Cultivating Conversations with... Joanna Smart, Verso Biosense

Our Head of Medical, Rob Bentham, speaks with Joanna Smart from Verso Biosense about all things femtech (female-centric health technology).

Joanna talks about how to address the lack of female health data, how femtech can continue to draw investment and why femtech is so important.



Rob

Welcome to the podcast. Today we will be tackling the world of FemTech, which is, for those that don't know, a relatively recently coined term, but a sector that hopes to address myriad women's health issues that have been previously somewhat overlooked by the technology space. Our guest today is Joanna Smart. For those of you that don't know Jo, her shining career has included executive appointments ranging from start-ups all the way through to billion-dollar global companies in both the UK and the US.

Her 20-something years in the market have been spent doing things ranging from enterprising growth, corporate deal making and the translation of technologies, and she is currently the non-exec for Verso Biosense, where she's recently stepped down as their CEO. Welcome, Jo. So, before we get into the wider subjects, I think for the purposes of those that may not know you, it would be useful to learn a bit more about your journey, and what's brought you to working in this space and with Verso Biosense.

Joanna

Of course, Rob, thanks very much for chatting with me this morning. As your introduction said, I have spent 20 years in life sciences and I've worked with companies of all stages, but one of the other things I've done - and I've spent over a decade working in this space - is the translational funding space. This is through my work with the NIHR, which is the UK's largest funder of health and care research. This is where I came across the academic founders of Verso in the 'I for I' [Invention for Innovation] programme.

That programme specifically funds the development of innovative health technologies to translate them from the bench through to tangible patient benefit. So, these guys were looking for academic grant funding for this as a project. So, I first met them from the University of Southampton through this programme.

What drew me to the technology was a combination of some really interesting factors that you don't always find in the medical health technology space. One of which was that it was a really ground-breaking technology, the platform, and I'll talk more about that in a little while. The platform itself is fascinating, but it came about because of a clinical need, and it was actually a clinical question that was asked of an engineering team. And this is one of the things that you often don't see, the origin of it was this unmet clinical need, and a really important question that some really amazing technology could help to answer.

So that was what really drew me to it, and then when I started reading more about the space and about female reproductive health research in greater depth, I was really surprised to find there are some really fundamental questions about the basic physiology that no one knows the answers to. And that was the final piece, I think, then I couldn't look away - this is a great piece of technology and a space that's really important.

Rob

 

Okay, perfect. So, you talk about the interesting technologies that Verso has. What are the fundamental products that they have, and what are they fundamentally looking to tackle with that product that makes it as hopefully disruptive as many of these technologies in the sector?

Joanna

Right, so the technology itself is a completely ground-breaking sensor platform. What it does is it works deep inside the body. It has no internal batteries and no wires, and it can monitor these physiological parameters continuously, over a course of many days. That's really important when you're looking to monitor biological systems, because what you don't want is to perturb the environment. So, this is an indwelling sensor that can sit there, it's biocompatible, and it can take these measurements over a long period of time, so it gives you this sort of 3D map of what's going on inside the body in real time if you choose to have it in real time. It's a really interesting piece of sensing technology, and the power is really interesting as well, because it doesn't have any batteries inside the body, but the power the system can generate gives you as much power as you would get from the smallest state-of-the-art batteries in that kind of system.

So, from a tech perspective it's a really interesting piece of technology, and as I said earlier, it's about a clinical need. It's sitting in, in this case, the uterus, because the fertility clinicians wanted to know what the endometrial environment is like. Because we've spent 40 years optimising incubators for embryos in IVF, and we culture this embryo for three to five days, and then we put it into an environment that we just have no idea about. We have so little information about what's going on in the uterus, so of course we don't understand why some embryos develop and why some of them don't, and why IVF, in most cases, only works in 30% of cycles.

Rob

Yeah, I must admit, to draw on a somewhat personal perspective, my wife and I went through IVF. And it's obviously a phenomenal thing. We're very lucky, we have a son, but there are so many questions and so many unknowns, and it is an incredibly difficult process for, you know, for my wife, particularly. I mean, I'm there almost as a bystander, but the reality is from my perspective, is there's so many questions that she couldn't have answered for her by the data or the information the fertility clinics have. So therefore, this sort of thing, it seems incomprehensible that this sort of science hasn't already taken place.

Now, to lead on from that, before we discuss some key topics... FemTech - some people love the term, some people dislike it. Obviously, Ida Tin coined it in 2016, it is relatively new. For you, what does it mean as a term? What do you put FemTech as, and what does that mean to you personally?

Joanna

You're right, it's a very broad term. I think for me it really covers any technology that addresses a health need that is either specific to, or differently experienced by women. So, anything from period tracking apps - and that, of course, is where Clue originally came in, and of course they do so much more than that now - to novel contraceptives, pelvic health, breastfeeding, and long-term chronic conditions.

So, it's not just about reproductive health; it's about any technology that addresses a need that's specific to women. Whether that's specific because you are a woman, or because you as a woman experience health conditions differently to men.

Rob

Now, you somewhat touched upon this when when you were giving your introduction to what Verso does. Some people may know that when the FDA in 1977 decided to exclude women of childbearing age from drug trials, that obviously left a fairly fundamental gap in the industry data, and that meant that the female populace really lagged behind in terms of the information that was available.

So clearly, all these technologies are trying to address something which hopefully will start to fill that gap. But how do you as an industry go about fulfilling what is essentially 30 to 40 years worth of data hole, to redress the balance? How do you go about that? I know that's a big question, but where do you start?

Joanna

It's a very, very good question, and one that I wish I had an immediate answer to. I think, as you say, a lot of it has to do with the historical lack of information, and that's something that you can't - either overnight or even over many years - you can't backfill that data. But what you can do is look forward and look at the real-world experience of both men and women with the drugs that are already on the market and new drugs that are being approved. 'Drug' is sort of a catch all term in this space, but you do see drug side effects and the monitoring of drug side effects sits alongside the monitoring of device side effects. But as you say, there's this kind of big data hole.

So this really came about because of thalidomide, and the response to the terrible foetal effects of thalidomide. At the time, home pregnancy tests didn't exist, so it made sense to exclude women of childbearing age from all clinical trials in case there were these additional terrible side effects. So, it made a lot of sense at the time. But the trouble is, it wasn't then used to understand the differences. So, the drugs were then approved on the market for men and women.

What you end up with is approved drugs - and Ambien is an interesting example of this - where, when it's in the market with lots and lots of different people using the drug, you end up with observed differences. And over time, as you amass that information, you can start to make retrospective decisions. So for example, with Ambien, FDA decided to lower the dose specifically for women, because they were seeing side effects the following morning, more of them in women than they were in men. So, what you can't do is fill in that complete gap, but what you can do is look forward prospectively and start to look at these observations and analyse the data. And that's one of the key things that, to an extent, is still missing.

So, there was an interesting report done by Brigham and Women's Hospital, probably about six years ago, that drew attention to some of these key areas. One of the things that it highlighted was that a lot of clinical studies, even though they now have to include women if they're NIH funded - this is the US clinical trial funder for a huge number of them - what they don't always do is include the analysis of those sex-related differences in the results. So, what you don't see is what was observed in that clinical study. You also don't always get the right number of women recruited, so you might not be able to do that analysis. But again, it's all done behind closed doors, because they're not declaring that information.

So, what I think we can do is start to push to have that information disclosed. It may be that it's not perfect, none of this information is perfect, but at least it's a start in starting to understand what these differences are, and part of it is about having that broader conversation.

Rob

Yeah, and I think you correctly point out you, it's impossible to fill a gap that is so so cavernous, but ultimately, you can try to address it as quickly and efficiently as possible. And it seems like the green shoots of this sector are starting to do that. Now, one area which I suppose comes as a bit of a shock to anyone - it certainly did for me when I started to read more about female-specific technologies - is the fact that women make up 51% of the population, and there are a lot of feminine products in almost every other avenue that there is, but yet technology lags so far behind.

I was reading the interview that Tania Boler did with The Telegraph recently, and one of the statistics was that women are 75% more likely to use digital tools for healthcare than men are, which begs the question: why on earth is that market not being targeted? Given that all these unique, female health-related technologies are now coming to market, what do you feel about that investment, that resource being dedicated to those things? So many burgeoning areas of medical technology are going forward and are reaching quite exciting heights, but it's taken this long for FemTech to get to what feels like just the starting blocks now,

Joanna

 

I think a lot of it has to do with a set of historical factors, which are to do with women not being involved in multiple different places in this ecosystem. And I don't think it comes from misogyny, I don't think it's intrinsically that there is a bias against women. I think it's simply the fact that there aren't enough female voices offering these suggestions and these ideas and bringing them to the table. So, I think it has to do with diversity, but not as a feminist issue, but just as a lack of experience and lack of personal understanding. So, we all make decisions to a large extent based on our own experiences. So, what we bring to the table as individuals has to have an impact on the decisions that we make.

So, I think it's a set of these factors where the perspective of women's health wasn't recognised and wasn't brought to the table, so it wasn't recognised as an investment opportunity. And I think that's one of the exciting areas that made me most interested in the women's health space, because we're looking at investment opportunities that you don't see in other health spaces, because the investment hasn't been there and because the technology hasn't been there until recently. So, the types of problems that you're tackling in women's health are some of the really big ones, and it's not that women's health problems are intrinsically more complex, it's just that we haven't really tackled them yet.

On the flip side, that means that there are big investment opportunities, because you can solve big problems with comparatively simple solutions. So, if you compare it to the field of oncology, so much work has been done that what you end up doing is seeing incremental improvements in areas where there's already been a massive stride forward. But in lots of areas of women's health, we haven't yet taken those big strides. We're ready to take those big strides, so from an investment perspective, that's a really big opportunity.

Rob

 

Yeah, I was reading the Frost & Sullivan report from last year, although it was obviously pre-pandemic, which I guess will have had a little bit of a change to the predicted outcomes will be for the future, but they're talking about investments reaching $9 billion by 2025, and just over a billion of revenue from 2024.

So, clearly, there is a market there from an investment point of view, and I guess you're right in that, if you're a male investor - and unfortunately, the market is not massively diverse and the number of female investors is growing, but we're not there yet - I suspect it's that personal connection, isn't it? You see it a lot with the way that the founders are orientated. Although there are exceptions, people like Peter Asprey, who is tackling issues because of something he's encountered personally, but via someone he was talking to, rather than it being a direct personal experience. The reality is that most FemTech companies are founded by or led by women.

And one thing I would be interested to get your thoughts on - and from a recruitment point of view, this is an interesting factor - how do you stop a market like FemTech becoming a niche product and a market where you almost have the flip side of diversity? So, you end up with businesses with a massively outweighing female populace and don't attract enough men into the businesses, you don't get enough men moving towards the top jobs or taking on those roles.

What can the industry do to stop almost the exact opposite effect that you have in the current MedTech space, then occurring in the FemTech space? Is there anything you think might help that diversity level out across both sectors?

Joanna

It's a really interesting point, and one that, when I've been recruiting teams, I look very carefully at the way I think about recruitment, and make sure I am not either positively or negatively viewing anyone because of these characteristics. I think part of it has to do with approaching teams and approaching problems, and part of it comes from the candidates being interested in pursuing that particular avenue, solving a problem in this space.

It has to do with all of us taking that very broad approach as we think about all of these opportunities, but it also has to do with education and understanding the size of the opportunities. I rail against positive discrimination of women being chosen because they are a woman. You should be chosen because you are the best person to do the job, and it shouldn't matter whether you're male or female, from whatever background. It doesn't impact how good you are at the job, and I think that's crucial, but I think it's partly about understanding that these are not niche areas. It's not a niche market opportunity. These are massive market opportunities, you know, fertility issues affect 1 in 6 couples around the world - that's not far off hypertension as a market size. You know, these are big. So, it's really important not to see women's health as a niche space. They're massive market opportunities and therefore, they're interesting for all of us to want to work in to want to invest in and want to develop products in, because we can make these changes.

So I think, you know, from the recruiters and the R&D teams, that makes it exciting to work in. From a leadership perspective, you do need female voices to be heard, because you need to understand some of the issues that you encounter, but you need that balance, and I think you're quite right. You don't want purely female management teams for the sake of being female, because that's no more beneficial than only having men who who lack that breadth of experience. So, it is crucial that we don't end up with that situation where we invest in FemTech because it ticks a box, and I think we've got to be very careful to avoid that.

Rob

It's a difficult one, isn't it? Because you constantly want to raise awareness of shortfalls in the market, and you create this buzz around a term, but I think, exactly like you say, it's important that people don't get too wrapped up in it. Ultimately, I think part of the issue was that, and I think Tania Boler actually mentioned it, when she went to look for investments, people told her what she was pitching was too niche. But yet what she was pitching applies to over half the population, so how can that be niche? So really, FemTech isn't a term that should exist. It should be tech for humans, medical technologies, and it should almost not be a subcategory. But equally, if it isn't, then you can't raise the level. So, you have to sort of accept that it can be a positive thing, but avoid the negative connotations as well.

But ultimately, people are talking about it. There are articles in the New York Times, this article in The Telegraph. That wouldn't have happened two years ago even, I wouldn't suspect. So, it is on a positive trajectory. So, I think we've, we've tackled some of the core things. We could talk for four hours about all the ins and outs of what makes it a great industry and why people should want to work within it. But let's assume that things are going on a very positive trajectory at the moment.

There is, as we've discussed, a lot of investment potential, the revenue projections are high. How does the sector go about fulfilling that potential? What does it need to do to not be one of those things which people get excited about and then it loses momentum? How does the sector continue to gain more investment, more notoriety, and continue to grow? From your point of view anyway.

Joanna

 

I think it's going to be important to think about several things. One of which is, as we just talked about, separating the issue of diversity in women's voice from women's health. They're both important, but they don't have to be tied together, and I think that's one of the reasons why women's health is an exciting space, because people are starting to recognise that there are opportunities there. But it doesn't depend on being led by women, and I think that in terms of the women's health space and FemTech, that will lead to a much longer term, much more stable space within the industry, to create its own vertical, to separate it from being an issue and to make it into an opportunity within the market.

I think, as we talked about earlier, people sometimes refer to low hanging fruit in terms of investments and products and opportunities. I think realising some of those is going to be important. So, a lot of it has to do with building some of these successful businesses and then investors seeing exits from those successful businesses. Now, we are seeing more and more exits in the FemTech space, but we need to continue to see those and continue to see the success, because that's really ultimately what prompts further investment in the earliest stages, because you can see a track record of investments in that space that have been successful, so I think that's important. And I think it's really to do with capturing how big these opportunities are. You know, if half the population are going to suffer, at some point in their lives, from the menopause, then that's a big opportunity, and that's really where we should be looking to target some of these major health advances, because it's a big market.

So, I think it really has to do with focusing on how important this is as a market and taking out some of the issues that you can address and should be addressed within the space, but also about focusing on exactly the same metrics that we use in other health spaces in terms of investment. I think that's really what's going to prevent it being a bubble, and make it a long-term, really exciting space. And ultimately, the reason I'm in this and the reason I'm involved with Verso and a number of other businesses is because it's about evidence-based medicine.

So, the more we can bring evidence-based medicine to women's health, the greater the difference we can make, and that's really what's going to transform both the health of 50% of the population, and it will have knock on effects to male health as well, because we understand the diseases better. But it's also about making sure that we are solving these problems and taking the investment opportunities.

Rob

Well, that's a great summary. I've engaged with a number of mental health businesses, and I think that maybe the social stigma that would have once come from men talking about female issues, or men talking about their own mental health issues, or if it happens to be in fertility in men, or whatever it happens to be, now it seems that those social barriers are coming down.

And where we've got to with FemTech, I hope, will be something that can be replicated in other areas where potentially there has been a social stigma, and that's prevented investment progressing those technologies to a level where they should be for the human sustainability that the market claims to be pointing towards.

Joanna

I think you're right, I think taboo subjects are the cause of a lot of failures in our collective ability to solve health problems, because we won't talk about it. My own experience of speaking with investors over the last four years, it's changed. It's so much easier to have the conversations this year than it was four years ago, to talk about female reproductive health. There's a lot less discomfort on the other side of the table when you start talking about menstruation, you know.

It's really important to be able to talk about these issues, just in exactly the same way that we talk about cardiovascular health. Mental health is a really important space too, and a really important parallel. So I agree, I think it would be great if we can extend the conversations to other areas where we're less comfortable talking about it.

Rob

Great. Well, thank you very much. I think it's been a really interesting topic of conversation. As I say, I would quite happily talk about this for hours with you, but hopefully it's been something which has given people cause for thought. Maybe some of the investors that have been out there will get a little bit more of an insight into what goes on there and will make them think, next time they're going through their portfolios, how they might potentially diversify, and hopefully it brings a bit more of a spotlight onto what is a hugely exciting area and an area which has a lot of human good ahead of it. So thank you very, very much for your input. It's been greatly appreciated and we look forward to getting comments from our listeners as well.

Joanna

Thank you, Rob, I really enjoyed it.



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Rob Bentham

28th May

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