Just under 30 years ago, US Congress passed the National Institutes of Health (NIH) Revitalization Act which mandated the inclusion of women in government-funded clinical research¹. It formally rescinded the 1977 policy that excluded women from participating in medical studies and recognized the widespread gender bias in healthcare research¹. Yet, today women are still grossly underrepresented, and predominantly male-skewed data continues to represent medical solutions for everyone.
As the healthcare industry begins to take advantage of novel technologies such as artificial intelligence (AI) for solutions from drug discovery to patient care, there is a real risk of perpetuating fundamental gaps in our health data and amplifying long-overlooked biases which continue to leave major knock-on effects for both the medical practice and the health of women.
These issues in the healthtech development space are beginning to be examined. In recent years, more women’s health pioneers have driven data collection efforts. A new crop of startups are leveraging connected devices, wearables, and at-home testing to close existing gender data gaps and ultimately use the data to develop and implement evidence-based solutions for these underserved groups. Femtech is still in its early days, but as more light is shed on gender inequalities within healthcare, my hope is that we will begin to see new, inspiring innovators and entrepreneurs look at women’s health as an opportunity to challenge the gender inequalities that exist today.
Fundamental Gaps in Women’s Health Research
New policies are beginning to address gender bias in research. However, many do not mandate real-world benchmarks for women participation and do not cover private research, which includes clinical trials completed by pharmaceutical companies². The industry as a whole is still catching up, and we continue to see gaps in the system that leave women out of the data:
- Women are routinely excluded or under-represented in the cells, animals, and humans studied in biomedical, clinical, and public health research, meaning their conclusions are not always applicable to women. These gaps are prevalent across medical conditions. A 2010 study found that male bias was evident in eight of 10 disciplines, and most prominent in neuroscience, with single-sex studies of male animals outnumbering those of females 5.5 to 1³.
- Few studies sex-disaggregate research, or analyze and report male and female data separately and explore the role sex may play in outcomes. In biomedical research, almost 70% of papers in 2016 did not report the sex of study samples⁴.
- Women’s health issues are poorly researched. In the UK, less than 2.5% of publicly funded research is dedicated solely to reproductive health despite the fact that one-third of women suffer from reproductive or gynecological health problems⁵.
Why has Women’s Health Been Neglected?
Historically, women were viewed as a deviation from the ‘universal model’ of the human being. Science and medicine tend to view the male as the baseline and the template against which bodies react to drugs and are judged. Factoring women into studies has historically been avoided due to fears that reproductive cycles and hormone fluctuations could complicate the variables⁶. Accounting for varying hormone states was thought to prolong and increase the cost of the research process. Additionally, women of ‘childbearing age’ were, well-meaningly, excluded in drug trials in case the side effects impeded their ability to reproduce or proved toxic for their future fetuses⁷. This ultimately excluded all women, regardless of their preference and choice to reproduce.
Additionally, women need to be a part of leadership conversations to ensure diverse perspectives are heard and included when AI health innovations are developed, tested, and evaluated. Few women advance to leadership positions in the overall medical community. Just 19% of hospitals are women-led, women hold only 13% of CEO roles, and they make up 33% of senior leadership positions in the healthcare industry⁸. Historically, men disproportionately occupy the majority of seats at the decision-making table, the implicit biases, that plague all humans, can come into play leaving the female perspective, body, and needs as an afterthought.
Consequences of the Data Gap
Failing to study women can have serious health consequences, such as:
- Drug side effects: A one-gender-fits-all solution has caused women to suffer adverse side-effects at a 50–75% higher rate than men. Between 1997 and 2000, eight of 10 prescription drugs that were recalled in the U.S. were removed because of differences in side effects and health issues in women⁹ ¹⁰.
- Delay in care due to ‘atypical’ symptoms: Unintended knowledge gaps have led to diseases being misdiagnosed. For example, heart disease research was historically conducted on male subjects. Women were 50% more likely to be misdiagnosed following a heart attack because female symptoms mimicked indigestion and not the ‘typical’ symptom of chest pains experienced by men¹¹.
- The disparity in research funding has left women-specific conditions underdiagnosed or under-treated and has ultimately led to slower innovation in the space. For example, endometriosis, a disease that affects one in 10 women, can only be diagnosed with an invasive laparoscopy surgery that hasn’t changed since the first one was performed — over 100 years ago¹².
Looking forward, to ensure technology does not amplify the historical male bias and its consequences, healthcare innovators must be thoughtful and critical of data’s roles inside their systems, and how data creation can better reflect our larger community.
Ushering in a New Wave of Women’s Health
To design AI that eliminates bias, action must be taken to collect sex-disaggregated results and data on women in general.
Luckily, in the past few years, the momentum has increased for technology-driven solutions in women’s health and femtech. In particular, taking a data-first approach is in the DNA of many of these companies, which have been propelled forward by the widespread adoption of mobile apps, wearables, and at-home testing devices and kits.
We saw ‘femtech 1.0’ data companies spring into action with self-managed tracker apps, particularly around menstruation and pregnancy, which allowed women to collect their personal data points with the goal of gaining more clarity on their health. These companies validated the interest women have in measuring their personal data, the existence of a data gap, and the need researchers demonstrated for this information. For example, the popular period-tracker app, Clue, which has over 10 million users, has been collaborating on several women’s health studies with Columbia, Oxford, and Stanford¹³.
These applications have set the precedent for the second wave of women’s health data technologies that are pushing beyond wellness and activity-tracking. Today, we are seeing healthcare entrepreneurs move towards marrying qualitative and quantitative data from connected devices, wearables, and remote monitoring/testing that has resulted in advancements in human biology. This robust, real-world data has the power to enable a comprehensive understanding of a women’s body, but also to turn data into concrete solutions for primary care, enable new diagnostic methods, and allow for faster conclusions from clinical research.
Just as important, these companies are tackling opportunities through all of a woman’s life stages.
A number of start-ups are looking to contribute to sex-disaggregated data in gender-neutral health conditions. For example, companies such as BloomerTech has created a “technology that is embedded into women’s bras to read metrics such as the electrocardiogram, pulse rate, respiratory rate, heart rhythm” designed to tackle the gender data disparities seen in cardiovascular disease and ultimately provide personalized care for women.
Others are working directly with their users to tackle areas that are women-specific and build unique datasets to unlock new methods in prevention, diagnosis, and treatment where research and data are sparse.
- NextGenJane is working towards diagnosing diseases using menstrual blood. By leveraging the genomic signals from the cells found in menstrual samples, which they collect from used tampons, they hope to find early markers of endometriosis and diagnose the condition in a non-invasive fashion.
- Juno Bio is working to “decode the vaginal microbiome” — the microorganisms and bacteria found in the vaginal tract. The team’s research is a vital step in helping the medical community understand the microbiome’s relationship to women’s health, from bacterial vaginosis to infertility. This research could allow the team to identify a more effective diagnostic and develop therapeutics that can be personalized for each woman’s vaginal microbiome.
- Eli Health allows women to monitor their hormones with an at-home saliva-testing device. The team hopes to use this continuous, real-time data with learning algorithms to inform women on their fertile window for use cases in fertility and contraception. The ability to monitor multiple hormones allows the team to unlock solutions across various health conditions (ex: menopause, migraines, or menstruation) that are driven by hormonal fluctuations.
The current momentum for data-first femtech companies is a step in the right direction. These companies are contributing vital data that ensures women and women-specific symptoms do not get left behind from technology advancements. The potential to transform the healthcare system for women starts with founders and leaders who are optimistic and determined to overcome the stigma and historical bias in the industry and create a more representative system.
Time to Start Creating…
Today, the pace at which healthcare companies are adopting novel technologies such as AI is as much a challenge as it is a catalyst. Many innovators, scientists, and technologists are poised to take this unique opportunity to solve the gender gap disparity and help shape the AI healthcare space with equality in mind. Start-ups and founders that are studying sex differences in health and building unique datasets on women’s health are paving the path for a holistic understanding of all of the elements and data that play a role in a woman’s body.
Company creation is just the beginning. To further propel initiatives and solve these problems, investor support and resources will be vital. Dollars signal to the market that there is an opportunity in this space, and also demonstrate to innovators that there will be support for those who can leverage technology to advance healthcare for everyone, equitably.
If you are one of these fantastic entrepreneurs working in the women’s health space or just want to chat to learn more, please reach out at email@example.com!