby Cosgrove, who has you know, since become one of my best mentors and colleagues and friends, thought of redesigning what medical education would be in a five year program where, you know, it was all about getting med school or med students early access to kind of clinical workflows and systems. So, like me, my background, passion areas, systems like an engineer mindset. So biomedical engineering was my background. So, love system deployment and kind of love the general hypothesis of how Toby was thinking about, medical education, of course, like coming out of residency. The one good thing that you're really good at is probably medical education, because you're so slow, you're so intimate with it.
So, other than clinical care, you kind of understand, the art science of clinical education. And so, I decided to take this opportunity. So, I'm in my hospital. The internal medicine background focuses on inpatient care. Take this opportunity and probably a month into it, just so happened that the clinic was beginning to explore at the time, if you remember, COE or order entry. So, this is where we would still, and in my chicken scratch low presser and the clerk would then put it into the computer and we were an Epic install. And there were beginning to kind of think about an EOP or clinician provider order entry. So rather than be penning it, I would write it and I was fairly vocal about the hospital's kind of having a seat at the table.
There was a moment, an infamous meeting that I kind of had seared into my life, my cortex, where I think Toby and some other executives were in the room, and I was the kind of, you know, kind of loud, brash person. And I got this page because we still had pages at the time, to come to Mahogany Row. Right. New executive suite. Yeah, I know, and I was like, all right, well, this is it. Like. Yeah. Been fun. It looks like I'm going back to Boston. And, you know, it was interesting to kind of hear my perspective of what was needed. At the time, our CIO was in a position. So, C. Martin Harris is well regarded in this kind of space and ambulatory provider. I'm inpatient. So there began my kind of journey of understanding and deploying health I.T. for the clinicians. So rolled out CBOE for the physician staff and then clinical documentation as an encore, if you will. And so just again, I found myself in the right place at the right time. And, you know, Toby placed a bet. And I think that kind of let the foundation for kind of 16 years of doing it within, you know, an organization that really prides itself on kind of innovation and pushing the status quo.
Dr. Craig Joseph: So, I've heard this story so many times, of someone just has a big mouth. And I'm saying that that's a medical term. Hey, I'm going to tell you what I think, and I'm not sure what the outcomes are going to be, but I'm going to tell you what I think, and then you're expecting to get fired or demoted, and then oftentimes you get just promoted, which was never your intention in the first place.
Dr. Will Morris: Yeah. I think it's the big mouth or cerebral diarrhea. I think it's the ICD ten code, where you, you know, you're early in your career that you kind of lack those frontal synapses. And so, you, you say things that, you know, perhaps are politically or unsavory. But, you know, this was early, early on and EHRs were kind of done to you, not with you. And I was really, really passionate around systems of care. And if done well, this pane of glass, this experience could actually do remarkable things in terms of better-quality care or provider experience, but also patient experience. So, you know, we're glutton for punishment. I think we all kind of share that ethos of being perpetually dissatisfied with the status quo. We know we can always do better, or we should strive for better for our patients and for those who are providing care.
Dr. Craig Joseph: So, let's talk about the state of the software. When all of this was happening, as you mentioned, in the olden days, and by the olden days, I mean, when I was a resident in the 90s, I would write things on paper and then they would happen. And I've gone back when I worked at a large EHR vendor. There were many times where I'd work with our customers who were physicians, and I'd say, can you tell me how from your perspective that works? And, ultimately, it came down to this I write something on paper, magic happens. And then I get the lab result. We never had any idea how that happened, but I think you gave us a little clue. The clerk or the unit secretary who called different things in different places would do something, some call someone. The idea of moving that to the physicians and have them do it did cause some controversy. Now, when we were preparing for this interview, you had mentioned that you were at Beth Israel Deaconess in Boston, and they had some sort of an EHR that they had built themselves. And now you're dealing with at Cleveland Clinic. It was certainly Epic. And so what was you know, how did that feel? Were they at the same place or was one different than the other?
Dr. Will Morris: It was different. I mean, I think and again, so John Halamka, who was the CIO at DMC and was thinking about a web application, so true, web front end with a very intuitive, gooey, graphical user interface that kind of was purpose built by clinicians for clinicians. So it was kind of handy, to be honest, when you're dealing with enterprise software like Epic, you're kind of you have to be jack of all trades where you have to be thinking about, hey, not only does this system work for ambulatory, but it has to work for inpatient, it has to work for the O.R. And so, it is a challenge, right? It is a software development challenge where you're trying to build a holistic enterprise solution. You know, everyone kind of bashes, you know, bumps and cachet. But like, let's be clear, it is the right database because it is blazing fast. And if you know what you're doing, you can do unbelievable capabilities. But like, you know, for Epic and you work there, it's a challenge because they have to be thinking about not just one customer but all person. So you or rate of innovation is kind of at the lowest common denominator. And so I do I empathize, while I empathize, I still push. Right. And so we had a really, I thought, a healthy relationship with our vendors in the sense of we would push and they would say no, and we would just push harder.
And if done through the lens of a better patient experience, a better provider experience, lower cost or scalability and interoperability, then I think, you know, the willing idea and vision would prevail. Our big kind of early breakthrough at the clinic was, you know, we're in Northeast Ohio. It's not like we have, you know, teams of high end developers who are all learning, you know, you're not going to engineering school or computer science school and be like, I want to be a cash developer. And so, finding these resources are really, really difficult. It's like a needle in the haystack. But web service layer service-oriented architecture is relatively universal outside of health care, right? It's the how the entire interweb works. And so, one of the core hypothesis was, could we leverage, at the time, we were the largest single instance of Epic at the time, I think we can connect. So at the time it was ten hospitals and they use something called chart sync that would actually synchronize, because there wasn't a jukebox big enough to actually do a single instance. Truly. And so we would do this chart sync. And one of the core capabilities within this, not to go down to geeky is the interconnect web service, the web server that was intended to kind of sync databases and they're really hypothesis well, how could you do this and build out modern APIs that would reimagine a visualization or reimagine how we think about a population like the ICU?
And so we were lucky enough to hire a couple of really, really smart developers and a boatload of really smart web front end people who know e-commerce, you know, visualization, all these are great things, very affordable and very scalable. And so we were doing stuff like remote ICU, which is fast forward almost 12 years, still live today, right? A thin web view. But rather than viewing one patient, it's all, ICUs across all of our hospitals and using algorithms to kind of show the right information in the right format at the right time. And, you know, where I think we should be focusing on is experimenting on visualization, experience and alerting and stuff like that, not necessarily trying to do incremental advances with the, dashboard. You know, we got heavily involved at the federal level, around in the OMC, you know, 21st Century Cures and a lot of the fire resources that grew out of radiology spaces. You know, the amazing people are going to project and smart on fire all of these things. But the core hypothesis is how can you layer systems of engagement over systems of record? Epic is tremendous. So is Cerner, and so is, you know, similar in terms of more transactional stuff. Like you said, even in paper, a black box apps. Right. You would write an order and paper and something magical would happen, even that happens today in your EHR, right? You write a med and you think it just goes to an order and, you.
Dr. Craig Joseph: Know, it just goes into the patient.
Dr. Will Morris: Yeah. Right. Right. Magic like into the IV, right?
Dr. Craig Joseph: It goes into the IV from my keyboard I built. That is how I believe it works. Are you questioning that?
Dr. Will Morris: Well, I mean, when you remove your tinfoil hat, I would say there's a little bit more complex work. There's a lot of drug interaction, drug therapeutics. That might be the formulary. There's a whole host of business logic that you need to honor. You know, the worst I've seen is, is when, you know, brash startups or even hyperscale's go, oh, we can we can solve water entry and we can do these things, but they don't know thousands of hours that are spent within each EHR company. You know, doing all of the business logic, the unsexy truth of what happens. And so, you have to honor that. You can't just explain it away and say, yeah, we're going to make this. And so I fervently believe there is a natural symbiosis, not antagonistic, but a symbiosis between the four systems of record, where you're doing all of that logic, posting on formulary, all of that kind of stuff with new ways to experience that data or interact with data that I think is, you know, to me, really where I'm passionate and, you know, smarter people than myself are, are really wrestling down.
Dr. Craig Joseph: So the first place that you were working, I believe, was in Cleveland. It's called the Cleveland Clinic. And then you decided to go work for a startup called Google. Okay. And what do they do?
Dr. Will Morris: They make the world's data universally accessible and useful, right? Or at least that's what it said 26 years ago when, you know, they started it. Right. So, the general premise of search is to organize the world's data. And I think two important things. And I actually do love this, mission statement is to make it universally accessible. So democratize the data but then also useful utility. And so I think about like maps, it's not just, hey, you now can search and find stuff like making it useful as, hey, we're going to provide APIs and make it allow to, you know, track your, your, you know, your delivery, your drone delivery to will. And so, I joined, actually Google Cloud to be the chief medical information officer for kind of our health care life science group. So, as any good job changes you, you learn more than you actually give and do. Everyone kind of explains away complexity. I place an order, magic happens. Right. Oh computer language or an LLM like I can just talk to it and magic happened. The amount of things, inerrable effort and time all the way down to the chip level.
Fundamental physics, engineering, you know, all the way up into the language was just something to be. And you learn to have a deep appreciation. Right. And you respect that. So I think they're doing tremendous work. And so during that day, I kind of came to two fundamental hypothesis, which is, you know, the speed in which computer science, the language, the application, the chipset, all of it, it's just exponentially going up. Right? It's Moore's law. The same hypothesis is what makes Google's the market of the US, the open AI great is that kind of core philosophy is making it useful. But they're not always the one doing the last mile, right. They're not the one who's ultimately providing the utility. And especially for something like health care, where to me, utility is you have to understand the provisions of care.
You have to do, like we always say, do development where work is perform that perfect intersection where you have to be careful not to be solving a workflow issue or person issue with technology because you just get broken faster and more expensive. And so I kind of had problems, but at the same time I kind of said, well, I think the utility aspect where I draw passion, love, I love the provisions of care. As a clinician, I love the operations reality of what it makes to do workflow changes and change management. And I love the people, I think the elevation of not just the physicians, the nursing staff, but it's also about the red cycle side. It's also about the unsexy realities of what you place that order. A lot of things happen, including the pharmacy check, then finance and rep cycle and bills drop like all of that. And so I want her to be closer, more proximal to do that. And you know, my core hypothesis at that time was, you know, this startup were really, really focusing truly with a degree of humility to get it right is where the puck is going to be.
Dr. Craig Joseph: So you learned some stuff at Google, and I know that you've recently made a change to a real startup because Google. I don't think I was kind of a joke. I don't know if you sense that, but I was kind of joking to think of Google as a startup.
Dr. Will Morris: Now it is. It's like 248,000 employees. So it's like it's maybe a little bit more mature than a startup, but it's still you know, it's in the garage. The garage just happens to be the Googleplex.
Dr. Craig Joseph: Yeah. Yes. So what are you doing now?
Dr. Will Morris: The arc of this whole story is I feel like I'm like the Brownian motion, and things happen or opportunity presents it, and you're like, all right, I'm going to do it. I wasn't looking. I met a gentleman named Nick Budimir, who was co-founder of a company in the space of ambient documentation. And I'll be honest, I was incredulous because I'd always kind of perceived that kind of space as a little bit of Mechanical Turk, right? I mean, I grew up for 15 years, and watching the evolution of AI scribing, which oftentimes meant it was a teller scribe, right? It was someone across the pond working magic. And the Mechanical Turk that you didn't see. And, you know, it was kind of, to tell you, like, unbelievably suspect. And, I was like, no, like, everyone says they have something different. And, one of those typical Silicon Valley whiz kid stories, very personable. And he didn't have kind of what I would say is the typical founder, you know, arrogance of we walk on water. It was one of deep humility and around the opportunity. So company called Ambiance. We did a one-on-one demo and I'd say like this would be the one for all.
If there is even a pearl out of this conversation, it's, you know, you're looking at something, asked to see the product, and if the founder or CEO goes I want you to break it. I want you to give me the edge case. I don't want you to just, you know, go the happy path one, but show me the nah, the reality. Because, as you know, that to me is where the rubber hits the road is true edge and so and again maybe I was channeling my 20-year-old Kobe moment where I was that big mouth jerk and said, yes, I would love to break it. And boy did I try, right? And I could. And I remember getting off the phone and kind of going to bed talking to my wife, and I'm like, there must have been someone there. I was there because, you know, it worked flawlessly, and did all of these things that probably are not appropriate to include in a podcast. NC-17 and they did it flawlessly, almost eerily like where you get the sense of like, oh my Lord. Like, this is truly what you know, through AI and reasoning could do. And it was real. And so I said, yeah, I'm going to do something. My wife said you're insane. Is leave the confines of a big brand and go do something that's bigger than myself. A moment where the company is. It's not about. And it's really about in service of the clinicians and the health systems.
And I like that feeling where you're not kind of living vicariously or hiding behind a brand where, you go, I work at Google and use the conversation, stop right there. Like, right. And it's but you become very, very vulnerable when you're like, I made that jump and I'm working for this. And they never question, what do they do? Why did they do it? All of these kind of things. That makes you very focused and clear on your intentions and belief. And I think that's such a blessing when you're given those moments where it kind of pushes, you know.
Dr. Craig Joseph: What do you say you're an internist? I understand your hospitalist, but you're an internist first, there are internists. I'm a pediatrician. It's a little different for me, but there are internists to say, listen, listen, I part of how I help patients is by writing the note. Because to write the note, I have to sit down and think. And sure, I have a lot of ideas about what's going on with the patient when I'm sitting there with the patient. But really, that process that takes 5 or 10 minutes or some amount of time for me to like, oh, let me write down what my plan is. And the process of writing that plan is part of the care that I offer. And I'm afraid some say that if you take that away from me, the care I provide won't be as is, as in-depth or thoughtful, or I'll miss something. How do you respond to that? I don't think there's a I'm not looking for the answer. I don't think it's for the answer is not for.
Dr. Will Morris: But I am a visual learner. Actually, I think I mean, humans’ visual cortex is a whole lot bigger than our auditory, right? I mean, we are visual learners. And so I would 1,000% agree if your solution is only about just capturing what you and I say and documenting that is a commodity and that is not the destination, but you raise an important point. It's the mental model of going in or interacting and seeing, right? I would know the clinical documentation, right? Is it a billing aspect? Is it a medical legal aspect? Is it a patient communication or. I would also say it is also my scrap, right? It is a where I kind of put ideas and concept and then try to group them, right? I see patterns when I write, I know I see a chief complaint and I see a lab and maybe that off, and I see the ace inhibitor and your med list are, right. It's that visual depiction that all of the sudden unlock the assessment plant. And in fact, like when I look at copy forward, you know, copy and paste and I want my prior note in front of me oftentimes it's that, right.
It's what was I thinking. Oh yes. You know dust off a couple synapses and go, yes. Okay. In the context of this patient's chief complaint, this is the patient's history. Let me do the right thing. And so for us, I think we are it's that chart on the chart summarization exercise that's really, really interesting. So for us you can't just have eye with ears important. But it needs to have eyes. It needs to help. One of the biggest burdens I think, for clinicians is gathering the information for you to then do your scratchpad, to think about stuff, and then engage the patient to have a conversation. So, how we're thinking about it is it's not what you said in the office, is it? But what should you say? What are those things that I don't know? I don't know, and that things I don't know, I don't know might be information that's buried in the chart or the context of a template against their own data. Or you know what? I am treating this condition and years and my mental model is fixed in, you know, 1982. But yet the guidelines of if you just do audio and reasoning, you're, you're not going to have AI penetration because those cognitive art that likes to collect information and paste all of the labs in the note and then wrestle it down is part of that stuff. And getting that right is a really interesting challenge. But I think it's this potentially beautiful design where the gathering of a variation, how it's presented, then informs our 40 watt light bulb of the brain to find a pattern and then engage the patient through, you know, therapeutic discourse and have a documentation that truly reflects the best of all of those capabilities.
Dr. Craig Joseph: The note writing process. It sounds like you and I would assume some of your competitors are trying to incorporate kind of the note writing as a clinical decision support tool itself, right? Like it's actually you're blurring the boundaries between documentation and decision support. It's one in the same.
Dr. Will Morris: It's one of the same. I mean look as you're typing the assassin plan, you're always asking yourself, does this make edits? Is there internal validity within the note? Is there internal validity between what you're documenting and what you have in the air? I mean, we know there's massive discord. Ask any data science person how many patients have, you know, have one or type two diabetes and then ask the question, how many are on insulin? And it's massively discordant, right? We have data inconsistencies all over the EHR. And so how I view things in this opportunity is it's not just creating a note, it's creating an accurate note. It's up dated representation of AI quality data that reflects, you know, all aspects of that patient. That's number one. And then number two, is it needs to then enrich the EHR. That means file discretely the ICD ends or file discretely. So there is data harmony with the record. What scares me the most, to be honest is just great. We have ambient listening. We address burnout, but now you just have more garbage in the record. We now have beautiful notes that actually still are discordant. And have we really solved the needle in the haystack problem?
No, we've just made it more, hey, like, you know, to visit lying by the author pod is now three pages of nonsense. And I haven't solved the needle in the haystack. It's just hay. We need to flip that. We. You have to think about improving the veracity and accuracy of the data. I'm a big fan of the name Alex Geary, but the founder of the Boy Scouts is, you know, leave the world a better place in which it found in me. Each interaction with the record should enrich it, right? I should try to resolve ambiguity problems that are no longer going away. Combining the lumping or the splitting of diagnosis or otherwise doesn't make sense. That is art and science. But from a design standpoint, there should be AI data. And guru and congruency between those elements. You should have anyone able to open up the record and there should be logic between the explainability.
Dr. Craig Joseph: Yeah. That makes complete sense. Then you know, you were talking about an author pod snow going from two lines to three sentences or to from like three lines to three, two to three pages. And I was going to say we don't need an AI for that. We've had that; the electronic health record has enabled no bloat, but sounds like there's one of the things that you're working on is how do you make it accurate in that?
It's so horrible when you're looking at an inpatient note. And the note describes where the endotracheal tube is based on the last X-ray. But in fact, the patient was activated three days ago. But since you're copying forward, the note does not accurately represent.
Dr. Will Morris: That like just the fundamental. You see it within a note. Is there a discord? Right. You've got a patient who's got a below the knee amputation, but their pulses are bilateral and symmetric. That's amazing. But it happens all the time thyroids palpated normally. Well, no one has done that. And you know they had a sweet scar I mean I used to, but we used to do that on resident rounds, like, you know, roughly the past surgical history and a scar ratio should be roughly 1 to 1. Right. And so, and the reason would be like, I don't know, past surgical history, but you go, and they got a strain on me like, you know there's a couple telling the number of medications and problem less is probably you know near one 1 to 1. Ratio things like that. Like in and so you have these cells in there, certain areas also the record that I'm already meaning there, they're true sources I use, you know, medications labs vital signs can be, you know, interpreted but right.
They're written in its kind of objective versus a note that might be subjective and prone to copy for copy paste. And so, you know, the challenge, I think any of these AI models or anyone building is really kind of again, discern that. I think that's where the attending record, you know, attending physicians are really, really good. It's not just looking at any data, but interpreting the validity of, you know, of that data, that potassium that's through the roof right there. It's a key. Molise. That's right. You know, context is everything, including for these at all levels. And so, for us if the context is just what you and I are talking about and I'm just reading a note, I think we missed the mark is the context that is really, really unique for that patient is who am I as a practitioner?
Where am I seeing you or is it in the hospital or is it in the ambulatory? And is number three the most important? Is that patient has an in our history that I otherwise won't really assign, you know really being critical of ourselves which insurance is we got to get this right and we have to be thinking of all of those aspects of getting it right. But then also to your point, which I think is really, really brilliant, we also don't want an unintended consequence, meaning I've just removed the political thought process of having a note or having an experience where I do have under dance, discord with myself. And if I remove that, what are we potentially harming? And we became aware of that. And so, we have to kind of think about other ways that we can work around those.
Dr. Craig Joseph: Yeah, I believe that I spent probably, well, that probably exactly four years in medical school and three years in residency to be able to say to a nurse or a lab person, hey, don't panic, because the potassium is way too high on this last lab specimen, because I'm trained to think and I need to look at the context of that. Like, does this patient have a reason to have a high potassium? Are they on some sort of medication? Do they have some sort of kidney problem? No, no. Let's go and look and see how the medicate how the blood was drawn. Right. And to your point, hemolysis. It just means if there was and if there was some trauma with the blood drawn. And we do that in kids all the time; they would get finger pokes, which is just you cannot do that. But we would still have phlebotomists do that sometimes. And you know, if you do a finger poke, and you try and get that blood out of there, you're almost certainly exploding some cells and giving us a false positive on the potassium.
And that's the idea that, hey, a high potassium, if that were real, then I'd have to be, you know, moving that patient to the ICU and starting them on lots of medicine and making sure their heart didn't stop. Right. That was the risk. But most of the time that's not the case. And how do you get technology to kind of learn some of those lessons? And it sounds like you're on your way. That's the training that we go through as physicians. And that's the kind of that, that art of humans that we need. And so, how do you find this is a rhetorical question, of course, but how do you find that balance?
Dr. Will Morris: Again, context is everything. And where do I want the system? Also, I think there's this fallacy. I always give an ear just give the answer and to me it's medicine's never black and white. What's more helpful, I think, is having I go, if I was going to give you the answer before that, I need to know three things or two things. Right. What are the two questions that I would ask that patient or the two labs that I would love you to get before I actually definitively say that this patient has high potassium hyperkalemia? Right. And I think that's a really interesting space around that. It is decisions or but it's not always just getting me the answer. It's, what is the thought process to ultimately arrive at a fork in the decision tree? And so that's what gets us excited, or at least me excited is medicine is art and science. And every patient is hiring unique individuals. And it can't be some ristic rule that just says potassium high alert like then is usually right. The sepsis alert without a text is actually more dangerous.
Dr. Craig Joseph: Well that but that's the current state right. The current state is that potassium comes back at, you know, 5.8. You will receive a call.
Dr. Will Morris: You will get a page because they have a policy. And the policy says if this, do this. And it's very binary, and I get it; context is everywhere. And I think the dream isn't just, hey; this is the context for the clinician or whatever, but for that nursing, for that phlebotomist as well, to say, hey, listen, don't do the finger stick because the last three ones in the past five days, like you've all been immortalized, are you this, this and this, like you're going to have to get someone to find something a little bit meatier, you know, that's the dream is think again, not to replace the humans, but to uplevel and assist and be ultimately accountable to the human.
Dr. Craig Joseph: I think that's one of those exciting things about medical education that AI is going to be able to offer is that thought process of, hey, you're about to call the attending, and you're suggesting isolate and dialysis. Hey, before you call, here's some things to think about.
Dr. Will Morris: I'm going to ask you a question because you asked me.
Dr. Craig Joseph: So, one way. It's a one-way thing. I asked a question.
Dr. Will Morris: It's got to be reciprocal. I mean, you're talking about medical education and the power of AI. And you've done a lot of these talks. And again, I don't have an answer. But this is something that I've been, you know, poised as we think about these systems. And let's use Ambien to build a note. What are your thoughts on the importance of medical residents actually learning and writing their own full peer history and physical exams without the support of an ambient reasoning model where they can actually, you know, get something on paper, but it's kind of like you said you were graded. Not in the ICU for you, you know, your three pages of beautiful penmanship, but your thought process, right? It was your bed. I'm curious about your thoughts on known, where should I be deployed, especially in the space of medical education.
Dr. Craig Joseph: I've seen the kind of controversy, and I've seen what some folks are doing. I have to say, having not thought through everything, every aspect of this, like this has got to be kept out of the hands. I would argue that this has to be kept out of the hands of junior learners. Okay, I don't know what that means. I don't know if that means all residents or your first three years of residency, but there's just no way you're going to learn how to effectively communicate. Forget about the note. How you're going to have to present a patient to a to even as an attending. We do this all the time, right? I have a patient that I'm concerned about. I called my friend the specialist. I have to present that patient. It's not very formal. It's much less formal, but that person's going to expect me to go right to the gist. And I have to do that differently by the way, if it's a neurosurgeon versus if it's a dermatologist.
So based on the problem, I have to kind of give them the information that I think that they need in the way that they need it at the time that they need it. In order to take the best care of the patient and do all of it as efficiently as possible. And I just don't know how you learned to watch it. The only way you learn that is by doing it. I was a fourth-year medical student, so I wasn't dumb, but I hadn't started my residency, and I know my notes they just were a list of medications. And it was great. I mean, everyone knew what medicine all the labs and what every vital sign was, but no one really knew what was important. I feel for the folks who have to figure this out, is it first years and then second years? Get to use some of it, or is it outpatient? It is different than inpatients, I don't know, but to some extent they have to do it themselves. I think it's kind of like your multiplication. I think you also don't need a calculator, but I do need to know that six times seven is 42. I need to learn that. If I want to ask you the final question that we always ask folks, which is, is there something in your life so well-designed that it brings you joy whenever you interact with it? And it can't be a product produced by your employer. Let me know if that's where you were going; it cannot be that.
Dr. Will Morris: Well, I love that I'm like a perpetual tinkerer. I worship my Leatherman too, which is what I think is the most effectively designed multi-tool. So, I mean, I grew up with the Swiss Army knife and everything was like small, kind of like this screwdriver was useless. And yeah, you had a toothpick, you know, that was still in there for God knows how long and probably the biggest, you know, disease factor. But like, the Leatherman is what strikes me if I reflect on it is you've got the Swiss army knife that is, like, ubiquitous and someone's like, you know what? We're going to build something, a multi-tool and completely displace it and actually make it more utility. And, when I have it all the time, so much so that oftentimes I get nailed by TSA and I have to, like, give it away and then buy another one.
And so like, I'm like a perpetually revolving door. So maybe their design should be some AirTag alert that alerts me that I'm about to be getting TSA. But I have to say it is small, but it has the best utility in terms of multi-tool capabilities. The one with the pliers doing, like, don't screw around with the one with the scissors. That's useless. But like the little plier ones. It's just so awesome. It's sweet. And I'm worse. Ironically, I don't have it on me right now, but I did.
Dr. Craig Joseph: No, because you gave the last one to TSA last week.
Dr. Will Morris: Probably. Yes. We haven't even gotten into what I can do with it, but it's like it'll jam all of the things.
Dr. Craig Joseph: Okay. All right. Doctor Will Morris, it's been a pleasure speaking with you. I look forward to all the great things that you and your company are doing, and I can't wait to see how it all turns out.
Dr. Will Morris: Thanks so much, Craig. I really enjoyed the conversation. Thank you.
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.