Beware the money trail and promises of femtech, experts warn

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Something was brewing for Ida Tin in 2013.

The Danish tech entrepreneur had been wondering why humans have managed to fly to the moon, and develop the internet, among other “wild” innovations, yet still hadn’t worked out which days of the month a woman could become pregnant.

So she decided to create an app for women who were trying to conceive, and for those actively avoiding pregnancy, based on data about their monthly cycle.

Are women being empowered or duped by femtech?

The app, called Clue, now has 10 million users in 190 countries.

Clue was among the first direct-to-consumer tracking and diagnostic technology products focused on women’s health. “Femtech”, as Tin coined it in 2016, is expected to grow to $103 billion by 2030.

In a TED talk earlier this year, Tin envisaged “cutting-edge” developments in the space, such as capsules to make vaginal mucus so sticky that sperm can’t swim; sweat sensors for continuous hormone reading; and breast cancer detection in urine.

Being a woman is “an intense ride”, she said: “Female biology comes with a lot of maintenance, and because of that, femtech is a huge business opportunity … there is a lot of money to be made and a lot of money to be saved.”

Proponents say that, until now, women have been ignored, dismissed and met with ignorance. Femtech has the power to redress the problem and transform healthcare for the 4 billion-odd women around the world.

But not everyone agrees.

In a session last week as part of the University of Sydney symposium on the commercial determinants of health, Professor Barbara Mintzes gave a talk about the risks of femtech.

“It builds on a lot of the language from women’s liberation but is misusing it for commercial purposes,” she said later, over the phone.

While many products promise convenience and empowerment, they often bypass clinical oversight, exploit women’s fears and co-opt their frustration about the historic minimisation of female-specific health issues, Mintzes, a professor of evidence-based pharmaceutical policy, and co-presenter Dr Brooke Nickel said.

Promotion on social media accelerates the growth of misinformation and unproven femtech interventions, which can lead to false positives, overtreatment, psychological distress, financial loss and inappropriate test usage.

Some of the messages are making women confused and feel the need to purchase products they don’t need.

Fertility tracking and testing is one example. Women can directly order hormone tests that look at biomarkers of ovarian reserve. The results cannot predict a woman’s chance of conceiving or her reproductive timeline, yet women are led to believe they can forecast their fertility.

In Australia, a survey found about a third of those obtaining these tests did so for future fertility planning.

The risks, said Nickel and Mintzes, include a false sense of security about delaying pregnancy, anxiety about the ability to conceive, pressure to freeze eggs and starting IVF when it may not be needed.

Similarly, products tracking or providing information about or promoting hormones during perimenopause and menopause can be problematic.

Vulnerable audience

As those in femtech businesses are in the business of sales, they have an interest in portraying it as a horrible experience rather than a natural life stage, Mintzes said. With menopause, it is often in the form of hormones.

“There are a minority of women who have severe hot flushes and find hormone treatment helpful,” she said. “Where [pushing hormones] is more questionable is for the range of symptoms that haven’t been associated with menopause.”

There isn’t consistent evidence to say things such as brain fog, depression or general quality of life differ in menopause compared with anyone else or any other life phase.

“There’s a vulnerability that is social discrimination related to ageing, and women being especially worried about ageing and telling people what they’re going to experience later is something to worry about.”

She is also worried about the framing of hormones to prevent dementia or cardiovascular disease:

“I’m concerned about the over-marketing of hormone treatments for menopause because of the concern that more women will develop breast cancer, that more women will develop serious blood clots.”

While women’s reproductive health is a focus, other femtech products sell plans based on the idea that women need to exercise or recover differently from men.

“The message that all women should prioritise or avoid particular intensities or rep ranges is not evidence-based,” said Dr Lauren Colenso-Semple, a researcher specialising in female physiology, exercise and nutrition at Canada’s McMaster University.

“Training should be goal-specific, not sex-based. For example, a powerlifter, a bodybuilder, a sprinter and a marathon runner will obviously have very different programs.”

Colenso-Semple said that many messages directed at women online (and then selling them “female-based” programs) were “not evidence-based, and they overcomplicate fitness for women, which I do believe is harmful”.

Mentzes said that women needed to “beware of the money trail”: that is, those who have a financial interest in providing misleading or overblown information because they have the “solution” in their app, program or device.

“We need independent evaluations of the scientific evidence out there in a way that’s easy for people to understand,” she said. “And regulation of social media, especially when there are disguised marketing messages.”

But she admitted that it’s not an easy problem to solve, particularly when many women have experienced the minimisation of their health concerns.

“I believe strongly in women’s rights, and there have been problems and continue to be problems in the medical care women get in certain situations,” Mintzes said. “But I don’t think the femtech movement is the solution.”

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