Latest / StartUp Health NOW Podcast / How These FemTech Founders Are Upgrading Below-the-Belt Health

Transcript

How These FemTech Founders Are Upgrading Below-the-Belt Health · StartUp Health NOW Podcast

• 0:00
  I was doing FemTech before FemTech was a thing. A few years in, I was blogging, I was writing a lot online into the ether.
• 0:06
  The way I did that in the early days was very much stalking medical health professionals who were specialists, so that pelvic health physiotherapists and physical therapists, women's health physiotherapists.
• 0:17
  Around the world, I just found them on Twitter, and I sent them my stuff, and I was like, "Is this safe? Would you give this to your patients? Does this work? Um, what would you change?"
• 0:26
  So from the very start, I really sought that medical approval and that validation and that check-in that, that this was right.
• 0:36
  [upbeat music] Welcome back to StartUp Health NOW, the podcast where we celebrate the entrepreneurs and innovators who are transforming health. I'm your host, Logan Plaster.
• 0:46
  A couple weeks ago, I had the privilege of hosting a panel at the Google headquarters in London.
• 0:52
  One of my four panelists, all of whom were StartUp Health founders, was Wendy Powell, CEO and founder at MUTU System, a fitness platform that helps women recover from pregnancy and regain a sense of independence and confidence.
• 1:06
  Wendy's been in business for more than a decade, and she made a telling comment on the panel. She said that she's been in FemTech since before FemTech really existed.
• 1:15
  She was referring to the fact that we've seen a surge and uptick in interest in women's health innovation, but that's relatively a new phenomenon.
• 1:23
  For years, we've tracked investment trends at StartUp Health, and we've talked and written quarter after quarter about how women's health has been underfunded.
• 1:32
  Thankfully, that is changing, and more and more founders and funders are actively bridging the divide.
• 1:38
  They're creating new necessary solutions for women, whether in fitness, pre- and postnatal care, chronic conditions, fertility, and menopause.
• 1:48
  Founders like my two guests today, who I met up with at the recent ViVE conference in Nashville. My first interview is with Wendy Powell from MUTU, who traveled over from the UK to be with us live in the studio.
• 2:00
  Then we'll hear from Missy Lavender, CEO and founder of Renalis, about how she's helping women with below-the-belt conditions like overactive bladder get the care they need through an AI chatbot called Cisi.
• 2:13
  First, let's hear a Health Moonshot update from Wendy at MUTU. [upbeat music] Wendy, thanks for joining me in the studio. Thanks for having me. It was very exciting to get to learn about what you're building.
• 2:26
  Uh, we had our first conversation when you joined StartUp Health. But, uh, let's just introduce to our audience what MUTU is. Absolutely, yeah.
• 2:32
  So MUTU System is rehabilitation and recovery for pelvic floor, for core, for abs postpartum. So we serve women at any stage of motherhood.
• 2:41
  Um, it's never too late, so new moms right through to not so new moms, um, dealing with all sorts of pelvic health issues, um, abdominal core issues. Okay. How did you get into this?
• 2:51
  I got into it because of my own experience. Okay. So yeah, so my history was I used to be a, a pre- and postnatal personal trainer. Okay. Um, and around... I-- my babies are 15 and 17 now. Okay.
• 3:02
  But, um, when I had my first- Impossible, but go on. [laughs] When I had my first one, Ava, um, I had very healthy pregnancy. I was training right through my pregnancy, but very traumatic birth.
• 3:13
  And, um, and then my son is only 18 months after that. Same thing happened again. And even though I was a highly certified personal trainer specializing in postpartum, I was like, "I know this stuff.
• 3:24
  I should know what I'm doi-" But, um, I didn't have the tools I needed. What I had been taught to teach wasn't adequate. And so
• 3:32
  through my own recovery and then searching for answers really because fitness, my industry at the time, didn't seem to know what to do.
• 3:41
  Um, it had certain strategies and techniques, and they s- they weren't working, and I saw them not working for my clients, and I, I-- they hadn't worked for me.
• 3:49
  So I kind of took my study outside of that industry, and I started working with bio-- um, with biomechanics, with, um, sex therapists, with midwives, with physiotherapists, um, medical professionals dealing with this bit of the body.
• 4:04
  Yeah. Yeah. That fitness- Below the belt health. Exactly. One person told me yesterday. Yeah. That's a great phrase, yeah.
• 4:09
  And it was-- it's, it's an area of the body that most of fitness industry doesn't really understand. Yeah. They don't really know what to do with it, apart from tell people to do ab exercises and- Yeah...
• 4:18
  and that's not enough. So yeah. Interesting. Uh, you said something that, that registered with me because I've talked to a lot of founders who said, "Even though I had this background, I still- Yeah...
• 4:28
  even I didn't have the access." Yes. And it really opens up this conversation about lack of access for folks.
• 4:36
  So maybe talk to me about, about that, about kind of who is able to, to reach a specialist and just who's being left out in the cold. Absolutely.
• 4:46
  So the postpartum period is a time when women just do not-- It's lack of information as well as access. People just don't know.
• 4:54
  I mean, we had a, um -- I-- There was a story in our community just this week of a, of a young woman. She was in her early 30s, um, recently had her second baby. She'd been told she had a prolapse. She was terrified.
• 5:06
  She had no information about that. She felt physically and, and emotionally broken. Mm. Um, you know, and j- so just that lack of information about what happens to our bodies.
• 5:15
  We're not really-- I think a phrase I hear so often is, "I wish I'd known. I wish I'd known what this was gonna feel like, what this was gonna be like," because the information just isn't there. Right. Uh,
• 5:28
  tell us a little bit about the trajectory of the company. How long has it been around? Kind of where are you at now? Sure. So it's about as old as my daughter because [laughs] I guess that's where it came from.
• 5:37
  Um, so yeah. So it's been-- we've been an online, um, digital platform for about 10 years now. Okay. Um, it's a bootstrap company. We've always-- We're, we're a small team.
• 5:46
  Um, we've served more than 100,000 women over that time. Um, and the, the-- it's evolved. The first, the first program for MUTU was- As things do... as things do.
• 5:56
  So the o- the, the original MUTU, um, I strapped a flip camera, which don't exist anymore I don't think, stra- strapped a flip camera to a tree in my back garden and filmed myself doing exercises. Wow.
• 6:07
  So that, that was the first iteration. [laughs] Yeah. It's, it's a lot more sophisticated [laughs] now. We've been through various, um- That means you're basically a pioneer- [laughs]... in this, in this industry.
• 6:17
  I mean- Yeah... you've been seeing it through the evolution. Um, and when did you see an inflection point?I- in the business? Yeah.
• 6:25
  Yeah, so, um, yeah, i- in the, with regards the pioneer, somebody kindly called- said I was, I was doing fem tech before fem tech was a thing, but [laughs] yeah. Little bit. Yeah.
• 6:34
  Um, so the, the inflection was a few, a couple years in, a few years in, um, I was blogging. I was writing a lot online into the ether. Um,
• 6:46
  Instagram wasn't around then, so Twitter was kind of where we made connections, and the way I did that in the early days was very much stalking, really, stalking me- medical health professionals who were specialists.
• 6:59
  So that's pelvic health physiotherapists and physical therapists, women's health physiotherapists, um, around the world. I just found them on Twitter, and I sent them my stuff, and I was like, "Is this safe?
• 7:11
  Would you give this to your patients? Does this work? Um, what would you change?"
• 7:15
  And so from the very start, I really sought that medical approval, if you like, and that, um, that validation and that check-in that, that this was right because these are, th- th- these are intimate- Yeah...
• 7:31
  areas of our bodies. They're intimate issues. They carry a lot of, sadly, a lot of shame and embarrassment for a lot of women. Um, so it needed to be right. And so I did that from the very start- Mm-hmm...
• 7:43
  that kind of really connecting with the medical profession in this specialist area, and it was really that that, that saw the difference because people started coming to me and saying, "Oh, my midwife sent me.
• 7:52
  My OBGYN sent me. My, my physio sent me." The validation piece. Yeah. Yeah. Very interesting. Yeah. So, uh, born in the UK, correct? Yes. And, uh, are you in the United States as well? Absolutely.
• 8:02
  Um, from the beginning, those first customers were actually from the States. Okay.
• 8:07
  So, um, it's quite consistently really over the last decade that around kinda 65% of our, of our customer base, our membership base- Okay... is actually US-based. Okay.
• 8:16
  A- and kinda what are, what are those expansion plans? So the expansion plans are really around new routes and getting to more people.
• 8:23
  The bottom line is that, um, a direct-to-consumer model like, like Mutu System, um, has great advantage in, in the sense that we get real-world evidence. We get real social proof.
• 8:34
  We really know that we have an absolute fit. But with except anything direct to consumer by definition is, of course, only available to those that can afford it and that those have- Got it...
• 8:44
  have that access and that information. Sure. So what we're looking at now is talking to medical providers. We're already involved with the NHS in the UK.
• 8:52
  Um, so talking to other medical providers and employers, um, to, to basically increase the access and that impact. Got it. What are you most excited about for the next 12 months?
• 9:02
  Uh, so for the next 12 months, we've got some exciting new trials happening with the NHS in the UK. Okay. So that's great. Um, there's gonna be more happening there.
• 9:10
  And we've also just started a partnership with a big European corporate, um, where we're doing...
• 9:15
  Uh, there was a pitch competition last year that I won, and they've invested 200,000 pounds into the business and, um, into, into promoting, um, a, a particularly around incontinence products.
• 9:26
  So that's sort of their area. Yeah. So we're doing a lot of...
• 9:29
  I'm excited about a lot of coverage that we're gonna be doing with that around the partnership between a corporate that creates and manufactures incontinence products- Okay...
• 9:37
  with a program that actually improves the situation. So it's kind of a whole- Yeah... whole approach. So you've been in this for a minute. Yeah. Uh, how have you seen the conversation change?
• 9:48
  How have you seen the culture change- Mm... around pelvic health? You're talking about incontinence, you know, just these industries.
• 9:55
  Uh, I'd like to think we're talking about them more now than we were 10 years ago, but how have you seen a change? It's definitely changed, and there is a lot more conversation.
• 10:03
  Um, what has been interesting a- as well, the, the conversation for me, my view is that sometimes it doesn't go far enough.
• 10:10
  Because what happens, what I mean by that is you'll see maybe on a daytime show or, or, or something aimed at women, you'll see conversation around incontinence, mild incontinence for moms, and it's laughed about.
• 10:23
  It's like, "Oh, yeah. You know, I'm not gonna go on a trampoline, and I can't sneeze too, or I can't laugh too hard."
• 10:28
  And so for me, I love that the conversation is more out there, so people are more willing to, to, um, share that, and there's a huge amount of value in that validation that you're not alone. Mm. That's important. Huge.
• 10:39
  But for me, it doesn't go far enough because it's like, yeah, you can do something about that. Yeah. You know? [laughs] You can fix that. So there is a lot more conversation. There's still a long way to go.
• 10:48
  These are issues that carry too much shame and embarrassment for women, and, and they're so common. I mean, 50% of women who have had a baby at some point in their lives will have some level of prolapse symptoms. Yeah.
• 10:59
  Um, half of them, and nobody's talking about it, so yeah. And that's just the women. I mean, there's, there's the, the husbands who care about- Exactly... their wives- Yes... who are struggling- Absolutely...
• 11:07
  um, and, and want the best for them as well. So it's a huge conversation. Yes, it is. Needs to be had. I love the work that you're doing, Wendy. Thank you.
• 11:14
  Thanks for taking the time with me today, and I hope it's an amazing 2023. Thank you so much. Okay. All right. [upbeat music] Next, let's go to my interview with Missy Lavender, head of Renalis.
• 11:27
  We'll hear about how her platform is bringing behavioral therapy to women who have suffered in silence with pelvic health conditions.
• 11:34
  We'll hear how she's not just extending a lifeline to women, but to their doctors as well, who have struggled to figure out how to manage this challenging patient population. Here's Missy.
• 11:45
  [upbeat music] Missy, always great to see you. Nice to see you, Logan. Thanks for having me. All right. Let's just level set. Give me the Renalis pitch.
• 11:54
  So Renalis is creating software-based solutions below the belt- Below the belt... for people assigned female to start. Women commonly say. We like to be more inclusive. Um, that's what we do. Okay.
• 12:06
  Uh, who i- who, who are you trying to help? Great question.
• 12:11
  One usually thinks of the patients because the patients are the ones with these very debilitating, expensive chronic disorders, but we created Renalis at the need of the providers. Oh, interesting. Yes. Okay.
• 12:23
  They were the ones in pain, hair on fire. T- tell me more. Why, why? Sure. Yeah. So-All of these disorders are chronic conditions. Okay.
• 12:32
  And the specialists at the top of the pyramid are essentially surgeons, and what they're trained to do are procedures. And especially with their first condition, overactive bladder, it is a great condition for...
• 12:48
  to be treated by behavioral therapy. Okay. Not cognitive behavioral therapy, bladder behavioral therapy. Okay. And that takes time. Yeah. Takes time they don't have.
• 12:56
  They're not gonna spend 20 minutes, they can't spend 20 minutes talking s- a patient through on how to do bladder training- These are day-... or fluid management... day-by-day trainings, I'm guessing.
• 13:04
  It, well, typically you go in to see a provider, and they give you a pamphlet, and they say, "Go home and try this." Yeah. Or they give you, if you're lucky, a script to a PT.
• 13:12
  And if you really can find one and pay them for one and continue to go to one, you learn a lot with them. They- Yeah. That's a gold standard. The reality is most people aren't gonna be able to access that.
• 13:22
  There's only 10,000 of those in the country. Yeah. And so, you know, it falls on usually the nurses, the allied healthcare people. Sure. And these are loss leader patients for them.
• 13:32
  And I, and I wish we were all value based. Mm. But we're not. So they were the l- they were the ones that were like, "Oh my gosh, these patients take so much time.
• 13:39
  Can you just handle them for us until they're ready for me to do my magic, bring them down the funnel to third line care?" That's what Sisi's designed to do. Uh, talk to me about the scope of the challenge.
• 13:50
  You said, you know, below the belt health. This is not, like, sort of headline health innovation when we think about, um... This is an unmet need, is what I'm saying. Right.
• 14:01
  Talk to me about how, how big of a problem this is for patients. Yeah. Great question. So conservatively, because th- it's not like anybody except me is running around going, "Oh my God, I leak urine.
• 14:12
  Oh my gosh, I can't control my bowels." Uh, you know, uh, so everybody's in the water closet suffering, and what happens with all of these conditions, we talk about leaking, bleeding, chronic pain.
• 14:23
  So we try, women are good at coping, right? So we just put a bigger pad on or give up running and walk, or then give up walking and then don't do anything. Mm. And the lives start to narrow.
• 14:35
  The bodies start to get affected by lack of sleep, lack of activity, lack of intimacy, lack of leaving my house. Yeah. Right? So our, conservatively, there's one in three women is the statistic you hear all the time.
• 14:47
  Wow. And from a dollars perspective, Logan, there's $100 billion annual spend in the category of pelvic health disorders in persons assigned female.
• 14:56
  Overactive bladder, back to our first, you know, indication, is 70% of that. Wow. That's ridiculous. It's ridiculous. Wow. So. And what's the status quo in terms of products or apps? Yeah.
• 15:09
  Obviously, you, you already talked about the provider shortage, if you will, just the lack of ability.
• 15:14
  But if I have overactive bladder, and I'm going to the store, I'm trying to find something at the pharmacy, what's that world like? Well, there is an over-the-counter patch.
• 15:24
  Um, it was a drug in a category called anticholinergics. You can get that if you'd like.
• 15:29
  The problem with the older medications, um, insurance companies like them because they're cheap, generic, and this one is over the counter.
• 15:39
  Um, the problem is they have lots of side effects, from dry mouth, constipation, dry eye, to dementia in potentially 11% of the patients even after they stop taking them.
• 15:49
  The other class of drugs, the better, newer one, well, sorry, the newer ones, um, like the ones I take, are really expensive. Wow. Yes. And so that's the second line.
• 15:59
  The problem is the first line, the stuff we talked about earlier, is just not accessible. I'm, you know. I, think about diabetes, right? We knew by telling a diabetic to eat less, move more, nothing was gonna happen. Mm.
• 16:14
  So enter Livongo. Enter people like that with coaching platforms, with connectivity to care, to knowing there's a care pathway. Turn diabetes on its ear.
• 16:23
  This is exactly the problem in our space, and that's what Sisi is filling, 'cause there really isn't anything, um, outside of, again, the absolute gold standard is pelvic floor physical therapy. We love it. We love it.
• 16:35
  We love it. Mm-hmm. Anybody that can't get there should have Sisi. Okay, you mentioned- Our product... Sisi a few times. Yes. What is Sisi?
• 16:42
  Sisi is our conversational agent, or chatbot, um, ironically named by, we've done a lot of work over the years with c- community health workers. Okay.
• 16:51
  And so when we were doing our usability testing as we were designing Sisi, we were meeting with them regularly. They were great. Everything from colors to language to GIFs to emojis. But we n- they named her.
• 17:03
  I wanted to call her Coco, 'cause she coaches and connects. Okay. They're like, "No, we want to call her Sisi." Huh. 'Cause it sounds like si si. Like, good. Okay. We like that. Okay.
• 17:11
  So that's actually our next expansion market- Okay... is into the Latinx space. Okay. And you said, okay, so it's a chatbot. What's the user's experience of the chatbot? Yep. Great question. That's the question.
• 17:20
  So the user gets a prescription from their provider. They go to their digital ther- um, pharmacy, which we'll connect them to. They get an access code. They go onto their, um, this is important, their device.
• 17:33
  We've web-based developed it, so it can be a computer, a tablet, or a smartphone, which is important for access.
• 17:40
  And they, they, they log in, they give themselves a name, be Logan, um, and they then get b- they get started with Sisi.
• 17:49
  And the first thing they do for day one is they fill out a bunch of validated questionnaires, things they would do if they were in a urologist office- Sure... in a much more fun way, 'cause she's very conversational.
• 17:58
  Think credible, accessible, and medical. Then she says, "Guess what? The next three days we're gonna collect a digital, we're gonna have you experience a digital bladder diary." Okay. Never very much fun.
• 18:10
  We've made ours as easy and fun as we can, but we give it this caveat of, like, "Look, we're gonna take those data and your patient goal, and from there you're gonna have a, a, an individualized journey- Yeah...
• 18:20
  that fits what you want out of this." Yeah. And so the patient then takes off. Four weeks, we do another one-day diary.
• 18:26
  At the end, we do the diary and the same questionnaires, and that's itSo it's an eight-week journey, and unless they're either not getting better at the midpoint or something happens where their symptoms are getting worse, um, so far that hasn't happened, knock on wood, um, they don't see the-- they don't t-talk to their provider.
• 18:43
  So that's the patient journey. How does that integrate with the provider- Mm-hmm... and how does that integrate with other part, you know, forms of care that the patient receives? Right. Good question.
• 18:53
  So right now we are pre-revenue. We're actually, um, raising a seed round to do our pivotal trial. We're taking this through FDA clearance. Mm-hmm. So we need a bigger data set.
• 19:02
  So, um, we are outside of the EMR integration, but when she is commercial, she, Sisi, will be integrated through the EMR. So again, they write that script. Sure. Gets fulfilled.
• 19:13
  Um, then those, all those data are available for the providers if they want it. I can tell you that most of them don't 'cause they'd have to do something with them.
• 19:21
  But, um, it's there, and then, um, at the end of that experience, the provider either has a follow-up visit at eight weeks and says, "Great. Have a nice life.
• 19:31
  Um, check back with me if anything changes," or they add meds, or they take them down the treatment pathway. What's interesting, Logan, and we just finished our proof of concept study.
• 19:40
  It was just presented at two scientific meetings last week. It'll be published very soon. Congratulations. Thank you. It's very exciting. Um,
• 19:46
  80% of the patients that went through that eight-week journey were either very or extremely improved, like they were done. Okay. Which is incredible. Every one of our, um- Based off of bladder exercises?
• 19:56
  Uh, behavioral- No. Great question. So people think, "Oh, it, is this just gonna be Kegeling?" Like, no. So when you were... Let's say you're working with a PT or a really patient care provider.
• 20:08
  You would learn about fluid management, like how much do I drink? What, what am I drinking? When do I drink it? Hmm. Why do I care what's in it? Um, you would learn about bladder training.
• 20:17
  So every overactive bladder patient is going to the bathroom too frequently. Well, I can't just say, "Hey, you know, go every two hours." Don't go. Yeah. Not gonna happen. Yeah, don't go.
• 20:26
  Um, so I gotta, I gotta go through that regimen with them. Okay. You know, how to do it, coach them, the, that's a big time- Just a range of, of training regimens that you just wouldn't go through otherwise.
• 20:34
  Pelvic floor is important, but for a different way than if you're trying to strength train it for stress incontinence. Mm. So I have to... It, it's very strategic. Yeah. You know?
• 20:42
  And, and these are things that should be aha moments for patients, so, you know, we get asked questions, "Well, they need a follow-up regimen."
• 20:50
  Some people may, and they may after a little while, but y- you know, somebody yesterday's, uh, was asking me a question about, um, well, behavior change is really hard, and, you know- Yeah...
• 21:00
  people, they fall off, they forget those things. I'm like, he was eating a banana. Yeah. And, and I said, "Okay, I get that, but it's different." So what if y- you, when you ate that banana, you threw up? Right.
• 21:11
  Would you ever wanna eat a banana? Right. No. Behavior change is easy then. Yes. But if I said behav- bananas are good, you should eat more of them, it'd be like, yeah, whatever. Yeah.
• 21:18
  So if your bladder's running or ruining your life, and I can give you a tip, topic- Oh... or trick- Yeah... you're gonna be like, "Done. I, I remember that." Yep. It's the painkiller- So-... versus the vitamin.
• 21:28
  Absolutely. We want the morphine. Yes. So. Yes. Very interesting. So you're raising, uh, your seed round. Mm-hmm. Uh, what will you do? What will that leverage you to be able to do? Great question.
• 21:39
  So that takes us for about 24 months. Um, it funds our pivotal trial. Okay.
• 21:43
  So we're going, we're doing a double blind randomized control, uh, all telehealth, which is exciting, against, uh, you know, her twin sister we call Contessa, which is basically a digital...
• 21:53
  We've chopped up an, uh, a state-of-the-art pamphlet- Okay... from the International Continence Society and put that into a digital, so it looks like a digital solution. Interesting. Um, yeah.
• 22:01
  There's just, which is great. Um, and we'll do that. We'll, um,
• 22:07
  do all the data analysis obviously, do the regulatory, the eQMS systems, get ready, submit FDA, get FDA approval, which we expect six months from when we submit.
• 22:16
  And then we get a little breathing room to validate our commercial, um, hypotheses, test the market, get some clinical validation, and then raise the next round. Fantastic. Yeah.
• 22:25
  Well, Missy, I appreciate you taking time with me. You are addressing an unmet need in the market in a really creative and innovative way, and I'm, uh, really excited for this next year for you. Thank you.
• 22:34
  I am too, 'cause we have more products to come- Good... and, um, more to talk about. Awesome. Thanks, Missy. Thanks, Logan. [upbeat music] Thanks for listening to Starter Health Now.
• 22:46
  We'll be back again with another episode next week. [upbeat music]