Heather Bowerman is on the brink of launching the first saliva test for endometriosis, a condition that affects 176 million women worldwide. Normally diagnosed via a surgical procedure called laparoscopy, Bowerman's team at DotLab developed an innovative test that replaces the invasive procedure with a simple saliva sample. An emerging presence in healthcare, Goldman Sachs named her one of the Most Intriguing Entrepreneurs of 2017.
Leaping from bioengineer and biotech investor to now CEO and co-founder of health tech company DotLab, Bowerman spoke with us about their technology and how the company plans to ease the uncertainty around endometriosis testing for women.
Sherrell: Talk about DotLab’s origins and why you’ve decided to zero in on the endometriosis disease.
Bowerman: I studied bioengineering in college and went to UC Berkeley. My first job after college was working for a large investment firm in New York where I led acquisitions of biotech and diagnostic companies including one of the first tests for H5N1 and H1N1, Swine Flu, and Bird Flu—I was really interested in diagnostics.
After working at that firm, I moved to Boston and worked with another small firm that partnered with earlier stage companies, and then became a McKinsey Consultant. I think that what stood out to me was that through all these experiences, I learned a lot about building companies and about diagnostics, but I always wanted to build something specifically in women’s health.
I noticed that there are chronic reproductive conditions and diseases where clear protocol for how to investigate was just not well established. Particularly for endometriosis, the average time for diagnosis in the US and around the world is 10 years, and the average number of physicians that women see—while they’re trying to get a diagnosis for a disease that’s so common and affects so many women—still averages five separate MD visits, seeing different doctors each time in order to get a diagnosis. It really requires an amazing amount of persistence and access to those resources when, at the same time, endometriosis is a top cause of infertility and chronic pain.
Forty percent of the one-in-ten women who have endometriosis are infertile, which is so many women! I teamed up with my co-founder [Dr. Hugh S. Taylor]—who is a key opinion leader in this space—to develop this test, and we're really excited to be able to take it to market.
The product specifically calls for saliva to begin testing for the health issue. How is this possible when laparoscopic surgery seems so precise?
This call with you is very well timed because we’re presenting our new “Perspective Study” at the largest conference for OBGYN, which is called ASRM (American Society for Reproductive Medicine). That conference is coming up at the end of this month, and we’ll be revealing our Perspective Study for the first time that goes into detail about our methodology and testing validation.
But in summary, laparoscopy is the only way to diagnose endometriosis, which is to say, surgery is the gold standard for diagnosing the disease. So what our lab did was to measure the quality of our biomarkers and compare it against women to have actually had laparoscopies, and they were consistently on par.
How does distribution work in order to get to you target users? If I wanted to use the test, would I have to first make an appointment with my doctor?
For the purpose of what we’re offering at launch, the initial audience is physicians who will prescribe the test to patients, so the same way you’d prescribe any other test, the doctors would make sure that patients get access to this summary. The test itself (the saliva test) is shipped to the patient's door and then she spits in the tube and mails the sample back to our centralized lab so we can process the sample and share the results with her physician (and her).
What are you hoping patients will do after receiving their results and diagnosis? How will the DotLab technology affect their decisions around therapy and treatments for the disease?
This is an important question. I like to start by thinking of women who have chronic pain that is currently untreated. So say there’s a woman with untreated pain, the first kind of therapy for endometriosis is an oral contraceptive pill. For a lot of young girls—young teens who perhaps just started menstruating—going on the pill is actually a scary thing and a [tremendous] family decision, because the pill can have serious side effects. For the young girl, [her results] would be giving her the confidence to know why she's experiencing pain and to go on the pill and see how she responds to that initial therapy.
The next scenario would be if you’re testing a patient who’s already on the birth control pill and still has pain. Our test can identify who’s failing on the pill and therefore eligible for a second line of therapy. If the pill’s the first line of therapy and she’s already on it, after the test you could choose to offer her a second line of therapy which would be a discussion with the physician but could include any of the treatments for endometriosis that are already on the market.
Let’s talk data. You’re collecting an interesting sampling of women’s DNA to survey various biomarkers. How are you using this information in the long-term?
We’ll continue to run clinical trials and studies in order to deepen the understanding of the biology of endometriosis. [The disease] is so complex and common that there’s great opportunity within this single disease, but because it’s an inflammatory condition, it's related to so many other conditions, and many of those links are poorly understood right now.
Examples would be autoimmune diseases such as rheumatoid arthritis, women’s cancers, or cardiovascular disease in women. These are all known comorbidities of endometriosis, and with our data around who has endometriosis and how she’s responding to different therapies over time, what I can share at this point is that we’re definitely interested in contributing to medical knowledge as that dataset grows.
Let’s talk about your company as a whole. How many employees do you have? Where did you start and where would you ultimately like to end up?
We have a medical team and a product team and we’ll continue to hire more people on both. We’re currently at about 10 employees and both teams will be growing in the near future.
We do have the team in place to support our launch. As far as goals, I think the first goal we have post-launch is to work on the Physician awareness piece about our test and to make as many OBGYN’s as possible aware of the test to prescribe it and/or order it for patients and build upon that going forward.
Describe the interplay around data collection and how the DotLab technology fosters engagement between patients and physicians.
Because it’s a medical grade test—not a genetics test that predicts how likely you are to develop endometriosis, it’s actually confirming the presence of active disease, which is really different from a medical standpoint—working with the physicians is really important to us. But at the same time, because it’s such an easy test, all the physician has to do is make sure it gets ordered for the patient. We have a physician portal and patient portal to support the ordering process and results sharing. So the idea would be that if a patient has been diagnosed with endometriosis and tests more than once, she can see a graph of how her results over time and see how she’s either stabilizing or progressing.
In having the surgery, it’s not the case that it’s more harm for everyone, but it is real surgery that can have serious consequences. The fact that you have to go through that to get diagnosed is exactly what we’re trying to solve for.
In your opinion, why have alternative options for endometriosis testing taken so long to evolve?
I think there’s a multi-factor answer or scenario as for why we haven’t moved forward in the standard of care for this disease. I think one [reason] is the complexity of the disease itself, because the biology is incredibly complex and the hunt for biomarkers has been pursued by many labs around the world. We’re not the first to try to solve this problem, but we are the first that has what’s called “sensitivity and specificity” of the biomarkers at the level that makes it a diagnostic test.
So part one [of the lack of options outside of surgery] is the complexity of endometriosis, and part two is the fact that women’s health is unique. I think a lot of women’s health conditions, certainly including endometriosis, just often doesn’t get the attention that it deserves from various stakeholders in health care. We feel optimistic that it’s changing and it's definitely something that we’re interested in helping to push forward.
Thank you to Heather Bowerman for discussing the start of DotLab and how it's aiming to reshape testing for a complex and all-too-common disease. To learn more about Heather, please click here. For more on DotLab and all they offer, check out their website by clicking here.
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