How to Finance a Law That Saves Women's Lives/Bhairavi Parikh, Richard Arney - 2%, WHIC, Voter Initiative ~ Spark of Ages Ep 48 - Spark of Ages

Episode Transcript
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Bhairavi Parikh (00:00):
Women already receive, as you mentioned, about
two percent of venture fundingfor women's health and only a
fraction of federal researchdollars.
We compound that with clinicaltrials that excluded women until
the nineties, and even today,only 30% of participants are
women.

Richard Arney (00:14):
All those statistics that Bairobi put
together are unacceptable.
I mean, they're they're dark.
The idea that you have womenthere leaving hospitals, being
misdiagnosed, given the wrongmedications is frankly
outrageous.
The moonshot is that doesn'thappen anymore.

If we pursue things the traditional way, the
traditional playbook for kind ofcompany by company, indication
by indication, startup bystartup, the research will go
too slow, we'll never get there.
And so we really needed amassive influx of capital and a
different way of pursuinginnovation in healthcare.

Rajiv Parikh (00:53):
Welcome to the Spark of Ages podcast.
I have a really amazing episodetoday where we're going to talk
about women's health and how wecan use our own initiative to
solve the problem or take shotsat the problem.
I care about this because I'veseen my family members,
especially my mother-in-law,deal with all sorts of medicines

(01:13):
that she's been prescribed thathelp her or don't really help
her, but because they're poorlystudied, it takes a long time to
get to resolution in a way thatI see male members of my family
get answers to quickly.
So this is a world where the USspends $1.5 trillion annually
on healthcare.
It's about 18% of our GDP.

(01:34):
And what's amazing about thisis that we have this reality
that our healthcare system wasbuilt without women in mind.
We'll explore the monumentalshift that's happening to
correct the disparities withsome amazing innovators working
to close them with bold policyinitiatives aiming to fund
science, especially as thesehealth gaps is projected to

(01:55):
generate a 3x return on economicgrowth.
Our guests today are BhairaviParik and Rick Arney.
Bhairavi is a founder of theWomen's Health Institute of
California, WHIC, a proposedstatewide research initiative,
which we'll be discussing indepth today.
She's also the founder and CEOof Clarity Health Alliance.
Previously, Bhairavi served asCOO of Health Rhythms and

(02:18):
Wildflower Health.
As a serial founder, Bhairavihas built multiple MedTech
companies, including Cellscapeand Apieron, collectively
raising over $70 million fromventure capital.
Bhairavi earned her PhD inbiomedical engineering from the
UMass Medical Center andWorcester Polytech with a
master's in science inbiomedical engineering from the
University of Connecticut.
Rick Arney is a recognizedauthority on privacy.

(02:40):
He's co-authored the CaliforniaConsumer Privacy Act or CCPA
and the California PrivacyRights Act, CPRA, which was done
as a citizen's initiative onthe ballot.
Prior to his current role, Rickserved as BlackRock's global
head of alternative distributionand led BlackRock's hedge fund
product strategy.
He served as the head ofinvestment strategy for the

(03:03):
Global Market Strategies Group,where he managed BlackRock's
largest $10 billion hedge fund.
Rick is a Fulbright scholarwith an undergrad degree from
Stanford in economics and an MBAfrom Harvard Business School.
Welcome to the Spark of Ages.

Thank you.

Well, I'm very excited to have both of you here
today.
This is a really importantsubject.
So I know both of you and to meas well.
I'm very fortunate to have awonderful wife and two
daughters, now another onethrough marriage.
And so the whole topic ofwomen's health, we talked about
in a previous episode withJoanna Strober at MIDI Health.
And now we get to talk to youabout one of the biggest

(03:39):
problems in women's healthtoday, as well as understand how
it can be appropriately funded,guided, and enabled.
So I want to start withBhairavi on this question, but
please both of you can jump in.
Women's health receives only 2%of venture funding.
And you've warned Bhairavi of aproliferation of AI trained on
biased data that will exacerbatethis crisis.

(04:00):
So for our listeners, can youpaint a picture of what happens
in the next decade if this genAI divide isn't bridged?
What does that world look likefor the health of our mothers,
sisters, and daughters?

The next decade would look a lot like our past,
but just worse.
Women already receive, as youmentioned, about 2% of venture
funding or women's health andonly a fraction of federal
research dollars.
We compound that with clinicaltrials that excluded women until
the 90s, and even today, only30% of participants are women.
And we still have norequirement for subgroup

(04:32):
analysis.
So what that means for us isthat the majority of medical
technologies and treatments thatwe have available today were
built for the male body, not forthe female body.
So now if you add AI into thatmix, you know, it learns from
existing data.
And so if you start with abiased data set, the bias
multiplies.
It doesn't go down.
And so the end result is thatoutcomes get worse and costs

(04:54):
skyrocket.
And largely because you don'tknow how to keep women healthy,
you miss diagnoses, you haveineffective treatments, it's all
expensive.
So, you know, the bottom lineis if we don't course correct
now, we'll see a widening gapwhere women continue to be
underserved by innovation, andAI will accelerate that inequity
instead of closing it.

Yeah, Bhairavi's right.
I mean, you have a situationhere built up over years where
there has been essentially abias in healthcare, which has
led to less access, less quickaccess, misdiagnoses, which has
all led to outcomes that areless favorable quantitatively,
whether it be mortality rates orhow easily someone is served

(05:35):
with the medicine they need orthe medical care they need.
And this has been built up overtime, and it's it's very clear
as you add AI to that, it'llaccelerate it in ways that are
just not favorable.
And the most interesting thinghere is that this is just very
costly at the end of the day.
I mean, people can talk aboutaccess and things like that is
fine, but really, you know, thisends up being quite costly for

(05:55):
society as large and the state,and that's something that we're
very concerned about.

So I think like when you're talking about the
difference today, right?
So the problem statement ofthis is that because women's
health has not been funded orhas not been studied
differentially, there's a bigdifference in adverse outcomes,
right?
There's a big difference inmortality rates.
Maybe you can highlight some ofthat?

Yeah, for sure.
I mean, uh, there's adifference across the board,
right?
We get diagnosed on averagefour years later.
We get for chronic conditions21 days later for acute
conditions.
In terms of outcomes, wesuffer, as you were mentioning,
or asking about the adversereaction rate to medications.
We suffer at twice the rate ofadverse reactions to medications
than men.

(06:36):
The result is that we spentabout 500 more days of our lives
in poor health than we should.
We shoulder 15 billion more inout-of-pocket costs every year.
We have 34% higher health carespending, even after you adjust
for women-specific conditionsthat don't adjust in men's.
So, you know, across the boardfrom well-being to health care
costs, there's justdisproportionate spend that

(06:57):
really affects quality of lifeand our ability to contribute to
society.

I'll just add here that historically the
approach has been almost treateveryone equally.
When in fact, in much ofmedicine, there is a
differential approach and adifferential outcome is that
that's needed.
One of the major problems thatwe've highlighted and that we've
discovered is that part of thereason that's happened is just
the lack of differentialresearch.
So you have a situation wherethe research has been a little

(07:22):
bit of, at least from thewomen-men perspective, sort of
one size fits all.
And with that comes, you know,an approach and outcome, whether
it be medication or treatment,that is less efficient when you
place it on top of theseparation of men and women.
So that leads to these outcomesthat are not favorable.
And what's really causing it isa lack of research into what

(07:44):
the differential approach shouldbe so that you have less
misdiagnoses, less treatmentthat's inappropriate, and more
quick identification of specificproblems that from a medical
perspective the women might befacing.
So if if you have betterresearch up front, these things
won't happen as frequently asthey currently obviously do, and
the stats are showing that.

This is really helpful.
So like women weren't includedin research until the 1990s.
So why haven't things improvedsince then?
Oh boy, that's a really take usthrough it.
I think it's really helpful forpeople to understand.

There's a lot of different reasons, but I
would say the two that kind ofpop up to the top of the pyramid
are one is that there's noregulation that insists that
there be a subgroup analysis.
And so in scientific speak, itmeans that you just don't power
your studies to be able to knowthe specific effects on women
versus a whole population that'spredominantly men.

(08:37):
The second reason is that whenclinical personnel are
recruiting women, what they findis that women want to know more
and more difficult to recruit.
And so you preferentially tryto recruit men into those
studies.
And so again, because there'sno regulation that insists that
there be parity in the number ofwomen and men and that a

(08:57):
subgroup analysis be conductedbecause it'll push trial sizes
higher and things will get moreexpensive.
You get left with a situationin which the clinical trial
participants are lopsidedtowards men.

If you can imagine that bias flowing
through a huge portion ofstudies, the studies may be seen
as complete and successful.
However, the data that comesfrom them and then the
corresponding treatments aren'tnecessarily as well done with
respect to women.
So it may appear that thingsare flowing through just fine.
There's a lot of researchthroughput, there's a lot of
things that are approved, but infact, it's not actually meeting

(09:29):
the needs of women.

Okay, so Bhairavi, you have a successful track
record founding VC-backed medtech companies.
So with the Women's HealthInitiative, you're pursuing a
significant public funding modelthrough a voter initiative.
That's I think that's one ofthe reasons you've paired up
with Rick.
What was the spark that led youto pivot from the traditional,
hey, I'll just raise money fromVCs and go build a company and

(09:51):
change the world?

I'm smiling because the because it was Rick
is the bottom line, but it wasbecause my husband forced me to
go to a Diwali party.
And he really, I don't know ifwe like argued about politics
the first time we met, or if Ijust kind of spat at you this
whole problem with women'shealth and made you listen.
But Rick, he really opened myeyes when he helped me dig into

(10:16):
and understand kind of the storyof the California Institute of
Regenerative Medicine, which isthe initiative which was funded
by a ballot initiative where wecreated a $3 billion fund that
transformed kind of stem cellresearch on the heels of the
federal government not fundingthose research activities
anymore.
So really what it did is itkind of showed me that public
will, kind of not just venturecapital and federal grants, can

(10:38):
drive breakthrough science atscale.
At the same time, it was kindof obvious that if we pursue
things the traditional way, thetraditional playbook for kind of
company by company, indicationby indication, startup by
startup, the research will gotoo slow, we'll never get there.
And so we really needed amassive influx of capital and a
different way of pursuinginnovation in healthcare.

(11:00):
And so really I hand thatcredit to Rick.

Too kind.
It is true, a lot of thingshappen by serendipity.
And one of the things I'venoticed in my career is that
oftentimes the market forcapital, whether it be venture
capital or private equity orjust major corporations, some
things do fall through thecracks.
And it is often incumbent fornot always, for government to
step in and think about ways tosolve problems that aren't being

(11:24):
solved.
And sometimes those problemscan't even be solved by the
legislature.
It has to be solved by thepeople.
And in this state where we arein California, that's exactly
what we have.
We have a situation where thelegislature is there to solve
problems.
Occasionally it can't seem toget that done.
And so then the people have anoption in this state, which is

(11:45):
not available in all states,where we can decide to write a
law.
Anyone can.
This is kind of a surprisingthing for a lot of people I talk
to.
You don't need to be anattorney, you can just be an
average person.
You can write a law, and aslong as you collect, you know,
the requisite signatures, rightnow it's 1.6 million signatures,
you can put a law on theballot.
And if 50% plus one vote yes onit, it becomes a law,

(12:08):
equivalent to a law passed bythe legislature.
And so, as Bairave, youmentioned, a while ago, the Stem
Cell Institute came up as anidea.
There was not enough researchmoney being spent on stem cells.
The federal government steppedout of it because there was some
overlap with the abortionissue.
And so a group of people inSilicon Valley actually decided,

(12:29):
you know what, it's time wefill that gap.
And they did exactly theprocess I just outlined, which
is write an initiative that sayswe're going to raise this money
through bonds, generalobligation bonds, to fund
research and stem cells.
And they put it on the ballotand it passed.

So it passed, right?
And the cool part about it isit passed, but the purpose of it
wasn't necessarily to fundcompanies and their products,
was it?

That's correct.
It was to fund basic researchin the idea of stem cells.
And you can write a law howeveryou want.
What they did is they said,let's get together and raise
this money with bonds and thenallocate it in a grant form to
major universities and researchgroups in California to close
the gap in research and stemcells.
So it was a brilliant idea thathad just been sitting there.
I describe it as a financeperson.

(13:14):
There was like a billion dollaridea sitting in the road, and
they grabbed it.
They said, you know what?
We think the voters would bealigned with this.
And they got it on the ballotand it passed.
And that became a researchinstitute that has really closed
the gap in stem cells.
Now, it was so successful thatthey effectively started running
out of money and they went backto the voters and just raised

(13:35):
more money.
This is the model that we wouldlike to pursue with respect to
women's health.

So, yeah, so you're seeing something similar,
right?
There's a big gap that you guyssee.
And I think you guys shouldreally talk about it.
Like there's a gap the way theresearch is being done.
And it's not to fund someone'scompany per se to go
commercialize something.
Your issue is there's just agap in basic research.

Totally.
And in fact, that gap iswidening.
As we all know, the federalgovernment is more recently just
decided to step out ofessentially the big basic
research industry.
I mean, and somebody's going tohave to fill that gap.
Historically, the federalgovernment has been the major
funder of that.
There's no reason why the statecan't step in.
We are the home of innovation.
We know where this gap is.

(14:16):
And so then the issue becomesokay, let's use our resources as
a state to fund the gap ofresearch that's very important.
And like I said, it's like abillion-dollar bill in the
roadway.
We have lots of women in thisstate that are not being served
appropriately from a healthcareperspective.
And we already have the modelwith the Stem Silence suit.
It's already been approvedessentially by the voters twice.

(14:39):
Now we want to direct theattention to women's health
care.
And the case is verycompelling.
And the research dollars aredrying up.

Yeah, so this is the interesting one.
So the feds have pulled back onbasic research, but were they
actually funding women's healthat all originally?

So across the board, there's been at the
federal level a decrease infunding of all
healthcare-related research.
And so it will theoreticallyapply to women's health in the
same way that it applies togeneral health.
And so, you know, if we werereceiving 10% of funding in the
past, we would expect that wewould still receive 10% of
funding moving forward.
Where it gets exacerbated is infunding of other things like

(15:16):
Medicaid programs, whichdisproportionately affects women
and children.
But that's on the care deliveryside and not necessarily on the
research side.
So we expect, and we don't haveenough information yet, that
while it will disproportionatelyhit women and their outcomes,
it'll be for different reasons,not the defunding of basic
science research.

Interesting.
So they're not necessarilycutting back on just women's
research, they're just cuttingback across the board.
That's right.
And because the differentialalready is there, it's worse.
That's right.
I think you you would have donethis anyways.

Well, right, because as we stated right up
front, right, we get less than2% of venture dollars.
There's less than 10% offederal grant monies that go to
studying women's specificconditions.
And then when you compound thatwith lack of participation in
clinical trials and gender biasin the delivery of medicine, you
know, you get left with thisbig hole.
You don't really understandwomen and or their bodies.
And so that equation doesn'tchange.

I'll just add it could not be a better time to do
this because you have the biasis built up, the outcomes are
not good, that's clear, and theresearch is being cut.
So it's it's actuallyliterally, I think, uh the most
prime time to address thisproblem that's been built up
over years.
And now we're having asituation where the research
dollars, which have not beendedicated to women in the first

(16:30):
place, are going away.
It causes a total rethink interms of what the state should
be doing from its researchperspective.

Awesome.
So then what's the secretsauce, Rick, for convincing
voters to publicly fund asignificant scientific endeavor
like this?

So when you do a state initiative in California,
the core question is are thevoters with you or not?
I mean, it really it's aquestion that anybody who's a
voter can ask themselves if youput some on the ballot, is it
gonna get 50% plus one?
And there's a lot of rules inthe initiative world.
There's not many people that dothese things.
There are about a hundredpeople in the state that wake up
in the morning and decide theywant to make laws.

(17:07):
And so, you know, it comes downto is it clear?
Is it already in the minds ofthe voter?
Let's be clear, let me take astep back here.
It's very hard to get people'sattention in California.
Everyone is on their devices,it's a barrage of things that
they're concerned about in theirlife, their job, their
children, their family, they'reon TikTok, and there's all this

(17:27):
stuff going on.
So imagine a world where youhave to sell something to about
nine million people, okay?
And you got to get them to sayyes to something that may have
an impact on, say, their taxesor their rights or something
that happens in their life.
That's really the corequestion.
So you have to craft somethingthat they know is a problem.
They know that the legislaturehasn't really acted.

(17:48):
It's it's it's been shown inthe research that if there's
something you put on the ballotthat people really think the
legislature should be doing,they're gonna vote no for it.
Also, another sort of rule isif you put something on the
ballot that's confusing, peoplevote no on it.
So in this situation, we almosthave free advertising.
Every time you read the news,there's something about research

(18:10):
being cut.
Okay, it's sort of the attackson research.
So, in that sense, you don'thave to spend money on the
creation of the problem that'salready the voters are already
primed for this.
Also, the data is verycompelling.
When you tell a voter, like,hey, look at these outcomes
here, they're not favorable,they're clearly not designed for
women.
Then you have a voter that'skind of primed with it.
We also have voters that havealready voted on the stem cell

(18:33):
initiative.
Those are all very positivethings when running a statewide
initiative.
It's not a new issue, it's notsome out-of-left field issue.
It's something they already arekind of primed for.
And then what you do is youdeliver something to them that
looks reasonably familiar andisn't too crazy and too
expensive.
And that's why when we beganscoping this, you know, we want
to make sure this is veryfocused.

(18:53):
It has outcomes that aretested, that it's something that
a voter can say, yeah, that'sworthwhile to spend money on.
And we're not going crazy.
We're not saying this is goingto be a hundred billion dollar
adventure.
We've scoped it out at 750million of bonded indebtedness.
It doesn't even break abillion.
I know these numbers are veryhigh, but in statewide finance,
it's not considered a majorleague spend.

It's the state of 40 million people, fourth
largest economy in the world.
It's a multi-trillion dollareconomy.
So $200 plus billion dollaryearly budget.

Yeah, and one of the things that happens with
initiatives is I I've actuallygone around the state and
interviewed a lot of people thathave done initiatives because I
I continually want to learnabout it.
And one of the things thathappens with initiatives is
people get greedy.
It's very hard to get somethingin front of the voters.
It's very hard to get somethingto the legislature.
So when you are imminentlygoing to do that, you get
approached by a lot of peoplethat want to say, Hey, can you

(19:42):
just put this in there?
Yeah, let's, you know, I wantto get my idea in there.
And oftentimes that happens,and people say yes, and then the
thing gets so larded up thatwhen it hits the ballot, voters
are like, What is this thing?
It's kind of like ahydra-headed mess.
You don't want other people'sproblems to become your problem
when doing an initiative.
It has to be very clear whatyou're trying to do and get that

(20:04):
done that way.
And that's what I've done inthe case of privacy.
You know, it was very clearthere was an issue in privacy.
And by the way, surprisinglyenough, it happened just the
same way I met my Ravi at acocktail party.
A friend of mine, our kids goto school together, we decided
at a party there's this problemwith privacy, and that was the
beginning of the campaign wherewe drafted things, you do focus

(20:25):
groups, you do polls, you createdrafts of what the initiative
should look like, and then yourun to it and get the
signatures, and then you do acampaign.
And this, to me, fits perfectlythe time we're in.
It's something that needs to bedone, and everyone knows about
it.
Everyone knows there's a realproblem.
Not bringing to somebody aproblem they don't know exists.
Okay.

Right.
I mean, half the population canjust stand up and say, Yeah,
this is a problem.
I see that other you know, menseem to get you know diagnosed
faster.
Yeah, they seem to have fewerissues with drugs, right?
So this is something people cansee.
They can see and feel.

A lot of people have sisters, daughters,
mothers, and a lot of people aretaxpayers.
They don't want their moneywasted.
So there's a lot of good thingsthat can come from this.
And we're very enthused aboutit because with initiatives, you
gotta have timing is veryimportant.
You have to have kind of peoplethat say, I'm ready for this.
And the good news, we alreadyhave advertisements coming out
of Washington, DC in the form ofcuts.

(21:22):
So it's already freaking peopleout.

That's a great description, Rick.
So, of how this whole thingworks.
And so, Bhairavi, how will theWomen's Health Initiative of
California fundamentally changethe kind of research it plans to
pursue versus what we've seenin the past?
And just as importantly, howwill it package and deliver its
findings to truly empower womento make better, more informed
decisions for themselves andtheir families?

(21:46):
Or am I conflating twodifferent things?

No, I don't I don't think you are.
So today, women's health isit's treated in silos like most
of medicine.
You'll have a clinic formenopause, you'll have a program
for an app for pregnancy,you'll have a startup that's
tackling new diagnostics forbreast cancer.
Most importantly, like the itdoesn't really address the many
conditions that women share withmen.
So cardiovascular disease, forinstance, where outcomes are

(22:10):
dramatically worse for women.
So, like just pulling on thatthread for a second, like if you
take heart disease as anexample, women are 50% more
likely to be misdiagnosed duringa heart attack.
We're half as likely to beprescribed painkillers after
bypass surgery.
We are seven times more likelyto be discharged while still in
the middle of a heart attack.
And that's not, it's notbiology, that's bias and a lack

(22:31):
of data.
And I think most people don'teven understand that it's the
number one cause of death forwomen.
And so the Women's HealthInstitute is really designed to
change that.
We'll fund research that well,it spans the full arc of women's
health across all of theconditions, across the diversity
of populations that we have,not just women-specific issues.

(22:52):
I think just as importantly,we'll invest in research that
not only funds basic science anddiscovery, but will allow us to
develop the tools and thepolicies that we need to align
payers, providers, and patientsso that when we're aligned, it
will allow us to rapidly collectthe data that we want,
translate them into insights,and deliver them to a clinical

(23:14):
setting so that women canbenefit from better science
today and not 10 or 100 yearsfrom now.

That's great.
So that's a very differentapproach than simply publishing
studies that you hope industrywill just pick up and go run
with.

Well, I mean, for sure we need basic science
research, but we also need toknow how to translate that
effectively and quit rapidly toa real world environment.
And so you have to figure outhow to do those things.

So now this is for both of you.
If the Women's Health Instituteof California is wildly
successful, what is the moonshotoutcome 20 years from now?
Rick.

Yeah, I think that's a great question.
All those statistics thatBhairavi put together are
unacceptable.
I mean, they're they're dark.
The idea that you have womenthat are leaving hospitals being
misdiagnosed, given the wrongmedications is frankly
outrageous.
The moonshot is that doesn'thappen anymore.
It's equivalent.
They get the care that theyneed when they need it,

(24:08):
accurately prescribed, accuratetreatments, that we don't have
stats like that.
And look at those stats, it'scrazy.
I mean, why would you have asituation where half the
population has completelydifferent outcomes?
The moonshot is that we don'thave a need for this institute
anymore.
That's really the moonshot, iswhere people up front say, yeah,
when we do research, we have tohave the right clinical trials

(24:29):
populated by the rightparticipants, that we have the
right intellectual dispositionto look at this and say, there
might be a different outcomehere, and we got to make sure
that happens.
That's the moonshot that we'reshooting for with the Women's
Health Institute.

Yeah, and just to add to what Rick was just
describing is that if we try toput a number around it, we want
500 more days of our lives ingood health.
And if you think about that,the ripple effect is just, it's
kind of enormous, right?
You get families andcommunities will be stronger.
Women are pillars of theirfamilies and their communities,
healthcare costs will fall.
And as I don't remember, maybeRick was talking about this

(25:02):
earlier, but you expect forevery dollar invested a 3x
return and a financial return.
And so you'll gain billionsfrom women being able to fully
contribute their talents andtheir energy from a societal
level.
And so my personal definitionof the moonshot is that we
finally close the gender healthgap and women get the healthy
lives that they deserve.

I love that vision.
It's uh amazing that we can getthere.
Now, that's 20 years from now.
What are we doing right now toget this initiative off the
ground?
Is this something I'm gonna beable to vote on this year, next
year, a couple years later?
How does this work?

It's a great question.
So, where are we now and wheredoes this go?
So, initiatives in Californiahave to be done in general
elections.
Okay, so the the generalelection that we will be able to
put this on is 2028.
It used to be in history thatyou could do initiatives in
primary elections, but now it'slimited just to general
elections.
And the way it works is we arenow in the mode of drafting this

(25:56):
initiative.
In other words, what does itactually look like on paper?
So, exactly what is thestructure of it, what exactly
how much money is going to beraised.
It's really the beginning ofour campaign.
And so we are talking to lotsof different people, they're
leaders in the women's healthmovement, and we're talking to
people that are could beinterested in helping fund this.

(26:17):
Initiatives are not free, thestate doesn't pay for them.
So, what that means is when youdo a campaign, you have to
think about two things draft orthree things drafting the
initiative, collecting thesignatures, and then once you
get it on the ballot, actuallycampaigning for it.

Yeah, you said 1.6 million signatures.
That doesn't happen overnight.

No, it doesn't happen overnight, and you
generally need to raise money todo it.
There's very few initiativesthat have been done solely on
volunteer effort, unfortunately.
The last one I'm aware of isthe ban on hunting mountain
lions in California.
That was done all by people inthe 80s.
I haven't heard one since then,so you do have to raise money.
And in California, you may seethis.
You'll see people at Costco orTarget or wherever that are

(26:58):
collecting signatures.
That's what we're going to bedoing.
And, you know, I've done thatactually myself.
I've stood in front of storesand do it.
And it's one way to get themessage out.
But the first thing is to, youknow, we're putting the team
together.
We're talking about people thatare in the research movement
that see the need here.
And then we're talking aboutpeople that want to join up and
become part of this, whether itbe with their time or resources,

(27:19):
to actually get this importanteffort done.
The main things, again, aredrafting it, raising money,
collecting signatures, and thengetting out and campaigning for
it.
And we we think we will besuccessful doing that.

How do they go and find you?

So we are going to be launching a website for
sure.
We're not there yet.
We just we're in the process ofdoing that.
You can find us both of us onLinkedIn.
It's Rick Arney on LinkedIn.
Certainly send a message or byBhairavi as well.
If anyone is out there isinterested in becoming the part
of future healthcare for womenin California, we welcome your
input.
We welcome your views, yourtime, and your treasure to be

(27:53):
part of this campaign that'sgoing to change the course of
history for women's health inCalifornia, if not the United
States.

I love it.
All right.
What we're going to do now isthis is really helpful, Bhairavi
and Rick.
We're going to now go intoopinions about the American
healthcare system.
So we're going to get yourpoints of view.
So in this episode, we'retackling a topic that affects
every American, the U.S.
healthcare system.
It's a multi-trillion dollarmachine that's both a marvel of

(28:19):
innovation and a source ofprofound frustration.
When Bhairavi and I started aApieron, US healthcare spending
as a percentage of GDP was 11%.
20 plus years later, it is now18%.
And we wonder, are we getting alot of value from it?
So despite all this massivespending, health outcomes are
worsening and systematic gapslike those in women's health are
more apparent than ever.

(28:39):
So we've compiled some opinionsdesigned to spark a debate that
goes beyond the usual talkingpoints.
So here we go.
The obsession with patient dataprivacy is a major obstacle to
medical progress.
The ability to aggregate vastde-identified data sets is far
more valuable to public healthand research than the
individual's right to keep theirmedical information entirely

(29:01):
separate from the larger system.
All right, Rick, you're thedata guy.
What's your opinion?

Okay, so this is a very important debate to have
because people's information,whether it be their employment,
their net wealth, or mostimportantly, their health care
and their health status, hasalways been at the forefront of
privacy.
And the question becomes how doyou set this up such that
people do not get discriminatedagainst, their privacy is not

(29:26):
violated, and yet we use thedata for research.
Historically, that has not beendone well from my perspective.
You have situations wherepeople are vulnerable because of
their health conditions fordiscrimination for the provision
of services like insurance oreven employment.
We have laws against thosethings.
You can't discriminate againstsomebody because of their health

(29:47):
condition.
But the problem is a lot ofthat data has been very
discoverable and it's beenhoovered up by a lot of
companies and sold in a verysort of fig leaf de identified
way, where eventually people dofigure out okay.
Okay, here's a list of peoplethat have these conditions.
Let's not sell insurance tothem or charge them too much for
their insurance and let's makesure they don't get employed.
So, in the law that we wrote,we wrote exemptions for

(30:11):
research.
HIPAA is the major lawgoverning healthcare
information.
Many of you are familiar withthis.
When you go to doctors, youhave to sign a HIPAA release.
These things have not workedextraordinarily well.
And going forward, it's goingto be very critical,
particularly as Bhairavimentioned, the usage of AI,
machine learning, very quickdecision making, that we have to
be very careful that we strikethe balance between being able

(30:34):
to do research that movesforward better outcomes, which,
as you've mentioned, Rajiv, theoutcomes are going down, not
going up, but while at the sametime doesn't lead to any type of
discrimination based onsomeone's pre-existing condition
or their health status.

Okay, Bhairavi, your point of view.

I think I actually share Rick's point of
view.
I mean, I think I would frameit a little bit differently,
right?
Patient privacy, it's not anobstacle to progress.
It's kind of the foundation ofit.
And so if women and or justconsumers in general don't trust
that their data will beprotected, they won't share it,
and then we kind of all lose.
And so the question is like,how do we develop systems that

(31:09):
protect the individual whilekind of unlocking the collective
good?
And we have some of thosesystems in place, rigorous
de-identification, kind oftransparency in how we govern
those data, giving patientsvisibility into how their data
is being used, which doesn'thappen today.
I think if we can build afoundation of trust where
patients can see that theirinformation is safe and that

(31:30):
sharing it will help us makeprogress and closing the gaps
that we've been talking about,they'd be more willing to
participate.
And so I'm not the one to talkabout, you know, the nefarious
use of the data, but I think thefoundation is right and we have
to build the trust that allowsus to access those data.

Are there a few like entities that do it well?
Is it like the VA does it well?
Does Kaiser do it well?
Does certain countries do itwell?
I'll just answer that.

I think we're in very early days, and Bhairavi,
you set this up perfectly, isthat in history for information,
we as Californians andelsewhere have just decided give
up your information, don'tworry about it.
I mean, it's like if youinterview people, which I've
done on privacy, you ask people,what do you think of privacy?
And it's like, well, I reallylike it.
It's important.
And then you say to them, Wouldyou spend a dollar to enhance

(32:16):
your privacy?
A lot of people are like, Yeah,I'm not so sure about that.
So it's it's one of thesethings that it's a it's a
developing right.
It's a right we've had before.
California is one of the onlystates that has in its state
constitution the right toprivacy.
So we're very early days in howpeople think about their
information.
In the past, people just kindof let it go.
Now we've given people tools tobring it back and actually

(32:38):
respect that information.
Businesses are showing morerespect for the information as
opposed to hoovering up andfiguring out what to do with it
later and not securing it.
So we're in early days, and thegood news is people are waking
up to it.
It's become more popular forbusinesses and people to say,
What are you doing with myinformation?
And people are willing to giveup their information if they
think it's being usedappropriately.

(33:00):
And in this case, people dowant research to be done.
They just don't want them to bediscriminated or to be used
inappropriately in the past.
So this is a developing right.
You know, there's a lot ofrights that are very developed:
free speech, assembly, thosetypes of religion, a lot of
stuff that's very developedtheir time.
Privacy is not one of those.
And so we're in the early dayswhere now people are showing

(33:21):
respect for their information,they're questioning what happens
to it.
But I think they're very opento healthcare information being
used to advance science.
That's an area where peopledon't have a problem with as
long as it's being done securelyand anonymously.

I think, you know, as a company that works in data
to help companies find theircustomer, I think it's actually
a good idea to have clearregulation for data.
CPRA has not damaged ourability to help marketers find
their customer and market tothem more effectively.
It just we still want topresent the same information.
We don't want to put a wallbehind it.
In the end, the company stillwants to get information to

(33:56):
people.
So you've got to be cleverabout it.
And you got to ask them forpermission.
And I think that's completelyfair.

One thing I'll add to that is what we found is
that people really do, when theydecide to do business with
somebody or a company, they'refine with the transfer of
information.
As long as that company can betrusted, isn't selling it, and
isn't transferring on, they'reactually fine with that.
So, Rajiv, you're right.
I I don't think this is anextreme thing where people like
don't use my info, but therelationship they have with a

(34:21):
company is changing and it canbe used well as long as
everyone's responsible about it.

Absolutely.
All right, next one.
Any attempt to preemptivelyregulate AI in healthcare is a
colossal mistake.
So our favorite subject, AI.
The market through competitionand the imperative for companies
to demonstrate safety andefficacy will be a more
effective and faster regulatorthan any government body could
ever be.
Over regulation will onlystifle the very innovation

(34:48):
needed to address the healthcarecrisis.

Take a shot.
Okay.
So I actually like and believein regulation.
I'm just going to put it outthere.
I would not go so far as to saythat regulation is a colossal
mistake.
But I do think that if youprematurely regulate, it risks
kind of locking us into outdatedmodels kind of before we even
see the full potential of AI inhealthcare.
But at the same time, you can'tjust assume that the market

(35:12):
will kind of self-regulate andself-correct because the stakes
are literally people's lives,right?
If you start making mistakes.
So the right balance here isactually agile governance, which
will be new for us from asafety and efficacy perspective,
right?
These are the two words that weall live and die by in the
healthcare space.
And it's what FDA demandsbefore bringing new technologies
to market.

(35:32):
So providing clear guardrailsaround safety, around efficacy,
around the resulting bias ofthese new technologies while
still kind of giving those of usthat are innovating in the
space the room to experiment andprove what works.
That whole model needs tochange and shift.
And the FDA has been, quitefrankly, very receptive to
AI-based technologies.
I believe the most recent datawas that there's 700 medical

(35:54):
devices that have been approvedby FDA, kind of again in silos,
largely centering aroundimaging-based technologies.
But you're starting to see itcreep into the drug development
pathway, how new drugs aregetting approved for use.
So it sets standards, but alsokind of what we need to do is we
need an agile system that setsstandards but still continues to
evolve as we learn more.

All right.
Agile governance.
Do you have a point of view onagile governance, Rick?

I do.
I actually think that hits iton the head because in history,
if you look at regulation ofindustries, at least in the US
and at the state level, has beenvery lagging.
And we've accepted that.
That's not, I don't mean thatpejoratively.
It's like we get a newtechnology, we kind of see how
it plays out, and then weregulate it.
Other places in the world, it'sdifferent.
It's like something comes upand then all of a sudden it's
regulated before it actuallysees the light of day.

(36:41):
With the rapidity and howquickly AI is developing and
what it can do, it does requirequicker governance, or as you
put it, Bhairavi, agilegovernance.
So as the implications of thetechnology play out much faster,
the governance has got to bequicker, but not ahead of it in
the sense that it squelches itout.
There's plenty of examplesglobally where, in fact, in you

(37:03):
know, I've known some regulatorsglobally, and they they
literally think about okay, whatis going to happen with this
technology?
Can we regulate it now beforeit happens?
That's just not the dispositionwe've had in the US.

It's a more European thing, right?
Like in Europe, they're muchmore uh about protecting from
potential overreaches orterrible outcomes that we all
imagine.
Where over here in the US,we're more about let's try it,
let's see what happens, becausewe don't know what could happen.
We don't know what great thingscould happen, right?

Yeah, that's spot on right.
And the only difference nowwith AI, it's just a little
quicker.
So I'm not saying we have tosquelch it out and rub it out
before anything happens, but theimplications is technology is
coming quite quickly.
So you've hit it on the head.
In Europe, it's just adifferent approach.
Here, I think we just need toaccelerate the governance a
little bit faster than we've hadin the past.

This is great.
Thank you.
Okay, next one.
The US healthcare systemsdysfunction is not a financing
problem, but a supply sideproblem.
The core issue is a systematiclack of accredited medical
professionals.
Until we fix the pipeline ofdoctors, nurses, and specialists
by reducing debt andstreamlining training, no amount

(38:09):
of funding or policy reformwill fix the system.
Just use AI.

Yeah, I mean, I don't think there's any
question that we have a work forworkforce crisis in healthcare.
We don't have enough doctors,nurses, and specialists all at
the time where our population isincreasing and getting sicker.
Training pipeline is too long,it's too expensive.
There's just like there's justa huge problem.
But I still wouldn't say whatwe're talking about here today
is a supply-side issue.
Uh, even with more clinicians,women will still face late

(38:38):
diagnoses, they'll still havehigher adverse reactions to
drugs.
There's still what we've beentalking about this whole time
gaps in care that come from theknowledge deficit.
We just don't know enough.
We have to fix both.
We have to understand women andtheir bodies.
We have to bring new tools andtechnologies to market, and we
have to have the providers todeliver that care.
So where the Women's HealthInstitute comes in, it's like

(39:00):
it's not just about fundingbasic science research, but it's
also about funding the researchthat allows us to bring those
tools and technologies tomarket.

Rick, you have a different point of view?

Yeah, totally agree.
I mean, it's it's more aboutyou know adjusting how this
research is being done to reactto the problems out there.
Certainly there's a supplyproblem with doctors and medical
professionals, but that that'snot the core problem here in the
sense that the research hasn'tproduced the outcomes we need.
So we need more research donemore specifically for women's
health.
And that's what we intend toclose that gap.

(39:31):
That's really helpful.

All right.

Next question (39:33):
the gradual incremental move towards
value-based care.
Oh, this is one of yourfavorite topics, might it be.
The gradual incremental movetowards value-based care is a
cowardly approach.
We must immediately andcompletely abolish the
fee-for-service model in itsentirety, as its perverse
incentives are the singlegreatest cause of runaway

(39:53):
healthcare costs and pooroutcomes.

Yeah, I mean, I fundamentally like the idea of
value-based care, but you can'tjust overnight dismantle a
system that's been operating forforever.
So the real challenge isn'tjust like getting rid of the
fee-for-service environment.
It's creating a value-basedcare model that will actually
work.
And right now, what we have isa healthcare system that
operates in silos.
You have different providerscaring for different people that

(40:17):
may or may not be connectedtogether.
They're all billingindependently.
And even a lot of ourvalue-based care models are
still built on the foundation ofa fee-for-service model,
meaning they're charging forspecific services and
procedures.
So, really, one of the majorcomplexities is when you have
multiple providers caring forthe same patient, who do you
attribute the risk and thereward to?
And how do you come up withthat equation?

(40:39):
And so there's like hands down,like a mathematical challenge
here.
And until we solve thatproblem, value-based care just
can't deliver on its promise,even though the fundamental
concept is right.

Rick?

Totally agree.
Yeah, I don't have anycontention with that.
It's a model that really needsto be examined, the math
essentially.
It just doesn't work.
So I I completely agree withBhairavi here.

There is some bending of the cost curve,
right, with Medicare cost.
Originally it was supposed to,it was like a linear situation
where Medicare was supposed toessentially be bankrupt by now.
And it hasn't.
And I think some attribute itto Obamacare, which did
encourage more preventative careor it caught more people into

(41:22):
the healthcare system.
Is that because theyimplemented more value-based
care or more preventative care?

Or was it a combination of all those things.
There are bright spots all overthe place.
And so if you look at Obamacareand its emphasis on
preventative care, you know, weas a society, we practice
reactive medicine.
We do not practice preventativemedicine.
And so we wait for something togo wrong and then we put a
band-aid on it.
And so the demand to accentuateor highlight preventative care

(41:47):
does do good things.
We know that if you go to yourdoctor's visits and you have
your screening tests and you'reproactively dealing with
lifestyle factors, then you canbend the cost curve.
And the same thing on theMedicare side.
It is a model that has beenshown to work from a financial
perspective.
But then moving that model torealize its full potential and

(42:09):
then to have it trickle throughto a commercial setting and then
to a Medicaid setting, we havenot yet been able to do that in
a practical way.

Amazing.
Thank you.
I got one right up your alley.
Women's health isn't a niche.
It's the perfect microcosm forthe entire system's failure.
By focusing all reform effortson closing the gender health
gap, we would be forced toaddress the root cause of
dysfunction from misdiagnosisand lack of research to provider
shortages and payment issues.

(42:38):
And in doing so, we'll fix theentire system.

It's not a niche issue.
It's just the fixed lens of howwe can see how the whole system
is broken.
So if we can close the genderhealth gap, we'll have solved
all of the problems that drivedysfunction everywhere.
Misdiagnoses, lack of research,provider shortages.
What else have we talked aboutthat today?
Like broken payment models.
And so if you fix the women'shealth issue, it's like a

(43:04):
template.
You just kind of rinse andrepeat and you apply it to all
people.

Yeah, and and all that women are not a niche,
right?
We're talking about a niche.
What you're saying is true.
It was truly a niche, but we'retalking about women.
It's not not a niche.

By definition, but somehow it's been traded as
one.
So I think we need to coin theterm men's health and start
cutting that up as men's health.

We don't want to go there with men's health.
That's a whole point.
Okay, well, thank you for that.
So welcome to the Spark Tank.
Today we're thrilled to haveBhairavi Parikh, a visionary
who's a driving force behindClarity Health Alliance, a
mission-driven collectiveworking to close the massive gap
in women's health.
She, along with Rick Arney, areboth leading the women's health

(43:53):
initiative in California.
And Rick is a finance andpolicy strategist who's
navigated the worlds of globalinvestment and has literally
helped co-author California'slandmark privacy legislation.
Today's challenge, Two Truthsand a Lie, has a focus on
women's health, healthcarepolicy, and the state of
Massachusetts.
We've all spent some timegetting our education and has a

(44:14):
very robust history and has somuch well-kept records, so it
was really helpful, easy for usto put together a great game for
us.
So I'll give you threestatements that sound almost too
wild to be true, but two ofthem absolutely are.

Your mission (44:27):
spot the fabrication amongst the shocking
realities.
Here's how it works.
After each round, I'll countdown three, two, one.
And you'll both reveal whichstatement you think is a lie.
Okay, here's round one.
In the 1960s, Boston Universitystudents helped overturn
Massachusetts law that made it acriminal offense to provide

(44:49):
birth control or informationabout contraception, even for
adults, unless they weremarried.
Number two, Boston oncerequired all licensed midwives
to wear large purple hats inpublic so city officials could
keep track of them.
Boston's got a long history.
Number three, Massachusettsinfamous crimes against chastity

(45:10):
law once made it illegal foranyone, married or single, to
obtain contraception, an archaicpublic morals code struck down
by the Supreme Court inEisenstadt versus Baird.
Okay, so one is the BU studentsoverturned the Master's Law,
right, about birth control orinformation about contraception.
Number two was about midwiveswearing purple hats.

(45:32):
And number three was uh crimesagainst chastity.
So ready?
Three, two, one, two.
Both of you are saying numbertwo, and you both are correct.
Two is false.
While Massachusetts had strictlicensing for midwives, there's
never been a law requiring themto wear purple hats, even though

(45:52):
it's very on-brand for Boston'spreference for a colorful
vision.
Number one, birth controlaccess for unmarried adults was
banned until 1972, and BUstudents played a pivotal role.
William Baird's talk and arrestat BU triggered the Supreme
Court case Eisenstadt versusBaird, which created new rights

(46:14):
for all Americans.
And number three is true,crimes against chastity,
morality, decency, and goodorder covered contraception and
abortion.
These were only officiallycleaned from the books in the
2010s, even though they had beenunenforceable since the 1970s.
I can't believe they were evenenforceable in the 1960s.
But, anyways, here we go, roundtwo.
All right, you both have one.

(46:36):
I'm very excited about this.
Massachusetts archaicreproductive laws meant that by
the 1970s, Boston women seekingan abortion were required to
convince a panel ofpsychiatrists they were suicidal
in order to get legal approval.
Number two, in the 1940s and1950s, Harvard affiliate
researchers in Boston pioneeredthe use of diethylstilbesterol,

(46:59):
or DES, a synthetic estrogen, tocontrol pregnancy hormones in
women.
The drug was prescribed tocountless pregnant patients even
after animal studies showed itcould cause cancer and birth
defects.
And number three, a19th-century Boston public
policy required any farm thatraised chickens run by women to
spend one day a year devoted toegg appreciation, led by the

(47:23):
city's first ever egg czar.
Okay, so you ready?
Ready?
Got your answers?
Yep.
Three, two, one.
All right.
You both came out as three.
Which is false, yes.
While Boston has a rich farmingand policy history, there's no
evidence of an egg appreciationday what eggs are in city

(47:46):
government.
But number one and two weretrue before Roe versus Wade,
Massachusetts required women toseek dangerous and humiliating
legal and medical approval, evenfor life-saving abortions.
And number two, Olive WatkinsSmith, Harvard biochemist, and
her husband, a Harvardprofessor, pioneered the use of
diethylstobesterol, or DES, atthe Fearing Hospital in Boston.

(48:09):
DES was initially heralded forpregnancy support, but later
discovered to cause cancer andbirth defects, leading to
widespread scandal and legalchanges in women's health
policy.
So sometimes good changeshappen after bad things.
Okay, round three.
Number one, a tradition atBoston's Fannual Hall in the
1800s required new femalephysicians to recite a public

(48:33):
health oath while standing atopa block of ice as a test of
their firmness in the city'scold winters.
Number two, again, this was1800s.
Number two, for decades,Massachusetts had a law making
adultery punishable by up tothree years in prison, and it
remained on the books until itwas quietly repealed as part of
a women's health overhaul in2018.

(48:54):
Number three, in the 19thcentury, Massachusetts banned
unmarried women from obtainingany contraceptives, and the
text, woman, was not evenallowed in public notices for
health lectures.
Okay, you ready?
Three, two, one, one.
Why'd you choose one?

Standing on ice.

You don't think they would do that in Boston?
Well, you're right.
Boston is famous for bothhistoric oaths and frigid
winters, but there's no recordof ice block ceremonies for
women in physicians.
We should just be crazy.
But I guess it would be itwould be a deterrent.
Number two, is true, the 2018repeal of archaic statutes as

(49:42):
part of modernizing women'shealth law included formally
removing a colonial era adulterylaw that carried a shockingly
harsh penalty.
Even in recent decades, the lawtechnically mandated up to
three years imprisonment foradultery.
It's crazy.
Three, strict bans on women'sreproductive information were
enforced for decades, even withpublic discussion strictly

(50:03):
censored in Boston.
All right, so now we're gonnago to number four.
Since you both have three, thiscould be the tiebreaker.
So we're gonna ratchet up thehardness of this.
I mean, since we gave you threelayups, I'll give you a real
hard one.
You ready?
We'll see if this is reallyhard.
Okay, number one.
Boston's women-only gymcontroversy in the 1990s led to

(50:24):
a lawsuit from a man who claimedhe suffered emotional distress
after being denied entry to afemale-only health club.
He briefly became a minorBoston celebrity.
Number two, MassachusettsArchaic Health Code once
regulated who could sell ordiscuss undergarments, and
official corset inspectors couldfine store owners for carrying
unapproved supportive devices.

(50:45):
Number three, for decades,women were routinely excluded
from clinical trials nationwide,including Boston area
hospitals, until a 1993 federalNIH mandate required inclusion,
drastically reshaping women'smedical care and research.
Okay, so which one is false?
Three, two, one.
All right.

(51:07):
Well, you're tied.

Tied again.

What's wrong with having a corset inspector?
You don't think that wouldhappen in Boston?
Haven't we spent time atvarious Boston bars and seen all
kinds of things?
Okay, you both are correct.
Number two is false.
Our staff was very kind to you.
So while old Boston lawregulated many aspects of public
and private life, there's neverbeen a state certified corset

(51:32):
inspector.
Number one, the women-only gymcase hit headlines and made
waves in Boston legal circles,exposing the oddities of gender
discrimination law as applied tohealth clubs.
So that was a thing.
Number three was also correct,which is the NIH 1993's policy
ending exclusion of women fromclinical trials was a landmark

(51:53):
moment in medical research, withBoston hospitals amongst those
forced to adapt protocols andresearch design.
And luckily, because they didit, everyone else did it too.
That's why Boston's been aleader, it has the richest
history, it keeps great data,and gives us something really
interesting to talk about.
So thank you both.
You both tied for the victory,which is what I hope happens
with your initiative.

Thank you.

We've never had a four-to-four outcome before.
So you guys can nail it.
All right, let's go to theseinteresting things about you.
So I'm going to start withRick.
What's something you'recurrently learning or trying to
get better at that has nothingto do with advancing your
career?

That's a terrific question.
I used to play Badman in highschool.
In fact, I was NorthernCalifornia's state champion
Badman, and I dropped it forlike 40 years, and now I'm
picking it up again.

Oh, there you go.

Yeah.

Is it like riding a bike?
Are you are you taking it?

I picked it up quickly.
Yeah, I've been buying a racketand everything.
I'm actually doing it again.

That's awesome.
That's awesome.
Sounds like a lot of fun.
It's a great game.
It's very popular.
I go to India every threemonths.
Super bite.
Super popular there.
It is like the sport.
Okay, for Bhairavi, when you'rehaving a terrible day, what's
your go-to thing that almostalways makes you feel a little
bit better?

Oh, going for a walk and talking to friends
while I'm walking.

Ah, okay.
That's it.
I thought you'd have adifferent answer, but I love it.
I love it.
That's a great answer.
To going for a walk and talkingto friends.
And you can do that because youlive in Northern California.
I can do that all the time.
Awesome.
Okay, Rick, if you could addone subject to the high school
curriculum that wasn't therewhen you attended, what would it

(53:32):
be and why?

Personal finance, very clearly.
Because it's something a lifeskill that isn't taught
generally, and yet it can havehuge outcome differentials for
people if they just know thebasics of personal finance,
budgeting, investing, et cetera.
It's just to me, it's thelargest gap in education I could
see.

Crazy we have Home EC, we have sex ed.

And no money.
Nothing about money.
Nothing about money.

We see this with a lot of college kids because our
kids are college age.
We see it with their friends,how smart they are, but how
clueless they are about money.

Totally.

It's unbelievable.
Okay, for Bhairavi, what's themost useful thing you've learned
from someone significantlyyounger than you?
I'm gonna force you to choose.

Oh, how to be more carefree.
Oh.
And to not treat life asseriously as I as I have a habit
of doing.

And what got you to do that?
Or kids.
Do you want to say which kid?
No.
Was there a particularinstance?

No, it was a combination of kind of all four
of them, just kind of watchingthe way that they're leading
their lives and what's importantto them.
It's different than the waythat we are.

In what way?

I know.
I think their priorities arejust different in a way that I
appreciate.
Okay.

You don't want to go for other you don't want to
name.
Another podcast.
Okay, Rick, if you could goback and witness, but not
change, one ordinary day fromyour past, what day would you
pick?

The day after I graduated from college, I'd go
back to that and and think moreabout what I'm doing.
I didn't have a job at thetime.
And I wish I knew better whatthat meant and what to do about
it.
I was gonna deal cards in in acasino in Reno.
That's what I was gonna do.
And I wish I wish I had thoughta little bit more about what
was going on in the world.

Did you actually do that?

No.
I like I got lucky.
I got a job before I my cousinwas dealing cards up there, and
he said, I understand you don'thave a job, you should come deal
cards.
I'm like, okay, cool.
But luckily, for me at least,that change.
It was gonna be a fun time, butI just didn't know what I was
doing.
Yeah, that's amazing.

Sometimes it's who you're around.

Totally.

Takes you in whatever direction you go.
It's more serendipitous thanjust simply breaking it down
from a research perspective.

Yep.

All right, and the final one for Bhairavi, if you
had to choose between beingknown for being incredibly kind
or incredibly smart, which onewould you pick and why?

Kind.

Unequivocally.
Unequivocally.

Yeah, because I mean I think kindness makes the
world go around, and you can'thave quality in your life and or
your society without it.
The rest of it is justancillary.

Well, I just want to thank you both.
Those are great answers andreally helps us understand what
you two are about and whatyou're trying to create with the
Women's Health Initiative inCalifornia.
I think this can make a hugedifference in the world.
We are talking about a ratherlarge niche, and it's a big
problem that we want to address.
So I really appreciate havingyou here and helping us tackle
this huge problem in a moreinnovative way than we would

(56:28):
normally talk about it.
So thank you so much.
Thank you.

Thank you.
Terrific podcast.
Thanks a lot.
Appreciate it.

That was a lot of fun today.
We have two people I knowreally well, of course, one I
know extremely well, join us.
And I've had a chance to startmy own medical device company
with her back in 2001.
So I know a lot more abouthealthcare than I ever would
have.
And what's interesting withwhat Bhairavi and Rick are
talking about is that there is amassive gap that's sitting

(57:01):
right under our nose.
That for more than half ourpopulation, we have a situation
where they are not getting thekind of care they need.
And that's just because of aresearch and policy and
procedure gap.
We have so many smart people,so many smart people in medicine
and health, and we still arelagging behind.
And wow, we can make anincredible change.
And we can make an incrediblechange in a time where research

(57:24):
funding is being cut.
And we can make a big changebecause in California, we have a
citizens' initiative process.
And it was so helpful forBharavi and Rick to talk about,
and especially Rick to talkabout how the whole initiative
process works in California, howyou pick the right subject, how
you put it together, how youget it to the voters.

(57:46):
Because you want to find thatsituation where people can
understand it, they can feel it,they can feel that it's
unaddressed and that it can besolved.
How you go about fundraisingfor it and getting it put
together and approved.
And this is because of his ownwork in privacy rights that
became hallmark legislation thatwe all run by today.
So it's really amazing how allthis comes together.
And I'd say the final thingbeyond knowing so much about

(58:10):
these two amazing people is beopen.
I say be ever curious, but Ithink part of being ever curious
is being open to going tothings that you may not want to
go to.
So it may be a cocktail party,it may be a devalue or
celebratory party, it may be aPassover event, it may be a
Christmas party.
Sometimes it's just good to goto these things because you

(58:33):
never know, especially here inSilicon Valley, if you may find
someone of a common interestwith the ability to get things
done.
And I think that's what we gotto do when we serendipitously
brought Rick and Bhairavitogether.
So super excited about that.
All right.
Thanks for listening.
If you enjoyed the pod, pleasetake a moment to rate it and
comment.
You can find us on Apple,Spotify, YouTube, and everywhere

(58:56):
podcasts can be found.
It makes a huge difference tous.
We are a top 10% podcast, andwe want your help to get to top
1%.
The show is produced by SandeepParik and Anand Shah,
production assistants by TarynTalley, edited by Lauren
Ballant.
I'm your host, Rajiv Parik fromPosition Squared, a top-notch

(59:17):
AI-driven growth marketingcompany based in Silicon Valley.
My company sponsors this foryour benefit, so please come
visit us at Position2.com.
This has been an F Funnyproduction.
We'll catch you next time.
And remember, folks, be evercurious.

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How to Finance a Law That Saves Women's Lives/Bhairavi Parikh, Richard Arney - 2%, WHIC, Voter Initiative ~ Spark of Ages Ep 48

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}How to Finance a Law That Saves Women's Lives/Bhairavi Parikh, Richard Arney - 2%, WHIC, Voter Initiative ~ Spark of Ages Ep 48