Show notes
There’s this kind of pattern you can see sometimes, when you dig behind very successful projects, a lot of times there is some woman who is dead set on making it happen. And for a lot of them, she’s working behind the scenes and you don’t find out until you get real close, what’s really going on. But occasionally you meet these women who are badass leaders that are so dogged that they’re going to make something happen by force of will. And I’m always honored to get to meet them. Today we get to spend some time with Saundra Pelletier, the CEO of Evofem Biosciences. This is a super fascinating company that is dedicated to creating medical and healthcare products for women. You don’t find a lot of companies focused on that, which is sad because women are the ones who drive a lot of the healthcare decisions for their entire families. So I don’t understand why the market hasn’t picked up on that one. I think you’re going to love Saundra. She’s created a product at her company called Phexxi. It is the first and only FDA approved, non-hormonal contraceptive gel for women. They can use it anytime on demand whenever they want. This is the kind of product that is really important to change the balance of power and determining who ends up procreating and when. We want that control to be in the hands of everyone, but in the past, a lot of the responsibility has landed on women and, they’ve been given, in some sense, relatively crude tools to do it. Most women in America at least are using a hormonal contraceptive, which has a lot of additional health side effects. As Saundra will tell you, she developed late stage breast cancer. She survived through a double mastectomy but the doctors told her the only real reason that she probably had cancer, in the first this place was being on a hormonal birth control for 20 years. Lots of stories like that, that you probably know and have heard with your own friends and family. So I think this is a very important project. This type of advancement in a technology that changes what humans can do, when they can do it, who has the decision-making power is important. We have a lot of options here where I’m at, but when you look globally at what’s happening with contraception in other countries especially in the developing world, there’s a lot of social stigmas that affect what women can get away with when they’re trying to find contraceptive choices. Giving them some options is paramount, not just because I would like to see population managed in a more thoughtful fashion. And hopefully create a few less humans that we don’t have a plan for, but also to give them the ability to choose when the time is right, who the right partner is, what they want to do, and not have to subject themselves to the entire weight of society’s idea about what they should do with their lives. That’s important, I believe for humanity as a whole. And so I’m really excited about Phexxi getting some support. Evofem Biosciences is publicly listed. So I certainly don’t want to give anybody investment advice, but these are some folks who could really use some help. And if they can get enough support for this company, they’ll be able to take Phexxi around the world and that’s gonna make a big difference for a lot of people. I hope that you guys love this very soulful conversation I got to have with Saundra, and I’m thrilled to be sharing her with you. Pablos: What I’m really excited about here is that I think the things that matter in the world for humans to do is how we’re gonna evolve as a species. How we are going to keep going? How are we going to make it possible for more lives to exist? And but also for those lives to thrive in some sense, right? And when you look at what has worked so far in all of human history, it’s humans inventing a new technology, bringing it into the world, solving a problem at a bigger scale, and being able to advance the species. That’s really how we got where we are and we’re not done…we might be done. But we might also be able to effect our fate go forward. And so it is super exciting to me because, one of the biggest problems in the world in some sense is that we went from millions of people on this planet just a couple hundred years ago to billions of people in the last 200 years. 7 billion in 200 years. And we’re making a lot of extra people. It’s not totally clear that we need them all, but I’m not going to tell you which people are extra. I just think that it might be smart for the species as a whole to figure out if we want to course correct on that a little bit and maybe in the future make a few less. And maybe less but better people would be a goal. But anyway so I know Evofem is…I don’t know if you are fixated on contraception. Is that the only thing guys trying to do or want to do, or is that just the main thing where you started? Saundra: That’s the main thing where we started. I will say this to your comment. I just want to tell you this, that not only do I find your opening statement provocative but I actually believe that one of the biggest levers to poverty elimination, as we evolve is for women being able to choose when and if, and how often they have children. Access to contraception that they’ll use is a huge poverty eliminator. So yes, contraception is our beginning. But we also are in late stage phase three development for the prevention of chlamydia and the prevention of gonorrhea with the same product. Which by the way, the CDC has said they are on the rise for the sixth year in a row. And gonorrhea, it’s an epidemic because it’s antibiotic resistant. So we’re really leaning into innovation. And that’s why it’s so cool. We’ll pick this all apart, but just to get the audience up to speed, why don’t you describe the product you have Okay. So the company Evofem Biosciences, the whole platform is innovation for women. And that might sound like great words, but we are delivering. So there has not been innovation in the contraceptive category in two decades. So our product is called Phexxi, not just because it rhymes with sexy which is a nice attribute. So here’s it works: it is a gel that comes in a pre-filled applicator. And I know your audience is hearing us, but I’m going to show you. A prescription is a box of 12 pre-filled applicators, and you put it in right before sex or up to an hour before sex. Now women have used tampons. It’s scary to guys. It might be scary to guys, although I will tell you… But the guys will get to use it. Not only that but guys really love the fact that this is very lubricating. So if any woman has vaginal dryness or pain with intercourse. But here’s how you see. So 5 mLs in each applicator. Is that the whole dose? That’s the whole dose. Okay. So what I’m seeing is like a size of three or four jelly beans worth of gel. Yep. And you can feel it. And it just feels like Vaseline or something. Yeah. And the gel is just so you know, it’s lactic acid, it’s citric acid and potassium bitartrate. And here’s how it works. So a normal vaginal pH is 3.5 to 4.5. When semen enters the pH goes to seven or eight, and a woman gets pregnant. When chlamydia enters and when gonorrhea enters, the pH goes up to seven or eight and a woman gets a sexually transmitted infection. So what Phexxi does is it is acid buffering. So it helps the vagina just maintain normal vaginal pH inhospitable to semen and inhospitable to STIs. It keeps it low. Correct, so there you have Phexxi. So just like men who have had condoms forever. So for example, you could go out with a condom in your pocket and can have safe sex, but women have had to use a hormone every day, every week, every month, year after year. And the side effects… Doesn’t it seem like a lottery winner for the few women who take the pill and don’t have a problem? Yeah. Without question. Want to hear something crazier? I say the worst trick played on women is that most hormones lower your libido. So they’re taking a drug every day that makes them not want to have sex. And they’re having side effects of headache and weight gain and bleeding. And the one crazy part is that I talked to a lot of young women and they say to me, they were put on an antidepressant or put on an anti-anxiety product. And then when someone really looked at their levels, they realized it was their hormonal birth control. And once they got off of this hormonal birth control, they felt normal again. Yeah, I’ve experienced that multiple times as a close observer. And by the way, women don’t have sex every day, which you may, or may not have experienced. But like seriously for example, would you take something everyday if you were having side effects that you didn’t even need to save your life. Well, men don’t have to do that, but I get your point. Okay cool. If I’m using this, can I also use lube? Yes. You can use lube. You don’t have to use a condom. Like any contraceptive it says it can’t protect you against HIV. But the wonderful thing about this product, are you ready for this? So in the United States, half of all pregnancies are unplanned. So I want you to imagine that the pill was introduced, even now. There’s 18 categories of contraception. They pill came out in 1960 and still all pregnancies are unplanned because 23 million women identify as saying, we are not going to use a hormone. We’ve tried pills, patches, IUDs . We are beyond hormones and they say stuff like, look, I don’t have hormones in my milk. I don’t have it in my meat. And I joke and say if chickens can be hormone free…come on! Why do women have to put up with hormones? So these women are saying like, I do yoga and Pilates and eat healthy and I care about my longevity. Why am I going to take a synthetic hormone? It doesn’t make sense. But 23 million women is our target audience and those women are without question very engaged. They are ready to go. Yeah. A of times these technologies, we take them for granted because it’s what we’re used to now, but that’s just the best technology we had at the time. Fucking with your hormone cycle was the best technology we had at the time. Now we can do better. This is an example of being able to do better. And it seems remarkably straightforward. I’m looking the box it has the ingredients listed. And by the way, I joke that like I could make this in my garage. I don’t, but it was originally developed by Rush University in Chicago. And when they developed it as a vehicle looking to do HIV prevention studies. So at the time in the early 2000s, there were a whole bunch of academic institutions who said, we need to find something for HIV prevention. But those studies are very challenging, like in South Africa with vulnerable populations. And so the majority of those failed. So what Rush University knew this product is considered to be something called an MPT, multipurpose prevention technology, which means has the capability to continue to look at areas. So contraception, sexually transmitted infection, bacterial vaginosis. So they knew getting to market as a contraceptive would be the quickest way to get it approved by the FDA. Okay. So we’re going to play all the legal disclaimers for this, but we’ve got this thing approved already as a contraceptive and it’s on the market. If you want to buy it, you can get it at a pharmacy or where? Yes, you can go to https://phexxi.com/. We have a concierge, or you can go to your doctor, and they can give you a prescription, but if you go to our website, you can it mailed to you within 24 hours. Okay, cool. And then the way it works is you install it using a tampon. Yeah. And throw away the applicator. Load it up and throw it away. Yep. You’re good to go to have sex and get started within an hour. Correct. Yes, as long as you put it in right before or within an hour. What if you’re an all night operational? Well, you got to use it again. Good for you by the way! Okay. And then you’re currently working going back and doing trials for some other benefits that it already provides, but aren’t already approved and aren’t already proven and phase three trials, whatever. So that’s the work now? That’s correct. And then what hope to show with those is? The prevention of chlamydia and the prevention of gonorrhea. And just to give you an indicator of how pervasive those are: in the U S there’s 1.8 million cases of chlamydia annually, and 600,000 of gonorrhea. And for the sixth year in a row, the CDC has said both of those are on the rise, is antibiotic resistant and literally there are no products approved for the prevention of either of these. And look, I want to tell you why some people say to me, why the hell, hasn’t a bigger company with a lot more money done this? And I say, look, number one, it’s easier for them to just come out with a lower dose of hormones. So they’ve got something and they come out with new ways of giving you hormones. And by the way all it is that women aren’t stupid. Come on. They understand that it’s still a hormone. Just because it’s in a patch, doesn’t mean it’s not a hormone. Just because it’s in an IUD, doesn’t mean it’s not a hormone. So they come up with lower doses because it’s cheaper and quicker. But we have really taken the heart painful work of developing this new innovation. But the good thing is that the year, the FDA has given us a fast track review for chlamydia and gonorrhea. So we’ll have a six month review instead of a month review. So we’re excited about that. I have to be honest right now we are getting so much positive response from women on this product and that is phenomenal. So let me ask a couple questions. If you get through all those trials, then the same product will be approved and could even be prescribed in some sense. Yes. If maybe if you don’t care about like I got fixed, but I am excited because I still get to use this product Yes. And women who cannot get pregnant, they can still use it to prevent chlamydia gonorrhea. Yeah. Or will be able to. And I think one of the things you mentioned that I think is important to point out is a barometer for whether something is worth developing, whether it’s a good idea or whether it’s gonna work or whether it’s any of those things is not whether or not existing medical technology companies who got around to working on it. That is not a good metric because, I think one of the things you alluded to earlier is the market, that they go after 23 million women in their minds probably isn’t enough. And maybe partly because it’s only 23 million and partly because it’s women. And so we’ve got to find a way to change those dynamics and show that this is a viable market. We’ve gotta be able to show that we can make products that are profitable in that market. And that seems like the more pioneering thing that you’re doing as a company. I have to tell you, I love you for saying that. Because you gotta think about it this way, right? When you really evaluate, women are really the healthcare consumers for themselves, or their husbands, for their children, for their parents. When they get older. If you can get the right positive lever in a woman’s mind as a company, right? A woman trusts you and thinks you really care about innovation: 1) They are the consumers and 2) to your point, they’re half of the population, but 3) so little innovation is introduced to women. I have gotten a lot of investors will say to me, if it’s not immuno-oncology, diabetes is man and women, heart disease is man and women. This is just and women and we don’t know if we’re interested. And I say, listen, I want to remind you’re here because of a woman. And at the end of the day, when a woman’s quality of life is better because she feels better. She doesn’t feel a little crazy because she has a synthetic hormone in her body and when she doesn’t feel that she’s suffering every day. You know that whole adage, when mama’s happy, everybody’s happy? This product is so important because women now are more empowered than ever. And they’re sayi…
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