Conversation with Heather Bowerman, Founder & CEO, DotLab
Bringing Endometriosis Diagnosis into the 21st Century
September 19, 2018
1. What is your business?
DotLab is developing and commercializing the world’s first non-invasive, accurate test for endometriosis, a disease that affects one in ten women worldwide and is the top cause of infertility and pelvic pain. Today, the only way to definitively confirm active endometriosis is through laparoscopic surgery, requiring general anesthesia. With our non-invasive test, DotEndo, a patient’s saliva sample is all that’s required, and in under two weeks, women will know whether their biomarker levels are consistent with women who have the disease.
Until now, there hasn’t been a simple test for endometriosis, and the disease has been very difficult to diagnose. It currently takes women with endometriosis about ten years of tests and trial and error to determine whether they have the disease. In the meanwhile, these women are not receiving the treatment that they need, and they may continue to experience chronic pelvic pain or their fertility may be worsening.
Dr. Hugh Taylor, my co-founder, DotLab’s Chief Scientific Officer, and the Chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine, led the discovery of the test, which utilizes biomarkers called microRNAs to confirm the presence of active endometriosis disease. microRNAs are small non-coding RNA molecules that function in post-transcriptional regulation of gene expression and are not translated by proteins but bind to other RNA to control their expression. It is an emerging area within diagnostics that’s starting to be applied across different diseases.
2. What made you decide to start your business and/or switch careers?
At the end of the day, entrepreneurs want to build things that we’re personally excited about or that we can relate to. It was striking to me that such a prevalent disease has a diagnostic solution that hasn’t improved in decades. Since laparoscopy, which has been around for 100+ years, there has essentially been zero innovation that has made it into the clinic for confirming active endometriosis.
I was thrilled by the prospect of being able to help in two key areas. First, I was excited that the test could potentially be used in patients with unexplained infertility. Research has shown that women with endometriosis undergoing IVF experience lower pregnancy rates. Identifying and correcting endometriosis prior to IVF could help improve outcomes for these women. Second, the test might be helpful to patients with untreated pelvic pain to help understand the symptoms.
3. Was there one moment that gave you the confidence that this was a good idea?
DotLab started with my frustration that so much of women’s health is still a black box. I had been working professionally in diagnostics for about ten years, on investment teams and later as a healthcare management consultant. I had also worked on the policy side of healthcare and technology at the White House during the Obama Administration. So I had these diverse experiences where I had a peek into how the biotech ecosystem works in government, finance, science, and strategy. After I moved to the Bay Area and joined an early-stage diagnostics startup, I eventually became determined to apply those experiences to women’s health. I started really digging into the best-in-class women’s health biomarkers in 2015.
4. What obstacles did you face in getting started and thinking of yourself as an expert in a new setting?
I was learning everything I could about the best biomarkers in the space. For example, genetic tests (which DotEndo is not) can predict the onset of women’s health diseases with some accuracy. But I wanted something that would be immediately helpful to women—beyond identifying risk profiles. Many areas of women’s health are woefully underfunded and understudied, and I wanted to make a positive impact.
DotLab is a science-led company, and the clinical development involved years of brilliant scientists investigating the roles of microRNAs in endometriosis. The DotEndo test is based on a combination of these endometriosis-associated microRNAs, which we have shown in clinical studies to be both highly sensitive (not missing patients with the disease) and highly specific (not incorrectly classifying the disease in people who don’t have it) when compared to surgery.
5. Was there ever a particularly tough time that in retrospect was a priceless learning moment?
An example that comes to mind is building the technology to support the distribution of our test. We expected that building a digital platform would be the first step, but it turns out that many physicians prefer to receive results via fax, and some use fax communication exclusively for HIPAA compliance and security reasons. That is a surprise to many in Silicon Valley!
It’s really interesting to think about how different the healthcare ecosystem is from the technology ecosystem. It’s tempting as a young company to overbuild your technology stack based on what you think is needed, but ultimately, there’s nothing like a customer discussion to level set around what it really is that you need to build.
6. Was outside funding/cost a challenge to getting your business off the ground?
One thing that’s really interesting about diagnostics is that the market dynamics are very different from other areas of medtech. We’ve seen many businesses that have raised tens of millions of dollars in capital and then suddenly encountered a five-year delay on the reimbursement side. As a result, diagnostics businesses are often beholden to payers. Having been on the other side of the funding process previously in my career ended up being very helpful because I understood how venture firms think about the risk in diagnostic companies. As a result, I wanted to be very careful about how I financed this company so that I didn’t create timing problems with revenue and expenses. I’ve worked hard to limit outside capital, taking it as the business has needed it.
7. Have there been positive or negative impacts on your family and work/life balance once your business was off the ground?
I don’t have children today but would love to one day. I’ve chosen to focus on DotLab right now. My wonderful, patient husband is an amazing sounding board and my most important advisor. There’s something about problem-solving out loud and talking with him that I find incredibly helpful.
8. What would be your biggest piece of advice you would give to yourself ten years ago?
Looking back, one thing that I think I’m grateful for is trying to join organizations where I could learn problem-solving and storytelling tools. You may forget a shortcuts in PowerPoint, but you’re not going to forget how to tell a story and you’re not going to forget how to communicate. Storytelling affects everything: communicating with your team about a deal opportunity, or explaining your technology to potential partners. I think that toolkit has actually been one of the most important drivers for what I’ve been able to do in my career.
9. What was the best and worst piece of advice you have received as you were starting your business?
Probably the best advice I got was to be really thoughtful about early team members. I think, looking back, that one of the best things I did was to not increase our burn rate too much with team members unless we really, really needed them. If my burn had been much higher earlier on, I wouldn’t be here today.
Date of conversation: August 3, 2018
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