What’s Holding Back Women’s Health?

Speaker A: Despite the breadth of the problem, it's been treated as a relatively narrow field. It's really half of the population. It's most of medicine. It's still poorly understood. And I believe it's one of the biggest untapped opportunities in healthcare that, uh,

Speaker B: really goes to the heart of what the women's health gap is.

Speaker A: So, to me, understand the biology early, stratify the patients, and then you can change the entire pathway of care. It's a shift at every level, and that's precision medicine. That's what needs to happen.

Speaker B: Welcome to Biology Matters, the podcast exploring how a deeper understanding of biology can transform healthcare, a time when it's becoming globally unsustainable. I'm your host, Rowan Gardner. Now, uh, let's get into it. Welcome to Biology Matters, a podcast exploring how a deeper understanding of biology can transform healthcare. I'm Rowan Gardner, chief business and investment officer and co founder of Precision Life. And today I'm bringing aboard Varanique, chief medical officer at Precision Life. Veronique's an experienced physician, executive board advisor, healthcare innovator, and, um, more than three decades of international experience spanning biopharma, digital health, venture strategy and precision medicine. She's built her career translating scientific advances into practical patient impact, with a particular passion for tackling unmet needs and chronic diseases and advancing new insights in women's health. And you've been an absolute kind of advocate for, for more focus on women's health for many years, Veronique. And we've had lots of conversations on that. So without, um, further ado, welcome. Can't wait to, um, get into this. And, you know, really, let's start with women's health. Why are you so passionate about women's health?

Speaker A: That's a really good question. Well, first of all, I was drawn to medicine because I clearly, I wanted to help people, but I also love solving complex problems. So after qualifying, I worked in a lot of specialties, and that included obstetrics, gynecology, pediatrics, as well as general medicine. So over the years, I've really dealt with a lot of the issues that women face right across their whole life, from adolescence, childbearing, the menopause, old age. Do you remember that far back, Rowan? Back then, nobody knew very much about things like endometriosis, right? And we certainly didn't have the tools to understand the biology. Sometimes I kind of feel it hasn't changed that much. But then after years of working in hospitals of EC and pharma company, I really started to feel we need more research, more innovation, And Better Care, which is designed for women's biology and help solve these very complex diseases. And now I work for a great company, Precision Life, that has some fantastic tools to solve some of that complexity. So especially since we've studied about, was it 60 diseases by now, and 80% of them are right in the, uh, women's health space. So I feel we kind of have a wonderful opportunity now and I can use all my skills and experience to help in an area where women have been overlooked for far too long.

Speaker B: So you said 80% of the, uh, diseases that we've studied are in women's health. I think that would surprise people. When we talk about the complex chronic diseases that we've studied. Alzheimer's as als, rheumatology, respiratory neuropsychiatry. What do you mean when we talk about women's health? And are we talking about mainly reproductive health?

Speaker A: Oh, you're referring to the bikini medicine side of women's health? No, it's clearly the way it's been perceived in the past. But, you know, these reproductive diseases, they make only 5% of the disease that, uh, affect women. So we've got to start talking about that whole range of conditions you mentioned and diseases that, uh, affect women either exclusively, disproportionately or differently compared to men. So you mentioned depression. Women are twice as likely as men to suffer from depression. They're three times more likely to have migraines. 80% of autoimmune diseases are in women, and two thirds of Alzheimer's patients are women. So they also are conditions that can present differently. So look at cardiovascular disease. It's still the leading killer of women globally, yet women often present very differently. They're still underdiagnosed, and actually they're twice as likely to die in the year following a severe heart attack compared to men. So all these differences, they influence risk of disease, they impact the way women present to doctors, and then the treatment response can also be very difficult across therapeutic areas. But despite the breadth of the problem, it's been treated, uh, as a relatively narrow field. It's really half of the population. It's most of medicine. It's still poorly understood. And I believe it's one of the biggest untapped opportunities in healthcare.

Speaker B: I think that's a really great point because so often people describe women's health in fairly niche terms. And if you think about the burden of non communicable diseases, I know you were at an event yesterday with me, and we were talking about cost of care increasing above gdp, driven really by Those chronic conditions that medicine struggles to diagnose and treat. And the majority of those or it's significantly increased by women's experience of chronic conditions differently. Right. So care pathways aren't necessarily thought of on a sex basis, biological sex basis, you know, a bit of sort of public information broadcasting. We were having a conversation yesterday. A heart attack and a woman presents very differently. We're all taught that the symptoms of a heart attack will include really excruciating chest pain or pain in the arm. How would a woman experiencing a heart attack typically, what are the symptoms they'd experience since you're a clinician?

Speaker A: Well, I've actually spoken to two recently who've had heart attacks. One of them just thought she had indigestion. She was very lucky because she was with her son who was a doctor. Instead of having the crushing chest pain going down the arm, you could have pain in the jaw. You can feel just generally unwell. Somebody I spoke to recently said they felt woozy, they didn't feel right in the head. The pain is sometimes not there even. It's just a vague discomfort. And the problem is you go to casualty, you get dismissed because you're not presenting, uh, with the typical symptoms. But it's not just the way they present. There are some causes for heart attacks which are different to men, and that means they're not necessarily picked up as easily by the doctors and on the ecg. So it does take a lot of education, I think, for doctors to realize that, oh, this could be a heart attack.

Speaker B: And patients, I wanted just to kind of explore that because that really goes to the heart of what the woman's health gap is, I think, is that's how it kind of impacts real life. Can you say more about that?

Speaker A: Yes. I think by the women's gap, you are referring to this whole idea that these diseases affect a whole raft of things. And potentially, I think the figure is quoted is a trillion dollars a year in economic impact by 2040. Well, women actually live longer than men. That's an issue. But they spend 25% more of their lives in poor health or even in disability. So that's got a huge impact on quality of life and day to day care. They have chronic inflammatory diseases, so they can often spend years trying to get diagnosed, you know, moving between specialists while symptoms are dismissed. And that delay has real consequences, not just in terms of the economic impact it could have. And it affects relationships, careers, mental health, people's sense of identity, and, um, diseases. Then, um, progress, they get worse, healthcare costs rise Even more. And here we're talking multiples of drug costs here. So for me, it's not just statistics. It's really something that millions of women experience every day. And it's important we try and do something about it.

Speaker B: Yes. And that time to diagnosis, when so many of these chronic conditions are progressive or degenerative, you are increasing cost, but you are massively impacting individual's quality of life and potential outcomes. So you've been speaking to a lot of patients and clinicians recently. I know you've been to a lot of events. What have those conversations been like and what's really stuck with you?

Speaker A: It's really been enlightening. I think what struck me most is the disconnect between the conversations you have in a company boardroom and with investors, where it's all about ROI and exits, basically, and the reality that patients are going through. So the most common things I've heard is the term, uh, medical gaslighting. And that's women being told their symptoms are normal, hormonal. Oh, it's stress. And sometimes they're told this for years. Recently I've met young girls who were told they were too young to have endometriosis. This is rubbish. We know it starts in adolescence, right? Women being told severe pain is just period pain. You know, they're doubled up in pain, vomiting, and they're told that's normal. Some women being prescribed antidepressants when really it was menopause and they should have been given some hrt. But the two that struck me most, I spoke to one woman who needed 11 consultations before receiving a diagnosis of endometriosis. And another one, a lovely black lady. And we know there are issues with inequalities of care. She waited more than two decades and then when she finally got a laparoscopy, they found 29 lesions. I mean, it's mind boggling. And, you know, if you've got years of delay and you've got women, I think it's up to 40% of women only get diagnosed when they get to an infertility clinic. You still have a whole raft of unaddressed issues. Women still having debilitating pain, fatigue, neurological symptoms, being told they're normal. Uh, but it's not just the medical problem, if you see what I mean. It's also a systems problem. It's a listening problem also.

Speaker B: I think, I think that's really the challenge because you said it at the beginning of this conversation. You said, I got into medicine because I wanted to help people and I think that is a universal motivation. I've never come across a clinician that didn't want to do the best for the patient in front of them. But if you don't have tools to treat somebody and the pathways are, ah, patchy and uncertain, your temptation is to refer someone to gastroenterology because if they've got ibd, then that could be treated perhaps. And so you can kind of understand why there is this sort, uh, of circular path that maybe why diagnosis is still taking so long. I'm sure there are lots of reasons. What are they?

Speaker A: Oh, uh, there's a raft of reasons. So we talked about the gaslighting. Symptoms are dismissed or not recognized. I've alluded to the fragmented healthcare pathways because access to specialists isn't equal, sadly. But there's also, you've got to remember this hasn't always been up to take clear guidance. If we again go back to endometriosis, because that's thing we're working on. The major clinical guidelines hadn't been updated for over a decade until just recently. And I looked up the numbers and only 7% of um, world Health Organization member states have government endorsed guidelines. So that's a real issue. Then you've got a diagnosis issue. Imaging like ultrasound or mri, which are standard. It's good at picking up advanced disease, but it often misses, uh, the smaller, more superficial disease, which is what makes up 70 to 80% of cases. A normal scan doesn't rule it out yet many clinicians still rely on that for diagnosis and it's relied on for clinical trials. And then two more things. Finally, many women's diseases, not signal diseases, they're driven by lots of different biological mechanisms. So you've got some inflammation, you've got metabolism, immunology, neurology, et cetera. If you take polycystic ovaries syndrome, up to 70% of patients are unaware they've got it. There's several phenotypes you don't necessarily present with peri, arms and acne. But in fact it's just been renamed as pmos. I'm just still trying to get my head around it. It's polyendocrine metabolic ovarian syndrome. But I think it's great it's been renamed because I think it finally acknowledges that there is a hormonal and metabolic basis for these diseases which we don't really understand. You know, in endometriosis, after a while you get what's called central sensitization. The pain becomes dissociated from the lesions. So it Stays even if you've removed them, you've got a huge amount of complexity which we haven't solved for. And all of that, I think, contributes to the diagnostic delay.

Speaker B: So there's two clear pathways at least. There's the pathway to get in front of a doctor who can give you a diagnosis, which is a large piece of the time. And then the second issue is the diagnostic methods themselves could be better. And so you talked about, we don't understand these diseases very well. Why is that?

Speaker A: There's a number of issues, but I think there's two that we really need to think about because I think we can do something about them. There's scientific funding and then there's the translational aspect. So if you start with looking at research activity and you look at the disease that make the broader definition of women's health, then only around 20% of program research funding is woman focused. More than half of that only goes to two conditions, ovarian cancer and menopause. And that's actually two to three times less funding than for prostate cancer, which is a men only disease. And then if you then look at these diseases that have the greatest burden for women. So you mentioned cardiovascular disease, migraine, Alzheimer's, mental health. Only about 9% of that is women focused. Cardiovascular number one killer. We said less than 5% of NIH funding has historically been allocated to women's cardiovascular health. And in the UK then only about 2% of publicly funded research goes into reproductive health. So scientific publications, only 16% of articles are women focus. So actually most of the research does not cover sex specific differences. And when you get to clinical validation, it's even worse because fewer than 3% of clinical trials are women focused. And then 96% of that development activity is ovarian cancer. So I mean, there's this huge gap across broader women's health needs. Yes, awareness of women's health is improving, but there's a lot of cool scientific research which is not focused on sex differences and it's not consistently translating into development pipelines, scalable products and even in reimbursement pathways or equitable access for women. So it would be great if governments and funders would start focusing on these aspects.

Speaker B: Yeah, I mean, we're still being treated as little men, aren't we, really? And I certainly don't have a problem with ovarian cancer receiving the majority of the funding. It's got huge unmet need, but it's disproportionately small compared to the male equivalent. And everything else is getting Almost nothing. It seems to me that there are many ways of intervening to change that and one of them could be various regulators as demanding evidence of either the drug treats women and men equally or proportionality of biological sex in the trials. But I don't see those conversations taking and happening. And uh, they're difficult conversations to impose on the biopharma industry who see those trials as very high investments in the kind of diseases we're talking about. But nevertheless, there's huge unmet need. Right? And um, you've always said to me where there's unmet need, there's opportunity for new innovation. So where are the biotechs and where are the VCs with appetite? Because they must be rushing into this space, right?

Speaker A: Well, they are and they aren't. Yes, VCs are investing a lot into healthcare. Uh, I think over the last five years about $2.8 trillion have gone in. But guess how much has gone into conditions affecting women specifically?

Speaker B: Well, it won't be a lot, will it?

Speaker A: No, it's only 6%. And then 90% of that has gone, as we mentioned in women's cancers, reproductive health and maternal health. And less than 2% of that capital usually goes to women specific diseases. And um, by that I mean the endometriosis, the menopause, there are signs of improvement. So we're seeing investment broadening outside the US where the money's being traditionally focused. There is more going on into the post menopausal chronic diseases and the market has now got dedicated funds to women's healthcare, but they're still over focusing on Fentech, the reproductive health diagnostics apps, service providers. So that's because clearly they're less capital intensive than biotechs and they've got re established reimbursement pathways, quicker exits. In fact I think one report estimated there'd been more than 100 billion in femtech exits over the last 25 years. So that's an attractive sector for investors. But really when you look at it, much less capital is going into the deep biology, the biomarkers, the drug development. And pharma hasn't fully stepped in either, which is an issue because 60% of their revenues come from conditions that affect women. But if you look at the pipelines, only 4% are focused on female only diseases. And you know, Gates foundation stepping in, they've committed $2.5 billion welcome Leap, Pivotal $100 million amongst others. But they can't fill that gap alone. And yes, it is a huge opportunity as you said, but I think the Issue is the capital isn't yet fully aligned with either the biology or the market need. That's where it needs to shift.

Speaker B: So is it the same in China because Biopharma is increasingly buying its innovation from China. Have you seen any reports on Chinese innovation in female health?

Speaker A: Do you know that's a good question. I haven't seen it explicitly mentioned. I have talked to people who say that pharma is now increasingly, not just for women's health, fishing for early assets in China because it's a lot cheaper, it's faster development. But these deals are not necessarily published. We do know though that there is an issue because if you haven't funded the research and you haven't got enough biotechs being able to do the translational work, then there's a uh, lack of later stage assets because pharma likes de risk assets. Most pharma companies have exited the space as we know, and so what they're looking for are uh, assets they can bring into their development pipelines. But the pipeline in biotech is really thin at the moment, so that's also another issue.

Speaker B: So beyond the funding, how big is the gap in our fundamental understanding of the biology and how much does that hold back the development of more biotech and investments?

Speaker A: Well, historically, male biology has always been treated as the default, right? Until 1980, women were excluded from early stage clinical trials. And that's very understandable. There'd just been the disaster with thalidomide. But there's also been a long standing belief that women were too complex to study due to, you know, the hormonal variability. So that means that uh, much of modern medicine has been built on data generated in men. It's getting better. But even though women now make up around half of participants in phase two to four trials, a later stage, they're still underrepresented in key disease like cardiovascular and even oncology. And in phase one trials then it's still only 25 to 40% of volunteers who women. But again as we said, even when women are included, we're not generating the sex specific insights we need. So most studies still routinely publish the uh, fully sex desegregated outcome data. And that matters because as you rightly mentioned, you know, diseases behave very differently in women. And Alzheimer's, we've done a lot of work in Alzheimer's. It's a striking example. 66% are women. If you look at the ADUHELM trials, that didn't really work very well. Later analysis suggested that men may have responded better to the drug than women. So initially people thought, well, there were underrepresented because there were only about 50% of women in those trials. But I think it does raise a bigger question here. Are we really fully understanding the biology of Alzheimer's in women? I mean, we've studied early onset Alzheimer's. We know that actually there's at least six basic mechanisms driving disease, and that, uh, Aduhelm was only targeting one that was present in 32%. But again, what about the women in those trials? So are we still testing treatments against a, uh, completely incomplete picture of a disease like Alzheimer's or any of the others? Because, you know, if the trials don't reflect the biology of the people who are most affected, then we're going to develop treatments that don't fully work for them. Right.

Speaker B: I wonder whether trials are actually a symptom of the earliest stage in biology in that we find targets, we take them forward in cellular assays, perhaps in organo or animal models that tend to be male. So actually that we're blind to the difference of biology and we're blind to the opportunities that might be there. But that's almost an ophthalmology problem by the time you get to trials. Is that why big pharma has been cautious about investing in women's health? Because they don't really see the opportunity at all? Never mind the difficulties with the translational models, which, you know, we could dive into. But fundamentally, are biopharma really interested?

Speaker A: I think they are interested, actually. I mean, the irony is that, uh, pharma companies are deeply invested in areas like autoimmune disease. Women make around 80% of patients in that area. But to date, I don't think that's been framed as women's health. But then when you look at the pipeline, then only 70% of pharma R and D targets are in women's health. And again, almost half of that goes on to oncology. So if you look at endometriosis, ADENO, PMOs, it's almost like, uh, an afterthought. I think it's because women's health diseases have understudied biology. As you said, the models are imperfect. The endpoints like pain scores, they don't really reflect the underlying disease. So that that makes translation from lab to clinic really challenging. And over the last two to three decades, dozens of programs have failed or stalls. And not just safety issues, but really poor translational biology or child design. I mean, if you've built a phase two trial based on preclinical data in male rats. It's not really surprising. Then I think for pharma, back to the size of the market, there's been that long standing perception that these conditions are a niche opportunity. So the risk reward hasn't really looked that attractive. But that really doesn't hold up. Take the broader definition of women's health and that market is projected to reach $600 billion by 2030. And demetriosis, that's 190 million women globally. So there's a lot more potential there. Yeah, but there's only a few hundred clinical trials in Endo and PMOs at the moment, and even less in, I don't know, compared to tens of thousands in diseases like diabetes. So it isn't just a gap, you know, it's an order of magnitude in research activity. There is evidence actually of renewed interest and we've talked about it. Right, because you've been talking to pharma companies who want to do something more. So we saw Gideon Rishta recently, uh, bought Cellmatics. So they've acquired a full discovery stage portfolio which includes fertility of urine, aging. Endo, uh, Bio has just launched Linkuette. And that's quite exciting because that's the very first non hormonal drug treating hot flushes. But a lot of companies, pharma companies, have actually scaled back early R and D in this space. So back to your point, they're mostly relying on external innovation. And the problem, because early stage in translational research has been underfunded, there's a shortage of well developed assets for pharma to partner with. So I don't think it's a lack of need or opportunity. It's how you translate that biology into drugs. The funding that's required to do this and pharma needs to revisit the area because it is a huge market and there are some very interesting approaches being taken on by biotechs in the space.

Speaker B: I find this sort of discussion sort of very much like a cure. It's egg. I mean, one, when we look at pipelines and we say they're not interested, and then we measure it by numbers of trials in classical women's health conditions like endo, ovarian cancer, et cetera. But we want to claim that women's health is bigger. There is no way, of course, of looking into a pipeline in immunology and really understanding a target's role, whether it's going to work. It'd be more effective if we target that medicine to people of female biological sex or men. So those Numbers are imperfect and um, it's just the reality of where we are. And I think perhaps some of the big opportunities that represent low hanging fruit, things like maybe drug repurposing, not necessarily as treatment end goals in themselves, but actually demonstrating novel biology, they're not really interesting to biopharma. Those are not regarded as commercially attractive by the pharma industry. Nevertheless, with the conversations I have with healthcare organizations and we've seen directions coming from the FDA where if you discover a new indication for a repurposed medicine, there is talk of rewarding organizations like that. And there's been a lot of investment in the EU trying to encourage this, that might be a way forward. So given perhaps mixed signal in biopharma, uh, and all of the challenges we've discussed around biology trials investment, how do we actually move this forward and what are we doing at precision Life?

Speaker A: Well, I think we really need to strengthen the entire innovation pathway for a start, from funding research to late stage development, commercialization. But that's going to have to be a huge coordinated effort with multiple stakeholders. I think what we can do in the research community however, is really just get to grips with the biology of these diseases. Because women's health conditions are complex and they're multifactorial and they're not caused by a single gene. They're driven by networks of interactions, interacting pathways. So we need better data, better uh, analytics to understand what's driving disease in different patient groups and guide personalized treatment. So first of all, we need really good longitudinal data sets and they need to integrate clinical genetic multiomics data so we can properly characterize them. By the way, we also need to fix a major limitation, right, because about about 80% of genomic data sets are from European populations. So we limit how well treatments generalize. So we need better uh, ancestry. What I think is really exciting about what precision life is doing is that we are focusing exactly, not just for women's health diseases, but for all chronic complex diseases. Why? Patients who look clinically similar may have very different underlying biology. So rather than looking for single genes, we use combinatorial analytics to identify all the networks of interacting biological pathways that drive disease in different patient groups. So what we're doing is moving from one size fits all medicine towards stratification, which is the sweet spot of precision life, because that's going to lead to more targeted therapies and true precision medicine because we'll be able to understand not just what disease somebody has, but what's causing it in their particular case and what treatment will work for them. And that's really, really important in women's health, where these diseases, uh, are heterogeneous, basically.

Speaker B: And that's so often the case in all of complex chronic disease. I mean, I know some people, some regions call them non communical diseases. I prefer complex and chronic because they are complicated and they, those are definitely, uh, as we get more experienced, I won't use the aged word, but once we get more experienced, we are more prone to these conditions. So I'm definitely invested in solving for this. And you mentioned the sort of challenge with ancestry in genomic data. I think one of the underappreciated advantages of precision life is because of how we analyze data and use combinatorial analytics to chase combinations of common variants. Because they're common, quite often they do survive, as I say, travel, I, uh, like to say time travel. They do survive that signal into disjoint populations of different ancestry better. It's not perfect. We definitely need much greater diversity in the underlying genomic data. There's some phenomenal work going on in the Middle east and the Far east where there is a real focus on this. And I think that then some of the people I've been talking to this week have got some very exciting plans for, uh, improving data access whilst maintaining the sovereignty and security of these very important resources. So I think we're fixing the data layer. You know, I can see there's a path and there's an interest and, you know, governments, philanthropists are funding this. So we have the substrate. What we don't have is all the things that we've been talking about in this conversation. But if we can make it work, what happens, you know, what changes if this approach works?

Speaker A: Well, let's use the example of what we're doing in endometriosis, again, since this is about women's health. So. So we've been granted a 2.5 million euro fund from EIC and the project is called Transcend. And what we're doing is developing a very rapid, non invasive genetic test, just a simple buccal swab, that's going to be able to help triage patients who present with chronic pelvic pain assess their lifetime risk of endometriosis and related conditions and understand the underlying mechanisms driving their disease. And then alongside, as you mentioned, we're also going to be doing repurposing trials. I think the difference with our approach, with the repurposing trial is that we will actually match the repurposing drugs to the mechanism that's been identified.

Speaker B: Precision repurposing.

Speaker A: It's precision repurposing as opposed to the previous ones which you quite rightly mentioned. For example, aromatase inhibitors to reduce estrogen in endometriumin, uh, GLP1s used in PMOs and increasingly in endometriosis, and then, you know, switching immunovascular therapies to target inflammation or blood flow. What we will be able to help patients with is to get an earlier diagnosis for a start, as well as more targeted therapies. So for the patient the difference will be huge. I mean, you're not going to have to spend in seven to 10 years navigated fragmented healthcare systems. You know, at least this will help them go to the right specialist, which is a number one thing. And then I think giving patients a diagnosis that's grounded in biology is hugely important and not just clinically, but psychology. So we've done a lot of work in ME CSF and until Precision Life came along, there were no genetic associations with ME CSF. And then we found, I think 33 novel genes. And the ME community is actually delighted that finally their disease has a genetic basis because these patients were historically dismissed, misdiagnosed, told they were lazy, they were skiving work, et cetera. When you identify genetic and biological driver, you shift the narrative from something that's perceived as psychological or it's normal, your pain's normal, to a validated, ah, disease. And hopefully then a clinician can give a, uh, better treatment which is based on that biology rather than trial and error, you know, trying four different treatments for rheumatoid arthritis until you land on the right one. But that has an impact for healthcare systems, right? Because if you've got earlier diagnosis, you've got less unnecessary referrals, you're not doing repeated testing, you are not trialing ineffective therapies for months. So that's a major driver of health costs. And then for pharma, if you have a biomarker led approach for pharma, we know you can reduce the risk in trials, you can lower the cost, you improve the outcomes. So if you de risk R and D, then that's going to increase investor confidence in the sector. Right? And that's, I think, is also going to encourage more pharma companies to invest in women's health. So to me, understand the biology early, stratify the patients and then you can change the entire pathway of care. It's a shift at every level and that's precision medicine. That's what needs to happen.

Speaker B: And uh, I Think it's that impact across the entire value chain, driving better outcomes, bending the cost curve down, um, and I think also solving the productivity issue for healthcare. So we know that the world's populations are getting sicker, we're living longer, but with more complex chronic disease. And, you know, we can't clone doctors. There's not enough trained physicians and uh, nurses and other professionals to deliver care in the way it's been delivered in the past. And so if you can prevent, I hate to say this, but the unuseful consults, because the wrong person is in front of the wrong clinician, you're actually freeing up capacity. And, uh, that's a productivity driver, which I think is worldwide, something that healthcare wants to see. So that's kind of what gives me hope, because I think it's that benefit across the whole pathway. But what gives you hope about the future here, particularly in women's health?

Speaker A: I think what I'm seeing is for the first time in quite a few years, you've got science, technology and policy and a bit of investment and they're all beginning to converge. So I think we're at an inflection point where we might be able to move from awareness to action. We have the tools, we've got AI. You've got AI helping in radiology and pathology, you've got biomarkers for precision medicine, you've got better systems biology. So I think you've got the science that's going to be able to help you move away from symptom management towards stratification in specific diseases. Recently at conferences I saw that endometriosis is increasingly being recognized as a systemic inflammatory disease. And people are looking at some really new, interesting research areas, the microbiome, the vagus nerve. You've got biotech companies looking at non hormonal mechanisms, pain, inflammation, you've got startups with novel biomarker panels, novel diagnostics. So I think it's all moving in the right direction. There's a lot of noise about great exits in femtech and yes, it's not ideal, but private investment in that space is beginning to grow. And we've also actually seen some general VCs moving into the space. But I think really women are increasingly driving healthcare decisions and influencing where capital flows. So if we can mobilize those voices, then we are going to be able to align the need, the policies and the funding across us, UK and Europe, and then push governments, not just philanthropic organization, to start funding. It seems like it's the first time that women are finally being recognized as a serious, uh, scientific and economic priority. So that's what gives me hope.

Speaker B: Well, as they say, first recognize the problem. It's their path to solving the problem. A bit of fun, Varunit. We're going to do some rapid fire questions, right? So for those who are the TikTok generation, let's see what we can do. If we could change one thing in the medical school tomorrow, what would it be?

Speaker A: Stop treating pain as a niche issue. Teach it as a multi system disease problem from day one.

Speaker B: Biggest red flag in a doctor.

Speaker A: Anyone who says that's normal when a patient is in pain.

Speaker B: What's pharma's most underutilised asset?

Speaker A: Failed drugs. Many weren't matched up to the right patients.

Speaker B: What's the biggest research opportunity?

Speaker A: Decoding the biology of chronic complex diseases in women.

Speaker B: How do we deliver the future of women's health?

Speaker A: In one word, mechanistic.

Speaker B: Your ten year vision.

Speaker A: Uh, a world where women are diagnosed and treated based on biology rather than being told to live with their symptoms.

Speaker B: So let's hope we can stop women screaming in pain and frustration. So I want to give you a special thank you because you're a lot of preparation and for sharing your insights that you've gleaned over your career at, uh, the forefront of healthcare innovation, clinical strategy and precision medicine. Today's conversation was just a really powerful reminder that solving women's health diseases requires better science, stronger collaboration, the tools to intervene much earlier and a sharper focus on the real needs of patients. Thank you very much, Veronice. Thank you and look forward to the next time. So on that note, please be sure to, uh, follow Biology Matters on your favourite podcast platform so you don't miss future conversations with the leaders shaping medicine. And to learn more about Precision Life and our work, please visit precisionlife.com and I'll see you next time. Thank you. If this episode changed the way you think about precision medicine and chronic disease, share it with someone who should be part of the conversation. And for more discussions on how a deeper understanding of disease biology is reshaping healthcare, follow Biology Matters wherever you listen. You can also learn more about Precision Life and the work that we're doing@PrecisionLife.com and remember, the better we understand disease, the better we can predict, treat and prevent it. Biology matters. Until the next time.