International Women's Day interview: Addressing the balance of women in medicine, research and clinical trials

Sanskriti is the chief growth officer for Medable. She’s spent the last 25 years in life sciences. Half of that time has been in industry, the other half in consulting. She also sits on the World Economic Forums Future Council for Women's Health, as well as digital health. She is very passionate about women’s health and is speaking out for change.

We all know what happened in 1977, with thalidomide and the effect that had on women and babies but also the effect it had on women in trials in general. I'm wondering, how far do you think we've come in the last 25 years and what is there still to be done? ​

At the surface, it comes back to how we make medicine. And the reality is until about five or six years ago, we have been under the orthodoxy of a model for medicine that ages about 100 years. And so ultimately when we think about women's health, it's also about women's economic prosperity, it's about the health of our children, it's about the development of communities. Overall, I'd like to encourage people to think about women in clinical research or women as part of making science as a leading indicator to the outcomes for women's health.

If it takes us 10 years to make a medicine and we don't bring women into the making of that through clinical trials, then 10 years later the outcome is negative. And we know that today, even though women represent 51% of the US population, about 40% get invited to clinical trials, even fewer complete clinical trials.

And the ultimate outcome is there are about twice as more adverse reactions to medicine for women in the current population. Ultimately that means even though two thirds of the 5.1 million women are currently suffering from Alzheimer's disease, we're probably not going to have optimal medicines for them as we age. Ultimately chronic diseases show higher prevalence in women and still that means we will not have optimal medicines for women. So, in addition to the overall gender parity gap, I still do research on this, it's going to take us 132 years or something to ever reach parity. Given how many factors affect parity, health is a number one factor of that. So, when I think about clinical trials, we treat the global population, but if we don't make medicines for women, it doesn't matter for women. It's not as bad as I think as it sounds, even though the outcomes are shocking.

Because while we can serve the US population fairly equitably, especially given new policies and we can see forward-looking impact the global population, a large majority, two-thirds of women, are left behind. We don't have access to medicines; therefore, they won't have access to clinical trials, therefore medicines won't be made for their ultimate needs. So, I think that we must be profoundly aware of this problem. I think that it is a problem that is getting solved in first world countries slowly, but it is a problem that is nowhere close to being addressed in the global population.

So going back to what happened all those years ago and obviously there was a justified response to women being included in and taking part in trials - everybody was full of fear. That was a long time ago. Do you think that fear still exists in women and is it a contributing factor? ​

If I could use an analogy, think about COVID for a moment, the world stopped and every part of the scientific community turned their investment to vaccines. Very few people know that the number one impact was on family planning, on women's services, on maternal health. The things that we stopped spending on were equally as important as the vaccine. We pivoted all our investment to vaccines, and we dropped some of the core fundamental women's family health concerns. To this day we haven't recuperated the services for women globally in the amount of spend. That's something to think about. Why do women lack trust? Why is there fear? Ultimately if we knew that, how many women are aware or are educated as to the outcome? If women were aware and educated, there are plenty of women whose voices could carry change, but this is not a topic people talk about.

And I think that is the biggest foundational problem. The investment in women's health is the lowest dollar investment across science. Why is that, when every child born is an outcome of a woman? It is shocking, but people don't talk about it. I sit on boards for VC funds that invest in women's health. The amount of dollars that go into women's health, early-stage dollars, is so far fewer, even despite the femtech revolution, than broader healthcare technology. It's a leading indicator that, again, the future of technology is likely not to be distributed towards the outcomes of women. So, in answer to your question, I think when the reality is made clearer, when the dialogue is made available to women who are now in many parts leading the world – and that is true, leading the world with open voices, leading social media, narrating the dialogue, yet they're not aware of these realities.

How is it that educated women who take the stage every day do not speak on these points? So, I think if there was education, I think if there was awareness, I think that if women would not be afraid, there would be change.

I think ultimately also the 50s, 60s and '70s were very different times for women. The lack of education in science and medicine created a lot of fear. The fact is, 60% of people with psychiatric disorders are women and it's shocking how they used to be treated, how they were used as tools, as scientific props to test dangerous medicines on. That doesn't exist today. Ethics has evolved, but ultimately if they were educated about these outcomes, people would make different decisions.

Talking about underrepresentation, you mentioned mental health being one, but we've got cardiovascular and cancer too. Why do you think these areas are so underrepresented for women?​

It's interesting because the numbers are not that great anyway. How do we know how many women are in clinical trials? Most demographics are not required when we do clinical trials. Most of the data comes from the United States Mission to the European Union (USEU) and it's not global. So ultimately the data isn't great. But when we talk about psychiatric disorders, 60% of people who suffer are women, but only 42% are in the trial. So, how is that equitable? It's not. We're not going to make the right medicines for women, we will not know how they suffer, we will not understand the side effects, we will not know how it interacts with their body, how it can implicate their quality of life, affects their work, if we don't ensure that that population is mostly women, if it's affecting mostly women. So, it's the dynamic of what is in real-world versus what we do to test.

So, in theory, if a disease has 50% of women affected and 50% of men affected, the best outcome would be to do research that represents 50% men, 50% women. But ultimately women live longer. 51% of cancer patients are female, but 41% of cancer patients in trials are female. So, there's always just too much of a gap. And now part of that is, is it a question of effort? Is it a question of emphasis? Is it a question of making medicine more trustworthy and accessible? It's all of that together. But it is perhaps the only exclusion here is maternal health. So, we would only find equitable clinical trials in contraceptive trials, et cetera, but even there when we look at what is equitable, we must represent the right diversity.

We must represent Asian women, African American women - ultimately this is about longevity. This is about quality of life. How can a woman break a glass ceiling if she's already not given the chance, but then ultimately her health is impacted further on top of that? So not having the services, not having the healthcare, not having the right medicines for women is an overall decline of their ability to succeed in life and their ability to have healthy and happy families and a future.

What took you to Medable?​

I was last the head of life science research at Accenture; I was asked to run our COVID response. CEOs asked me, ‘where are we going to get patients in clinical trials?’ And the first thing I thought wasn't just about the patient, I thought about the mother of the children who's running her family, who's putting herself last, how is she going to make money and work if she has to take her child to a clinical trial every day? And the reality was that in that moment, because we were facing a global pandemic, people were able to make a courageous choice, which was to say, ‘let us rethink how we make medicine of 100 years late and let's apply new methodologies. What Medable does as a DCT company, decentralized clinical trials, is simply the application of appropriate digital science, digital methodologies, to clinical trials. And you could see the pivot for the world in that moment.

Nothing would have pushed regulators, CEOs of big pharma, people who are making money the same way for 100 years to do things differently outside of that. And ultimately for women, it is an absolute fact that women in every span of their life, whether they're CEOs of companies, whether they're executives, whether they're journalists, whether they're moms, whether they're working any kind of job, always put themselves last. And in doing so, regardless of trust and doing so opt out ultimately of the making of science and then the future of the healthcare system that is a byproduct of that. And so this ability to bring science, bring clinical trials, bring the making of medicine closer to a woman in her home where she exists, where she finds comfort, whereas their convenience is created, it's more than an enabler. It is a proactive effort to bring women into research and into science.

And until it becomes more a foundational methodology for the globe, we're still going to see women not making the choice to take care of themselves and not being able to invest, essentially it is an investment, invest their time into making medicine or being part of a clinical trial. This low participation of women in clinical trials ultimately exacerbates the chronic disease epidemic globally and the epidemic of chronic disease is 86% of the US healthcare expenditure. So if we just were able to think about why is it that we're making these changes? Why are we applying digital methods? Why do we care about women and children and their access to science? It's not just about the treatment. It's really about creating trust, building a bridge so that it's not so far away from people when it's so core to their foundational biology and their health.

Join us for the second part of the interview next week where Sanskriti discusses in more detail how women can be more encouraged to become involved by taking part in decentralized trials and the use of technology.