WEBVTT
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Unstable Vitals is the podcast that takes the pulse of American healthcare, and the prognosis is critical.
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Dr.
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Adam Brown and Dr.
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Laura Zibners, physicians turned entrepreneurs and business leaders.
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Expose why the system is unraveling before our eyes.
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All right.
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Well, hey, we've got another episode of Unstable Vitals.
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I'm just adjusting my seat.
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My seat was rolling back and moving all around, you know.
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But anyway, Laura, it's so good to see you.
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Good to see you.
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Happy Unstable Vitals Day.
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Is it Happy Unstable Vitals Day?
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Well, anytime we're on Unstable Vitals, it's Unstable Vitals Day.
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Okay.
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Happy Unstable Vitals Day.
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Sure, sure.
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Particularly unstable today?
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Um well, it's a I, you know, uh that was a long answer just in that pause.
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So, right?
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So it just kind of like that up.
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I got it.
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You don't have to say anything else.
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Yeah, I I went on I went on a vacation, or as they say, in the UK on holiday.
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And then um, that was lovely.
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It was nice, some good beach time.
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I wore my 50 SPF, folks.
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You gotta wear it, helps with wrinkles.
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So does Botox, but you know, um, but yeah, it did that.
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Yeah, so I don't even want to say what I use, but let's just say, yeah, disposable cash has its purpose.
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Of course, of course it's anyway.
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Okay, um yeah, and uh so that was nice.
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Um, but the instability, I'll just say it.
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I you know, you and I were talking about it earlier.
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Someone broke into my apartment, which absolutely feels crappy and sucks.
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You expect it from mice and rats, yeah, yeah.
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Well, you expect it in London, but yeah, but not like by a spider buzz bucket in a hoodie.
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I know, in a hoodie that we caught on camera on the Nest Cans.
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You know, we we had their full like UK CSI team.
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Okay, it was one lady, but like that came out.
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But she was real serious, she was very serious.
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And did she have a little checkered hat?
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She actually didn't have a checkered hat.
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And the constable uh who also came, we had two people.
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Um, he did not have a checkered hat.
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He did talk about a Bobby, you know, but he might have one of his Bobbies come by and check around, but which I don't really know what that is.
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But anyway, I think a bob I can say without a gun.
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They none have a gun, do they?
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Or I guess some of them.
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The police have guns here.
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We're not gonna be able to get a big we just like dart people in London, right?
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Like a license for it.
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Oh, okay.
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Well, so this guy had like a baton, whatever you call that.
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Um, had like you can tell I'm really, really tactical, you know, in my you know, boy.
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Were you in the special forces?
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Uh no, I was in the piano and Bible quiz team.
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Yeah.
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So I was on the Science Olympiad team.
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Oh, yeah.
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So it it, you know, it was a great holiday, but then came back to that.
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I mean, just what the just awful.
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So the worst feeling, it's so violating, it goes beyond just your stuff getting taken, right?
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Like I had my car stolen when I was in college, and there was part of me that was delighted because it was my mother's 1979 brown Cadillac that was effectually known as like the shitmobile.
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But when when she I was home for Thanksgiving and she gets this letter and she gets all mad at me, like, why'd you leave your car downtown?
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And I'm like, why would I leave my car downtown?
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And then it turned out it was left downtown with like no parts.
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And it was this horribly violating feeling of like, what did I do to you?
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What did you do?
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Well, yeah.
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Well, then but then you know, the other thing that's odd about it is what's very odd about it is it's not only the violating piece, it's then I feel like, well, what did I do wrong?
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But I was the victim.
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So like it's it's just kind of an odd thing.
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How dare you have a watch that somebody wants to steal?
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Steal, exactly.
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Is the Charlie Brown one you had in high school too good for you?
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No, it was a nice one that was given to me by my husband on an anniversary, so that was a big boo.
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But those things can be replaced, you know.
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It's what happens with age.
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We have these things happen to us.
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Yes, I well, I don't like to say like these should happen or do happen, but they do.
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So, but we will move on.
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Um, we will move on.
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But hey, speaking of moving on, we want to talk about our white paper that we are releasing or we have released.
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Here's a news flash.
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Just in case you're as confused as I was, a white paper is not white.
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No, it's not, right?
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It's I mean, it used to be and could be, I mean, with black letters and words, but on a white page.
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But you know, now white papers have gotten zhuzhed up a bit, you know, they're kind of depending on the intended audience, you know, they you want them a bit more interactive, you want them something that you can share.
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For serious stuff.
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Yeah, yeah.
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And I mean, you can write an academic white paper of kind of your own kind of research and pulling things together.
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And we did that.
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We we did that.
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We did that, but we wanted people to read it exactly.
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And so so we wrote about menopause.
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But we didn't just write about menopause.
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That's right.
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We talked about a little more nuance than that.
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You know, so here's the thing everyone's talking about menopause, right?
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Because it's important, and if it's something that all women who live long enough go through, we should all be talking about it.
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And we should be making sure that women don't suffer unnecessary consequences.
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And who do we have to teach in order to make sure that happens?
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Well, that would be our healthcare providers and our medical students at the very first point they enter medical school.
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And this is not a novel concept, right?
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So the European Menopause Society came out with um a position paper in 2022 with a proposed curriculum talking how important it is that menopause, you know, estrogen affects every cell in the body.
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And when your estrogen goes away, every cell in your body says, wait a minute, that's not nice.
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So we need to be teaches.
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So they they wrote a beautiful position paper.
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And I know that there's talk in the US about also incorporating menopause education into medical school, but we wrote about it from a different viewpoint, and it was one that I think you and I share, which is follow the money.
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Exactly.
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I mean, that's one of the things that we talk about on Unstable Vitals a lot is about the financial impact of healthcare to individuals, to like society, but also how finances drive decision making.
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And so, what's I think is very important from the business perspective of teaching about menopause and perimenopausal symptoms is that number one, half of the world's population, 51% of it, have menopause.
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That's more than half if we're gonna split hairs.
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That's right.
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So 51%.
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Number two, um, that's billions of dollars that could be a market accessible to innovators who want to treat menopause symptoms, that uh for people who want to come up with new ideas and ways to kind of fix some of the problems that happen with menopause.
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Um, but just to put a finer point on it, I think that if our doctors don't have actual curriculum that is teaching them about the signs and symptoms of perimenopause and menopause, then it's invisible to them in some ways.
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It's not something that they're going to try to innovate for and try to solve some of those problems.
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And so women are left in the lurch.
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And then financially, we are missing an opportunity as well.
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Well, so you know who got me thinking about how important it is to get menopause education at before doctors specialize?
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It's Jocelyn Whitstein who was on our Unstable Vitals year ago.
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She's a um uh one of the few female orthopedic surgeons in the United States.
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She's at Duke.
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And she said that, you know, after a hip fracture, the number one cause of the number one complication is urinary sepsis from a urinary tract infection.
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And the reason that women get so many is because of genital urinary syndrome of menopause, which is a lack of estrogen in the tissues.
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So she told her male colleagues when you have a woman who has a hip fracture, you need to be prescribing vaginal estrogen.
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Estrogen, right.
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What predicts the a fracture, the biggest predictor is a previous fracture.
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And if these women are having UTIs and they're waking up in the middle of the night and they're going to the bathroom, then they're gonna trip, and then they're gonna come in with another fracture, and then they're gonna die of sepsis.
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And her colleagues all said, fine, but how do we apply it?
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So that's that's become my running joke.
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Where, Adam, where does vaginal estrogen go?
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I think in the ears, correct?
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Like or in intranasal.
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It's the nose, yeah.
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No, no, okay.
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No, it's the nose.
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No, it goes in the vagina.
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Yeah.
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So that was the person who got me thinking about how important it would be if an orthopedic surgeon would know that his patient has osteoporosis and is therefore menopausal, and ask, are you on veginal estrogen?
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And we need to be starting this in hospital to prevent your urinary sepsis for the next fracture.
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We could save the healthcare system billions.
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Or if you're just referred to a patient who's osteopenic before, you know, osteoporotic before they've had a fracture, then that you get them on the prevention for the urinary sepsis with the estrogen.
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Like there's so many ways in which, because I don't know of a single specialty in medicine that does not treat menopausal women unless maybe you're a prostate surgeon.
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Oh, okay, fair.
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Um, I I was like, prostate women do not have a prostate.
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No, they are the only ones I'm exempting from the curriculum.
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Yeah.
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Well, okay, so we wrote about the business case for integrating menopause education to medical school curriculum because it's really two-sided.
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There's kind of like the potential for savings.
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There's the savings of if we identify and recognize symptoms of perimenopause, menopause, we treat those symptoms with estrogen, hormone therapy, et cetera.
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Um, if if doctors, which only about six to seven percent have had really any formal education around menopause, if we if we educate doctors and get them more comfortable in treating it and knowing the evidence that is there, the evidence-based practice, we can prevent some diseases.
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Like you talked about osteoporosis, hip fractures, um, cardiovascular disease, immobility issues.
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There's like a lot of preventive type things.
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But but there's a flip side.
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Yeah.
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And this is if 51% of the market goes through menopause, and we're trying to come up with pharmaceutical improvements, medical devices, et cetera, there's a business opportunity.
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So there's a savings and a revenue opportunity for innovators as well.
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And so we thought about this from kind of this two-sided two sides of the coin that you can prevent a lot of issues, and also you can potentially make money as well.
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But but doctors need to know the information.
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I'm gonna make it a three-sided coin.
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Have you got a three-sided coin?
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There probably is more no, that's probably next in our government.
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Anyway, we also looked at a lack of waste because there's something like$4,600 that's wasted per patient per year, just in women going to the doctor, and the doctor's like, I don't know, have an EKG for your palpitations, not thinking this is menopause.
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And that waste translates right into the workplace, right?
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Where women are afraid to take time off of work because of symptoms.
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You know, the compared to Europe, actually, women miss a lot less work, but it's because we don't have a national health care service.
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So we have private insurance, you have to go to work, but there's a lost productivity, and when women are told they have to go to work or leave work, they leave work, and that has impacts on our GDP as a nation, right?
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So there's there's savings, there's opportunity, and then there's prevention of waste.
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Yeah.
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So great three-sided coin.
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You like that?
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Um, I do like it.
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Um, I do.
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Um, but you know, so if we look to the menopause market alone, some estimate that by 2030, it's anywhere between 17.8 to 24.3 billion dollars, with the United States holding the largest share.
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And some of that is not because we have a larger population, it's just because we spend a lot more than other nations.
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And so there's more potential profitability in the industry, but there's also more cost there.
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And so, you know, but when we what we're what you and I see, because we work with investors a lot, we work with innovators a lot, that menopause has been dumped in as like a women's health issue, almost like it's a charity on the part of the investor community to invest in women in menopause, not recognizing that it's not, it's it's uh it's not an impact fund, it's it's health for half of the population.
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Menopause is not just a hot flash.
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Like we make it sound like menopause happens on a Tuesday.
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You have a hot flash and then you're done.
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That's not like that's one of the unpleasant symptoms.
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And I know because I've had one and it feels stupid.
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And that's when my husband said, This is menopause.
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And I said, How do you know what menopause is?
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And he said, Well, I'm a nurse and I work with women.
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And I'm like, Oh, turns out it was menopause.
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Anyway, it's not just one hot flash and you're done.
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It is 30 years of my life in an estrogen penic state where my bones are getting thinner and my heart attack risk goes flying up.
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And like I want to live healthy with like activity and not, I don't want to be the what we call them in emergency medicine.
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Do you guys ever refer to the L O L N A D?
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Little old lady disease?
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No apparent distress.
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Yeah, yeah, yeah, yeah.
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I don't want to be, I don't want to be living in frailty like that.
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I want to be, I want to be rock climbing and ice skating when I'm 80.
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I don't do those things now, but I still have hope.
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Yeah, yeah.
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By the way, fun fact, you call them L O L's, little old ladies.
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We call them DFOs too, Dunfell Out.
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That happened in Philly all the time.
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That's like when you're at church, you get filled with spirit, you fall out, you break your hip, that's a DFO, or you pass out.
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Um, that's just that's just a side, you know.
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And then um uh oh, I won't even go into it.
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There's a whole lot of that's a side topic.
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We can do a whole episode off.
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A whole episode on it.
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Yeah.
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But you know, if if we're looking at every single year 1.3 million women going through menopause, if I'm an investor and I'm like, what's my addressable market?
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And I'm like, holy shit, I've got 1.3 million women every year that's going to be going through this.
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And it's not just like a singular point in time, it's that they go through this and they go through it like 80 to 96% of them go through it for years.
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It's a compounding interest by what is what's the guesstimate by 2060?
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90 million American women will be post-menopausal.
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Like that's a lot of women who are thinking they'd like to preserve their ability to play with their grandkids or go to shop or exercise, or you know, where's the highest rate of STE rise or STI rises, right?
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It's the retirement home.
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Old people want to get jiggy too.
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Yeah, yes, they do.
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And I absolutely I want to I want to go to something though, and I think this is that what we've got to draw the connection sometimes, is that when women lose estrogen, which is what happens in menopause, a whole host of cascade of things happen.
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Mobility goes down.
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When mobility goes down, people don't move as much, which means when they're eating food, I mean that's by definition, but when they're eating, there's not as much caloric burn, so they gain weight.
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And these hormone changes also change metabolism, so they gain weight.
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So now you're selling sensitivity goes down, so all of a sudden you got menobelly, right?
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And that's not good for your heart, exactly fat.
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Exactly.
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And so the more kind of uh the the le less amount of movement that you have, the more fat you get, the more weight you gain, the higher likelihood of cardiovascular disease, the higher issue uh the increase in osteoporosis, the increase or the decrease in muscle mass, all of those things start to add together.
00:16:58.480 --> 00:17:06.559
And so when you kind of look at this, it's like, why aren't we treating one of the most obvious sort of things?
00:17:06.720 --> 00:17:09.279
And it's because we weren't taught how to treat it.
00:17:09.440 --> 00:17:11.119
We weren't taught or to identify it.
00:17:11.680 --> 00:17:18.640
So one of the superstars of our paper is Miriam, who was a rising second-year med student when we started talking about this.
00:17:18.880 --> 00:17:25.519
And she writes a perspective in our paper about being a student and realizing that you're not being taught something.
00:17:25.680 --> 00:17:27.440
And she and I actually had a conversation about it.
00:17:27.519 --> 00:17:40.880
A lot of this was born from our shared frustration that 30 years later we're still not teaching it the way we should, even though we know that two-thirds of women are out, like two-thirds of Alzheimer patients are women, and there's potentially a link.
00:17:41.039 --> 00:17:45.200
You know, our brain health depends on being healthy, having muscle mass.
00:17:45.279 --> 00:17:47.519
It's not just the hormones, it's a it's a cascade.
00:17:47.599 --> 00:17:54.000
And and to go back to little terms that ER docs use that are colloquial, we would call it the dwindles, right?
00:17:54.160 --> 00:18:11.680
You get fracture, and then you're immobile, and then you have urinary sepsis, and then you you you don't have any energy, and then you don't have muscle mass, then your balance goes, and then you fall over putting your underwear on, and you get confused in the night because you have dementia, and then one day you just die of the dwindles.
00:18:12.480 --> 00:18:17.440
And that should not be, especially if it's something that you can prevent.
00:18:17.680 --> 00:18:29.680
You know, if you you know, I made a comment earlier that only about six or seven percent of doctors really feel that they adequately trained in menopause, and those are not like surgeons.
00:18:29.839 --> 00:18:45.039
That's our family practice doctors, internal medicine doctors, OBGYNs are now, even though some residency programs, like 30-some percent of residency programs, have some curriculum, it's pretty inadequate.
00:18:45.359 --> 00:18:47.680
But it's it's also it's too late.
00:18:47.920 --> 00:18:54.799
It's too late because we need to get these doctors with before they specialize because and it's not like we're talking about a whole new curriculum.
00:18:54.880 --> 00:18:59.839
We're talking about by the way, when we're teaching heart attacks, women present differently.
00:19:00.079 --> 00:19:06.880
By the way, if she's not on estrogen, there's she's got the minute her estrogen falls, her risk of heart attack goes skyrocketing.
00:19:07.039 --> 00:19:11.839
By the way, you know, like all these things that could just be by the ways for everything we've been taught.
00:19:11.920 --> 00:19:16.720
It's just adding one more sentence to everything else that we're being taught before we specialize.
00:19:17.039 --> 00:19:30.640
Because again, unless you're a prostate specialist, you will treat or a well, even a pediatrician has to deal with menopause because you've got like post-menopausal new moms whose hormones are all over the place, or you know, right.
00:19:31.119 --> 00:19:36.079
Well, you're also dealing with your I mean, because as yeah, I mean, you're a pediatrician.
00:19:36.160 --> 00:19:39.119
So, I mean, how many times were you just taking care of the child?
00:19:39.599 --> 00:19:40.799
About never.
00:19:41.200 --> 00:19:41.519
Right.
00:19:42.319 --> 00:19:43.200
They come with families.
00:19:43.279 --> 00:19:46.000
It's like you're like a whole family, not one person.
00:19:46.160 --> 00:19:49.119
Pediatrics, you're not caring for just one patient.
00:19:49.519 --> 00:19:50.160
Exactly.
00:19:50.400 --> 00:20:06.559
You know, I do wonder if some of the reason you and I are not that far apart in age, and we we grew up in an age of um the women's health initiative trials and and how hormone replacement therapy really was poo-pooed, and this was in the early 2000s.
00:20:06.799 --> 00:20:14.160
And I I mean, I in medical school, it was basically suck it up, buttercup, you're gonna go through the hot flashes and menopause.
00:20:14.240 --> 00:20:16.640
Here's some black kohash, and that's all you're getting.
00:20:16.799 --> 00:20:18.640
And that's basically it.
00:20:19.119 --> 00:20:26.559
Um, and uh, and because if you were to treat with estrogen, here comes a PE and breast cancer, you know.
00:20:26.799 --> 00:20:29.839
Oh, well, and you are so talk about what you were told that.
00:20:29.920 --> 00:20:33.200
I mean, we were just told if she's pre-menopausal, get a pregnancy test.
00:20:33.359 --> 00:20:38.640
If she's postmenopausal, you might want to get a pregnancy test anyway, unless she looks really old, right?
00:20:38.799 --> 00:20:39.440
Never trust people.
00:20:39.759 --> 00:20:53.519
Well, no, we were told we were basically told like, do not give anyone hormone replacement therapy because of the risk of breast cancer, because of the risk, but that's been debunked.
00:20:54.079 --> 00:20:54.880
That was wrong.
00:20:55.039 --> 00:20:56.799
That was the wrong group of patients.
00:20:56.960 --> 00:21:06.319
The results were interpreted poorly, the entire co-authorship was not given ample time to respond to this ending of the study and the publication.
00:21:06.559 --> 00:21:07.920
But you know what happened during that?
00:21:08.000 --> 00:21:13.279
This is a great example because HRT use plummeted.
00:21:13.440 --> 00:21:17.119
And it even for the doctors who read through the data and were like, wait, that's not what it says.
00:21:17.279 --> 00:21:25.200
Their patients were too afraid to take it, which means we have a whole generation of women who lost out on appropriate care.
00:21:25.599 --> 00:21:28.400
Because, you know, we we used to not live this long.
00:21:28.559 --> 00:21:33.920
That's the whole thing, is that we used to die, our life expend expectancy was before menopause.
00:21:34.000 --> 00:21:39.039
But now I plan on living a hell of a lot longer, you know, like many, many years after.
00:21:39.200 --> 00:21:50.000
And and I think it's really sad that we we have a generation that we owe a big sorry to because doctors were not trained in the true risks and how to interpret that study.
00:21:50.079 --> 00:21:51.680
And the the conversation wasn't there.
00:21:51.759 --> 00:21:53.440
It was just a well, so what?
00:21:54.000 --> 00:21:59.119
But you know, your point is a good one around it, wasn't just the doctors weren't trained, there was a societal thing.
00:21:59.200 --> 00:22:01.359
So I I To go back to something.
00:22:01.519 --> 00:22:06.880
If you remember when we were growing up, Nancy Reagan had breast cancer.
00:22:07.039 --> 00:22:14.400
There, that was when the advent of the um the pink campaign around breast cancer, the hyper focus on breast cancer.
00:22:14.480 --> 00:22:26.480
And so just to be super clear, I'm not saying that there should not be focus on breast cancer, but that but the awareness factor of breast cancer really really went through the roof in the 80s and the 90s.
00:22:26.640 --> 00:22:39.200
And so the women that were in their 20s or in their 30s and 40s in the 80s and 90s are now heading into 2000s, and the women's health initiative hits.
00:22:39.440 --> 00:23:08.079
And all of a sudden, women who were, you know, get your mammogram, um, uh lump, lump checks, self-checking, all of that, the common language around that, which is appropriate, but it over-indexed on breast cancer being the scariest thing and not recognizing that cardiovascular disease, immobility, diabetes can also be at a very, very problematic thing.
00:23:08.240 --> 00:23:15.359
And so you had this kind of confluence of societal focus on breast cancer, and it should have been.
00:23:15.759 --> 00:23:33.119
However, with that focus, and then on the back of that, the WHI, it created this big fear within the population without the opportunity for doctors to jump in scientists to say, wait a minute, let's look at this study in detail.
00:23:33.279 --> 00:23:34.640
Was this the right population?
00:23:34.799 --> 00:23:36.880
To your point, was this the right dosage?
00:23:37.039 --> 00:23:39.440
Um, were they tracked appropriately?
00:23:39.599 --> 00:23:40.480
Yeah, et cetera.
00:23:40.720 --> 00:23:49.759
And those were the things I think that created this 20-something year um multi-generation kind of approach to no hormone therapy.
00:23:49.839 --> 00:23:53.599
It wasn't until last year that estrogen, the black box warning came off.
00:23:53.920 --> 00:23:55.039
I know, I know.
00:23:55.200 --> 00:23:59.440
And and, you know, I think we could go back to the media.
00:23:59.519 --> 00:24:04.160
I mean, we kind of have to point some fingers at the media because everybody loves a big story.
00:24:04.400 --> 00:24:06.640
And you had media jumping all over this.
00:24:06.720 --> 00:24:12.559
But to your point, if you ask women what do women die of, they'll say breast cancer, and the answer is heart disease.
00:24:13.119 --> 00:24:13.279
Right?
00:24:13.599 --> 00:24:23.279
It's cardiovascular disease, strokes, hip fractures, urinary sepsis, you know, that that's what's costing the healthcare system billions of dollars.
00:24:23.599 --> 00:24:33.279
And we think that you can make a great case for medical students being that first easy entry point to cut some of those costs.
00:24:33.680 --> 00:24:48.000
Well, and one of the things we talk about in the paper is that we're not talking about adding courses and courses, we're talking about integrating um menopause education into multiple facets of disease.
00:24:48.079 --> 00:24:50.799
And to your earlier point, estrogen affects every cell.
00:24:50.960 --> 00:25:06.319
So every body system, every system should be discussed as from that perspective of like what happens to the heart pre-menopause, perimenopause, post postmenopause, you know, like what should happen in that?
00:25:06.480 --> 00:25:13.519
No different than we do of like, why are men more likely to have a heart attack in their 40s and 50s versus in their 20s?
00:25:13.599 --> 00:25:26.480
You know, like this is how we've approached it because we also know that the amount of medical knowledge has accelerated significantly, just in the amount of available medical knowledge has accelerated significantly.
00:25:26.880 --> 00:25:40.640
And so we understand, well, you have your master's in in medical education, so you clearly understand the limitation on time that you get with a student or with a resident.
00:25:41.039 --> 00:25:44.319
Yeah, so that's why we said not addition, but integration.
00:25:44.720 --> 00:25:48.000
We're not adding anything extra, we're just finishing the sentence.
00:25:48.720 --> 00:25:51.440
And in women, this happens.
00:25:51.839 --> 00:25:53.599
And in women, this happens.
00:25:53.759 --> 00:26:04.880
It shouldn't, it's just extending the sentence a little bit at the same time that they're even talking about shortening the training for medical school because of all the technology and people are learning in different ways.
00:26:04.960 --> 00:26:11.119
So I think there's there's no one way we're saying you solve this problem, but it's shouldn't be considered a whole extra curriculum.
00:26:11.279 --> 00:26:18.480
It's literally just adding the part about women that is has been left out.
00:26:19.279 --> 00:26:31.039
So so who there are some schools, and the NIH actually, despite all the things that have been happening, has started to do some tip their toes in into the this space.
00:26:31.200 --> 00:26:42.559
Uh who are some of the schools that you've been hearing about um that uh some academic centers, um, you know, that we've we we in a part of our research.
00:26:43.200 --> 00:26:46.400
Well, I think I'm not gonna name names.
00:26:46.559 --> 00:26:49.759
Isn't that gonna put somebody on the on the uh you know what?
00:26:49.839 --> 00:26:50.640
That's that's okay.
00:26:50.720 --> 00:26:55.359
We we don't need to name names, but I you know what they can read the paper because we're gonna be able to do that.
00:26:56.559 --> 00:27:05.359
But I'm gonna say that if you are not one of the schools that is talking about this, because it's not the majority of schools, but there is a cost of best of practice curriculums.
00:27:05.440 --> 00:27:07.839
I know that there's there's a real push for it.
00:27:08.079 --> 00:27:13.519
If if your name isn't on that list soon, that is a reputational hazard.
00:27:13.839 --> 00:27:38.559
Because as students start demanding good education, as patients start demanding better trained doctors, as healthcare systems are demanding cost cutting where we can, if you are not at the head of the pack, that is gonna be a problem because medical students bring money and attention and all those things that academia wants, you had better be at the leading front pack of this movement that we're calling it.
00:27:38.720 --> 00:27:39.519
A movement.
00:27:39.920 --> 00:27:40.720
Yeah, exactly.
00:27:40.880 --> 00:27:51.359
I mean, so I think what I want to make sure that people know, and we're gonna talk about in a second the website we created, um, that uh is just masterful, I must say.
00:27:51.920 --> 00:27:54.400
To be clear, neither of us actually created a website.
00:27:54.720 --> 00:27:55.039
Yeah, yeah.
00:27:55.119 --> 00:27:57.440
There was my ABID team that created the website.
00:27:57.599 --> 00:27:58.480
Uh that's not us.
00:27:58.640 --> 00:28:00.799
Yeah, we'll we'll we'll talk about that in a second.
00:28:01.200 --> 00:28:05.599
But for medical schools, you know, we've talked about completing the sentence.
00:28:05.759 --> 00:28:25.039
So when you're teaching cardiology, when you're teaching physiology, when you're teaching psychology, psychiatry, when you're teaching these different types of systems or courses, including how the body changes during menopause and how those different systems change during menopause is a very nice way.
00:28:26.400 --> 00:28:29.200
Just a few slides, just a few questions on the test.
00:28:29.839 --> 00:28:38.880
And if you need more than our downloadable slides, you can ask me about the time I had a panic attack because I was having palpitations while driving on the freeway.
00:28:38.960 --> 00:28:48.319
And I called 911 because I was worried I was gonna die, and they told me to take my pulse, and I couldn't find my pulse, so I started screaming hysterically.
00:28:48.559 --> 00:28:54.079
And that sounds like a crazy lady whose doctor button just wasn't switched on, but guess what that was?
00:28:55.839 --> 00:28:58.000
A panic attack associated with perimenopause.
00:28:58.319 --> 00:29:02.319
It was palpitations thanks to hormone fluctuations associated with perimenopause.
00:29:02.400 --> 00:29:05.200
And oh, by the way, my anxiety is through the roof.
00:29:05.359 --> 00:29:10.400
And when I saw my doctor, we went up on my estrogen, it all got better.
00:29:11.359 --> 00:29:16.400
And something you said earlier when people do have palpitations, EKGs are a good thing.
00:29:16.720 --> 00:29:17.759
Oh, yeah, they are totally.
00:29:17.839 --> 00:29:21.200
I had one on the side of the road that day with the when the ambulance came.
00:29:22.160 --> 00:29:24.720
The cute firemen are like crazy lady.
00:29:25.359 --> 00:29:26.480
But yeah, I did.
00:29:26.960 --> 00:29:48.480
Yeah, I mean, but now for program directors, you know, we we one of the things that we had recommended is that within the different specialties, whether it's family medicine, emergency medicine, internal medicine, surgery, program directors can start looking for where what are the places where menopause touch.
00:29:48.559 --> 00:29:50.400
So what does menopause already touch?
00:29:50.480 --> 00:29:57.839
So if you're talking about, if you're an orthopod or surgeon and you're talking about hip fractures and the treatment of hip fractures, add the sentence.
00:29:58.160 --> 00:30:04.960
Post-hip fractures, urinary tract infections are likely and can extend delays in hospitalization.
00:30:05.119 --> 00:30:09.680
Therefore, vaginal estrogen, which newsflash is applied in the vagina.
00:30:10.880 --> 00:30:11.920
We've settled that issue.
00:30:12.480 --> 00:30:15.039
We've settled that, um, should be given.
00:30:15.200 --> 00:30:17.440
You know, like it's the completion of that sentence.
00:30:17.599 --> 00:30:24.240
If you are talking about palpitations or cardiovascular disease, it's it's that kind of talking about that population.
00:30:24.319 --> 00:30:39.599
And so um, you know, there is, I think you have talked about before about how to use the EMAS position statement as a model of how to kind of tap into didactic resources.
00:30:40.000 --> 00:30:59.119
And, you know, we know that that faculty, depending on their areas of focus, they may or may not have interest, but we really are in thinking of this as a long-term investment because so many students are are going to benefit and resonance will benefit from this because of the populations they're touching.
00:30:59.359 --> 00:31:00.960
And it's not just the benefit.
00:31:01.119 --> 00:31:07.200
I think it's about, you know, for those who have already trained, who are in specialties where they don't understand why this is so important.
00:31:07.440 --> 00:31:12.559
If we don't treat it, then we are sending a message to our students that it doesn't matter.
00:31:12.640 --> 00:31:18.000
And that is something that is a state of existence for decades for over half the population.
00:31:18.240 --> 00:31:19.200
That matters.
00:31:19.519 --> 00:31:27.039
And we need this older generation of doctors to come back and remember that they are role models for our next generation.
00:31:27.119 --> 00:31:31.119
And how would they want their wife or mother or sister or daughter to be cared for?
00:31:31.519 --> 00:31:34.799
Or and when you add an and, not an or.
00:31:35.279 --> 00:31:37.920
And you and I are examples of this.
00:31:38.079 --> 00:31:41.039
More and more doctors are not just doctoring anymore.
00:31:41.599 --> 00:31:49.680
We are on boards, we are fractional chief medical officers, or chief medical officers, or innovators, or entrepreneurs.
00:31:49.839 --> 00:32:01.279
And if we want to create solutions that are going to take care of half of the world's population, we need to have doctors, number one, at the table.
00:32:01.519 --> 00:32:11.359
But we really need to have doctors who understand the situation because that's financially better for investors, that's financially better for your return on investment.
00:32:11.519 --> 00:32:17.759
I mean, having a healthcare company that's full of tech people and no doctors, that's just a tech company, you know.
00:32:18.000 --> 00:32:24.079
Like you really need to train doctors, though, to know what to look for, to know what to think about.
00:32:24.319 --> 00:32:34.400
And so I think I, you know, that's that's where I see this opportunity, um, both altruistically and also from a profitability standpoint.
00:32:34.720 --> 00:32:41.359
Well, listen, our paper is out, and so I want to talk about the website, okay?
00:32:41.680 --> 00:32:46.240
And so the website is closethennowledgegap.com.
00:32:46.559 --> 00:32:48.720
Close the knowledge gap.com.
00:32:48.880 --> 00:32:49.839
Very simple.
00:32:50.079 --> 00:32:55.119
And when you go to that site, you need to scroll all the way through from top to bottom.
00:32:55.279 --> 00:32:59.920
Easy peasy, because you can download for free the white paper.
00:33:00.160 --> 00:33:08.240
We have done this gratis, we've done this without kind of getting expecting anyone to pay us for this or anything like that.
00:33:08.400 --> 00:33:13.279
This is this has been something that you and I if you want to, you can.
00:33:13.599 --> 00:33:14.400
I mean, sure, sure.
00:33:14.480 --> 00:33:15.200
Like I'll turn it on.
00:33:15.519 --> 00:33:16.079
We're not gonna say no.
00:33:16.480 --> 00:33:16.960
That was not the point.
00:33:17.200 --> 00:33:19.440
We can throw our, but that was not the point.
00:33:19.759 --> 00:33:21.759
Um, but here's what's on the website.
00:33:21.839 --> 00:33:25.680
So, yes, you can download for free the the white paper.
00:33:25.839 --> 00:33:33.680
Number two, you can listen to the white paper audio, and you can listen to it in minute chunks.
00:33:33.759 --> 00:33:35.920
You don't have to like four or five minute chunks.
00:33:36.000 --> 00:33:38.400
You don't have to listen soup to nuts from beginning to end.
00:33:38.480 --> 00:33:41.920
You can listen to little chunks, you can read it in sections.
00:33:42.160 --> 00:33:42.480
Okay.
00:33:42.960 --> 00:33:46.160
So that's the first part of the white paper or the website.
00:33:46.319 --> 00:33:50.799
When you go further into the website, we want you to share it.
00:33:51.039 --> 00:33:56.720
We want you to send it to friends, to family, to your doctor, to your lawyer.
00:33:56.880 --> 00:33:59.039
We want you to send it to everybody.
00:33:59.279 --> 00:34:06.319
And so we've used all social media, like everything from Reddit to X to um, I hate calling it On.
00:34:06.559 --> 00:34:07.279
OnlyFans?
00:34:07.519 --> 00:34:08.800
We didn't do OnlyFans.
00:34:08.960 --> 00:34:10.480
We didn't do OnlyFans.
00:34:10.639 --> 00:34:14.320
You know, that's for you know, I only have fan.
00:34:14.559 --> 00:34:15.599
That's for the next one.
00:34:15.920 --> 00:34:20.639
Well, um, Twitter, uh, oops, X, Facebook, Instagram.
00:34:21.039 --> 00:34:31.039
We we made it where uh LinkedIn, where all you have to do is click the little icon on the website, and it immediately creates a post for you.
00:34:31.280 --> 00:34:36.239
We created a downloadable PowerPoint presentation that's already done.
00:34:36.480 --> 00:34:45.519
Slides are designed for you to share, to share with your team, to share with your program director, to share with your dean of your medical school.
00:34:45.760 --> 00:35:00.800
We created an email, a template that you can make some adjustments, but a simple template that says, This is what we're talking about, this is the importance of it, why we should we be why we should be doing it.
00:35:00.960 --> 00:35:01.920
That is all there.
00:35:02.000 --> 00:35:04.239
And even more fun, Laura.
00:35:04.880 --> 00:35:11.119
When you share it to Instagram, we created quote card graphics, graphics for you.
00:35:11.280 --> 00:35:16.800
So you can just share the graphics about the white paper, carousels.
00:35:17.280 --> 00:35:23.039
We did all of this in a one-stop shop so that it was an amplification type of powerhouse.
00:35:23.199 --> 00:35:27.119
And I know it's ready, it's easy, it's not just ready.
00:35:27.360 --> 00:35:32.079
We made it like we aimed for the lowest effort denominator.
00:35:32.719 --> 00:35:33.280
Exactly.
00:35:33.440 --> 00:35:36.079
And it's hashtag close the knowledge gap.
00:35:36.239 --> 00:35:38.559
That is is what our goal is.
00:35:38.800 --> 00:35:42.400
So um we're not asking anyone to build a new program.
00:35:42.480 --> 00:36:00.000
We're asking them to make some adjustments and complete the sentences that they're already saying in their program so that they can not only do a better service to their medical students, to the residents, but the impact of the patients that all of those people are going to take care of.
00:36:00.239 --> 00:36:04.159
So, you know, Laura, after writing this, I mean, this took months.
00:36:04.559 --> 00:36:07.519
Like we started this in I think February.
00:36:07.920 --> 00:36:11.440
I had the first draft to you in October, I believe.
00:36:12.239 --> 00:36:12.880
Really?
00:36:13.199 --> 00:36:13.840
Wow.
00:36:14.079 --> 00:36:17.679
Okay, so yeah, almost a year to pull this together.
00:36:18.719 --> 00:36:20.719
Because white papers are not just white.
00:36:21.199 --> 00:36:21.840
They're not.
00:36:22.000 --> 00:36:25.360
And they're not just like getting a piece of white paper and giant downsides.
00:36:25.519 --> 00:36:26.960
We had lots of contributors.
00:36:27.360 --> 00:36:29.519
We talked about Jocelyn, we talked about Miriam.
00:36:29.920 --> 00:36:32.639
Tamar Gurr, head of women's health at Ohio State.
00:36:32.800 --> 00:36:39.599
We've got Jessica Federer from the Women's Health Fund, we've got uh Laura Okifer from Perry Academy.
00:36:39.679 --> 00:36:49.679
Um, so we brought people in from the investor side, from the clinician side, medical student side, medical educator side, um, the uh lay population side.
00:36:49.760 --> 00:36:56.079
We we wanted to bring in all those voices because we're making a movement happen.
00:36:56.239 --> 00:36:59.920
And you know, a movement doesn't happen when one lady says move.
00:37:00.639 --> 00:37:01.199
That's right.
00:37:01.280 --> 00:37:02.880
We we've got to all say move.
00:37:02.960 --> 00:37:17.599
And so close the knowledge gap.com, free to read, free to share, easy to bring to your institution, and to add it to your agenda when you're talking to your program directors, to your deans of your schools, um, or even to your doctor.
00:37:17.760 --> 00:37:36.079
Um, and you know, I didn't mention this before, but something that societies, ASEP needs to talk about, the American Medical Association needs to talk about, you know, um ACOG, all of these other societies who some of them have some of this discussion, but move it out of the women's health interest group.
00:37:36.239 --> 00:37:49.519
That's right, and move it into the health interest group because it's it's not just a niche charity kind of foundational core knowledge.
00:37:50.400 --> 00:37:51.039
Yeah.
00:37:51.599 --> 00:37:56.400
So that is the title of the website, Close the Knowledge Gap.
00:37:56.559 --> 00:38:09.760
The title of the um white paper is um The Business Case for Integrating Menopause Education into Medical School Curriculum.
00:38:09.920 --> 00:38:12.000
Laura, this was a lot of work.
00:38:12.320 --> 00:38:13.199
There's eight sections.
00:38:13.519 --> 00:38:20.400
There's a lot of me because I know I had to work a little to get you on board, but now that we've done it, I'm super proud of what we've done.
00:38:20.639 --> 00:38:22.159
Yeah, I'm very super proud of it.
00:38:22.559 --> 00:38:25.519
Huge thanks to the team who actually knows what the hell they're doing, right?
00:38:25.679 --> 00:38:28.000
Makes the colors paint paints the paper.
00:38:28.400 --> 00:38:43.039
Yeah, my my my team at A B I G just a couple of shout-outs to Kelsey McNabb um and um Laura Jessups and the rest of the team who did a lot of really great work in Adam Lee on the graphics and the organization of this campaign.
00:38:43.119 --> 00:38:45.920
So let's get it out there, let's get it going.
00:38:46.079 --> 00:38:46.400
All right.
00:38:46.800 --> 00:38:47.840
It was good to see you, Laura.
00:38:48.079 --> 00:38:48.800
You too, Adam.
00:38:49.039 --> 00:38:49.360
Bye.
00:38:49.519 --> 00:38:51.840
Thanks for tuning into Unstable Vitals.
00:38:52.000 --> 00:38:58.000
If you enjoyed this episode, make sure to follow us for more unfiltered conversations on the pulse of healthcare.
00:38:58.159 --> 00:39:04.079
Connect with us on LinkedIn or visit us on Unstablevitals.com to stay in the loop.
00:00:00.080 --> 00:00:06.719
Unstable Vitals is the podcast that takes the pulse of American healthcare, and the prognosis is critical.
00:00:06.959 --> 00:00:07.360
Dr.
00:00:07.519 --> 00:00:08.720
Adam Brown and Dr.
00:00:08.800 --> 00:00:13.199
Laura Zibners, physicians turned entrepreneurs and business leaders.
00:00:13.359 --> 00:00:16.640
Expose why the system is unraveling before our eyes.
00:00:16.879 --> 00:00:17.280
All right.
00:00:17.359 --> 00:00:20.559
Well, hey, we've got another episode of Unstable Vitals.
00:00:20.640 --> 00:00:21.839
I'm just adjusting my seat.
00:00:21.920 --> 00:00:24.160
My seat was rolling back and moving all around, you know.
00:00:24.239 --> 00:00:26.800
But anyway, Laura, it's so good to see you.
00:00:27.039 --> 00:00:27.600
Good to see you.
00:00:28.000 --> 00:00:29.839
Happy Unstable Vitals Day.
00:00:30.160 --> 00:00:32.320
Is it Happy Unstable Vitals Day?
00:00:32.640 --> 00:00:35.759
Well, anytime we're on Unstable Vitals, it's Unstable Vitals Day.
00:00:36.000 --> 00:00:36.240
Okay.
00:00:36.560 --> 00:00:38.079
Happy Unstable Vitals Day.
00:00:38.399 --> 00:00:38.799
Sure, sure.
00:00:39.280 --> 00:00:41.039
Particularly unstable today?
00:00:41.520 --> 00:00:48.960
Um well, it's a I, you know, uh that was a long answer just in that pause.
00:00:49.200 --> 00:00:49.920
So, right?
00:00:50.079 --> 00:00:51.840
So it just kind of like that up.
00:00:52.240 --> 00:00:52.640
I got it.
00:00:52.719 --> 00:00:53.920
You don't have to say anything else.
00:00:54.240 --> 00:00:58.560
Yeah, I I went on I went on a vacation, or as they say, in the UK on holiday.
00:00:58.880 --> 00:01:00.799
And then um, that was lovely.
00:01:00.880 --> 00:01:02.560
It was nice, some good beach time.
00:01:02.640 --> 00:01:04.560
I wore my 50 SPF, folks.
00:01:04.640 --> 00:01:06.159
You gotta wear it, helps with wrinkles.
00:01:06.239 --> 00:01:09.920
So does Botox, but you know, um, but yeah, it did that.
00:01:10.079 --> 00:01:17.200
Yeah, so I don't even want to say what I use, but let's just say, yeah, disposable cash has its purpose.
00:01:17.519 --> 00:01:19.200
Of course, of course it's anyway.
00:01:19.280 --> 00:01:22.959
Okay, um yeah, and uh so that was nice.
00:01:23.120 --> 00:01:25.439
Um, but the instability, I'll just say it.
00:01:25.519 --> 00:01:27.519
I you know, you and I were talking about it earlier.
00:01:27.680 --> 00:01:32.560
Someone broke into my apartment, which absolutely feels crappy and sucks.
00:01:32.879 --> 00:01:36.560
You expect it from mice and rats, yeah, yeah.
00:01:36.719 --> 00:01:42.560
Well, you expect it in London, but yeah, but not like by a spider buzz bucket in a hoodie.
00:01:42.799 --> 00:01:46.239
I know, in a hoodie that we caught on camera on the Nest Cans.
00:01:46.400 --> 00:01:50.159
You know, we we had their full like UK CSI team.
00:01:50.319 --> 00:01:52.799
Okay, it was one lady, but like that came out.
00:01:53.200 --> 00:01:55.120
But she was real serious, she was very serious.
00:01:56.640 --> 00:01:58.159
And did she have a little checkered hat?
00:01:58.400 --> 00:02:00.640
She actually didn't have a checkered hat.
00:02:00.879 --> 00:02:05.200
And the constable uh who also came, we had two people.
00:02:05.359 --> 00:02:07.280
Um, he did not have a checkered hat.
00:02:07.359 --> 00:02:14.159
He did talk about a Bobby, you know, but he might have one of his Bobbies come by and check around, but which I don't really know what that is.
00:02:14.240 --> 00:02:17.919
But anyway, I think a bob I can say without a gun.
00:02:18.400 --> 00:02:20.000
They none have a gun, do they?
00:02:20.240 --> 00:02:20.879
Or I guess some of them.
00:02:22.319 --> 00:02:24.080
The police have guns here.
00:02:24.240 --> 00:02:28.400
We're not gonna be able to get a big we just like dart people in London, right?
00:02:28.479 --> 00:02:31.520
Like a license for it.
00:02:31.759 --> 00:02:32.240
Oh, okay.
00:02:32.319 --> 00:02:36.719
Well, so this guy had like a baton, whatever you call that.
00:02:36.800 --> 00:02:41.199
Um, had like you can tell I'm really, really tactical, you know, in my you know, boy.
00:02:41.280 --> 00:02:42.960
Were you in the special forces?
00:02:43.520 --> 00:02:46.960
Uh no, I was in the piano and Bible quiz team.
00:02:47.039 --> 00:02:47.439
Yeah.
00:02:47.759 --> 00:02:50.960
So I was on the Science Olympiad team.
00:02:51.120 --> 00:02:51.680
Oh, yeah.
00:02:53.280 --> 00:02:56.400
So it it, you know, it was a great holiday, but then came back to that.
00:02:56.560 --> 00:02:59.520
I mean, just what the just awful.
00:02:59.680 --> 00:03:05.680
So the worst feeling, it's so violating, it goes beyond just your stuff getting taken, right?
00:03:05.840 --> 00:03:16.800
Like I had my car stolen when I was in college, and there was part of me that was delighted because it was my mother's 1979 brown Cadillac that was effectually known as like the shitmobile.
00:03:17.120 --> 00:03:23.360
But when when she I was home for Thanksgiving and she gets this letter and she gets all mad at me, like, why'd you leave your car downtown?
00:03:23.439 --> 00:03:25.439
And I'm like, why would I leave my car downtown?
00:03:25.680 --> 00:03:29.199
And then it turned out it was left downtown with like no parts.
00:03:31.439 --> 00:03:36.000
And it was this horribly violating feeling of like, what did I do to you?
00:03:36.159 --> 00:03:36.800
What did you do?
00:03:37.039 --> 00:03:37.360
Well, yeah.
00:03:37.439 --> 00:03:47.439
Well, then but then you know, the other thing that's odd about it is what's very odd about it is it's not only the violating piece, it's then I feel like, well, what did I do wrong?
00:03:47.599 --> 00:03:48.719
But I was the victim.
00:03:48.879 --> 00:03:50.879
So like it's it's just kind of an odd thing.
00:03:51.680 --> 00:03:55.280
How dare you have a watch that somebody wants to steal?
00:03:55.520 --> 00:03:56.400
Steal, exactly.
00:03:56.639 --> 00:03:59.840
Is the Charlie Brown one you had in high school too good for you?
00:04:00.159 --> 00:04:05.680
No, it was a nice one that was given to me by my husband on an anniversary, so that was a big boo.
00:04:06.080 --> 00:04:08.719
But those things can be replaced, you know.
00:04:09.280 --> 00:04:11.039
It's what happens with age.
00:04:11.199 --> 00:04:13.199
We have these things happen to us.
00:04:13.599 --> 00:04:18.800
Yes, I well, I don't like to say like these should happen or do happen, but they do.
00:04:18.959 --> 00:04:20.560
So, but we will move on.
00:04:20.720 --> 00:04:21.839
Um, we will move on.
00:04:22.000 --> 00:04:29.120
But hey, speaking of moving on, we want to talk about our white paper that we are releasing or we have released.
00:04:29.439 --> 00:04:30.959
Here's a news flash.
00:04:31.279 --> 00:04:35.839
Just in case you're as confused as I was, a white paper is not white.
00:04:36.240 --> 00:04:38.000
No, it's not, right?
00:04:38.160 --> 00:04:45.360
It's I mean, it used to be and could be, I mean, with black letters and words, but on a white page.
00:04:45.680 --> 00:04:58.160
But you know, now white papers have gotten zhuzhed up a bit, you know, they're kind of depending on the intended audience, you know, they you want them a bit more interactive, you want them something that you can share.
00:04:59.519 --> 00:05:01.360
For serious stuff.
00:05:01.680 --> 00:05:02.639
Yeah, yeah.
00:05:02.800 --> 00:05:09.040
And I mean, you can write an academic white paper of kind of your own kind of research and pulling things together.
00:05:09.120 --> 00:05:09.759
And we did that.
00:05:10.399 --> 00:05:11.120
We we did that.
00:05:12.079 --> 00:05:15.439
We did that, but we wanted people to read it exactly.
00:05:15.759 --> 00:05:19.040
And so so we wrote about menopause.
00:05:19.279 --> 00:05:21.279
But we didn't just write about menopause.
00:05:22.079 --> 00:05:22.480
That's right.
00:05:22.560 --> 00:05:25.360
We talked about a little more nuance than that.
00:05:25.680 --> 00:05:30.000
You know, so here's the thing everyone's talking about menopause, right?
00:05:30.160 --> 00:05:36.720
Because it's important, and if it's something that all women who live long enough go through, we should all be talking about it.
00:05:36.959 --> 00:05:41.839
And we should be making sure that women don't suffer unnecessary consequences.
00:05:42.079 --> 00:05:45.920
And who do we have to teach in order to make sure that happens?
00:05:46.079 --> 00:05:52.639
Well, that would be our healthcare providers and our medical students at the very first point they enter medical school.
00:05:52.879 --> 00:05:54.639
And this is not a novel concept, right?
00:05:54.720 --> 00:06:05.439
So the European Menopause Society came out with um a position paper in 2022 with a proposed curriculum talking how important it is that menopause, you know, estrogen affects every cell in the body.
00:06:05.519 --> 00:06:11.600
And when your estrogen goes away, every cell in your body says, wait a minute, that's not nice.
00:06:12.000 --> 00:06:13.279
So we need to be teaches.
00:06:13.360 --> 00:06:15.680
So they they wrote a beautiful position paper.
00:06:15.920 --> 00:06:30.240
And I know that there's talk in the US about also incorporating menopause education into medical school, but we wrote about it from a different viewpoint, and it was one that I think you and I share, which is follow the money.
00:06:30.639 --> 00:06:31.120
Exactly.
00:06:31.279 --> 00:06:44.639
I mean, that's one of the things that we talk about on Unstable Vitals a lot is about the financial impact of healthcare to individuals, to like society, but also how finances drive decision making.
00:06:44.800 --> 00:07:00.000
And so, what's I think is very important from the business perspective of teaching about menopause and perimenopausal symptoms is that number one, half of the world's population, 51% of it, have menopause.
00:07:00.319 --> 00:07:02.560
That's more than half if we're gonna split hairs.
00:07:02.800 --> 00:07:03.279
That's right.
00:07:03.439 --> 00:07:04.319
So 51%.
00:07:05.199 --> 00:07:26.480
Number two, um, that's billions of dollars that could be a market accessible to innovators who want to treat menopause symptoms, that uh for people who want to come up with new ideas and ways to kind of fix some of the problems that happen with menopause.
00:07:26.639 --> 00:07:41.759
Um, but just to put a finer point on it, I think that if our doctors don't have actual curriculum that is teaching them about the signs and symptoms of perimenopause and menopause, then it's invisible to them in some ways.
00:07:41.920 --> 00:07:48.959
It's not something that they're going to try to innovate for and try to solve some of those problems.
00:07:49.040 --> 00:07:50.959
And so women are left in the lurch.
00:07:51.040 --> 00:07:55.199
And then financially, we are missing an opportunity as well.
00:07:55.519 --> 00:08:01.920
Well, so you know who got me thinking about how important it is to get menopause education at before doctors specialize?
00:08:02.000 --> 00:08:06.560
It's Jocelyn Whitstein who was on our Unstable Vitals year ago.
00:08:06.639 --> 00:08:10.879
She's a um uh one of the few female orthopedic surgeons in the United States.
00:08:10.959 --> 00:08:11.680
She's at Duke.
00:08:12.079 --> 00:08:22.879
And she said that, you know, after a hip fracture, the number one cause of the number one complication is urinary sepsis from a urinary tract infection.
00:08:23.120 --> 00:08:29.680
And the reason that women get so many is because of genital urinary syndrome of menopause, which is a lack of estrogen in the tissues.
00:08:30.000 --> 00:08:37.279
So she told her male colleagues when you have a woman who has a hip fracture, you need to be prescribing vaginal estrogen.
00:08:37.759 --> 00:08:38.399
Estrogen, right.
00:08:39.039 --> 00:08:42.960
What predicts the a fracture, the biggest predictor is a previous fracture.
00:08:43.039 --> 00:08:51.519
And if these women are having UTIs and they're waking up in the middle of the night and they're going to the bathroom, then they're gonna trip, and then they're gonna come in with another fracture, and then they're gonna die of sepsis.
00:08:51.679 --> 00:08:57.679
And her colleagues all said, fine, but how do we apply it?
00:08:58.159 --> 00:09:00.480
So that's that's become my running joke.
00:09:00.639 --> 00:09:03.600
Where, Adam, where does vaginal estrogen go?
00:09:03.919 --> 00:09:05.840
I think in the ears, correct?
00:09:06.000 --> 00:09:07.440
Like or in intranasal.
00:09:08.000 --> 00:09:09.039
It's the nose, yeah.
00:09:09.279 --> 00:09:10.240
No, no, okay.
00:09:10.559 --> 00:09:11.120
No, it's the nose.
00:09:11.279 --> 00:09:12.480
No, it goes in the vagina.
00:09:13.919 --> 00:09:14.159
Yeah.
00:09:14.240 --> 00:09:25.120
So that was the person who got me thinking about how important it would be if an orthopedic surgeon would know that his patient has osteoporosis and is therefore menopausal, and ask, are you on veginal estrogen?
00:09:25.200 --> 00:09:30.240
And we need to be starting this in hospital to prevent your urinary sepsis for the next fracture.
00:09:30.399 --> 00:09:33.440
We could save the healthcare system billions.
00:09:33.519 --> 00:09:43.120
Or if you're just referred to a patient who's osteopenic before, you know, osteoporotic before they've had a fracture, then that you get them on the prevention for the urinary sepsis with the estrogen.
00:09:43.200 --> 00:09:52.000
Like there's so many ways in which, because I don't know of a single specialty in medicine that does not treat menopausal women unless maybe you're a prostate surgeon.
00:09:54.159 --> 00:09:55.759
Oh, okay, fair.
00:09:57.279 --> 00:10:00.799
Um, I I was like, prostate women do not have a prostate.
00:10:01.120 --> 00:10:04.159
No, they are the only ones I'm exempting from the curriculum.
00:10:04.559 --> 00:10:04.879
Yeah.
00:10:05.120 --> 00:10:13.440
Well, okay, so we wrote about the business case for integrating menopause education to medical school curriculum because it's really two-sided.
00:10:13.519 --> 00:10:16.159
There's kind of like the potential for savings.
00:10:16.240 --> 00:10:27.919
There's the savings of if we identify and recognize symptoms of perimenopause, menopause, we treat those symptoms with estrogen, hormone therapy, et cetera.
00:10:28.159 --> 00:10:46.159
Um, if if doctors, which only about six to seven percent have had really any formal education around menopause, if we if we educate doctors and get them more comfortable in treating it and knowing the evidence that is there, the evidence-based practice, we can prevent some diseases.
00:10:46.240 --> 00:10:52.159
Like you talked about osteoporosis, hip fractures, um, cardiovascular disease, immobility issues.
00:10:52.240 --> 00:10:54.639
There's like a lot of preventive type things.
00:10:54.720 --> 00:10:56.320
But but there's a flip side.
00:10:56.480 --> 00:10:56.960
Yeah.
00:10:57.200 --> 00:11:10.080
And this is if 51% of the market goes through menopause, and we're trying to come up with pharmaceutical improvements, medical devices, et cetera, there's a business opportunity.
00:11:10.159 --> 00:11:14.960
So there's a savings and a revenue opportunity for innovators as well.
00:11:15.120 --> 00:11:26.080
And so we thought about this from kind of this two-sided two sides of the coin that you can prevent a lot of issues, and also you can potentially make money as well.
00:11:26.240 --> 00:11:28.320
But but doctors need to know the information.
00:11:28.799 --> 00:11:30.799
I'm gonna make it a three-sided coin.
00:11:31.279 --> 00:11:33.200
Have you got a three-sided coin?
00:11:33.440 --> 00:11:36.639
There probably is more no, that's probably next in our government.
00:11:36.799 --> 00:11:52.480
Anyway, we also looked at a lack of waste because there's something like$4,600 that's wasted per patient per year, just in women going to the doctor, and the doctor's like, I don't know, have an EKG for your palpitations, not thinking this is menopause.
00:11:52.639 --> 00:11:55.600
And that waste translates right into the workplace, right?
00:11:55.759 --> 00:11:59.679
Where women are afraid to take time off of work because of symptoms.
00:11:59.840 --> 00:12:06.399
You know, the compared to Europe, actually, women miss a lot less work, but it's because we don't have a national health care service.
00:12:06.720 --> 00:12:17.919
So we have private insurance, you have to go to work, but there's a lost productivity, and when women are told they have to go to work or leave work, they leave work, and that has impacts on our GDP as a nation, right?
00:12:18.000 --> 00:12:22.639
So there's there's savings, there's opportunity, and then there's prevention of waste.
00:12:22.960 --> 00:12:23.440
Yeah.
00:12:23.679 --> 00:12:25.840
So great three-sided coin.
00:12:26.159 --> 00:12:26.639
You like that?
00:12:27.039 --> 00:12:28.159
Um, I do like it.
00:12:28.240 --> 00:12:29.039
Um, I do.
00:12:29.120 --> 00:12:42.639
Um, but you know, so if we look to the menopause market alone, some estimate that by 2030, it's anywhere between 17.8 to 24.3 billion dollars, with the United States holding the largest share.
00:12:42.720 --> 00:12:48.559
And some of that is not because we have a larger population, it's just because we spend a lot more than other nations.
00:12:48.720 --> 00:12:54.720
And so there's more potential profitability in the industry, but there's also more cost there.
00:12:54.879 --> 00:13:25.120
And so, you know, but when we what we're what you and I see, because we work with investors a lot, we work with innovators a lot, that menopause has been dumped in as like a women's health issue, almost like it's a charity on the part of the investor community to invest in women in menopause, not recognizing that it's not, it's it's uh it's not an impact fund, it's it's health for half of the population.
00:13:25.440 --> 00:13:28.159
Menopause is not just a hot flash.
00:13:28.399 --> 00:13:31.519
Like we make it sound like menopause happens on a Tuesday.
00:13:31.759 --> 00:13:33.600
You have a hot flash and then you're done.
00:13:33.840 --> 00:13:36.799
That's not like that's one of the unpleasant symptoms.
00:13:36.879 --> 00:13:39.519
And I know because I've had one and it feels stupid.
00:13:39.600 --> 00:13:41.519
And that's when my husband said, This is menopause.
00:13:41.759 --> 00:13:43.519
And I said, How do you know what menopause is?
00:13:43.600 --> 00:13:45.919
And he said, Well, I'm a nurse and I work with women.
00:13:46.000 --> 00:13:48.480
And I'm like, Oh, turns out it was menopause.
00:13:48.559 --> 00:13:51.120
Anyway, it's not just one hot flash and you're done.
00:13:51.360 --> 00:14:01.120
It is 30 years of my life in an estrogen penic state where my bones are getting thinner and my heart attack risk goes flying up.
00:14:01.360 --> 00:14:09.679
And like I want to live healthy with like activity and not, I don't want to be the what we call them in emergency medicine.
00:14:09.840 --> 00:14:12.000
Do you guys ever refer to the L O L N A D?
00:14:13.120 --> 00:14:14.240
Little old lady disease?
00:14:14.720 --> 00:14:15.919
No apparent distress.
00:14:16.240 --> 00:14:17.120
Yeah, yeah, yeah, yeah.
00:14:17.519 --> 00:14:20.799
I don't want to be, I don't want to be living in frailty like that.
00:14:20.960 --> 00:14:25.279
I want to be, I want to be rock climbing and ice skating when I'm 80.
00:14:25.360 --> 00:14:28.480
I don't do those things now, but I still have hope.
00:14:28.799 --> 00:14:29.519
Yeah, yeah.
00:14:29.679 --> 00:14:32.879
By the way, fun fact, you call them L O L's, little old ladies.
00:14:33.039 --> 00:14:35.679
We call them DFOs too, Dunfell Out.
00:14:35.840 --> 00:14:37.360
That happened in Philly all the time.
00:14:37.440 --> 00:14:43.279
That's like when you're at church, you get filled with spirit, you fall out, you break your hip, that's a DFO, or you pass out.
00:14:43.600 --> 00:14:46.320
Um, that's just that's just a side, you know.
00:14:46.480 --> 00:14:49.440
And then um uh oh, I won't even go into it.
00:14:49.519 --> 00:14:50.799
There's a whole lot of that's a side topic.
00:14:50.960 --> 00:14:52.080
We can do a whole episode off.
00:14:52.399 --> 00:14:55.440
A whole episode on it.
00:14:55.519 --> 00:14:55.679
Yeah.
00:14:55.919 --> 00:15:07.120
But you know, if if we're looking at every single year 1.3 million women going through menopause, if I'm an investor and I'm like, what's my addressable market?
00:15:07.279 --> 00:15:12.639
And I'm like, holy shit, I've got 1.3 million women every year that's going to be going through this.
00:15:12.960 --> 00:15:21.440
And it's not just like a singular point in time, it's that they go through this and they go through it like 80 to 96% of them go through it for years.
00:15:21.679 --> 00:15:27.600
It's a compounding interest by what is what's the guesstimate by 2060?
00:15:27.759 --> 00:15:31.039
90 million American women will be post-menopausal.
00:15:31.440 --> 00:15:47.200
Like that's a lot of women who are thinking they'd like to preserve their ability to play with their grandkids or go to shop or exercise, or you know, where's the highest rate of STE rise or STI rises, right?
00:15:47.279 --> 00:15:48.159
It's the retirement home.
00:15:48.320 --> 00:15:50.159
Old people want to get jiggy too.
00:15:50.559 --> 00:15:52.480
Yeah, yes, they do.
00:15:52.639 --> 00:16:07.840
And I absolutely I want to I want to go to something though, and I think this is that what we've got to draw the connection sometimes, is that when women lose estrogen, which is what happens in menopause, a whole host of cascade of things happen.
00:16:08.080 --> 00:16:09.360
Mobility goes down.
00:16:09.600 --> 00:16:22.159
When mobility goes down, people don't move as much, which means when they're eating food, I mean that's by definition, but when they're eating, there's not as much caloric burn, so they gain weight.
00:16:22.320 --> 00:16:26.159
And these hormone changes also change metabolism, so they gain weight.
00:16:26.320 --> 00:16:31.279
So now you're selling sensitivity goes down, so all of a sudden you got menobelly, right?
00:16:31.440 --> 00:16:34.399
And that's not good for your heart, exactly fat.
00:16:34.879 --> 00:16:35.440
Exactly.
00:16:35.600 --> 00:16:58.320
And so the more kind of uh the the le less amount of movement that you have, the more fat you get, the more weight you gain, the higher likelihood of cardiovascular disease, the higher issue uh the increase in osteoporosis, the increase or the decrease in muscle mass, all of those things start to add together.
00:16:58.480 --> 00:17:06.559
And so when you kind of look at this, it's like, why aren't we treating one of the most obvious sort of things?
00:17:06.720 --> 00:17:09.279
And it's because we weren't taught how to treat it.
00:17:09.440 --> 00:17:11.119
We weren't taught or to identify it.
00:17:11.680 --> 00:17:18.640
So one of the superstars of our paper is Miriam, who was a rising second-year med student when we started talking about this.
00:17:18.880 --> 00:17:25.519
And she writes a perspective in our paper about being a student and realizing that you're not being taught something.
00:17:25.680 --> 00:17:27.440
And she and I actually had a conversation about it.
00:17:27.519 --> 00:17:40.880
A lot of this was born from our shared frustration that 30 years later we're still not teaching it the way we should, even though we know that two-thirds of women are out, like two-thirds of Alzheimer patients are women, and there's potentially a link.
00:17:41.039 --> 00:17:45.200
You know, our brain health depends on being healthy, having muscle mass.
00:17:45.279 --> 00:17:47.519
It's not just the hormones, it's a it's a cascade.
00:17:47.599 --> 00:17:54.000
And and to go back to little terms that ER docs use that are colloquial, we would call it the dwindles, right?
00:17:54.160 --> 00:18:11.680
You get fracture, and then you're immobile, and then you have urinary sepsis, and then you you you don't have any energy, and then you don't have muscle mass, then your balance goes, and then you fall over putting your underwear on, and you get confused in the night because you have dementia, and then one day you just die of the dwindles.
00:18:12.480 --> 00:18:17.440
And that should not be, especially if it's something that you can prevent.
00:18:17.680 --> 00:18:29.680
You know, if you you know, I made a comment earlier that only about six or seven percent of doctors really feel that they adequately trained in menopause, and those are not like surgeons.
00:18:29.839 --> 00:18:45.039
That's our family practice doctors, internal medicine doctors, OBGYNs are now, even though some residency programs, like 30-some percent of residency programs, have some curriculum, it's pretty inadequate.
00:18:45.359 --> 00:18:47.680
But it's it's also it's too late.
00:18:47.920 --> 00:18:54.799
It's too late because we need to get these doctors with before they specialize because and it's not like we're talking about a whole new curriculum.
00:18:54.880 --> 00:18:59.839
We're talking about by the way, when we're teaching heart attacks, women present differently.
00:19:00.079 --> 00:19:06.880
By the way, if she's not on estrogen, there's she's got the minute her estrogen falls, her risk of heart attack goes skyrocketing.
00:19:07.039 --> 00:19:11.839
By the way, you know, like all these things that could just be by the ways for everything we've been taught.
00:19:11.920 --> 00:19:16.720
It's just adding one more sentence to everything else that we're being taught before we specialize.
00:19:17.039 --> 00:19:30.640
Because again, unless you're a prostate specialist, you will treat or a well, even a pediatrician has to deal with menopause because you've got like post-menopausal new moms whose hormones are all over the place, or you know, right.
00:19:31.119 --> 00:19:36.079
Well, you're also dealing with your I mean, because as yeah, I mean, you're a pediatrician.
00:19:36.160 --> 00:19:39.119
So, I mean, how many times were you just taking care of the child?
00:19:39.599 --> 00:19:40.799
About never.
00:19:41.200 --> 00:19:41.519
Right.
00:19:42.319 --> 00:19:43.200
They come with families.
00:19:43.279 --> 00:19:46.000
It's like you're like a whole family, not one person.
00:19:46.160 --> 00:19:49.119
Pediatrics, you're not caring for just one patient.
00:19:49.519 --> 00:19:50.160
Exactly.
00:19:50.400 --> 00:20:06.559
You know, I do wonder if some of the reason you and I are not that far apart in age, and we we grew up in an age of um the women's health initiative trials and and how hormone replacement therapy really was poo-pooed, and this was in the early 2000s.
00:20:06.799 --> 00:20:14.160
And I I mean, I in medical school, it was basically suck it up, buttercup, you're gonna go through the hot flashes and menopause.
00:20:14.240 --> 00:20:16.640
Here's some black kohash, and that's all you're getting.
00:20:16.799 --> 00:20:18.640
And that's basically it.
00:20:19.119 --> 00:20:26.559
Um, and uh, and because if you were to treat with estrogen, here comes a PE and breast cancer, you know.
00:20:26.799 --> 00:20:29.839
Oh, well, and you are so talk about what you were told that.
00:20:29.920 --> 00:20:33.200
I mean, we were just told if she's pre-menopausal, get a pregnancy test.
00:20:33.359 --> 00:20:38.640
If she's postmenopausal, you might want to get a pregnancy test anyway, unless she looks really old, right?
00:20:38.799 --> 00:20:39.440
Never trust people.
00:20:39.759 --> 00:20:53.519
Well, no, we were told we were basically told like, do not give anyone hormone replacement therapy because of the risk of breast cancer, because of the risk, but that's been debunked.
00:20:54.079 --> 00:20:54.880
That was wrong.
00:20:55.039 --> 00:20:56.799
That was the wrong group of patients.
00:20:56.960 --> 00:21:06.319
The results were interpreted poorly, the entire co-authorship was not given ample time to respond to this ending of the study and the publication.
00:21:06.559 --> 00:21:07.920
But you know what happened during that?
00:21:08.000 --> 00:21:13.279
This is a great example because HRT use plummeted.
00:21:13.440 --> 00:21:17.119
And it even for the doctors who read through the data and were like, wait, that's not what it says.
00:21:17.279 --> 00:21:25.200
Their patients were too afraid to take it, which means we have a whole generation of women who lost out on appropriate care.
00:21:25.599 --> 00:21:28.400
Because, you know, we we used to not live this long.
00:21:28.559 --> 00:21:33.920
That's the whole thing, is that we used to die, our life expend expectancy was before menopause.
00:21:34.000 --> 00:21:39.039
But now I plan on living a hell of a lot longer, you know, like many, many years after.
00:21:39.200 --> 00:21:50.000
And and I think it's really sad that we we have a generation that we owe a big sorry to because doctors were not trained in the true risks and how to interpret that study.
00:21:50.079 --> 00:21:51.680
And the the conversation wasn't there.
00:21:51.759 --> 00:21:53.440
It was just a well, so what?
00:21:54.000 --> 00:21:59.119
But you know, your point is a good one around it, wasn't just the doctors weren't trained, there was a societal thing.
00:21:59.200 --> 00:22:01.359
So I I To go back to something.
00:22:01.519 --> 00:22:06.880
If you remember when we were growing up, Nancy Reagan had breast cancer.
00:22:07.039 --> 00:22:14.400
There, that was when the advent of the um the pink campaign around breast cancer, the hyper focus on breast cancer.
00:22:14.480 --> 00:22:26.480
And so just to be super clear, I'm not saying that there should not be focus on breast cancer, but that but the awareness factor of breast cancer really really went through the roof in the 80s and the 90s.
00:22:26.640 --> 00:22:39.200
And so the women that were in their 20s or in their 30s and 40s in the 80s and 90s are now heading into 2000s, and the women's health initiative hits.
00:22:39.440 --> 00:23:08.079
And all of a sudden, women who were, you know, get your mammogram, um, uh lump, lump checks, self-checking, all of that, the common language around that, which is appropriate, but it over-indexed on breast cancer being the scariest thing and not recognizing that cardiovascular disease, immobility, diabetes can also be at a very, very problematic thing.
00:23:08.240 --> 00:23:15.359
And so you had this kind of confluence of societal focus on breast cancer, and it should have been.
00:23:15.759 --> 00:23:33.119
However, with that focus, and then on the back of that, the WHI, it created this big fear within the population without the opportunity for doctors to jump in scientists to say, wait a minute, let's look at this study in detail.
00:23:33.279 --> 00:23:34.640
Was this the right population?
00:23:34.799 --> 00:23:36.880
To your point, was this the right dosage?
00:23:37.039 --> 00:23:39.440
Um, were they tracked appropriately?
00:23:39.599 --> 00:23:40.480
Yeah, et cetera.
00:23:40.720 --> 00:23:49.759
And those were the things I think that created this 20-something year um multi-generation kind of approach to no hormone therapy.
00:23:49.839 --> 00:23:53.599
It wasn't until last year that estrogen, the black box warning came off.
00:23:53.920 --> 00:23:55.039
I know, I know.
00:23:55.200 --> 00:23:59.440
And and, you know, I think we could go back to the media.
00:23:59.519 --> 00:24:04.160
I mean, we kind of have to point some fingers at the media because everybody loves a big story.
00:24:04.400 --> 00:24:06.640
And you had media jumping all over this.
00:24:06.720 --> 00:24:12.559
But to your point, if you ask women what do women die of, they'll say breast cancer, and the answer is heart disease.
00:24:13.119 --> 00:24:13.279
Right?
00:24:13.599 --> 00:24:23.279
It's cardiovascular disease, strokes, hip fractures, urinary sepsis, you know, that that's what's costing the healthcare system billions of dollars.
00:24:23.599 --> 00:24:33.279
And we think that you can make a great case for medical students being that first easy entry point to cut some of those costs.
00:24:33.680 --> 00:24:48.000
Well, and one of the things we talk about in the paper is that we're not talking about adding courses and courses, we're talking about integrating um menopause education into multiple facets of disease.
00:24:48.079 --> 00:24:50.799
And to your earlier point, estrogen affects every cell.
00:24:50.960 --> 00:25:06.319
So every body system, every system should be discussed as from that perspective of like what happens to the heart pre-menopause, perimenopause, post postmenopause, you know, like what should happen in that?
00:25:06.480 --> 00:25:13.519
No different than we do of like, why are men more likely to have a heart attack in their 40s and 50s versus in their 20s?
00:25:13.599 --> 00:25:26.480
You know, like this is how we've approached it because we also know that the amount of medical knowledge has accelerated significantly, just in the amount of available medical knowledge has accelerated significantly.
00:25:26.880 --> 00:25:40.640
And so we understand, well, you have your master's in in medical education, so you clearly understand the limitation on time that you get with a student or with a resident.
00:25:41.039 --> 00:25:44.319
Yeah, so that's why we said not addition, but integration.
00:25:44.720 --> 00:25:48.000
We're not adding anything extra, we're just finishing the sentence.
00:25:48.720 --> 00:25:51.440
And in women, this happens.
00:25:51.839 --> 00:25:53.599
And in women, this happens.
00:25:53.759 --> 00:26:04.880
It shouldn't, it's just extending the sentence a little bit at the same time that they're even talking about shortening the training for medical school because of all the technology and people are learning in different ways.
00:26:04.960 --> 00:26:11.119
So I think there's there's no one way we're saying you solve this problem, but it's shouldn't be considered a whole extra curriculum.
00:26:11.279 --> 00:26:18.480
It's literally just adding the part about women that is has been left out.
00:26:19.279 --> 00:26:31.039
So so who there are some schools, and the NIH actually, despite all the things that have been happening, has started to do some tip their toes in into the this space.
00:26:31.200 --> 00:26:42.559
Uh who are some of the schools that you've been hearing about um that uh some academic centers, um, you know, that we've we we in a part of our research.
00:26:43.200 --> 00:26:46.400
Well, I think I'm not gonna name names.
00:26:46.559 --> 00:26:49.759
Isn't that gonna put somebody on the on the uh you know what?
00:26:49.839 --> 00:26:50.640
That's that's okay.
00:26:50.720 --> 00:26:55.359
We we don't need to name names, but I you know what they can read the paper because we're gonna be able to do that.
00:26:56.559 --> 00:27:05.359
But I'm gonna say that if you are not one of the schools that is talking about this, because it's not the majority of schools, but there is a cost of best of practice curriculums.
00:27:05.440 --> 00:27:07.839
I know that there's there's a real push for it.
00:27:08.079 --> 00:27:13.519
If if your name isn't on that list soon, that is a reputational hazard.
00:27:13.839 --> 00:27:38.559
Because as students start demanding good education, as patients start demanding better trained doctors, as healthcare systems are demanding cost cutting where we can, if you are not at the head of the pack, that is gonna be a problem because medical students bring money and attention and all those things that academia wants, you had better be at the leading front pack of this movement that we're calling it.
00:27:38.720 --> 00:27:39.519
A movement.
00:27:39.920 --> 00:27:40.720
Yeah, exactly.
00:27:40.880 --> 00:27:51.359
I mean, so I think what I want to make sure that people know, and we're gonna talk about in a second the website we created, um, that uh is just masterful, I must say.
00:27:51.920 --> 00:27:54.400
To be clear, neither of us actually created a website.
00:27:54.720 --> 00:27:55.039
Yeah, yeah.
00:27:55.119 --> 00:27:57.440
There was my ABID team that created the website.
00:27:57.599 --> 00:27:58.480
Uh that's not us.
00:27:58.640 --> 00:28:00.799
Yeah, we'll we'll we'll talk about that in a second.
00:28:01.200 --> 00:28:05.599
But for medical schools, you know, we've talked about completing the sentence.
00:28:05.759 --> 00:28:25.039
So when you're teaching cardiology, when you're teaching physiology, when you're teaching psychology, psychiatry, when you're teaching these different types of systems or courses, including how the body changes during menopause and how those different systems change during menopause is a very nice way.
00:28:26.400 --> 00:28:29.200
Just a few slides, just a few questions on the test.
00:28:29.839 --> 00:28:38.880
And if you need more than our downloadable slides, you can ask me about the time I had a panic attack because I was having palpitations while driving on the freeway.
00:28:38.960 --> 00:28:48.319
And I called 911 because I was worried I was gonna die, and they told me to take my pulse, and I couldn't find my pulse, so I started screaming hysterically.
00:28:48.559 --> 00:28:54.079
And that sounds like a crazy lady whose doctor button just wasn't switched on, but guess what that was?
00:28:55.839 --> 00:28:58.000
A panic attack associated with perimenopause.
00:28:58.319 --> 00:29:02.319
It was palpitations thanks to hormone fluctuations associated with perimenopause.
00:29:02.400 --> 00:29:05.200
And oh, by the way, my anxiety is through the roof.
00:29:05.359 --> 00:29:10.400
And when I saw my doctor, we went up on my estrogen, it all got better.
00:29:11.359 --> 00:29:16.400
And something you said earlier when people do have palpitations, EKGs are a good thing.
00:29:16.720 --> 00:29:17.759
Oh, yeah, they are totally.
00:29:17.839 --> 00:29:21.200
I had one on the side of the road that day with the when the ambulance came.
00:29:22.160 --> 00:29:24.720
The cute firemen are like crazy lady.
00:29:25.359 --> 00:29:26.480
But yeah, I did.
00:29:26.960 --> 00:29:48.480
Yeah, I mean, but now for program directors, you know, we we one of the things that we had recommended is that within the different specialties, whether it's family medicine, emergency medicine, internal medicine, surgery, program directors can start looking for where what are the places where menopause touch.
00:29:48.559 --> 00:29:50.400
So what does menopause already touch?
00:29:50.480 --> 00:29:57.839
So if you're talking about, if you're an orthopod or surgeon and you're talking about hip fractures and the treatment of hip fractures, add the sentence.
00:29:58.160 --> 00:30:04.960
Post-hip fractures, urinary tract infections are likely and can extend delays in hospitalization.
00:30:05.119 --> 00:30:09.680
Therefore, vaginal estrogen, which newsflash is applied in the vagina.
00:30:10.880 --> 00:30:11.920
We've settled that issue.
00:30:12.480 --> 00:30:15.039
We've settled that, um, should be given.
00:30:15.200 --> 00:30:17.440
You know, like it's the completion of that sentence.
00:30:17.599 --> 00:30:24.240
If you are talking about palpitations or cardiovascular disease, it's it's that kind of talking about that population.
00:30:24.319 --> 00:30:39.599
And so um, you know, there is, I think you have talked about before about how to use the EMAS position statement as a model of how to kind of tap into didactic resources.
00:30:40.000 --> 00:30:59.119
And, you know, we know that that faculty, depending on their areas of focus, they may or may not have interest, but we really are in thinking of this as a long-term investment because so many students are are going to benefit and resonance will benefit from this because of the populations they're touching.
00:30:59.359 --> 00:31:00.960
And it's not just the benefit.
00:31:01.119 --> 00:31:07.200
I think it's about, you know, for those who have already trained, who are in specialties where they don't understand why this is so important.
00:31:07.440 --> 00:31:12.559
If we don't treat it, then we are sending a message to our students that it doesn't matter.
00:31:12.640 --> 00:31:18.000
And that is something that is a state of existence for decades for over half the population.
00:31:18.240 --> 00:31:19.200
That matters.
00:31:19.519 --> 00:31:27.039
And we need this older generation of doctors to come back and remember that they are role models for our next generation.
00:31:27.119 --> 00:31:31.119
And how would they want their wife or mother or sister or daughter to be cared for?
00:31:31.519 --> 00:31:34.799
Or and when you add an and, not an or.
00:31:35.279 --> 00:31:37.920
And you and I are examples of this.
00:31:38.079 --> 00:31:41.039
More and more doctors are not just doctoring anymore.
00:31:41.599 --> 00:31:49.680
We are on boards, we are fractional chief medical officers, or chief medical officers, or innovators, or entrepreneurs.
00:31:49.839 --> 00:32:01.279
And if we want to create solutions that are going to take care of half of the world's population, we need to have doctors, number one, at the table.
00:32:01.519 --> 00:32:11.359
But we really need to have doctors who understand the situation because that's financially better for investors, that's financially better for your return on investment.
00:32:11.519 --> 00:32:17.759
I mean, having a healthcare company that's full of tech people and no doctors, that's just a tech company, you know.
00:32:18.000 --> 00:32:24.079
Like you really need to train doctors, though, to know what to look for, to know what to think about.
00:32:24.319 --> 00:32:34.400
And so I think I, you know, that's that's where I see this opportunity, um, both altruistically and also from a profitability standpoint.
00:32:34.720 --> 00:32:41.359
Well, listen, our paper is out, and so I want to talk about the website, okay?
00:32:41.680 --> 00:32:46.240
And so the website is closethennowledgegap.com.
00:32:46.559 --> 00:32:48.720
Close the knowledge gap.com.
00:32:48.880 --> 00:32:49.839
Very simple.
00:32:50.079 --> 00:32:55.119
And when you go to that site, you need to scroll all the way through from top to bottom.
00:32:55.279 --> 00:32:59.920
Easy peasy, because you can download for free the white paper.
00:33:00.160 --> 00:33:08.240
We have done this gratis, we've done this without kind of getting expecting anyone to pay us for this or anything like that.
00:33:08.400 --> 00:33:13.279
This is this has been something that you and I if you want to, you can.
00:33:13.599 --> 00:33:14.400
I mean, sure, sure.
00:33:14.480 --> 00:33:15.200
Like I'll turn it on.
00:33:15.519 --> 00:33:16.079
We're not gonna say no.
00:33:16.480 --> 00:33:16.960
That was not the point.
00:33:17.200 --> 00:33:19.440
We can throw our, but that was not the point.
00:33:19.759 --> 00:33:21.759
Um, but here's what's on the website.
00:33:21.839 --> 00:33:25.680
So, yes, you can download for free the the white paper.
00:33:25.839 --> 00:33:33.680
Number two, you can listen to the white paper audio, and you can listen to it in minute chunks.
00:33:33.759 --> 00:33:35.920
You don't have to like four or five minute chunks.
00:33:36.000 --> 00:33:38.400
You don't have to listen soup to nuts from beginning to end.
00:33:38.480 --> 00:33:41.920
You can listen to little chunks, you can read it in sections.
00:33:42.160 --> 00:33:42.480
Okay.
00:33:42.960 --> 00:33:46.160
So that's the first part of the white paper or the website.
00:33:46.319 --> 00:33:50.799
When you go further into the website, we want you to share it.
00:33:51.039 --> 00:33:56.720
We want you to send it to friends, to family, to your doctor, to your lawyer.
00:33:56.880 --> 00:33:59.039
We want you to send it to everybody.
00:33:59.279 --> 00:34:06.319
And so we've used all social media, like everything from Reddit to X to um, I hate calling it On.
00:34:06.559 --> 00:34:07.279
OnlyFans?
00:34:07.519 --> 00:34:08.800
We didn't do OnlyFans.
00:34:08.960 --> 00:34:10.480
We didn't do OnlyFans.
00:34:10.639 --> 00:34:14.320
You know, that's for you know, I only have fan.
00:34:14.559 --> 00:34:15.599
That's for the next one.
00:34:15.920 --> 00:34:20.639
Well, um, Twitter, uh, oops, X, Facebook, Instagram.
00:34:21.039 --> 00:34:31.039
We we made it where uh LinkedIn, where all you have to do is click the little icon on the website, and it immediately creates a post for you.
00:34:31.280 --> 00:34:36.239
We created a downloadable PowerPoint presentation that's already done.
00:34:36.480 --> 00:34:45.519
Slides are designed for you to share, to share with your team, to share with your program director, to share with your dean of your medical school.
00:34:45.760 --> 00:35:00.800
We created an email, a template that you can make some adjustments, but a simple template that says, This is what we're talking about, this is the importance of it, why we should we be why we should be doing it.
00:35:00.960 --> 00:35:01.920
That is all there.
00:35:02.000 --> 00:35:04.239
And even more fun, Laura.
00:35:04.880 --> 00:35:11.119
When you share it to Instagram, we created quote card graphics, graphics for you.
00:35:11.280 --> 00:35:16.800
So you can just share the graphics about the white paper, carousels.
00:35:17.280 --> 00:35:23.039
We did all of this in a one-stop shop so that it was an amplification type of powerhouse.
00:35:23.199 --> 00:35:27.119
And I know it's ready, it's easy, it's not just ready.
00:35:27.360 --> 00:35:32.079
We made it like we aimed for the lowest effort denominator.
00:35:32.719 --> 00:35:33.280
Exactly.
00:35:33.440 --> 00:35:36.079
And it's hashtag close the knowledge gap.
00:35:36.239 --> 00:35:38.559
That is is what our goal is.
00:35:38.800 --> 00:35:42.400
So um we're not asking anyone to build a new program.
00:35:42.480 --> 00:36:00.000
We're asking them to make some adjustments and complete the sentences that they're already saying in their program so that they can not only do a better service to their medical students, to the residents, but the impact of the patients that all of those people are going to take care of.
00:36:00.239 --> 00:36:04.159
So, you know, Laura, after writing this, I mean, this took months.
00:36:04.559 --> 00:36:07.519
Like we started this in I think February.
00:36:07.920 --> 00:36:11.440
I had the first draft to you in October, I believe.
00:36:12.239 --> 00:36:12.880
Really?
00:36:13.199 --> 00:36:13.840
Wow.
00:36:14.079 --> 00:36:17.679
Okay, so yeah, almost a year to pull this together.
00:36:18.719 --> 00:36:20.719
Because white papers are not just white.
00:36:21.199 --> 00:36:21.840
They're not.
00:36:22.000 --> 00:36:25.360
And they're not just like getting a piece of white paper and giant downsides.
00:36:25.519 --> 00:36:26.960
We had lots of contributors.
00:36:27.360 --> 00:36:29.519
We talked about Jocelyn, we talked about Miriam.
00:36:29.920 --> 00:36:32.639
Tamar Gurr, head of women's health at Ohio State.
00:36:32.800 --> 00:36:39.599
We've got Jessica Federer from the Women's Health Fund, we've got uh Laura Okifer from Perry Academy.
00:36:39.679 --> 00:36:49.679
Um, so we brought people in from the investor side, from the clinician side, medical student side, medical educator side, um, the uh lay population side.
00:36:49.760 --> 00:36:56.079
We we wanted to bring in all those voices because we're making a movement happen.
00:36:56.239 --> 00:36:59.920
And you know, a movement doesn't happen when one lady says move.
00:37:00.639 --> 00:37:01.199
That's right.
00:37:01.280 --> 00:37:02.880
We we've got to all say move.
00:37:02.960 --> 00:37:17.599
And so close the knowledge gap.com, free to read, free to share, easy to bring to your institution, and to add it to your agenda when you're talking to your program directors, to your deans of your schools, um, or even to your doctor.
00:37:17.760 --> 00:37:36.079
Um, and you know, I didn't mention this before, but something that societies, ASEP needs to talk about, the American Medical Association needs to talk about, you know, um ACOG, all of these other societies who some of them have some of this discussion, but move it out of the women's health interest group.
00:37:36.239 --> 00:37:49.519
That's right, and move it into the health interest group because it's it's not just a niche charity kind of foundational core knowledge.
00:37:50.400 --> 00:37:51.039
Yeah.
00:37:51.599 --> 00:37:56.400
So that is the title of the website, Close the Knowledge Gap.
00:37:56.559 --> 00:38:09.760
The title of the um white paper is um The Business Case for Integrating Menopause Education into Medical School Curriculum.
00:38:09.920 --> 00:38:12.000
Laura, this was a lot of work.
00:38:12.320 --> 00:38:13.199
There's eight sections.
00:38:13.519 --> 00:38:20.400
There's a lot of me because I know I had to work a little to get you on board, but now that we've done it, I'm super proud of what we've done.
00:38:20.639 --> 00:38:22.159
Yeah, I'm very super proud of it.
00:38:22.559 --> 00:38:25.519
Huge thanks to the team who actually knows what the hell they're doing, right?
00:38:25.679 --> 00:38:28.000
Makes the colors paint paints the paper.
00:38:28.400 --> 00:38:43.039
Yeah, my my my team at A B I G just a couple of shout-outs to Kelsey McNabb um and um Laura Jessups and the rest of the team who did a lot of really great work in Adam Lee on the graphics and the organization of this campaign.
00:38:43.119 --> 00:38:45.920
So let's get it out there, let's get it going.
00:38:46.079 --> 00:38:46.400
All right.
00:38:46.800 --> 00:38:47.840
It was good to see you, Laura.
00:38:48.079 --> 00:38:48.800
You too, Adam.
00:38:49.039 --> 00:38:49.360
Bye.
00:38:49.519 --> 00:38:51.840
Thanks for tuning into Unstable Vitals.
00:38:52.000 --> 00:38:58.000
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00:38:58.159 --> 00:39:04.079
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