124. Birth Control 2.0

Quinn:
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Quinn:
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Quinn:
Guys, this week's episode reveals the science behind birth control 2.0, and I couldn't be more excited about this. We're going to understand what's the landscape and what's next and also why it's taken so long to build something better. Our guest is Dr. Elizabeth Ruzzo and she's taking on the huge task of all those things and I couldn't be more excited to share her journey and her plan with you because look, family planning affects everybody. It even affects the planet and we are on the cusp of doing so much better. This stuff is just exciting as hell. So I can't wait to share it with you and as always any questions or feedback, please shoot it to us at questions@importantnotimportant.com. Here we go.

Quinn:
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Quinn:
Our guest today is Dr. Elizabeth Ruzzo and together we're talking about birth control and family planning and how it needs to be so much better. And because it's 2021 for better or worse, we might have the tools to do that and the people who are best suited to do so. It's time for 2.0. Dr. Ruzzo, welcome.

Dr. Elizabeth Ruzzo:
Thank you. I'm so excited to be here and talk with you today about birth control.

Quinn:
Let's do this. That is the first time someone has said that to me that I haven't gotten terrified. All right, Elizabeth, tell us real quick who you are and what you do.

Dr. Elizabeth Ruzzo:
So I am a PhD in human genetics, and I left academia to start a company called adyn and adyn has created the first test that's designed to prevent birth control side effects.

Quinn:
It sounds so simple.

Dr. Elizabeth Ruzzo:
It's hard to come up with the one sentence that makes it sound simple.

Quinn:
No, that's impressive. I have no idea what we do, but much less like put into one sentence, so that's really great. Awesome. Thank you for sharing that. So listen, we're going to get into more about the why of why to do it though that seems obvious, but maybe again, like we discussed previously, not to people who look like me with a beard. But I do want to start with one important question and it sounds like you'd been cheating by listening to previous episodes. Instead of saying, tell us your life story, I would love to know why do you feel like you're vital to the survival of the species, Elizabeth?

Dr. Elizabeth Ruzzo:
I wasn't sure if you asked that question to everyone, so I don't have a prepared answer.

Quinn:
Oh, I do. And it's much better if you don't have a prepared one because our listeners can feel the sweat on the phone.

Dr. Elizabeth Ruzzo:
Survival of the species is very ambitious. I think it's that I have a passion for using science to improve the way that we conduct medicine. So, and on top of that, I have a passion for educating people about that.

Quinn:
Okay. That sounds very legit. I still don't know how I'm going to answer this question someday. I'm probably just going to turn the camera off and run away, like I tried to earlier. That's fantastic. Well, we're thankful for you and thankful for your work and excited to get into it.

Quinn:
So here's why I wanted to have this conversation today. It's family planning. It affects everyone. It doesn't matter what your sex is, what your gender is, what your role is. It affects you, it affects the planet and all these different things, but obviously most importantly, it's about a woman's body and what does she choose to do with it and how does she feel after she chooses to do whatever she chooses to do with it? And a lot of times it's not great. There's trade offs, of course, for any kind of medicine. I feel like, should we make it through the next three years? We're going to look back and look at things like chemotherapy and say like, "Look, that was our best option at the time, but holy shit, I mean, how barbaric was that?" It's like when we used to cut sailor's legs off and then all of a sudden we had medicine, and the difference between World War I and World War II because of penicillin.

Quinn:
So thankful for the medicine that is there, and there's a huge variety of methods and not just medicines of obviously family planning and birth control, but for example, the pill has been around since 1960, I think something like that.

Dr. Elizabeth Ruzzo:
1960, yap.

Quinn:
I think it's like a hundred million or something like that. Women around the world use them. Again, this is my internet research, so Elizabeth please correct me everywhere I'm wrong. I believe if you're in the 15 to 49 year old age range in the US and using birth control, if you're not actually getting your tubes tied, you're using the pill. It seems to be among the most prevalent there.

Dr. Elizabeth Ruzzo:
Yeah, the pill is the most common, but there are multiple kinds of what we focus on, which is anything that's considered highly effective forms of birth control. So that also includes the patch, the ring, the arm implant and the IUD.

Quinn:
Gotcha. Okay. Awesome. Super duper helpful. And obviously those things, I mean the pill, it kick-started the sexual revolution of the '60s. It's, like you said, very effective, but again, all of these things, like many medicines come with trade-offs. And frankly, if you're not the one taking the pill, you might not be so aware of those. So one of the things that clued me in, and I was so excited to stumble on to the work you guys are trying to do is when folks earlier this year we're trying to understand the effectiveness and potential side effects of these new COVID vaccines, which again, disclaimer, like incredibly safe. We're incredibly lucky to have these things, right? One very, very rare issue that is real, but is very, very real that came up, it was a potential for a blood clot. And obviously that is scary. I get it. It's real. Of course. Again, very, very real.

Quinn:
A bunch of women chimed in to explain that the pills chances of a clot were higher. And obviously that is differentiated among many different humans, millions of humans. It's still pretty low. The side effects are no joke and it does affect everybody differently. Our bodies and how we react to everything is so different. We're finding that with the vaccines too. And with COVID obviously, from clots to hormones and all that stuff. And that's genetics. And that's why I want to dig in today to understand how you and your company adyn are trying to help design something in a cooperative way, in an inclusive way that is more effective and more tolerable and more safe for more women. So, tell me-

Dr. Elizabeth Ruzzo:
Yep. And that just fun fact, that J and J vaccine risk is 340 times lower than the risk from birth control that's used by millions and millions of women.

Quinn:
Right. I mean like children basically. You've got like young teenagers up to women as far as they know. I mean, it's wild. Wow, that's wild. Context, always helpful, always helpful. If we've learned anything in the past year and a half, it's like context is always helpful.

Dr. Elizabeth Ruzzo:
Absolutely.

Quinn:
I want to personalize this a little bit. Not on my end because I am not the one using birth control as much as I've offered to get the snip many times, different podcasts. So there's a two-part question I've become fond of in the past year or so. And the first part is why do you have to do this? And the second part is, why does it have to be you? So if you don't mind, Elizabeth, can you share your story a little bit with birth control, because I feel like to work on something so specific and so prevalent among so many different people, it probably needs to come from something personal, an experience you've had with this sort of thing.

Dr. Elizabeth Ruzzo:
Yeah. So I think my experience is not unique, but it was important to motivating me to want to work on this. So I think like many women, I was prescribed a birth control at an early age and in fact it was not for pregnancy prevention, but for medicine, like many women are the reason they're prescribed birth control and it caused me to be severely depressed. And it wasn't until the second time I went on it that I was depressed to the point of considering suicide, and went to my doctor and explained that I thought that the pill that I was on was to blame for feeling so terribly and was gas lit. Was told that there was no way, there was no evidence, that birth control wouldn't do that. So I trusted this medical professional and suffered through it for, I think, two more months, possibly three more months, and then went off of it and started feeling better.

Dr. Elizabeth Ruzzo:
So it just became this question in the back of my mind. I would talk to friends, I would ask them what their experiences were like and I learned that not everyone had depression, but maybe they had a blood clot, gallbladder removed, just you name it, that the range and diversity of side effects is crazy. And the flip side of that is some people felt better. They saw acne improvement, mood improvement, et cetera. And so it became clear that there was potential there for birth control to do good beyond even the freedom it offers from pregnancy prevention and family planning, but also that it has the potential to do badly if we're not matching people to one that makes sense.

Quinn:
And I guess before we get into the stuff of why does it have to be you and a further exploration of why you're doing this and thank you for sharing that I appreciate. That's obviously very personal. For those of us out here who don't take, or haven't taken birth control, whatever your reasons may be, sex or gender choice, whatever, could you just take a step back and lay out the landscape for us real quick? Just, I guess let's stick with the US right now. So most common options, the intended outcomes, or I guess how it's supposed to work and then what are the most common side effects that we see among those? So we can really understand the why of this.

Dr. Elizabeth Ruzzo:
Yeah. So, I mean, the main lay of the land is that there are nearly 200 highly effective methods of birth control available in the US. So the majority of those are pills, different varieties of pills, but also the other highly effective ones I mentioned, so the patch, which goes on your arm, the ring and then two that require being inserted for a longer period of time, the arm implant and the IUD, and there's also a shot that's available. The interesting thing about birth control is that because of these, because of these 200 options, there's also a layer of choice involved. So some people hate the idea of having something permanently implanted, or at least temporarily implanted in their body and some people hate the idea of having to remember to take a pill every day.

Dr. Elizabeth Ruzzo:
And then with that there's pros and cons to different ones. So certain ones are better for helping also regulate your period or letting you skip your period altogether, things like that. And the most common side effects I would say are probably mood changes, acne, obviously depression within mood changes. And one of the most controversial ones, although it's technically only been associated with a single drug is weight gain.

Quinn:
Okay. That's super interesting. Okay and now, again, this is very general and I know the entire point of the conversation is the variety of options in the variety of people taking them or not taking them or going through the gauntlet of trying all these different things like it seems you did, but is there a way generalize which... Gosh, where do I start? Sort of like is it by age usually that we know so far? Is it by drug? Is there a different things? If there's anything general there again, so people understand hey, when you're a teenager, you're more likely to have this problem, or you're more likely to take this, or... I'm just trying to understand it a little better.

Dr. Elizabeth Ruzzo:
I wish that there were really broad generalizations. I mean, this is why we're doing what we're doing is recognizing that there's a couple of specific places where we can help make an impact as to what you choose that helps you avoid the negative side effects. So if you have genetic variants that predispose you to blood clot, we also know which sets of birth control are more likely to cause blood clots so we can help you avoid those. There are some tendencies for adolescents to be more predisposed to that depression piece in particular on certain types of birth control.

Quinn:
I wonder if that's just because, and again, in case 124 episodes and people aren't clear, I'm not a doctor, clearly... But obviously when you're a teenager, your hormones are all over the place and going crazy, so I imagine it's just a complicated mishmash in there, no matter what you're doing.

Dr. Elizabeth Ruzzo:
Yeah. I mean, so part of what we're hoping to do at adyn in general is also bring endocrinology into the big data techniques, so with which we approach genomics. So thinking about how we can measure somebody's hormones, not just at a snapshot, in time and try to understand them, but instead measure them longitudinally at multiple time points throughout your life, and also make these gigantic reference ranges that are used in the lab more specific based on what we do know about you. So based on your age, your weight, your ethnicity, and all these factors that we know control your natural endogenous hormone levels.

Quinn:
So I guess that's all the answer to why I was struggling to ask the question is, is there aren't really any, because it's so specific and so varied, and that's the entire point of your work.

Dr. Elizabeth Ruzzo:
Right, right.

Quinn:
Sure. Perfect. Got it. Check. Let's back up even further then. So then now that we have that landscape, when did you get started on this work and I guess, how is adyn approaching it? Are you guys specifically working on one solution, are you doing sort of more general science to start with trying to accumulate data? What is the process been like to date and how is it operating, going forward?

Dr. Elizabeth Ruzzo:
So I alluded to this a little bit, but basically we're starting where we can. So the hardest part here is that this is a completely under studied area. So you mentioned that the pill was invented in 1960 and there's been pretty small amount of technological innovation since then and definitely not the kind of attention we want to see to things like how do we actually do precision medicine and make sure we're not just assuming that every birth control is going to work for every person.

Dr. Elizabeth Ruzzo:
And so we're starting with two of the most dangerous side effects, so that's risk for blood clot and risk for depression. And we also have a number of triggers that are things like are you interested in using birth control to help treat your acne, because there's a handful of them that are known to help with that or, and also preference, as I mentioned. So, are you interested in a longer term option or are you thinking about having children sooner? Things like that. And we help basically from there create a tool that you can then use with a doctor, either yours or aid in provided telemedicine doctor to help you have that contraceptive counseling appointment. And we're training our telemedicine providers to really understand all the nuances of you have power in this, you have a choice. We've now laid out all of these options with the pros and cons in general, and the pros and cons for you, based on what we understand about your biology, so that you can make the best decision for you and your reproductive planning.

Quinn:
It all makes so much sense. Part of what I try to do here, and I find that where we've been most effective is for myself, and certainly with situations like these, but also for other folks, this moment that we're in, which is not a moment, it's an era in so many different ways, whether it's climate or pandemics or personalized medicine, which has certainly had its ups and downs. We started working on the genome how long ago, but the cost have come down and now we're using it and you got 23andMe and then it's, oh my God, 23... It's all these different things. But a lot of it is teasing apart these systems and taking a page from my children, who all they do is say why, which is wonderful. And I'm always happy to indulge their curiosity, but it worked until I say like, "Fine, you can have the snack. Get out of here."

Quinn:
But in this case, you were saying one of the episodes you've listened to of ours was the conversation with Dr. Hasina Maredia and Errol Bush who were working at Johns Hopkins. I think she's actually moved on now to maybe Yale or Brown, but they're working on for years why young black men's health outcomes after heart surgery are just drastically worse than white men. And there's so many inputs to a problem like that. And they're complicated and they're medical and they're sociological in their anthropology and there are all these different things. But if you're paying attention, it's also not too difficult to guess at what the biggest ones might be. All you have to do is look at certain statistics and see, oh, well, 5% of doctors are black. That's it. And nurses are even fewer, and we all know how important nurses are. And that's the same thing in my conversation with a Representative Underwood talking about maternal health for black women. You're two to four times as likely to die in the year after childbirth if you're black and in her home state, it's six times as likely.

Quinn:
And so you look at these things and you go, to be clear, two to four times is very bad.

Dr. Elizabeth Ruzzo:
That's atrocious.

Quinn:
That needs to be fixable. That is a system that was designed that way. When it's six times, you go, wait a minute, what's happening here? These are power systems that are undefeated.

Quinn:
And so when I jot down my notes for conversation with you, and you go, okay, if it's been around since the '60s, and we have 200 different options, and there's this huge variety of folks who take these drugs for a huge variety of reasons, like you said, from acne to family planning to controlling brutal periods, it's easy to ask the question, why have these side effects been tolerated by, I guess, basically by not overlooked, but it's somewhere between overlooked and tolerated by the medical profession and the pharmaceutical industry for so long and it's also easy to understand the basic answer, which is just like, it's not women working on these things because they're generally not been allowed to. So that's why we always look at this pros and cons if it's 2021 thing, which is like, why did it take so fucking long to get here, but at least now we can do genomic big data stuff.

Quinn:
So what has been the history of trying to progress these things? Have there been efforts that have failed? I look at, I have a cousin that's suffering from ALS and it is like a lightning strike, as they say. We've learned so much more in the past 10 years, the ice bucket challenge went a long way. I also work a lot with pediatric cancer, which gets 4% of federal cancer funding. And you go, okay, so what acts of the people who have been working on the efforts that have been made? Is it not enough money? Is it not enough work? Have there been efforts like an ALS trial promising one flamed out today? Is it something like that? Where have there been successes and failures along the way to get you to where you are now?

Dr. Elizabeth Ruzzo:
Yeah, that's a great question. I mean, I think it's a combination of things. I think one clear example gets at what you were saying, which is the level of tolerability. So there have been, and continue to be efforts to create male birth controls. When there were early clinical trials for those, the clinical trials were literally canceled because men complained about, you guessed it, acne, weight gain, and depression.

Dr. Elizabeth Ruzzo:
And so it's been a bit of a battle and the responsibility has fallen on women and because the price you pay is so great. And the freedom you get has literally changed our ability to become educated and participate in the workforce so that tolerance is just there. And in terms of technological innovations and why I think adyn is possible now is a number of things, including things like people understanding genetics, the ability for us to do home testing, because of changes in the regulatory space, because of the ability to use a finger drop of blood to accurately measure a small number of hormones at one time and things like that that are paving the way for our ability to do this, as well as just large scale genomic studies that have been done, for example, in depression, which is how we're able to be reporting on that. We're using data that has nearly a million individuals, it's based on 800,000 individuals. So without those data, we wouldn't be able to make the progress that we are, and those efforts are continuing to grow, but not quickly enough, in my opinion, in diverse populations and specifically in diseases that affect primarily women and girls. So that's a big part of adyn's larger mission, which is to make scientific discovery more inclusive.

Quinn:
A few things. One, you use the plural for data, which brings me infinite joy.

Dr. Elizabeth Ruzzo:
Great. Glad to hear it.

Quinn:
If nothing else. Two, so you, it seems like you're actually able to, instead of, okay, we're starting from scratch. How do we sign folks up for our clinical trials or whatever they may be, it seems like you're able to actually piggyback on some of this genomic work that has been done so far. Can you talk a little bit out you source those and find things that are applicable to the work you're trying to do and then how you tease those in?

Dr. Elizabeth Ruzzo:
Yeah, I mean, so we are definitely standing on the shoulders of giants in many ways. There are some publicly available datasets that we can mine for developing a new technique that we're using called polygenic risk scores. You can basically think of this as rather than looking at a single site in the genome. You're looking at a multitude of sites in the genome and putting them all together to get the cumulative risk that somebody is exposed to. And so we are going to continue to do that for more and more studies as data become available, as well as do our own ongoing research, which is part of a question you asked before that I think I failed to answer. We are definitely doing ongoing R&D and hoping that people want to opt in because they believe in our mission and understand the larger picture of what we're trying to do.

Quinn:
Is it the NIH that's doing a big genomic study that's trying endeavoring to be more inclusive than we've been to date?

Dr. Elizabeth Ruzzo:
All for us, I believe it's [crosstalk 00:26:29]

Quinn:
All for us.

Dr. Elizabeth Ruzzo:
Yeah. They are and that's great. And there's a number of other efforts, but we are very far behind. And also I'm not an expert in that, but from what I have looked at, I'm almost worried it's too broad to fully move the needle when you have a specific use case. So let's say I'm interested in fibroids or PCOS, you really need to be able to do deep phenotyping to make sure that you have someone who has, or has not been diagnosed with that disease to be able to conduct the study that you want. So it's great that they're working on just a broadcast net to diversify the kinds of samples they're studying, but we also need to be sure that we as a scientific community are continuing to do really pointed research in a way that is as inclusive as possible.

Quinn:
So for your own research, there's been this, it could be a total false flag, but we're seeing things like the Apple Watch being stirred to use with their research kits stuff to enable, not everything by any stretch, but certain trials that would otherwise have been very limited geographically and demographically very expensive to run. Trials are so hard historically to actually fill. They're so expensive. In certain cases for that to walk like what they've done with their heart stuff, working with a few places and what they've done with I think how they built their walking tool. Obviously I imagine that is not the type of thing you can work with, but how are you guys when you look at, okay, we're going to build our own research here because some of these things might be too broad, we need to look at specific things. But what is the process there for building that as a startup?

Dr. Elizabeth Ruzzo:
It's a great question and one that keeps me up at night. I mean, I think that-

Quinn:
You're welcome.

Dr. Elizabeth Ruzzo:
... a big part of it, and part of why I left academia to do this is I actually felt I could help more people more quickly in a startup setting. But part of what you have to do in the challenge that you're up against when you're not behind, in my normal setting, which is an academic setting where people, I think inherently have a little bit more trust and probably rightly so is work on building that trust. So work on practicing what we preach on being inclusive in our own actions as a team, as a brand and educating and adding value for anyone even if they don't ever spend a dime or want to work with us in any way. So I think in order to do that, it's really just there's no quick solution here. You have to be transparent, build trust, get the word out, have people opt in to research. I feel optimistic based on some of the numbers I've heard from 23andMe about having, I think almost 80% of people opt in to research, which is fantastic because if you understand and believe that there's a bigger mission there, you're willing to help. And that's just critical.

Quinn:
It's interesting when you look at all of us and then 23andMe and let's leave you guys and the huge variety of other folks trying to do this, I don't want to just grossly label it biotech, but you get the idea. And I wonder if you can speak a little to the folks who are like, "I'm not giving my genomics stuff to the government, or I'm not giving it to a private company." And it's hard because I empathize with both of those, pros and cons at the same time, this stuff is so hard. Sequencing the genome has come down, I mean, as about as much as solar panels and batteries. It's incredible what we are starting to be able to do. But it still costs so much and it's so hard to do and to... I mean, I can't imagine, like you said, the paperwork. Is just got to be ungodly like no thing. I run a podcast and I've got enough shit. You're trying to make medicine. No, thank you.

Quinn:
So I wonder if you can speak a little to those, let's gently call them hesitancies among folks. Because it is interestingly, I mean, I think it's probably a human condition at times, that trust that you were talking about, but at the same time we had on a couple of women a couple of years ago, two years, time means nothing anymore, that work with DNA at NIH and one of the things that was so fascinating to me, I'm familiar with the NIH. I lived over there for a little while. I benefited from it for $0. But it's interesting that data collection there is actually, from birth, opt out which I was just like, "Holy shit I can't imagine again now what one could be able to start to do with that sort of thing." Were that here, if you imagine, can you imagine trying to turn that spigot on here? Like, good luck. But, so I wonder anyways, could you speak a little bit to how folks, I think feel with that in an era where we do need more data to do these sort of things?

Dr. Elizabeth Ruzzo:
Yeah. I think that people obviously should own their data and decide what they do with their data. And I think we have a great responsibility to protect those data and we take that very seriously. We are not planning on going around and selling individual data. The government has done some things to try to protect people's data from insurance discrimination and things like that, obviously with GINA, which is a massively important step. But it's also important to recognize that opting in, the more samples we have, the more you're contributing to making a big impact that increases our potential to do discovery and to do good. And so, like I said, that's why I think building this trust is really important because I get it, if you don't trust us, if you don't see a scientist's run female led company working on trying to do R&D for women's health as a place you want to be part of the community and share your data, that's on you. But hopefully we can convince you that we are trying to do good, and the way we convince you is by continuing to protect your data and actually make discoveries that are medically actionable and have a large impact.

Quinn:
And I imagine that's where you become effective, is once you're able to start to have a little bit of impact. So you can say, I fully understand your fears and your concerns. I will both answer those, but also show you this is not only what we're trying to do, but this is what we've been able to do so far with the help of the folks that have decided to opt in and share that with us who have trusted us so far. So where do you feel you're going to be able to start to see some of the fruits of your labor? And obviously I know it's very early in this thing is all incredibly hard. I mean, I feel like one of the things about these mRNA vaccines, not to denigrate the folks that Johnson & Johnson and all these, that they worked on the relatively more traditional versions, but... And the mRNA vaccines didn't come out of nowhere. Katalin Kariko worked on these. She tried to solve the inflammation problem for 20 years. Her story is just incredible. It didn't come out of nowhere.

Quinn:
However, we were told 18 months minimum and good luck if it's that. And then we got them and everyone's like, "Great. They're not good enough. It's only 94%." I just want to be like, "Motherfucker. Do you understand how hard this is?" So I don't want to put you on the spot and be like, "What's the deal lady?" But I'm curious where you feel like you're going to be able to go like we're doing it and we can show people this is what you can help with. And that's where I feel they always get me with the pediatric cancer thing. Two of the organizations I love is a Cycle for Survival, which works on rare cancers and Alex's Lemonade Stand, which is pediatric cancers, which is literally my biggest problem in the world. It's just like why?

Quinn:
But they'll bring out a scientist who works on rare pediatric cancers and they'll show you pictures of the child they saved because of the research they did and you're like, "Well, then you can have all my fucking money. What are you talking about?" Because they're like, this is what literally what it went to. We don't get much, and this is what I can do with it, because this is a person who is, like you said, "I'm going to spend my life on this." But at some point they do for themselves and their career and their profession need to show this is where we're at least starting to make progress or overcome some obstacles. So what does that look like for adyn and for you?

Dr. Elizabeth Ruzzo:
Yeah. I mean, I think the biggest thing is that we are already doing more than the current standard of care. So the current standard of care is essentially a little more than trial and error. Doctors look at this table put together from the CDC that helps doctors avoid the most dangerous contraindications, like if you're a smoker over 35, that increases your risk for blood clot, things like that.

Quinn:
Sure.

Dr. Elizabeth Ruzzo:
But we're already providing more help in the process of prescribing than exists before. And in terms of where I think we're going to make an impact with the data, we already have some preliminary dry lab data looking at the associations between different birth controls and the side effects that they cause. And so I think pretty quickly, we'll be able to layer on that biological information to increase the specificity of how we're doing these offerings.

Quinn:
Wow. That's exciting. That's got to be awesome. I mean, it takes me a week to put together a podcast, I can't imagine how you're already making progress on this stuff. That's constantly impressive. That's really exciting. So what are some of the obstacles you folks... Here's what I'm trying to do. We always work towards these action steps that folks can take, because I think I alluded to in our previous conversation offline, we've got policymakers and academics and folks who fled academia like you rightfully, in some places, and investors and founders and, and all these different things. But we've also got a lot of those who are looking to apply themselves somewhere else. Maybe they founded something else or invested in something and they're going, "Boy, I should really do infectious disease because we've been in our living rooms for a year." Or climate or whatever it might be or something like this.

Quinn:
So what I want to do is paint a picture for them, not just like, hey, look, this is this awesome person working on important thing, but also let's not cut corners. It's fucking hard. So what are some of the obstacles since you started talking to friends and hearing about your own situation, disagreements with the doctors and going on your own journey and friends with clots and all this to starting adyn, to starting to work on these things. What are some of the obstacles you've overcome so far and what are you guys dealing with that you can reveal right now that are your hardest nuts to crack?

Dr. Elizabeth Ruzzo:
Yeah. I mean, I think some of the obstacles we've overcome is really just what is that first version of the test that we can offer that adds value right now and that communicates fairly what the findings are. So how do we talk to someone who doesn't understand necessarily genetic risk about genetic risk and how do we simultaneously generate this report that is readable by not just the medical providers who were training to give these contraceptive counseling appointments but also someone with zero training in biology to understand what it means, why it matters, and how it can help them have all the information they need to make a choice that makes sense for them. So I think we've done a pretty amazing job at that. I'm really proud of where we've landed and how we're rolling out this first version of the birth control test.

Dr. Elizabeth Ruzzo:
And I think obstacles we are looking at now are a lot of what I've talked about, about building trust. One of the interesting things that I think comes from working on a product that can affect women for three... Women take birth control for 30 years on average. So how do you operate as a brand that appeals to three decades of women simultaneously? So it's a branding-

Quinn:
Good luck.

Dr. Elizabeth Ruzzo:
And messaging problem. Yeah. Exactly.

Quinn:
Yeah. That's a lot. And my adjacent experiences, obviously, there's an end of one, but just again without too much information, my wife's situation post having children is entirely different. So it's not like this... Well, I imagine for some women who choose or cannot have children for whatever reason who take it for 30 years straight, it's often on for a lot of folks too, and your body completely changes in so many way.

Dr. Elizabeth Ruzzo:
Exactly, exactly.

Quinn:
So is that something where you envision someone has to take a new test to see at what has changed and what hasn't? How does that work?

Dr. Elizabeth Ruzzo:
Yeah, so that's part of why I think this longitudinal repeat hormone measurement piece is so important. So with the exception of a few things, your DNA is your DNA and so we can measure that piece once, but I would recommend that people measure their hormones again, repeatedly. And so there are those moments in life, maybe the first time you're going on birth control or after having a baby, or as you're starting to experience perimenopause where you can imagine needing a different birth control because your body is different and/or your goals are just different.

Quinn:
Why haven't, and again, this might be the most logical answer, why haven't the big pharmaceutical companies done this work yet, or have they tried, or is it just a bunch of dudes?

Dr. Elizabeth Ruzzo:
So I don't know that I have an answer. My hypothesis is simply that birth control is highly effective, the ones that are out there. So if the primary indication is prevent babies, any drug you've made is preventing babies. Now there are some exceptions to that, and we can talk about that also, but if that's the goal, then that is your goal. And so you make it-

Quinn:
That's your threshold.

Dr. Elizabeth Ruzzo:
That's your threshold. And so you make a new one so that you can brand it so that you can charge more and then there's generics that come after that and then you rinse and repeat when the patent runs out on the brand.

Quinn:
But you're making it for millions of people?

Dr. Elizabeth Ruzzo:
Right.

Quinn:
It's a very broad blunt tool.

Dr. Elizabeth Ruzzo:
Yeah. And because people are still using it. And let's be fair, there are plenty of other drugs that also have side effects, but this one is-

Quinn:
Oh my God.

Dr. Elizabeth Ruzzo:
Yeah. But this one is one that just is so widely used and for so many years by so many people for so many different reasons that it just doesn't make sense to not take a more scientific approach to how we're doing the selection.

Quinn:
Why do you have to do this?

Dr. Elizabeth Ruzzo:
I literally got to a point where I felt like if I don't do this, I will regret it for the rest of my life. It was just this light bulb moment of realizing that I personally had this problem and also that I was in a unique position with my decades of experience in genetics, plus this idea of combining it with hormone levels that just felt like if I didn't do it, there wasn't going to be anyone who did it, and it felt like it became my responsibility to try.

Quinn:
What would you be doing if you weren't doing this?

Dr. Elizabeth Ruzzo:
I would be a professor somewhere in genetics. So it's still doing cool stuff.

Quinn:
Could you live with that?

Dr. Elizabeth Ruzzo:
Yeah. I mean, it was not an easy decision for me. I was finding autism genes, epilepsy genes, it was very rewarding and important work, but I just felt this call to make adyn and have this massive vision that I felt I could get to quicker.

Quinn:
I don't know if you saw the news this week, there's a woman named Sarah Blakely and she started a little company called Spanx-

Dr. Elizabeth Ruzzo:
Oh yes.

Quinn:
... which you might've heard about.

Dr. Elizabeth Ruzzo:
Yes.

Quinn:
I know her friend of a friend, she's as incredible as one would hope and a lot of folks have heard the story, was selling fax machines. Had a pair of pants, she was frustrated she couldn't wear it. Took it to the factory, factory filled with men's. No one would make it, yada, yada, she's a billionaire three times over. She sold it this week.

Dr. Elizabeth Ruzzo:
Oh, amazing.

Quinn:
And she just looked around and said, one look at this enormous, I mean, your founder or investors always like, "What's your market?" And you're like, "Half of the population of planet earth." Like, "Next fucking question." And by the way, hers was similar. I can imagine, and feel free to shoot me down where wherever and any way I'm wrong because that's my entire day. There's a moment where you look around when that is your end. 51% of the planet is either in need of family planning at some point in their life, for a large period of their life, for huge variety of reasons, or women don't feel comfortable in their bodies and they need an undergarment that works for them that's not made in the man factory, that they can hide, but also be proud of and maybe it can be sexy, all these different things. I imagine that when you then go tell your friends, because it's hard to share your secret for the first time. Hey, I think this is the thing I'm going to do. I imagine the reception was like, "Oh my God. Yes." But was it something different?

Dr. Elizabeth Ruzzo:
It was mostly, yes. It was mostly, "Oh my gosh. Yes," and it was a lot of like, "Well, why hasn't somebody done this before?" And I think one of the reasons I was surprised by the reception to leaving academia is because friends who were not in academia were so incredibly generous with their introductions to other people. Being so supportive, like just immediately like, "Yeah, you should do this." And you know, who should talk to? This person. And it was just not that academia is not networky and whatever, but everyone's just like, there's so many fewer pieces of the pie that people can get, that it-

Quinn:
Academia's a tough place.

Dr. Elizabeth Ruzzo:
It's a tough place. And so it was very refreshing to have so much support as I was exploring what it would even look like to run for-profit company.

Quinn:
To help 4 billion women.

Dr. Elizabeth Ruzzo:
Right.

Quinn:
Small cookies. Small cookies.

Dr. Elizabeth Ruzzo:
Yeah.

Quinn:
If you ever want to write a newsletter, let me tell you, it's tough nuts.

Dr. Elizabeth Ruzzo:
I believe it.

Quinn:
That's awesome. So listen, again, the point was there's a lot of folks, either they want to move careers, they're starting the careers, they're young, they're going on birth control for the first time or the fifth time, whatever it might be. They're like, "Do I get a patch? Do I put something inside of me? Am I going to remember to take this fucking pill or the sugar version?" I mean, my biggest question is always folks going, "What can I do?" And my answer is always to start at least in one on one conversations. It's like, "All right, Elizabeth, well, what can you do?" Because you're so much more likely to start doing something, to keep doing something and to be effective if we're meeting you where you are. Something you already love, you're already into or skills you already have, some combination of those things.

Quinn:
So we're going to go down two tracks before I get you out of here.

Dr. Elizabeth Ruzzo:
Okay.

Quinn:
The first one is for someone like you, when did you leave academia? How long ago?

Dr. Elizabeth Ruzzo:
It's been almost two years.

Quinn:
Okay. Two, you said three?

Dr. Elizabeth Ruzzo:
Almost two, I think.

Quinn:
Almost two. Okay.

Dr. Elizabeth Ruzzo:
Yeah.

Quinn:
Time means nothing

Dr. Elizabeth Ruzzo:
Left right before 2020. Yeah.

Quinn:
Great. Perfect timing. You three, four years ago, how would you advise someone who is coming up looking at a problem like this that was so personal to them and so meaningful to so many people, even if those people had understandably just accepted the status quo in the trade offs, how would you advise them to pursue something like this?

Dr. Elizabeth Ruzzo:
I would say start talking to people who know more than you about everything that touches what you're trying to do. So go, in my case, it was go interview the people prescribing birth control, make sure I'm not just is saying some secret key that they have to doing this. Go talk to more people and make sure you're sure it wasn't just you who was miserable on birth control.

Quinn:
Sure.

Dr. Elizabeth Ruzzo:
Talk to some people who are happy that they found one that worked. And then on the other side, if you're thinking of about switching industries completely, talk to people who have run a company before, who have built it from the ground up, who understand what a consumer business would mean in terms of brand, who can think about how you would interface with regulatory entities, thinking about working with doctors and hospitals and people who have built a team and a culture before and just be in this data collection mode and let yourself take it all in and dream about all the possibilities, and then at the end of the day, like trust your gut, because you're going to get different advice from everyone.

Quinn:
That's awesome. That's super helpful. Information gathering.

Dr. Elizabeth Ruzzo:
Yeah.

Quinn:
Always helpful. Always helpful. What's that from that don't jump to conclusions, Matt. God, what was that from? I don't know. All right. So that's super helpful and really thoughtful and you're still so close to that decision in that process. I think that's great.

Quinn:
The second track is someone's listening to this conversation, again, 50 whatever percent of planet earth and says this sounds like this might be for me. Where do they go from the podcast to, to participating in this if they can?

Dr. Elizabeth Ruzzo:
I would encourage them to go to our website, adyn.com, A-D-Y-N and join our early access program. We actually have a referral rewards program. So basically help us spread our mission and you can get free hormone tests, a full free birth control test and yeah, spread the word so that we can get more people participating and on the right birth control.

Dr. Elizabeth Ruzzo:
And the other thing is just help us destigmatize it. Tell your own and birth control odyssey as we're talking about. Tell your friends, tell your family, talk about your side effects, talk about them with your doctor. If your doctor ignores you, try to find a new doctor if you have those resources. Talk about how you found a birth control that worked for you if you did, if you were one of the lucky ones who already found a good one. We also are collecting these birth control odysseys or stories on our website or it's /your story if you want to share it. We are using these to also help drive our R&D and where we're focusing on kind of the biggest pain points. I will tell you right now, no two stories are identical and I continue to be amazed by what people have experienced.

Quinn:
That's awesome. So what is that, so they sign up for the early access list, you described it, they put in their email beep boo, beep boo, hit "Return." What happens next?

Dr. Elizabeth Ruzzo:
So then they will, I think they verify their email and then they can send their unique referral code to their friends who then if they sign up and verify their email, that counts as a referral. If you sign up for early access at all, you get free shipping. If you get one or maybe that's [crosstalk 00:52:30]-

Quinn:
Free shipping on what?

Dr. Elizabeth Ruzzo:
On the actual birth control test, once you buy it. And then if have one successful referral, you get either $50 off your kit when you buy it or a free hormone test. If you got three friends, you get both, $50 off and a free hormone test, and if you have five friends, you get the full birth control test for free.

Quinn:
Okay. So you ship them the test, they take the test, they send it back to you and what happens after that?

Dr. Elizabeth Ruzzo:
So you will get the test in the mail and you take a saliva sample in a tube and you prick your finger and drop it onto an absorbent card, that's for the hormone levels. We generate your report that you'll view in your secure HIPAA compliant custom portal and at that same time, you're given the opportunity to schedule a telemedicine visit with one of our providers. And so this is a 25 minute visit, which is pretty long. The average contraceptive counseling appointment in the US is 13 minutes. And these people are specifically trained in how to not just read the reports, but listen to you and help you prioritize what you want. And if you're interested in getting a prescription by a mail, we can also help you do that, but if you're getting the arm implant or the IUD you can go to your doctor to do that, and we can help with a referral there as well.

Quinn:
Okay. So is it a brand new? Is it a selection of brand new medicines are being offered or is it better matching to what is out there?

Dr. Elizabeth Ruzzo:
Better matching to what is out there.

Quinn:
Gotcha. Okay. Among those 200-ish options.

Dr. Elizabeth Ruzzo:
Among the 200-ish options. Exactly.

Quinn:
So far.

Dr. Elizabeth Ruzzo:
Yep.

Quinn:
Great.

Dr. Elizabeth Ruzzo:
Yep.

Quinn:
That's how many items my children would like me to put on the dinner table at night is 200 options. And I'm like, I've made four things that you ate yesterday.

Dr. Elizabeth Ruzzo:
How many-

Quinn:
It's impossible.

Dr. Elizabeth Ruzzo:
... of them are sauces?

Quinn:
I mean, so many of them are... They're sauces, but then they're just like, "I don't like ketchup." I'm like, "You fucking had it for lunch. I know you like it. You're lying to me." It's a whole thing. Anyways, fascinating, fascinating. And then are you following up on that journey with them? "Hey, how's it going? Did this matching work out for you? What are the side effects you're having?" Because I imagine there's still some trial and error.

Dr. Elizabeth Ruzzo:
Exactly. Yeah. So then we really partner with you to make sure that you're happy on your new one and if not, we are going to sure we get you there. And like you and I just talked about or there's a life change that's going to happen. You go off of the one you did. We helped you find that you liked so you could get pregnant and then you're thinking about which one to go on next and we'll be there for you then too.

Quinn:
And again, I'm imagining that these just very large pharmaceutical companies do have some of this data and have done some of the work but I you start to imagine the questions that maybe weren't asked before, because we just didn't have these data options to collect them or correlate them much less causation to say things like it turns out, this is how most, again, this is an incredible generalization that's not going to apply, but like this is indicative of how most bodies change after a first pregnancy or something like that. These things that can paint a picture that we've just never really understood and making babies this way for 200,000 years.

Dr. Elizabeth Ruzzo:
Right. Exactly.

Quinn:
It just seems like you may be on the cusp to at least like helping people to just, if it doesn't answer their own question, to paint a better picture of this is what's happening with what's going on inside of you.

Dr. Elizabeth Ruzzo:
Exactly. I think that people, there is increasing evidence that people, quantified selfers, the Apple Watch, people want this information about their body and I think that women in particular do 80% of healthcare spending in a household. So I think they are interested in getting that data. They also experience medical gas lighting at a higher rate. I think there's a ton of reasons why you would want to take some power back in how you're thinking about your health.

Quinn:
Absolutely. I mean, that was one of the most indicative and infuriating things about having the conversation with a Representative Underwood about maternal health outcomes is the incredibly personal and powerful stories that both Serena Williams and Beyonce shared about their-

Dr. Elizabeth Ruzzo:
Oh yeah.

Quinn:
... birthing stories and how they were both almost dead because doctors just didn't listen to them and you're like, ignore the fame, put that aside. Ignore how strong-willed these women are in the shape that they're in, put that aside. Two of the wealthier people on the planet and it didn't fucking matter. And so that's for them. Forget 'normal' people who identify as women. Forget marginalized... You go down the list and go like, okay, "But they're 80% of healthcare spending. How are we not doing everything we can to put more power in their hands to at least feel more comfortable?"

Dr. Elizabeth Ruzzo:
Yap, exactly.

Quinn:
Okay, last couple questions we ask everybody then you're out of here. Elizabeth, first time in your life you realized you had the power of change or the power to do something meaningful. And that could be little you, it could be with a crew, little gang, the Ruzzo gang, I don't know, on the playground, in academia, whatever it might have been. That moment where you're like, "Oh shit, I've got the power."

Dr. Elizabeth Ruzzo:
I think it was my second technician job. The first one was back when I thought I wanted to save the plan, it was a ecology lab. The second one was a human genetics lab. And we worked on a rare neurological disorder. And it was a known gene. It had existed my lab, discovered it before I was there. But we had a patient call and just go off about what it meant, the impact that it had on their life to have a diagnosis. Basically, it was HNA called hereditary neuralgic amyotrophy. You had sharp shooting pains down your arm. And this person just said, "I basically felt crazy. Having this genetic diagnosis means I can now... I feel relief. I know what it is, I don't feel like it's my fault, all of these things." It was so a impactful to just realize, oh, what we're doing makes a real impact on people's lives.

Quinn:
It's that one line, thank you for sharing that, where the person said, "It's not my fault." This is just like you said your DNA is what your DNA is. This is just the program, comes from... The [inaudible 00:59:34] is going to be what it's going to be.

Dr. Elizabeth Ruzzo:
Exactly.

Quinn:
What a relief.

Dr. Elizabeth Ruzzo:
And even parents, I think, feel that way to some extent. Like if they were, let's say a carrier who passed it on to their kid, they had no way of knowing that. It's not their fault.

Quinn:
It's amazing how far that testing has come. We did a ton of IVF to get to where we got. Might keep this in might not, but anyways, how that's come in the seven years since the last time we did it, they don't even prick the embryo anymore, it's a blood test and that's crazy.

Dr. Elizabeth Ruzzo:
Free cell DNA.

Quinn:
And it's also just so much more helpful. I mean, oh my God, what, what a change. What a change.

Dr. Elizabeth Ruzzo:
It's amazing.

Quinn:
All right. Who is someone in your life that's impacted your work in the past six months?

Dr. Elizabeth Ruzzo:
Ooh. I don't know if this is a cop out, but it's honestly true, is just my team.

Quinn:
Great.

Dr. Elizabeth Ruzzo:
Yeah. It's been incredible. I feel like I am inspired by them, motivated by them. Half the time I feel like I work for them, like what can I do to make you keep doing the amazing path that you're on? How can I help you with that?

Quinn:
That's the best sign of a leader, right, is hiring people who are just better and smarter than you and just being going, "What do you need from me?"

Dr. Elizabeth Ruzzo:
Yeah, exactly.

Quinn:
That's awesome. Okay. World is on fire, I mean, it was yesterday, I don't now. Inside, outside, everything's crazy. What do you do to shut it off? What's your self care? What's your exercise walk in the woods, Mario Kart, who can know?

Dr. Elizabeth Ruzzo:
It's a mix between walks outside, yoga and I have a Peloton, which is really good when I'm especially feeling anxious because just leave it all there.

Quinn:
Who's your instructor?

Dr. Elizabeth Ruzzo:
Cody.

Quinn:
Oh yeah, he is good. He's good.

Dr. Elizabeth Ruzzo:
He's really good.

Quinn:
He's really good. When I'm in a more fun attitude, he's really good. Alex Toussaint is my more usual just like tough love.

Dr. Elizabeth Ruzzo:
I like him too.

Quinn:
He's just like, "Just get on the bike. Let's go."

Dr. Elizabeth Ruzzo:
Yeah. Exactly.

Quinn:
Yeah. He's great.

Dr. Elizabeth Ruzzo:
Yeah.

Quinn:
Great. We'll talk about that later. Last one, what is a book in all the time you have, in your spare time, that you've read this year that has opened your mind to something you hadn't considered before or changed your thinking in some way? We've got a whole list on bookshop throw it out to everybody.

Dr. Elizabeth Ruzzo:
Oh wow. A book that's changed my thinking. I don't know if I have a good one. I read one about females as mosaics, which is really on brand about how we women have two X chromosomes and they inactivate one copy, but they don't do it in the same one in all the cells in the bodies. So yeah, that was a fun one.

Quinn:
Genetics is wild.

Dr. Elizabeth Ruzzo:
It's really wild.

Quinn:
That's so cool. All right. We're going to get you out of here. Where can our listeners follow you online and then spell out the website for us, all that jazz.

Dr. Elizabeth Ruzzo:
Oh cool. Yeah. So I am trying to learn how to be cool on Twitter, so you could follow me @sequinlabcoat.

Quinn:
Nice.

Dr. Elizabeth Ruzzo:
Yes.

Quinn:
That's a good one. We've got a collection of some pretty good ones. We've got a guy who was working on evolutionary biology named Brandon Ogbunu and his is big_data_kane, like Big Daddy Kane, the rapper. So sequinlabcoat, is that it?

Dr. Elizabeth Ruzzo:
Sequinlabcoat.

Quinn:
That's up there.

Dr. Elizabeth Ruzzo:
Yeah.

Quinn:
Oh, that's good.

Dr. Elizabeth Ruzzo:
Okay. I'm going to find him too. And then all of aydn's social is @aydnhealth and website is just adyn, A-D-Y-N.com.

Quinn:
Okay, awesome. Dr. Ruzzo, thank you-

Dr. Elizabeth Ruzzo:
Thank you.

Quinn:
... for your time-

Dr. Elizabeth Ruzzo:
It was so fun-

Quinn:
... and everything you're trying to do. You said in your first job, your first technician role, you thought you wanted to change a world and we didn't even get into the fact that of course this is about a woman's choice and what they do with their body and feeling comfortable. But like we said draw down, for what it's worth and they've done an excellent job. At one point family planning and educating girls were number five and six on the things we can do to reduce emissions, and you are doing that.

Dr. Elizabeth Ruzzo:
Amazing.

Quinn:
That's awesome.

Dr. Elizabeth Ruzzo:
Okay, good. Then it's back. And I haven't totally really given up on my aspirations of helping the climate.

Quinn:
Checking all the boxes, look at you. Done and done. Easy day.

Dr. Elizabeth Ruzzo:
Amazing.

Quinn:
Thank you so much.

Dr. Elizabeth Ruzzo:
Thank you.

Quinn:
Please keep it up and we'll check in and see how your journey's going.

Dr. Elizabeth Ruzzo:
Sounds great. Thank you so much, Quinn.

Quinn:
Thanks to our incredible guest today and thanks to all of you tuning in. We hope this episode has made your commute or awesome workout or dishwashing or fucking dog walking late at night, that much more pleasant. As a reminder, please subscribe to our free email newsletter at importantnotimportant.com. It is all the news most vital to our survival as a species.

Brian:
You can follow us all over the internet. You can find us on Twitter @importantnotimp.

Quinn:
Just so weird.

Brian:
And also on Facebook and Instagram @importantnotimportant. Pinterest and Tumblr, the same thing. So check us out, follow us, share us, like us, you know the deal. And please subscribe to our show wherever you listen to things like this, and if you're really fucking awesome, rate us on Apple Podcast. Keep the lights on. Thanks.

Quinn:
Please.

Brian:
You can find the show notes from today, right in your little podcast player and at our website importantnotimportant.com.

Quinn:
Thanks to the very awesome Tim Blane for our jam and music, to all of you for listening and finally, most importantly to our moms for making us. Have a great day.

Brian:
Thanks guys.