Women’s Health Watch: Trends in Innovation and Investment

Delphine O’Rourke, CEO, 8Fold Inc., speaks with Naseem Sayani, General Partner, Emmeline Ventures, about how the current legal and regulatory landscape is impacting innovation and investment in women’s health. They discuss the connection between investment and innovation and access to health care, where investment and innovation are taking place, how employers are driving the fertility market, and investment predictions. 

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Transcript

Speaker 1: 0:00

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Speaker 2: 0:07

This episode of A HLA speaking of health law is brought to you by A HLA members and donors like you. For more information, visit American health law.org.

Speaker 3: 0:21

Hello and welcome to ALA's Women's Health Watch. I'm Delino Roarke, your host for today's conversation. I'm CEO of Eightfold, Inc. Strategic consulting firm, lead partner with portfolio, a venture capital firm focused on fem tech at adjunct professor with Columbia Law School. I'm thrilled today to have a conversation with Nasem Sani , general partner of Emily Ventures. Welcome, NASEM .

Speaker 4: 0:47

Thank you so much. I'm excited to be here.

Speaker 3: 0:50

So on this podcast, we dive deep into a variety of different topics around women's health and women's health defined broadly . And today we're really gonna focus on investment, the capital markets, the impact of our current legal and regulatory framework on the investment capital markets, and more broadly, the connection between health and wealth. So, you know, Nasim , it would be great if you could kick off with description of Lene and your focus , um, because you're really a leader in this space, and we're seeing an investment in women founded companies and women's health companies increase at a much faster rate than other areas of healthcare. So we're thrilled for the audience to learn more about it and also what you are bringing to this role. 'cause you have a long role in financial services, and I think that's important for folks to understand the kind of glo um, of , um, you know, GPS that are attracted to the women's health space.

Speaker 4: 1:45

Sure, absolutely. So, Emily Ventures is a VC fund investing across healthcare, financial services and sustainability, specifically in technology and innovation that's helping women live and thrive. So what we're after is two things. One, we want to invest in solutions that are built by her. For her with her preferences and purchase decisions drivers in mind. Two 80 to 85% of spend sits in women's hands today. And arguably 99% of what we interact with wasn't actually designed with us for us and with our preferences in mind. And if we actually did that, we would open up $30 trillion of economic value. And so that, that is what we're after is, is really finding those things that are built around what she wants to spend on. And those things are most directly for us in healthcare, in financial services, and in sustainability. Uh, and that is because healthcare, as we know, the systems have never been designed around women's health, where huge gaps in data, huge gaps in care, very limited understanding about women's health physiology from the start. And we wanna be on the front end of investing in that sector because the arbitrage hasn't been opened up. The biggest players haven't been capitalized yet. Uh, so there's some real money to be made in that sector, and we wanna be at the front of it. Uh, financial services is important because, because of the spend sitting in women's hands, the things we invest in our platforms and tech that are putting real financial access, autonomy, ownership into women's hands quite directly around how she spends, how she saves, how she invests, how she's building generational wealth for her and her family. And health and wealth, which we'll come to this for women, are pretty deeply tied, and you can't really move one without moving the other . So we had to invest in both. And then the third sustainability, we had to wrap environment around those two things because women are disproportionately affected by climate and by climate change in particular. And so we, we needed to have that in our thesis as well, because it affects health, and health affects wealth. And these three things work together. So the trifecta that we're after opens up economic value and actually has the potential to change lives while we also make some money. Uh , and that's what we're after at the fund. My personal background, I come from years and years of time in , in digital strategy and innovation , uh, both in the context of being a core strategist at the big consulting firms I've worked at and led a digital agency. I also led a product studio. That product studio grew up into a venture incubator. Uh , and in all of those roles, as you can imagine, there was very little diversity of gender and or of race. Uh , and we were, by the end, we were building startups at scale, we were taking client money, we were helping them launch the business that would otherwise have put them out of business. Uh, and we weren't doing that with enough perspectives in the room and enough diversity in the room. And it became a little bit unsustainable for me personally to build a lot of great products, but not see the kind of impact I wanted to see from them or that I now needed to see. And so I went out looking for opportunities that, that we weren't seeing in my day job. And that meant female founders. That meant healthcare, that meant women's health in particular , uh, because I was watching the trends and the demand from me and my friends, right? People around me who were looking for better solutions Mm-Hmm . <affirmative> , and all of that was sitting with female founders. It wasn't sitting in the healthcare system. And so taking a bigger step into venture became the only way to really have the kind of impact and, and build an ecosystem in a way that could really drive some change. So

Speaker 3: 5:26

Tell us for, for some of our audience members who may be looking to either invest , um, you know, funds or whether portfolio, for example, we have LPs who are individuals. Tell us a little bit more about Emily Ventures and how people can reach out to you if they're interested in I say, people or companies or other funds , um, who are interested in learning more. Because I think ab it's just important to understand how the system works and what the opportunities are.

Speaker 4: 5:54

Oh, absolutely. It's a great question. So founders who are out there building great things across those sectors , uh, we have a pitch us link on our website. You can submit your company through that pitch us link. It goes right into our pipeline from there. I will say that by way of the thesis that we're after, and because we're looking for solutions that are really opening up what women can spend on the founders that are most aligned to delivering that by way of lived experience are women. So our entire portfolio is female CEOs. Uh , and we, we are prioritizing that profile because we're also trying to expand the 2% that goes to women today as founders. Education for us is a , there are one more thing

Speaker 3: 6:34

I was gonna say. Education is key. And you know, I asked you this not as a, as a, although I love that it's also a mini commercial. Yeah . I get all the time from funds that are investing in healthcare. I'm not specifically investing in women's health or women's founders who are like, you know, what's, what are even the options? Who should we start talking to to learn more? Yeah . Yep . And until this conversation becomes mainstreamed with every investor, women's health is just another category. Um, that educational piece is so critically important. And, you know, one of the things that we wanted to explore women's health is, you know, just like healthcare in general where you can have an impact, do good and, and also make money. And those aren't mutually exclusive. It's the, you know, no , no margin, no mission. And it's not an initiative. You know, it's , it's not charity work. No . There is, it is a industry sector. It is a booming industry sector and Jeanie's point, because there is opportunity and it's not saturated. When I hear, you know, there are two companies focusing on osteoporosis and <inaudible> , well, now the market is saturated. That couldn't be further from the truth. I mean, just sort of a , a when people say, what's the total addressable market? We're 4 billion women on earth, right? So there's a, a, a very large , uh, a tam and, and that TAM is only growing. And when we talk about financial services, you know , love to dive deeper into that. You know, let's not forget that in addition to the, the money that women are making, and we represent 65% of the workforce, there's also a massive wealth transfer that's going on right now. The, you know, it's been called the Great Wealth Transfer where , um, women are there approximately 30 trillion in wealth is set to change hands in the next decade . So basically now we're sort of four years in by, by 2030 , um, from baby boomers. So, you know, this is a, a significant shift in consumer power. It's definitely caught the attention of the private wealth management sector where women are already 80 plus percent of , you know, make 80% of the decision making in, in healthcare. The healthcare sector is not as in tune to this massive wealth transfer as other areas are. And it's important to note that. And the decisions that women are making about their, their, their, you know, everything from end of life decisions to how they wanna save, to where they wanna donate, important force that is coming together at the same time that we're seeing more and more women CEOs , you know, it's 60% of of companies that are solving for women's health problems were created in the past five years that we're seeing more funds like nasem . And I think it's important to note that they were one of the first and have really been trailblazers in this area. So, NASEM , let's talk about the, the health and wealth connection, because I think that's one of the broader themes as we dive deeper into, well, what are the impacts of, of lack of investment and what is chilling investment?

Speaker 4: 9:44

Yeah, it's a good question. So there's a couple of things. One , uh, there is a really good round of research now about maternal care deserts and OB deserts that are happening across the country. Uh , and there are parts of the country where the closest OB GYN office is two or three hours away. So for a woman to get even her regular wellness check , uh, she would have to travel three hours to do that. Uh , and there's a lot of reasons for that. There is, you know, there obs as a practice don't make as much money as other practices. Uh, so there's not enough of an influx of talent into that category. There are CPT codes that build differently for OB procedures versus men's health procedures. So these systems don't make enough money. And so it ends up being an area of healthcare that can easily get deprioritized because well , we don't make enough money on it. And the problem with that is that what we're doing is leaving women, you know, on their own to solve their own medical questions and without the data to do that, because we also have a massive data problem. Uh, and we don't know enough about women's health to begin with, let alone leaving most women on their own to solve those problems by way of Google searches, which is the worst possible thing any of us can do to find information. The other related detail is that in a lot of those same places, and this, it'll take us to , uh, reproductive rights in a second, but if we can't,

Speaker 3: 11:10

And I just say I'm guilty of looking online, you know, as much as you , we

Speaker 4: 11:14

All do it ,

Speaker 3: 11:15

You shouldn't be looking, you look online and all of a sudden, you know, I've got, you know, some kind of parasite from , um, you know , from a trip I've never taken <laugh> . Right ,

Speaker 4: 11:24

Exactly. That's , and

Speaker 3: 11:27

That's same

Speaker 4: 11:28

Snowballs . Absolutely. Yeah. And then if you pair that with reproductive rights and what's going on with abortion access, the same places where there are care deserts, there's also lack of reproductive access, and that includes abortion and or contraception. And so now we're leaving women in lurch on their healthcare in a pretty big way . The third layer, and this is where the wealth part comes in , is that if you stack the different regulations that sit in those same areas, so portions of the country that have the strictest or most restrictive abortion laws also tend to have lower minimum wages. They also tend to have union unionization levels that are half as high as other locations in the country. They also have lower rates of Medicare expansion. So we're, we're talking about women that are in locations where they can't get healthcare. They also have lower wages, they also have lower access to Medicaid. They're also not unionized. So they don't have a way to do any type of collaborative , uh, bargaining. So now you've, we've affected economic mobility to such a degree that now when she is pregnant and can't get the care that she wants to resolve that pregnancy, she now also don't , doesn't have the money to take care of this extended family that she actually didn't want to begin with. So we're further limiting economic mobility by not addressing the care deserts and the repro access because of the other economic levers that sit on top of that.

Speaker 3: 12:58

Well , it's a stacking effect. It's a compounding effect. Um , yeah. That, that makes it even more, more difficult for, there are women who are living in poverty and the number of children are living in poverty to get to, to get out of that. So , um, quickly, for those of you who are not familiar with health deserts and maternal health deserts, I encourage you to check out the March of Dimes. They publish a report every year , um, and a shout out to the CEO of March of Dimes, my friend Dr. Elizabeth Shiau . Um, they've added this year distance to , um, family planning is one of the indicators , um, and that we're seeing in the states that have restrictive bans. So not just, and I think I always, I bring this up 'cause I always think it's, it's important to think about the ripple effect and the ripple effect of, of the reproductive laws goes way beyond , um, abortion care, right ? Yeah. And for example , um, the closing of Planned Parenthood throughout , um, most of the south and the restrictive states where majority of women on Medicaid received their yearly health screenings, their , you know, mammograms, access to pap smears, access to prep for women at high risk of HIV , uh, early cancer detection is just one of the many areas where really Planned Parenthood was the primary care source. And that now that those Planned Parenthoods are closed , uh, women don't have access, particularly women on Medicaid, women don't have access. There's already a primary care shortage before dos , um, access to care, even though they are insured by, by the Medicaid program. And then also increasing the fear and distrust , um, due to some of the aiding and abetting provisions. So it , it , the , the downstream effect, and we saw last year, one of the highest rates for a variety of reasons of, of people on, on Medicaid in the us We were over a hundred million of Americans on Medicaid last year. So these are, these are crucial topics for men and women variety. We're gonna see more acute conditions coming into the emergency room. We're gonna see cancers that are detected at a later stage. This is, this is incredibly , uh, widespread and, and impactful. So, ine reproductive laws, how are you seeing , um, and and part of it is, you know, and we've talked about this, I've spoken on this extensively. It's the confusion. Yeah . No one's quite sure what's going on. And even when you see the media coverage of the Supreme Court decision that dropped , which is the Supreme Court protected of access to Mr . Bri Stone . No, it didn't, it dismissed the case on standing. So, you know, even the way it's portrayed is, is misleading. How is this regulatory landscape, legal landscape since almost two years now impacted investment in women founders, comma women's health solutions, both in the reproductive space and outside of the reproductive space? And I know that's a question.

Speaker 4: 16:06

Yeah, no , that's okay. I'll, I'll probably hit two appropriately and you'll have to remind me. Uh, so on one part, it has affected, it has accelerated to some extent the investment in some women's health startups. Uh, a company like, Hey , Jane , she raised her seed plus round right after Roe fell. It was her row round. The number of individual investors that wrote checks as angels into that round was enormous. She was, it was , it was such, it captured so much of the energy of all of the people who were severely distressed by Roe falling. It accelerated her round and she closed around that normally would've taken six or eight months. She closed in about two to three months. And that's significant because it was became this lightning rod, if I'm gonna do something right now, I'm gonna put money into this company because it's going to be the company that provides abortion access through telehealth to resolve this problem. So on some cases it has accelerated investment. In other cases, and this is more so on the founder side, it has led a number of founders, and I know at least three or four personally, who are moving their businesses out of states that have restrictive abortion laws. And that is one, it's because they work in women's health. And you can't, your mindset to build in women's health in a state that doesn't support it like it's a cognitive dissonance problem. The second is that if you pick that up and scale it, you're looking at enormous swaths of innovation that are gonna leave states in droves. And that, again, is an economic problem for that state. And I don't know that the lawmakers in those places have fully understood what it means to have that level of innovation, leave your state, because it's not just women that are picking up their businesses and leaving. There are also male founders picking up their businesses and leaving because they also can't attract talent. You can't get talent to move to Alabama right now to work on your startup in Alabama, because Alabama has restrictive women's health laws. And so how will you build a company? How will you drive business? And those implications are, we're sitting on both sides of the flywheel now, where we're shifting money, we're being much more thoughtful about what companies we're investing in. Things like profitability have become important. Again, we're looking for growth, we're looking for innovation. We wanna make sure they can change the system in some way. We are also, as investors asking questions about where they operate, how they operate, what does their legal team look like, how will they navigate the regulatory landscape? And the founders have to be much more thoughtful about what kind of legal expertise they have on their team and how soon they're asking questions when it comes to state by state expansion, because the laws are so different state by state . And it's also changing every single day.

Speaker 3: 18:51

So as, as our audiences, large part lawyers, we love hearing that you want legal involvement earlier on. Yeah . Um , and it's not, you know, it's not the joke. 'cause you know, lawyers wanna charge. It's because we, we always believe that we have value add and that we can help companies prosper if we're brought in at the beginning, and I say this over and over, particularly in healthcare, and then in decision in women's health . Be proactive. Understand how it's gonna impact you, and don't wait for the investor or your potential partner to say, whoa , what happens if, yeah . Um , how will that impact, how will that impact your business? And to layer on, you know , um, there was a Forbes, for example, article last year in April of 2023, was that nearly three quarters of college students say that state reproductive rights laws affect their decision of staying enrolled at their school. I mean, and that was a year ago. Um, there was a recent report that 62% of sort of new employees would, would pick a state Mm-Hmm . <affirmative> that did not have, you know, more , um, more lenient reproductive laws. We're seeing it over and over. I know there are, I've clients where people won't travel if they're pregnant, they will not travel to states even for a business meeting just in case something were to happen. Um, and that when looking at, you know, where would you buy your home? Historically it's been okay access to education taxes, that healthcare, including reproductive health laws are moving, moving up , um, up in priority. And in part it's because there's a concern that, okay, today it's reproductive. What is it tomorrow? Yeah . So today it's abortion, then it's IVF . And what if it becomes, you know , uh, is , is it's a seen as an attack on bodily autonomy. Um, what am I gonna anticipate? And to your point, how do I attract talent in an environment where , um, there's just more and more distrust of the health distrust, excuse me, of the healthcare system. Mm-Hmm. <affirmative>. So yet I haven't seen, I dunno if you have studies on, you know, I love that economic argument. It would be great to see a study. Maybe you've seen one that really connects for those, you know, we're talking about advocacy, those legislators saying, you're gonna lose jobs. You are going to, you know, this is like a plant closing, but in a very different way. Um , have you seen anything on that?

Speaker 4: 21:08

You know, I've seen similar studies to what you quoted. Uh, there was, I believe CNBC did a study. It was for the generation lab. Two thirds of younger workers would probably not, or definitely not live in a state that banned abortion. Uh, I've seen those types of studies. I haven't yet seen a full quantification of it. I've been looking for it. Because if we could, that becomes the hallmark of how we move the system and change how people are thinking about it, is if we could tell Alabama, I'll pick on them again , uh, that, you know, you have $10 trillion of potential economic value is leaving your state because of these decisions, I would hope that would change how they, how their lawmakers operated and, and how they made decisions.

Speaker 3: 21:50

Well , if anybody's listening and wants to be part of that report, or, or yeah,

Speaker 4: 21:54

We should do

Speaker 3: 21:54

It the report or fund it or , uh, you know, that would be fantastic when we start looking at what's the impact on what's the impact on the dollar , right? It's the economy. So, you know, we talk about women's health and, and within women's health, there's also a push to beyond reproductive care. Reproductive care is critically important. When I say reproductive maternal health, you know, I recently read a statistic that in more, in most re restrictive states, maternal death rates are actually 62% higher. So when we, when I talk about reproductive health, I'm talking about maternal health, I'm talking about , um, you know, and , and it's not just the time of delivery. It's also now, you know, one of the one in three or one in four , um, it depends again on the states , but causes of maternal death in the year, postpartum is, is suicide. So we have a massive maternal health crisis that needs to be addressed. Um, maternal health is a critical piece. I can't emphasize is enough , emphasize that enough. Because sometimes people say, well, what are you saying that maternal health isn't important? No , quite the contrary, but it's not the only piece of women's health. So at Lene , what are you investing in? What are you looking at to look along the continuum? Um, because we need more research in, in dementia. We need more research, cardiac care. We still know that, you know, heart disease is the number one killer of women. What are you doing to invest, you know, from , uh, from birth to death, so to speak, right. Um, in addition to, to reproduction.

Speaker 4: 23:28

Yeah, that's a great question. So we are investing across her entire lived experience . So we're looking at solutions . We have investments currently in mental health, specifically designed and tailored for women. It's a telehealth solution. We have two investments in maternal care. One is specifically around cultural competency to better support black women when they go into hospitals to have their children. On average, I would say two outta three black moms don't go to hospitals to have their children. They use doulas and midwives at home because they don't trust the system and the system doesn't hear them properly. This founder is building a cultural competency training program and curriculum to actually make sure hospitals are better equipped to support black women. They , when they come in, we've also made inve , we're looking now, I should say, for investments that are at the intersection of women's health and artificial intelligence. And we're looking for founders that are actually building the tech that can take the data, treat it thoughtfully, build the learning models on top of that, and be able to train those learning models to drive better insights. And there's a few that are sitting in maternal health right now, and once they are able to get the model working in maternal health, it's going to then scale out, you know, left and right into adolescence and then through to menopause on the other side. And once we can build the tech thoughtfully and other startups can leverage that tech, we're gonna accelerate the women's health ecosystem in a pretty substantial way. What all of our current founders are doing right now is they all have data strategies. They're all thinking about the data they're capturing, how to capture it well, how to keep it current, how to protect it. So the data privacy and other data security needs they have to think about are dramatically different than they were five years ago. Uh , but they're all, they're all doing that because we have to make sure that if there are purging needs or things that have to happen, that they have that in place. Uh , but we don't want every women's health founder to be building their own AI model. They cannot all build their own l lms because it's too expensive to do that. There will be two or three founders who build the tech that the other startups can use. And that's what we're looking for right now. Because what we need to get to is more precision diagnoses. We need to get to more thoughtful insight on different health conditions, different demographics, and how South Asian women respond to birth control versus white women versus black women. Like we don't actually know that right now, but a lot of women are suffering different symptoms from different kinds of birth control, and they're having to individually figure it out and test and learn, which is an impossible scenario. Uh , and so we're, we're trying to invest in things that can close those gaps. We have , uh, quite deliberately actually not invested in fertility directly yet. And that's been one because there , it's gonna sound crazy, but there has been a lot of money relative to other health sectors. Most of the money has gone to fertility historically. Mm-Hmm. <affirmative> . And we want to be part of investing in the rest of her life. And then we will circle back to fertility. And what we're looking for there also is our fertility investments may end up being more biotech investments, because we're also looking at biotech specifically in ovarian health. Because if we can find solutions that extend ovarian health or help us maintain estrogen in longer, more healthy ways, we actually resolve a lot of other problems that are sitting across her lived experience right now. So we may not make a fertility investments, but we may make one or two biotech investments that can affect ovarian health, which then ultimately touch fertility.

Speaker 3: 27:04

Let's talk about fertility per part of the, the driver of the fertility market has been employers. Yeah . What, what's your thought overall pulling out on the role of employers? And, and you know, I hear it all the time, employers are looking for, for different solutions to offer their employees and trying to figure out, you know, fertility in a way was very <inaudible> . There's a finite period. Um, it's not , let's say like menopause, which is sort of the next frontier. Um, what, what do you , what are your thoughts on the growing role of employers in, in providing new solutions and really being the drivers , the catalyst for scale?

Speaker 4: 27:43

Yeah. So employers historically have provided best case scenario, right? Maternity leave and mm-hmm. <affirmative> and coverage for maybe other pr maternity care support in the four months that you're out of the office after you have a baby. What needs to happen is employers have to actually pull much earlier, and they should also be providing coverage by way of their benefits for egg freezing, much earlier for IVF , for these other things that are supporting women's ability to have children whenever they decide to have children. Because what's happening right now is that it we're , our social development as women is going much faster than our biological retention or qualities . So our biological growth is not keeping up with our social growth. And so we're still all hitting our mid thirties and still climbing in careers or deciding to have big careers or making decisions around work. And we may not have thought about having children yet, but our ovarian health has already started to shift. And if I haven't already frozen my eggs in my early twenties, I'm not gonna be in a position to then do IVF in my late thirties because my egg health has already declined. So if employers are thinking about retention of their employees, if they're thinking about longevity, if they wanna best support the women and the families who work for them, they really should be adding more of these coverage options much earlier and making it known and saying, we have these options. Bring in people to talk about women's health as a more holistic experience than just fertility and give women the options they have earlier versus just at the point of having a child. Because there's a whole other set of questions that we're answering before the moment we give birth that isn't getting addressed by benefits. Well , today.

Speaker 3: 29:28

Well , with that comment, I'm even wondering if you don't, you know, make it earlier into higher education, starting to have those conversations.

Speaker 4: 29:34

Oh , absolutely.

Speaker 3: 29:35

Absolutely. As as , um, you know, women are every , you know , access to , to higher education. So you might not even be hitting the workforce in your early twenties. Um , yeah . And the part of the message to, to this audience is if you hear, you know, women's health is niche, women's health is saturated. You know , someone said that to me the other day. They said , well, breast cancer is, is saturated. Well, you know, maybe you can say that when there are no more women dying of breast cancer. Uh , but until, you know, please pause if you say that while women are, 'cause most of us know women who was diagnosed, treated, or tragically even died. So this perception that of , because women's health is coming , uh, to the forefront in the past couple years, it's now saturated. Couldn't be further from the truth. I wanna celebrate all the successes. There's also so much, and you've just touched on some of the areas , uh, where, where we need more investment, we need more information, we need to understand both the, the gender implications as well as the racial implications, the national origin implications so that we can have responses that treat and aren't all right . You know , one solution, one solution for everyone, and including on the data point, and I know this is an issue that's raised and , and is being addressed by the most forward looking companies, is I know garbage in, garbage out , garbage out . So if you're putting into AI biases , um, they will just continue to exist. So making sure that you adjust for account for, and make them culturally competent solutions. Um, you know, ellipsis health, which I know you're, you're familiar with . Mm-Hmm ? <affirmative> . Mm-Hmm . <affirmative> , they've been very intentional. I think we're one of the, the first to say, okay, we need to make sure that our mental health platform doesn't perpetuate biases and prejudices. And that's a critical component that we're seeing grow and grow in , in the AI space because it is such a concern. Uh , right . So looking ahead, you know, we know that the capital markets , um, have been flat for everyone. The public markets have been flat for everyone. Um, we're fighting with inflation. We have geopolitical uncertainty. We have electoral uncertainty, not just in the United States. We saw, you know, the results of the European elections, again , whether it's France or Germany, and the rise of the right wing. And then we saw in France, you know, full on dissolution of government per new election. Um, it's everywhere. So when we talk about in investment, yet at the same time , um, I don't know if you saw it on Friday, CMS put out , um, there's Fierce Healthcare did a great review of it, of increased spending in healthcare. Mm-Hmm . <affirmative> , which is blowing away every other sector. So we have this economic uncertainty in higher and higher spend in healthcare. What, what do you predict? Take out your, your crystal ball, what do you predict in the investor space? And I wanna be, this is a partially a leading question. A, because I'm a lawyer, and b because <laugh> , you know, I hear, oh, it's just 2% of women, you know, just, just 2% of investment. Yeah , yeah. But women's health sector is rebounded , uh, much better than other digital health sectors. So yeah. Is it where we need it to be? No, but we're seeing more and more investment, and I think it's important to reframe the messaging of we're persevering, there's grit, there's more and more investment. And even if investors are holding onto their dry powder, which has , you know, frankly become a dirty word. Mm-Hmm . <affirmative> . So everybody's holding onto their dry powder and you know, too many companies are in the valley of death right now. Um, what are you , what are you seeing ? What are you predicting in the next year or so? And I'm not gonna hold you to it, none of us

Speaker 4: 33:16

Know . Yeah , no . Well , we should, we should track outcomes. Right? So , uh, so here a couple of thoughts. One is the things that we are, the stigma that we're hearing when it comes to women's health, the things around, it's, it's niche, it's saturated, et cetera. We have to continue to dispel those myths because if you think about women's health in the greater continuum of time, right? The FDA didn't really fully get established till the early 1940s. That's when rtt , which is crazy randomized clinical trials actually became a thing in the mid 1940s. Then women were included in those RCTs in on 1993. That's just 50 years after RCTs were even done. Did we then start to include women? So yes, it feel it is absolutely a huge gaping hole, but we're talking about 50 years into the life of the FDA as an organization. Now we're in a place where generationally women are asking much smarter questions about their healthcare. I say menopause every day . My mother won't say menopause for the life of her, because for her it doesn't exist, right? It's like there's stigma in her head and she won't admit that it's a thing, whereas I'm already solving for it and I'm in my mid forties , but I, I have to be thinking about it. So when it comes to women's health and what I think is going to happen is that we are again on the cusp of doing this right? And we have a lot more smart people thinking about it now than in previous inflection points like this. So really smart investors are going to understand the arbitrage that we're sitting in front of. They know that we're at the front end of this category. If you wanna put money to work in a place where it could one, drive impact, and two have a very big ROI turn for you. The moment is to do it as to right now, the , some of the biggest companies were born out of recessions and troubled economic times. It is not the moment to hold your money. It is the moment to invest it because the valuations are better. You're not gonna overpay. It's not expensive to do that. So that I predict over the next two years, we're going to see a bigger influx of capital into women's health because more savvy investors, even new investors are gonna understand that the opportunity is right. Now, the other thing that we hear is that, oh, women's health, we don't know. There haven't been any exits and go , well , yeah, of course we're only five or six years into investing into this category. So no, there haven't been any exits. But you have to keep in mind that when these same savvy investors put money into Google, Facebook, and Amazon, there were no exits for search or for social or for e-commerce. What they were investing in was the behavior and a change in demand. And that is what we're at with women's health right now. Also, there are big behavior changes, big changes in demand, big requests for access to data and insight and the ability to get more specific on diagnoses and support. That's what you're putting your money into. And if those previous tech companies were any indicator of the size of the potential, that is where we're at with women's health. It's a trillion dollar category. We need to all go after it. And I do think in the next two to three years, we're gonna see much more capital go after the sector because we're understanding how these dots connect and the kind of unlock that we're sitting in front of that just doesn't have the priority right now that it should.

Speaker 3: 36:34

And I hope savvy investors are listening and there are different ways to invest is <inaudible> , well, I don't have any money to invest. Okay, well you can invest, you could be an advisor, you can , um, you know, there are a lot of different ways that you can , um, be part of this. And also for reference, because I think we all in as a country have sort of short term memories. 2021 was a blockbuster year. We cannot compare where we are today with 2021 when it was monopoly money. So I just pulled up quickly. So , uh, but for example, 2020 , uh, there are 480 IPOs, 2021 , 1035 IPOs. Okay? 20 22, 180 1 . I mean, talk about a , just a collapse overall. This is on women's health. This is overall and then 154 on the US stock market in 23. So there have been very few exits overall. Mm-Hmm , <affirmative> . Um , and I think it's important to think about that when you do say, oh, we there haven't been any exits in women's health. Um, you know, okay, but what was the overall f what was the overall landscape? And we are going to be seeing some exits I would predict in in 2025. Yeah . Probably of two or three, which, yeah . Um, but look back to, you know, early crypto or early, you know, I think your , your , your social media analogy was, was fantastic. And the other piece is this is not optional. And that's another thing when I hear, oh, it's a lifestyle. Well, you know what, actually endometriosis , um, is not a lifestyle when you have, you know, uterine tissue that's growing in your fallopian tubes. Um, so the demand is not going away. Right. Um, you know , and that is, and , and women are a realizing, wow, there are other solutions. We don't need to just listen, you know, sort of grin and bear it. Um , and, and so you have this sort of endless demand of, of need for services. It's, it's just supply and supplying, supplying great solutions that can be funded. Um, I'm very optimistic. Yeah .

Speaker 4: 38:48

I , yeah. One thing I'll add to what you were saying is that the, you know , the frothiness of 2021 and the, the extreme excess of VC deployments and investing that happened in 21, you're we're seeing the implica, the aftermath of that in all of the, the down rounds that have been happening in the last year or two Series A raises for companies that raised the seed in 21, a lot of their valuations have had to come down because they were inflated in 21. What's happening right now though, is that we're not in deep frothiness and excess VC spending. The VCs that are writing checks now are being much more thoughtful, much more pragmatic. And the companies that are getting seed funding now are not going to have down rounds in two or three years because they weren't overvalued to begin with. So I think what we're, we're seeing that come out of the system now, the problems that were created by 2021. So it's much healthier investment climate for VC today than it was in 2021.

Speaker 3: 39:46

Uh , couldn't agree more. Is it ? I'm very optimistic and what I would love to see is a change of that narrative. Um , yeah . Because once the narratives sort , you know, gets traction, it just continues, is saying let's really rightsize this narrative. And even some of the exits that did occur in 2023, where are they now? Um , and getting back to the investment opportunity. 'cause there are healthcare systems that are part of a HLA , many healthcare systems that also have venture arms. Um, you know, this is the time to get in and there's a real opportunity. Um, two , and you know, women have always been, why was there always such focus in the healthcare systems on labor and delivery have been the door to the entire family. So this is a strategic play, family loved ones, not just for women's health, but for the entire healthcare , uh, continuum, the entire healthcare market. So there are very few arguments against embracing women's health , um, as an economic opportunity. Um, and I think we're just gonna see it flourish. So Nasim , thank you so much for your time. Um, I encourage anyone to reach out to you at Emily Ventures if they have any questions or wanna talk about the market or hear more. Um, and this was really helpful to also make the connection, you know, particularly those of us who are on the legal side , um, exclusively, I'm not, but for many folks who are exclusively, to really see the connection between the regulations, supreme court decisions and the capital markets, and how clearly and, and closely those are connected and affected . Thank you so much for everybody who's joined us today. And again, thank you to Nasim and to a HLA.

Speaker 4: 41:32

Thank you so much, much Delphine for having me. This was great.

Speaker 2: 41:42

Thank you for listening. If you enjoyed this episode, be sure to subscribe to a HLA speaking of health law wherever you get your podcasts. To learn more about a HLA and the educational resources available to the health law community, visit American health law.org.