Transcript of Part I of the keynote talk for the 13th Annual Technology Venture Conference at Cambridge University’s Technology and Enterprise Club, June 25, 2016
— — by Ridhi Tariyal, co-founder and CEO of NextGen Jane, Inc.
Good afternoon! I’m Ridhi Tariyal, and it’s a pleasure to be with you today. I’ve been invited to talk about NextGen Jane, a startup I co-founded with my wonderful colleague Stephen Gire, how Jane is emblematic of the circular economy, and how we are leading the way in women’s health by reimagining waste as a resource.
We’ve developed a smart tampon — a way to detect signals of nascent and asymptomatic disease in bodily refuse that normally finds its way into landfills. We hope that, by turning a woman’s trash into treasure, we can diagnose disease early and extend and improve the quality of her life. That is alchemy at its best. I’m not sure how this audience feels about conflating science with magic, but it’s my first time giving a talk in the UK, and one of your own said,
“Any sufficiently advanced technology is indistinguishable from magic.”
— — Arthur C. Clarke
At NextGen Jane, we believe that we live in a world advanced enough that the magic of finding out you are sick yet asymptomatic, using a tool you rely on every month anyway, should exist. And, we intend to contribute to creating that world.
I was also told that you might be interested in hearing my journey about getting NextGen Jane off the ground, some of the stories from the front lines, and the complexity of fundraising for a reality that doesn’t make it into mundane conversation, let alone a venture capitalist’s brag list.
“I was early on the sharing economy…Bitcoin and menstruation…”
— — No One. Ever.
By the end of this talk, I hope to relate that the best innovations are deeply personal, manage to find a uniquely compelling position in a complex context, and appeal to their main constituency on a very primal level.
So, first things first: I have pitched NextGen Jane many times and given talks at different venues. Without a clear idea of what a smart tampon looks like, your lizard brain is working in overdrive, imagining various embodiments.
And, if you’re a woman, you are familiar with the speculum, stirrups, and other cold metal instruments that have come to symbolize the feminine reproductive health experience…
…and you’re probably sitting here in dread.
Let me relieve your stress. Whatever you’re imagining in your head, I promise you it’s not that.
A few weeks ago, Fast Company wrote an article about NextGen Jane that we really like. However, the editor’s selection of the title The Quantified Vagina was met with some resistance. We saw Twitter responses and opinion pieces soon after that captured this sentiment…
The “internet of things fatigue” is real and perhaps merited. But, we don’t think we fit into the “internet of things” invention category. The tampon we provide is 100% organic cotton.
A question we often hear is, “Well, could you use any tampon?” Hypothetically, yes, but tampons have different bleaches, chemicals, and additives, all of which make standardization difficult. Given this, we anchor our technology on the simplest form of absorbent cotton we can find to reduce variability in sample collection.
I want to emphasize this point, in particular, so that you might spread the word. Others are starting to use the term “smart tampon” to describe their gadgetry-enriched tampons, and it’s beginning to confuse our user base. While we do own the trademark, we would rather use your voice to disambiguate the phrase than resort to litigious means.
Now you might wonder what the utility of our invention is and whether it is actually “smart”. For some of you, the last time you examined a pictogram of a woman’s reproductive organs would have been in high school. I take nothing for granted.
(A male doctor once asked me if my intent was to collect the single tampon a woman wears during her period. Ahem…the one she places in on Day 1 and takes out on Day 7.)
For anyone who laughed uncomfortably but didn’t catch the joke, women don’t wear a single tampon for the span of their period. If we did, we’d all have toxic shock syndrome.
Allow me to offer a refresher on what happens on a monthly basis, for many women, for 38 to 40 years of our lives.
The uterus, or womb, is the powerful reproductive organ that is responsible for gestating a fetus during pregnancy.
#props to the uterus for its ability to nurture the fetus and its ability to push out an entire baby.
Bear with me now: the cervix connects the vagina to the uterus, and the top of the uterus is connected to the fallopian tubes. The fallopian tubes connect the ovaries to the uterus, and once an egg is released from an ovary, it begins its journey through the fallopian tubes.
In the case of successful fertilization, sperm will have traveled from the vagina, through the cervix and uterus, to meet the ovum and form a zygote. The zygote implants in a thick layer of vascularized endometrium that lines the uterus.
If there is no implantation, your body sheds this endometrial lining and starts the process over again. The process of shedding this lining is called menstruation.
A tampon provides unprecedented access to this system. First, tampons access shed endometrial lining that can be investigated for diseases of the endometrium, like endometriosis. In the endometriosis disease state, the tissue that lines the uterus in preparation for implantation of the zygote is found outside of the uterus. The diseased tissue migrates to a woman’s ovaries, fallopian tubes, bowels, and other areas of the pelvic region. Endometriosis affects approximately 10% of women, can remain undiagnosed for 7 to 10 years, has the long-term consequences of sub-fecundity and infertility in women, and is accompanied by years of debilitating pain and nausea during menses for the afflicted population.
And the gold standard for diagnosis? Laparoscopy. That’s right: you have to have surgery to find out whether you have endometriosis. The surgery, in part, explains why women wait years for a confirmatory diagnosis. Other reasons for the delay in diagnosis range from OBGYNs’ normalization of the grave pain women face during menstruation and patients’ desire to downplay their pain because they fear they may have cancer. All told, women ploddingly make their way through the medical diagnostic process, one that might begin with a gastrointestinal specialist and, after years of referrals, culminate in a gynecological surgeon’s office for the correct diagnosis.
We can do better than that.
A pioneer in endometriosis research, Linda Giudice, has done work to show that genomic changes in the “normal” endometrial lining (that is, endometrial lining where it belongs in the uterus) can be predictive of endometriosis (that is, endometrial lining outside of the uterus).
This is a remarkable improvement relative to laparoscopy. We now have a path from surgery and visual assessment of aberrant tissue in the peritoneal cavity, its biopsy, and histological confirmation…
…To something minimally invasive: entry through the cervix, local biopsy of endometrium, and molecular analysis for disease differentiation.
Our work is the natural evolution of Linda’s. We know that, every month, a woman’s body is naturally biopsied. Because a woman’s body expels the endometrial lining, might we look for genomic changes in her shed lining? Could we develop the first completely non-invasive endometriosis diagnostic ever? We believe this is a hypothesis worth pursuing. We are pursuing it.
Most women will now make the natural logical leap we made. There’s got to be even more that you can detect in there.
Academic labs have been exploring tampons as a mechanism to capture mutated tumor cells from ovarian and endometrial cancers. What about uterine or cervical cancer? Could there be an opportunity to re-engineer Pap smears to improve screening for HPV-positive women? What about sexually transmitted infections like chlamydia and gonorrhea that sit in the cervix and are asymptomatic in 80% of women?
We found academic literature in which scientists in remote areas of Australia used tampons to collect chlamydia and gonorrhea elemental bodies, in lieu of a cervical swab, because the tampon proved to be a better capture method. The abstract summarized the research as follows:
This is a clear conclusion to the question,
How do we improve testing of STIs outside of the clinic for remote communities?
But, what if we ask a different question? What if we ask,
Would a woman, in any context, ever have cause to test herself for a highly stigmatized infection, in the privacy of her home, with an immediate outcome? Is there value in that?
We drew a slightly different conclusion from their work, and an exciting one.
Empower women to test themselves in a judgment-free way, and you might non-trivially impact the spread of infectious diseases, sustain her fertility, and equip her with critical health information, transforming “that time of the month” into a pretty exciting period. Pun intended.
As you can see, the use case is much broader than remote, inaccessible communities, if you change your framework.
Stephen and I are committed to exploring every reproductive question on a woman’s mind and every worry that plagues her at 3 AM.
I won’t bore you with the pipeline of questions we are beginning to explore and the real data we are collecting. I think you understand the breadth and potential of this innovation in a woman’s life.
But to the women in the audience: I want you to know that we are investigating questions like how the vaginal microbiome may affect pregnancy outcomes and ways we might track monthly changes in the environmental toxins we are exposed to. I want you to know that Stephen and I will pursue these questions ad infinitum because these are our questions, too. They are my worries. They keep me up at 3 AM.
Now we have come full circle to the first of my three take-aways. The best innovations are deeply personal. When I turned 33 I had a bizarre conversation with my doctor. I asked her how I could know whether I was okay, from a fertility perspective, or whether I should be worried. She asked me if I had any reason to worry, as in signs or symptoms of something amiss. I answered honestly, that there were no visible manifestations of anything, no…just a desire to be proactive in my fertility management.
I told her that I’d heard of a test that could give me some indication of my ovarian reserve, or how many eggs I had left. She pushed back and told me that I’d first have to prove I was infertile before she could start prescribing tests to characterize and investigate my infertility.
The medical definition of infertility:
She said she knew I hadn’t been trying at all, because she knew I didn’t have a partner during that time. She made a few things clear to me in that moment. (But, in her defense, she really clarified the position of the complicated U.S. healthcare ecosystem of third party payers, providers, and patients.)
- First, I was made to understand that my fertility was a joint function between a man and me, and that I could not be defined independently in this context.
- Second, preventive care, though widely heralded, is more abstract and difficult to enable in frontier fields like fertility. Since the case can be made that fertility treatment is not a medical necessity (so, insurers are not on the hook to cover it,) no one really cares about paying for infertility prevention.
- Finally, there is a normal and natural negotiation between doctors and patients about access to data and information. Doctors don’t want us to worry unnecessarily, a reasonable starting point for negotiation. But, in a world in which we can acquire as much information as our minds can absorb, at the click of our fingers, consumers will push to restore a balance in the physician-patient power dynamic. This will play out in many different ways in the years to come.
So, my OBGYN told me “no” to my fertility information requests. Anyone who knows me knows how I would react to such a response.
During that time, I’d started an entrepreneurial fellowship at Harvard to help spin out life science enterprises from the University. I was in the thick of feeling that my agency had been taken from me. Words like “arbitrary gatekeeper” and “paternalistic medical system” kept me up at night.
So, I approached a prominent chemistry professor at Harvard, George Whitesides, and asked if I could explore ways women might track their own fertility at home, without excessive intermediation, in his lab. He was wonderfully generous with his time, resources, and attention and encouraged me to go down this rabbit hole. To be sure, I started on this adventure to answer a keenly personal question.
One of the first impediments I encountered was that the amount of blood I needed to run the most interesting fertility assays was prohibitive. A finger stick didn’t provide enough material, and the biomarkers I sought were not readily assayed in urine or saliva.
By this point, you’ll know the punch line. It seemed less like an epiphany and more deus ex machina.
How perfect that women alone have a biological function that provides not just volumes of blood, but novel insight into our reproductive health. I couldn’t have contrived a better solution. Because of the access to unique cell populations and bacteria, we believe menstrual blood will prove to be a superior, not comparable, sample type for long-term fertility management.
And that’s what made this access point important to us: there’s a huge gap in how we manage our long-term fertility. The combination of societal trends and biological phenomena make it harder for women to have children if and when we want to.
A woman’s age at first childbirth has been rising steadily for decades. It’s inextricably tied to our educational and professional ambitions and to the economic output of our demographic. Society has acknowledged the importance of enabling and encouraging women to be a vibrant part of the workforce, but the associated support mechanisms currently in place are based on antiquated modus operandi.
If a woman begins family planning in her late 20s and early 30s, her approach to fertility management should evolve with her lifestyle. It now becomes important for her to track the natural senescence of her fertility, so that she is not caught unawares. She also should check herself for communicable diseases like chlamydia, which sound no alarm and, over time, can ascend her reproductive tract and lead to damaging conditions like pelvic inflammatory disease, a precursor to infertility. Non-communicable diseases like endometriosis, if unchecked and untreated, can devastate a woman’s fertility prospects, too.
Outside of fertility, there is the grave fear of mortality. The burden of receiving a HPV-positive diagnosis alerts women to their increased risk for cervical cancer at some point in her life. But when? Inheriting BRCA1/BRCA2 mutations predisposes us to breast and ovarian cancers… again, we ask ourselves, when? The value of early diagnosis for cancer is clear. I don’t have to belabor that point. Tests like the Pap smear have borne out the promise of screening and early detection.
But, how can we create a system that meets the nuanced and demanding design challenge of tracking all of a woman’s reproductive health concerns? A system that has a chance in hell of capturing nascent or asymptomatic conditions, or tracking a woman’s health closely enough to help her reconcile her family goals with her career goals, would have to be used consistently and frequently. It would have to have high compliance and require minimal behavior change.
Again, you’ll guess the punchline here. The final benefit of a tampon-based testing system is how it integrates into a woman’s life and around habits that, for many women, are unavoidable.
At the onset of this process, we were nervous about trying to fit into such a complicated system. Trying to help women with long-term fertility management means trying to detect and track many things, since fertility is inherently multifactorial. But, if one finds a unique position in this system, it’ll be nearly impossible to be dislodged by an alternative. So, we push forward.
The final take-away is about appealing to your constituency on a very primal level. Stephen and I debated for months about whether we are a product company or a services company, and what we offer to our customers.
We debated the merits of first pursuing STIs, developing the first non-invasive diagnostic for endometriosis, or helping women understand their risk for pre-term labor.
In the end, we realized that we offer a single product to women: peace of mind. That is our primary product. Everything else is technology we’ve developed to support that offering. We can decide which supportive technologies we bring to market first, but they all serve to reduce the anxiety of our customer base. This messaging resonates with women of all ages, ethnicities, and socioeconomic backgrounds. We all want peace of mind.
At our core, we are not a biotechnology company masquerading as a lifestyle brand; we’re a lifestyle brand backed by biotechnology.
We want to be with you from your first period, to your last, and beyond.
This is a picture of Stephen and me at the end of my fellowship. We’d just reviewed my fertility biomarker data, were unfunded (why we’re drinking $3 wine), were burning down our savings, and were trying to put together our value proposition. He asked me if the year I’d just been through was worth it.
I answered him honestly and said “yes”. It was worthwhile because I had gained peace of mind. But, I was also troubled because, at that point, our idea did not scale beyond me or beyond that moment.
But NextGen Jane hopes to change that.
As I mentioned at the start of this talk, NextGen Jane’s smart tampon is deeply personal, has found a uniquely compelling position in a complex context, and appeals to its main constituency on a very primal level. I hope it appeals to you, too.
We want to give all of you a chance to ask the questions that plague you, and help you find the answers that give you peace of mind.
We are developing a product which can help you understand what your body is trying to tell you and reveal important…www.nextgenjane.com