Meet Dr. Nimmi Ramanujam, Robert W. Carr Professor of Biomedical Engineering and a faculty member in the Global Health Institute and the Department of Pharmacology & Cell Biology at Duke University. She is the Director of the Center of Global Women’s Health Technologies (GWHT) and founder of Zenalux Biomedical Inc. and Calla Health. Ramanujam has spent the last two decades developing precision diagnostics and more recently precision therapeutics for breast and cervical cancer, with a focus on addressing global health disparities. She has more than 20 patents and over 150 publications for screening, diagnostic, and surgical applications, and has raised over $30M of funding to pursue these innovations through a variety of funding mechanisms. Learn more about this innovator, entrepreneur, and academic and how she is working to improve health outcomes across the globe.

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Full Transcript

Speaker 2 (01:07):

Hi everybody. Good evening. Good morning. Good afternoon. Depending on where we are looking at watching this from around the world we are really thrilled to have Dr. Nimmi Ramanujam. I hope I said that correctly. Joining us in our new mini-series innovators and innovations. So she’s both an innovator and has not multiple innovations to her name. So we’re thrilled to have her today in this new series that we’re doing. The reason that I think we’re doing this mini series is to actually showcase people who are transforming the world. And I think in this time of of the pandemic it is more important that we actually focus on all the possibilities rather than all the negatives that are going around. So that’s why we thought we do this a mini series and feature people that are making a huge difference in the world and as just sort of a data point, I think during the bubonic plague of the black debt directly and indirectly contributed to the Renaissance.

Speaker 2 (02:08):

So we are hoping that the pandemic eventually will create a better world for all of us. And that is is the hope and innovators like Nimmi will probably lead the charge in that sense, or, you know, we would love to introduce and talk to her about it. So welcome to pandemic punditry me. Thank you. Thank you for having me. So in way the background, I think you’ve, you know, you’re, you’re a uniquely sort of an an academic, a professor at Duke. You got, you know, 20 patents to your name you know, 150 publications. You’ve raised $30 million for two companies that you’ve you’ve started I guess within Duke itself. Maybe you could tell a little bit more about, you know, what the Zara Luxon biomedical and caller health, the two companies that maybe I just should take a step back. I’m a professor at Duke

Speaker 3 (03:00):

And you know, over the years I think both the academic institutions, as well as the academics faculty members have you know, seen the potential impact of the innovations they’re developing, but there’s this chasm between what they develop and the impact that it has, especially for social good. And so if you’re sort of in this space where you want to have meaningful impact, and I don’t mean just the bottom line of making lots of money, but you actually want that innovation to serve a lot of people, then you have to shepherd it. You can’t necessarily expect somebody else to share your vision when they do. It’s nice, but when they don’t, then you are responsible. So I’ve transitioned from, so I’ve done as much as I can at Duke with respect to innovation, but there’s a time when there’s a conflict of interest.

Speaker 3 (03:56):

And so at that point, you start to bring the technologies into companies that share that same mission and value. And of course, we ended up founding those companies and that’s how Calla Health was born. It was born out of a need to take a technology that was developed at Duke that was actually evolved to a phase where it was ready for manufacturing and it had regulatory clearance. And then we said, okay, now that we’ve, de-risked the technology, let’s get it to the next step. So I don’t see color health and Zen Alex as an independent. I see them as a continuum of this process of starting with a concept and then reaching individuals, say, for example, in Cambodia, India,

Speaker 2 (04:43):

And, and, and, and these work, these companies address sort of the same continuum in terms of survival in breast cancer, but they do two very different things as I can understand. So maybe a little helpful if you were to sort of expand a little bit on what each of the companies have produced and what the objectives are of those innovations.

Speaker 3 (05:05):

So I have a center at Duke call the center for global women’s health technologies, and the focus there is to really prevent cancer and to avert recurrence, right? The two things that can cause mortality in high income settings, we’re more focused on recurrence because we have very well organized screening and diagnostic and treatment programs. Whereas in low resource settings, you really want to prevent it because the idea of building capacity for full fledged treatment is challenging, especially in low income countries. So our efforts have focused on more pragmatic technologies for low resource settings, and then looking at how we can create tools that can facilitate understanding of the underpinnings of a cancer recurrence with respect to metabolism. So Zen Lux focuses on the ladder, which is to do the discovery through the use of technology, particularly with respect to metabolic ism, which is sort of a fundamental need of cancer cells to essentially be resilient, particularly in a harsh environment that is induced by therapy. And then on the other side, we’re developing imaging and therapeutic technologies through a health foundation to democratize access to preventative care and with a focus on cervical cancer prevention. So think of set Alexis focusing on breast cancer and colon health, us focusing on cervical cancer. But of course, inherently they would require different technologies because we’re focusing on different aspects of these diseases.

Speaker 2 (06:44):

So, so then, so the, these about precision sort of diagnostics, right? So they, I mean, the and is the main sort of value proposition that these are significantly cheaper in terms of the, I mean, if you, if you were to go to a mammo to get a mammography or something like that, what is the sort of the equivalent in a, in a more affluent country that somebody would use this?

Speaker 3 (07:07):

So that’s a very interesting question and I need to break it down because it’s sometimes, may not be obvious. So when you’re working with a very pragmatic technology that you want to bring out of a hospital so you want to bring the technology out of the hospital. You want to actually bring the expert out of the hospital. And that’s where AI, for example comes in. You know, something that I’ve learned is in academia, we tend to think of innovation in that sense of, has anyone done it before? And if they haven’t and you’re the one to have done it, right? Because that’s what gets your papers and grants, but actually that’s not, what’s necessarily impactful in a setting where resources are scars and also from a perception point of view. So let me give you an example in Cala health or commercially commercializing the technology called the pocket colposcope and the collar scope.

Speaker 3 (08:00):

They’re not innovative in the sense that they are essentially colposcope, which would be used in a gynecology gynecology clinic in a hospital. So the innovation is not in the fundamental sort of shift in how you do things, but rather in how you can take something that has been well bedded it’s used in as a standard of care in affluent settings and then reimagining it. So that’s where the innovation is, re-imagining it? So it could be a point of care device, in other words, in somebody’s pocket, but have the same capability as it’s hospital-based counterpart. In other words, we’re not saying lower costs, lower performance, we’re actually saying lower costs, higher performance. And I believe that could happen because it just requires us to dismantle traditions of the past, because we tend to add to the layers that someone else has created previously. But what if you just took a fresh perspective like five-year-old and said, well, if I was to do this again in the current era, how would I do it? And so that’s what allows you to essentially keep up with the pace of technological advances and bring them in to healthcare. And so, I don’t know if the word is precision diagnostics, because that’s, it has a different connotation, but I would say point of care, diagnostics that has the same capability as what standard of care provides, say for example, in the United States.

Speaker 2 (09:34):

Wow. And I saw, and I saw the, I mean, there’s several videos on YouTube about the device and how it’s used. I mean, you have to ask the question. I mean, this is, I mean, obviously from a standard of care standpoint for a lesser fluent countries, it makes perfect sense, but it actually makes sense for anyone actually, you know?

Speaker 3 (09:56):

Absolutely. And I will just add that. So I forgot to mention this. So why do we want to have just replicate standard of care versus creating something new? So from a regulatory standpoint, it’s easier to get clearance when you have a me too technology. And we don’t realize that, right, because drug companies spent billions of dollars with new medicines, but that takes money and time. And then you want to recoup that. And that’s why you charge more when the customer or the insurance company or whoever’s paying for it. But here, if we’re trying to be pragmatic, you actually want to build a me too technology and be able to essentially get it to more people. But the other thing I want to bring up is yes, we want to democratize technology and bring it to people who don’t have access to it. But we also have to consider the fact that there are cultural barriers.

Speaker 3 (10:47):

So for example, with gynecology, it’s not enough to say I’m going to bring a colposcope out into the field, because what if an individual there says, Oh, this is completely counter to my cultural religious practices. And I don’t want to go into a hospital and be seen by particularly a male provider. I don’t want to be vulnerable, so I’m just going to avoid it. So we also have to consider the human dimension. So it’s not enough to just say I’ve built it in a come and get it. You know, we know what value propositions of the customers don’t use it. There is no value. So that’s where you have to start always with the end in mind. And in this country, in the United States, I feel like sometimes the providers are the customers, right, because they deliver care. But if you start to get to home care or patient centered care, you have to think about the individual and how they perceive the care that’s provided and it’s going to be different in different countries and different chocolates.

Speaker 2 (11:47):

Absolutely. I, you, for that question.

Speaker 3 (11:49):

Yeah. So I’m just wondering in your, your speech about Democrats taking health to us, just inspiring, by the way, but in your quest to do that, how do you hope to break such social cultural barriers in countries like all the African countries, et cetera? Like how do you hope to achieve that? Yeah, so you have a very good question there, because just because, you know, we’ve built something that’s woman centered there will be barriers because in some countries, for example, women want doctors to see them in other countries. They don’t. So I think a big part of that is education empowerment, but I’ll give you an example of introducing, for example, the women’s centered technology, which is essentially a gynecology without a speculum, a pelvic exam without a speculum in Peru and Ghana and the U S so for example, in Ghana, when my former PhD student introduced it, she’s got an and in, in the clinic, women were very trepidatious.

Speaker 3 (12:51):

They looked at it and I thought, there’s no way I could do it myself. And there’s no limit to insert this tampon like device, but once the first woman introduced it, I mean, used it, she just started screaming with excitement that she had complete control of her body and that she could see her cervix. And then, you know, news spreads like wildfire. The next thing, you know, 20 women came in, they all wanted to get their pelvic exam. The point is you need a champion. And once you convince the champion, then it’s a cascading effect, same thing in Peru. Once one woman tried it, everybody else did and did, and the end, they said, Oh, we really want this technology. We really want you to, you know, have this be available to us, but here’s some of the suggestions to make it even better. So both we got feedback, but as well as sort of endorsement of the technology. So it takes a few champions who have who the community can relate to and trust to bring that technology. So if we educate, it might not be as productive as someone from that community educating sort of a peer to peer education. And so we need local champions. We cannot go there and, and claim to be able to do it well. So you need to build a tribe.

Speaker 3 (14:09):

Well, they need to build a tribe.

Speaker 2 (14:15):

I mean, I got the sense from, from some of the information I’ve reading that it’s your three D printing, the actual speculum alternative, is that correct? Okay. And so is that something that, I mean, is it a single use thing or is it a, you know, immediate order of silicones, so you can sort of stabilize it and reuse it, or

Speaker 3 (14:32):

We are planning for both models, you know, the risk of using it without in a disposable format. It low resource settings is that, are they really gonna dispose it? And so you kind of have to think about how you can achieve quality control and disinfection would be a good way it’s only high level disinfection. So it would be a good way for people to practice you know safe ways to you know, use and store the device in countries where there is a business model that allows for use of consumables. I mean, that is something, for example, that’s entrenched in this country, in the United States. And I keep saying this country, but I want to say United States, because I know this country could mean many different things to many different people. You know, we might use a different business model. So I think it’s, it has, we have to learn from market seeding and understanding the customer, what they want and be flexible enough to create different solutions. Because I think we know in the global health setting one size doesn’t fit all particularly in precision diagnostics, but that is pervasive, right? When we assume that the average person is whom we’re trying to serve, you may miss a lot of customers.

Speaker 4 (15:52):

Yeah. I have a question because, I mean, I know you were talking about one size, doesn’t fit all. And again, back to the democratizing of the healthcare and the end customer, I was just wondering, you know, similar to how pregnancy tests are just available, where you can get it off of the shows. Is this something that’s going to be available where women can just go get it off the shelf?

Speaker 3 (16:13):

I mean, ideally, so it’s a, it’s interesting that you bring up the pregnancy test. I actually wrote a blog on that. I perhaps you read it. And that’s perhaps why you’re bringing it up. I guess I could bring it up again, because I think it’s such a poignant example of both the barriers, as well as the amazing innate ability of women to, you know, essentially do things that people never imagined they could do. And so Margaret Crane who basically bought, brought the pregnancy test to the masses had a very difficult time doing that because first of all, providers, you know, said women can’t do this. And the second is that people didn’t want money to go elsewhere. And I feel like it’s a very similar story. Every time you introduce a new women’s center technology, there’s that I’ve heard providers say, Oh, women will not do it.

Speaker 3 (17:13):

And others say, well, how will this affect the practice? So I think that our, our vision is that it will be similar to a pregnancy test in that women can, for example, in the United States could take, you know, have it on a shelf at CVS or as a prescription, you know, solution for, you know, screening for cervical cancer at home, or for that matter looking at your cervix during labor. So you don’t have to come to the hospital to have a physician tell you, Oh, you can go home because it’s not real, but labor it’s labor. So there’s many, but I think like the pregnancy test, it’s going to take time, it’s going to take time for adoption. You know, again, a few early adopters will have to demonstrate its potential and then it hopefully spreads into the larger population. And we recognize that. I mean, no sort of big change happens overnight. And to assume that it will, we’ll actually, I think first of all, it would make me very depressed. And second of all, I think it defeats the purpose of what you’re trying to do, which is to challenge status quo. And if you thought challenging status quo would reap benefits overnight. I think that would be 

Speaker 2 (18:32):

Let’s do that. We set the, I mean, this is not just the replacement of speculum, Monday’s a camera at the end of the the, the business under this, there’s a app I’m assuming with artificial intelligence running so that it can actually detect whether you have cervical cancer, right? So they, so there’s a lot of intelligence and technology built into this. So this you’re essentially replacing that pelvic exam that, you know, most women I know hate to do, you know, on the stirrups, you know, they all complain about how cold it is, right. I mean, I personally have nothing to relate this to, but I haven’t been around any of this to know. So it is not a very,

Speaker 3 (19:09):

It healed,

Speaker 2 (19:13):

Right? So, so you have this, you know, very invasive kind of thing going on and you’re not in control. The doctor is in, usually it could be of any gender. So I think this is, I mean, I’m going to, I see the whole point about democratization. I see the ease of use. So, you know, like a breast self exam that, you know, most women do and men are supposed to do a similar thing. I think this would be something, I mean, are you seeing the vision that this would be something that, you know, will be a part of a home medical kit and that, you know, women give themselves a self exam, cervical self exam that will then have all the intelligence of a, of a specialist to see whether you’ve got time.

Speaker 3 (19:51):

That’s the vision. And thank you for clarifying that. It is really a colposcope and an expert and the speculum all packaged into one. And they will be introduced it in different phases because not everything can be introduced at the same time, but we also have a clinical version. That’s used for the speculum. So again, we’re providing options. We recognize that patients get come to the clinic, they want to do it at home. Different people need different things. So we have multiple solutions just as you brought up that is, is there a consumable or how do you clean it? We need multiple solutions. Will the provider use it versus the patient? Or will the speculum be used again? They want to have different options, but yes, the idea is to stretch it as far as you can. So you widen the base of who will use it

Speaker 2 (20:43):

Talking about the base. Sorry, cutting out. How widespread is it right now? Is it, is it are past the clinical trials phase? I mean, where are you in the, in the sort of medical device spectrum and where is it being used?

Speaker 3 (20:56):

So the co the pocket colposcope is matured to a much greater level than the collar scope because the Conoscope was a derivative of the pocket cope scope. So the pocket colposcope has FDA clearance. It’s gone through multiple clinical studies and trials. We still continue to do it because I think clinical trials are important from an academic perspective. It’s not just enough to say the technology works. We’ve demonstrated that, but there’s a whole other piece about implementation. How does it fit within the workflow? What is the cost effectiveness? What is the incremental cost effective effectiveness? What is the you know, the quality of life and life, you know, you’re safe. So there’s many other questions that will be important from an adoption perspective, especially at the public sector level. That’s what we’re doing. Now. We’re asking some key questions relative to standard of care in an overall health framework.

Speaker 3 (21:48):

Whereas before we had to prove that the technology was equivalent to standard of care, so there’s multiple phases and we don’t need that for FDA clearance. And clearly we have it. What you needed for is acceptance for, by ministries of health or the private sector that says, why should we use this over what we do? And you have to make, again, it’s a value proposition. How do they benefit? How do the customers benefit? How do the providers benefit? How does the public sector benefit, et cetera? I think I’ve got a question I was really interested because I know we were talking again, back to the democratization of health. Suddenly once you get to that critical mass, you have all these people, women using these devices and the app detecting all of this information. So obviously with the big data angle off, it all, you suddenly, from a research perspective, have so much of information that’s gonna help you find a cure.

Speaker 3 (22:52):

Yeah, I mean, the big data is going to help us initially to hone in on the accuracy of the algorithm. And in other words, you’re sort of iterating in real time, once you have some foundation. So that’s where it’s gonna increase, increase the precision of diagnosis, the good news about cervical cancer and why we’re tackling this problem is they’re proven solutions. So we know what, what can be done. But our goal is to think of how, what can be done is could be packaged in a different way that could be more accessible, and that could be more patient friendly. So that’s the good news about cervical cancer. We know exactly what needs to be done. It’s a question of how do you make it cheaper, but also how do you make it something that non-expert providers can use in a community health setting or in a level one health center or a level two health center? So that’s the idea. For example, breast cancer is a different kind of problem. There are still issues with the discovery aspect, but in cervical cancer, I feel like that’s a low hanging fruit, and we need to almost show that that works before we can get to a harder problem.

Speaker 2 (24:03):

So the analog technology that’s using biophotonics right. It’s called spectrum spectrometer technology. So you’re non invasive. You’re sending, you know light rays, UV, light rays, I guess, and then reading the bounce backs, just explain just for all the lay people and myself included in that how that would work. So you would, you would hold it against the breast or breast tissue or, or

Speaker 3 (24:29):

It’s actually, I should clarify. It’s a preclinical device. So what we’re doing is for example you might have an animal model that essentially you know, not simulates, but goes through the different phases of, you know, you have a primary tumor, you, you know, legend it with some sort of treatment, let’s say chemotherapy or some sort of molecular therapy. Most of the cells are killed, but some cells basically, you know, resist treatment and then they sort of lay dormant under the radar and they come back. So we’re very interested in that, that window. So what we want to do is look at different metabolic endpoints that can tell you something about how the tumor cells eat and how they survive, how they generate energy. And there are indicators or contrast agents that do that, but then you need a technology that can actually measure that quantitatively.

Speaker 3 (25:26):

And you want to measure the multiplicity of end points at the same time. So what we’ve developed is both the imaging technology and the spectroscopic technology, but the way spectroscopy works is you send in light of a particular wavelength or different weight blends, and then it interacts with molecules in the tissue. So for example, if you’re looking at absorption, you’re looking at the loss of light. If you’re looking at scattering, you’re looking at the bouncing of light before it comes out. And with fluorescence, you’re essentially looking at the change in color because of, of energy transfer and losses. So the point is you can essentially tune your optical method to the type of contrast you are seeking. And in this case, we’re looking at fluorescents and by essentially measuring that signal coming out, you can model it. So we have developed a series of Monte-Carlo models, which essentially kind of follow the photons as they travel through tissue.

Speaker 3 (26:26):

And then basically once you have the observation, they then use an inverse model to get the underlying tissue properties, which then report on the signals that you’re looking at. So it’s, it’s more of a physical mathematical model. It actually describes the actual events that happen in tissue compared to, for example, machine learning algorithms, which look for patterns and then makes a decision, which those features might be empirically determined. You know, for example, in the case of cervical imaging, but here it’s, it’s based on physical principles. And so what you’re measuring and what you’re getting is related to directly that related directly to the underlying features that relate them to the dormancy of the tumor that we’re trying to characterize. So just to give you a little bit more detail on the dormancy picture, cause I think it’s kind of interesting is, you know, a Warburg who got the Nobel prize said, Oh, cancer’s like sugar, right?

Speaker 3 (27:29):

So it has a sweet tooth and that was the belief for many years. But now we’re finding out that when cancers are deprived of sugar or go through therapy they switched to eating fats, for example, some breast cancers do. And so they basically, you know take the resources from fat cells and breast cancer is full of fat cells or at least the neighboring tissue. And then they change the subtract substrate, which is the fats. And they go through a different pathway for metabolism. So targeting glucose is no longer of interest. So what I’m saying is we don’t know what proportion relies on sugar versus fats, but it’s, it’s important to study metabolism because you can get a sense of that picture, which now people have to do by cutting tissue and then measuring it one, you know, one tissue at a time. Whereas now we can dynamically look at that process. So it tells you what the transient changes are and can look at multiple end points at the same time.

Speaker 2 (28:32):

This technology is actually it’s unlike the previous one we talked about. It’s not actually, it’s not replacing, it’s actually a whole new way of diagnostics, right? I mean, this is, this has nothing to do with making an older combination of things easier and more democratized. This is actually a whole new therapy or, or diagnostic technology or

Speaker 3 (28:54):

Yeah. And just to make the point it’s preclinical, right? So you obviate the need for regulatory clearance, which is often what makes the technology very expensive and takes a long time. Like for example, there’s a, there are two types of regulatory clearance broadly speaking in the U S there’s the five, 10 K, where you could be a me too technology. You don’t have to have any clinical data. You just have to show your way to, and then you have something like the Zenescope where it gets used in patients. It would go through what’s called a premarket approval, which would, you know, it’s this much paperwork and lots of money. So we’ve specifically targeted preclinical models. But our vision is to take that knowledge and maybe ultimately use an imaging system and some sort of organoid, which is basically a scaffold on which you can say take patients cells much like you do with a patient derived xenograph models, you know, animal models where you patient cells.

Speaker 3 (29:41):

And then you look at various phenomenon with that, but that’s expensive and has a low yield. So we want to take these organoids and essentially harvest patient cells and then sort of track the entire process from, you know, primary tumor to dormancy, to recurrence in that very simplistic model and then use imaging to essentially track what’s happening in a patient without that being in a patient. And that too can be you know, go through a simpler regulatory process. So we’re very mindful of being, not, not having to go through an onerous process to get these solutions to impact issues. So, so we focused on the preclinical space with new technologies and the clinical space with more of the me too technologies.

Speaker 2 (30:29):

There’s an Alexa, also something that can be used in less affluent countries. I mean, is that part of the mission there? No.

Speaker 3 (30:37):

Well, it’s interesting that you asked that the naive me 10 years ago would have said, yes, we took this analytics system before it became commercial to Haiti after the earthquake to do cervical cancer imaging, because it can tell you about the vasculature, which is very important in late stage precancerous cancer. And so from a logical perspective, it was a perfect tool to use, but it fell on its face in a place where there’s no temperature regulation. There are no products that you can do to quickly replace the components to quickly replace broken stuff. And, and it was hard to use and many barriers and it needed, you know, AC power, which, which is hard to come by. So when you look at that, that was our first sort of lesson in how, you know, we can’t just take a brand new technology that people are not accustomed to and just launch it.

Speaker 3 (31:32):

The other thing is people oftentimes don’t want something new. It, it makes them nervous. Like if they haven’t seen it or Western countries haven’t used it, they’re a little trepidatious about it. So it’s nice to start with something they know, and they understand the providers know, but colposcope is a period of gynecology clinic. They know they don’t have it because of the various resources needed. So here is a solution that can recognize, and that’s how you start. And once you build a trust, then you can introduce new solutions, but not right away. So we keep them separate. I will say the pocket colposcope, which is the clinical based version of the colposcope, the, the, the portable called scope that is giving us that engine is something we’re thinking about to flip over to Zen, a Lux where that could in its could use that same underlying principle to develop low cost technologies for imaging. So for example, think of that organoid. I mentioned in the clinic, we’re not going to use the fiber book based technology. We’re going to take the pocket colposcope, rejig it, and then use that as a very simple microscope to look at these samples in a scaffold. So I think we can have interchangeable technologies, but right now it’s a one way street.

Speaker 2 (32:51):

Huh? Fascinating.

Speaker 3 (32:53):

Okay. Well, we have some audience questions. Why from one, all we do,

Speaker 2 (33:01):

It was a very regular question person.

Speaker 3 (33:05):

And in this case, he has a person that can make is this process at Duke, also an experiment in how academics can lead innovation to the markets and, and change how academics approach, research and ideation. Absolutely. That was my original goal. In fact, it’s been proven to be very successful because first of all, you know, we tend to silo things and people always ask me, students ask me, how can we be entrepreneurs? I tell them, you’re not, you can’t just want to, all of a sudden wake up and be an entrepreneur. And entrepreneurship is more than just, you know, developing a business plan. It’s understanding the problem and being able to implement that in a very systematic way. And as I said, it’s a continuum. So that has been actually the most exciting part because if I relied on the technology being successful, I think I’d be very disappointed because many things fail.

Speaker 3 (33:59):

But what I know won’t fail is the knowledge transfer and the practical experience they get. I’m working on the solutions. The other interesting things is, you know, we always talk about the representation of women and minorities in engineering. Well, this is a great way to get them in. If they understand personally what these problems are, they’re more likely to be engaged and always think of engineering as more of a tool. Just like you might have paint, brushes, and canvas, but what you create is yours. And so I tried to make them think of engineering that way, because engineering and STEM are dirty words to many people, right? They, they create tension and intimidation. And so the way I think about engineering and I was a reluctant engineer, myself is it’s just a tool. There are social science tools. There are many types of tools, business tools, but at the end of the day, how do you use them to make life better?

Speaker 3 (34:58):

And so I tell them, you don’t have to be an engineering. You can be someone who graduated from comparative studies. You can be someone that graduated from neuroscience, nothing prevents you from being an engineer, because what you’re essentially doing is saying, I want this and I might use a M an arsenal of tools of what, of which one is engineering. And I also feel personally that at a time now, when we have so much access to sort of basic knowledge, we also have to create an environment where students have to have a reason to come to school. I mean, why don’t they just learn everything online? It’s likely the future for a good amount of time. And so how do we give them authentic experiences that them to tie all these concepts in your package that allows them to think about the fact that a, I know how to use these tools in a way that, you know, yields some kind of something of value.

Speaker 3 (35:50):

And second, I can be a lifelong learner because I can learn different tools and be able to use them. So I think there are many merits to bringing the, the idea of commercialization entrepreneurship into the academic setting and to Warren’s point, the sense of ID issue is also something that is based on a, you know, a paper or some sort of theoretical framework. Here’s a problem. And then here’s the solution. And I was very much like that. And then you realize you have the solution, but is that what the customer needs and wants? Are they willing to pay for it? And that’s why the ideation phase has to really begin with the customer in mind. And we call that, and it’s not my term I coined by human centered design. And you use that with students when you’re teaching, but you also use that in product development. And so it can be used, that’s underlying principle in whatever we do. And that I think makes you more successful in getting the products to the people who need them in ways that they would actually use them.

Speaker 2 (36:50):

So is this, this sort of program that you’ve set together in Duke? Is it unique that, you know, you sort of have this sort of engineering and then you actually can translate that directly into something that actually would work and in a setting, I mean, this sounds like a sort of an end to end full life cycle learning, doing experience. Is Duke the only school that’s sort of doing that in biomedical engineering, or is it just as the norm? Because I feel like I want to sign up and go to school again. It’s so, so

Speaker 3 (37:20):

Yeah, I would lie if I said it’s unique because it’s not, there are many groups that were very successfully doing this, and in fact, they inspire me to do this, but I would say that each perspective is unique. So I think what’s unique about what we do is that we’re focusing on women’s health, through technology. And as I said, that brings multiple people to the table to work on problems. They care about second women’s health is not just technology, for example you need to build capacity. So another program that we had is women in engineering, mostly women engineering students in engineering, going to different countries and teaching engineering design for practical solutions that women and girls in those community space, for example, energy, poverty or clean water, and not necessarily to solve the problem, but to teach them how, what could solve the problem using technology and giving them that sort of exposure to a different kind of mindset.

Speaker 3 (38:25):

And we found that some students use that for activism. And some students use that for competitions. So people you use them in different ways, or someone actually helps their brother fix a flashlight. So we believe that there are multiple dimensions. And another thing that we did is, you know, to an earlier question on, so just because you build it, why would women use it? So we’ve created a whole social science program to understand the perspectives of women. And we also had an art exhibit last year to essentially raise awareness around reproductive and sexual health. So there are many ways to do it. And what we say is the core is technology, but it’s really an intersection of technology, storytelling social science, and many other dimensions that make it whole we have created a program called wish women inspired strategies for help focused on cervical cancer prevention.

Speaker 3 (39:26):

And it’s completely about removing structural and what I call social barriers so that women have very few barriers to accessing care for cervical cancer prevention. And the idea is that instead of being screened at a primary healthcare clinic, that comes to a woman’s home, and instead of being diagnosed in a clinic or hospital that comes to the community setting. And when we think about the fact that cervical cancer or cervical disease the prevalence of say, for example, two out of every hundred women, what that means is that 98 women can get their services or screening done at home. And only two out of every hundred women actually need to get some kind of care at a, at a community setting clinic. And so by doing that, we’re actually not only saving money, but we’re conserving resources by focusing on the ones who really have a problem.

Speaker 3 (40:22):

Whereas right now, for example, in India, with screening, there’s such a high false positive rate is that the hospitals get sort of overwhelmed with a lot of people coming in, who don’t even need to be seen. And the other on the other side, we see that people who need to be seen don’t often come, so we’ve got two problems. So that’s what wishes about, and you can just do that again by saying, we got the Sweeney technology and we’ve got the diagnostic technology with the treatment. The storytelling piece comes in with being able to hear the voices of women showcasing the voices of women peer to peer networking, because if one woman is excited and advocates for it, she can essentially spread that like I talked about earlier. So why not use that human capital in a positive way? Why not empower women to be the agents of change and, you know, by doing that, you can serve more women and save more lives.

Speaker 2 (41:23):

Yeah. So you did mention that you were reluctant engineer, so maybe so how did you end up in biomedical engineering? I mean, if that’s, I mean, so, I mean, because I think a lot people from the South Asian background, I mean, we have story has become a doctor, lawyer engineer sort of thing. And you know, there’s so many fields out there of learning now. I mean, biomedical engineering, I’m, I’m learning what synthetic bio biology. I mean, there’s all this new stuff, right. And it seems like a very exciting time to be sort of in school or learning because the fields are not no longer narrowed down to these, you know, sort of earning crap categories of education that, you know, our parents used to tell a drill into our heads. And I think you know, just listening to you, I’m, I’m hoping a lot of people that are inspired to say, Hey, maybe I should look at biomechanical name medical engineering. Maybe I should look at other things. I think, you know, that’s, that’s part of the objective of the sessions, but, but how did you end up where you were?

Speaker 3 (42:18):

Yeah, I had well, I had some of that, you know, you need to do something that, you know, will pay you well or whatever. But I started off playing music. When I was growing up, my mother taught me and that was a big part of my life. I was doing a lot of public performances and it was probably the only way I could distinguish myself from my male peers because, you know, I was always told that, you know, I couldn’t do math as well as my brothers, et cetera, et cetera. Not that it was true, but probably maybe at the time it was. And I think that that gave me, gave me a very creative sort of skill that I still value today. And I went into engineering because my brothers went into engineering and I really resented it every day.

Speaker 3 (43:05):

And I think part of that also was my learning style. Which was I learned by doing, I don’t learn by just listening. And so I felt like I missed that opportunity in the traditional form of education. But then at some point when I started doing research, that changed because I could finally internalize what I was learning because I would do the experiment. I would make a mistake and the mistakes would actually help me get better and reinforce learning. So I, I embrace, you know, failures and mistakes because that’s what has helped me grow, whether it’s a social or a physical or experimental, whatever the mistake might be. And then when I saw those connections between the creative side and also had a very analytical side and could follow rules because of my upbringing. So I felt like those two worlds came together.

Speaker 3 (43:53):

I had the discipline, but I also had the creative energy. And so, as I evolved in my career, I realized, and I said this earlier, that engineering is a tool and we shouldn’t be intimidated by a tool. We should be able to harness its its utility. And I realized that like music, you know, you can learn the scales on a piano and that’s, to me like learning engineering or whatever else you want, but to compose the music, you can’t just rely on the scales. You have to use those scales in a creative way. And and then what’s cool about music is it’s music too many years, right? I mean, if you say, you know, here about engineering, many people may not sign up. So thank you for those who signed up. But if you say, come listen to some music, that’s a universal thing for the most part, unless you’re into pop music or something and I’m not.

Speaker 3 (44:41):

But the idea is that music is pervasive. And I thought to myself, if I can use engineering to compose creations and those creations are something people can connect with, then maybe I can impact more people, you know, create a like-minded community. So I use music and art as an analogy because to me, everything is about music. I have a piano next door and I play really badly. My kids play much better, but I just teach myself not that I want to be a pianist, but I just, because I think that every time I’m writing a grant and I go to the other room, it’s like meditation, right? I’m playing, I’m focusing. I’m, I’m basically learning something new. And when I get from scales to music, I reminds me of the process. I need to go through in creating the innovations that we create in my center.

Speaker 4 (45:38):

That was a question that came through essentially what is the estimated cost per instrument for cervical diagnostic?

Speaker 3 (45:47):

We anticipate we have a bill of materials and was just starting to, you know, go through manufacturing. But for the pocket colposcope, we’re expecting to be you know, between 500 and thousand dollars, which is already like an order of magnitude lower than what a standard colposcope costs and for the Conoscope, because we want it to be used in women’s homes. And there’s potentially a larger market. We’re expecting it to be about a hundred dollars. But again, with, with, with reuse, which is what we’re hoping, the cost per test will be much lower.

Speaker 4 (46:20):

Okay. and also it’s interesting because you spoke about music as an analogy and stuff like that. I, I, throughout this whole session, I put the question I really wanted to ask you was what was your inspiration or who was your inspiration for you to move into, you know women’s health, you know, detection of cervical cancer and breast cancer, et cetera.

Speaker 3 (46:40):

Yeah. I’m my graduate advisor. She’s a phenomenal woman. She’s actually got an amazing program called rice, three 60. And she’s really impacting babies lives in a profound way. She is an incredibly dedicated you know, person who uses engineering in the most impactful way, but I think she also has a work ethic. That’s unparalleled. So not only does she have the vision, but she has the, but that’s to back it up. And I think you learn by watching those role models and she’s not arrogant. She’s very humble. And so you would never know that she has all of these things. Her name is Rebecca Richards Corda, and she is the director of rice, three 60 at rice university, a encourage people to check her and her program out. And I think that she, amongst others are the inspiration for me to do what I do. In fact, my first women’s health research was done under her guidance. And then ever since then, I’ve sort of used that as inspiration to create my own programs. So yeah, I would say that she is one of several people that I look up to. I mean, there are others, obviously over the, the course of your career that inspire you. So she was definitely the one of the early ones. There’s a lot of discourse about women and the stigma of women in STEM, et cetera. What is yours?

Speaker 2 (48:14):

Like, why do women have to jump?

Speaker 3 (48:15):

There are so many hopes, well, that’s a tough question, but one of it is, you know, if you don’t see many of yourself, how do you, you know, do you want to be the only person in the room that looks like you, I’m going to, we’re having that conversation right now about racial inequity in STEM, not just, you know women. And so I think you have to have more people who look like you, who you can relate to. So you’re not the outlier. The second is I told you, the word itself has such a negative connotation, right? You need to do step. Why can’t you work on a social problem and use STEM as a solution? So that’s a little bit to me. One of the reasons, I mean, I could say that about myself, right? The word engineering sometimes in my mind feels like a word that I don’t want to think about.

Speaker 3 (49:12):

The other’s opportunities, right? If you’re in a community where people assume that, you know, less than someone, a male peer, that immediately creates a bias that doesn’t get even give you a chance. So it’s both your preconception and your fears, but it’s also the lack of access. And I would say, you know, the perceptions actually probably aren’t big part of what deters women from STEM. And that’s exacerbated by the fact that the system doesn’t necessarily address that. So for example, if you say, I want to have more women in a program and let’s say you recruit them, that’s not enough. You have to give them an environment where they’re confident and they feel like they can succeed. Otherwise you’re going to fail. So it’s both recruiting and then persistence.

Speaker 2 (50:03):

So what’s I mean, we are sort of at the 45 plus minute Mark, I just want to, so what is next for you? I mean, are there, I’m sure there may be other innovations in the pipeline or maybe there’s a, you know, you’re taking something that you already have and want to make this w what is next for Niemi and, and, and, and, and, and the center that you run in terms of what we can expect. Yeah. Mean, I would say

Speaker 3 (50:28):

We’re always innovating because there’s always problems and we learn about the problems by implementing, right. You solve one problem, and then you see the next one. So there’s, there’s, there’s always a need for innovation. In fact, we’re working on therapeutics. I don’t mean the first thing, but therapeutics, but we’ve made some good progress on low cost therapeutics. So the idea is that you don’t just stay in your comfort zone, you work on new problems and new solutions, but I would say my biggest goal for now is wish, you know, how do we implement this, this program globally? How do we actually change status quo and make this a new relapsed reality? Because if we can do this, imagine all the other women’s health solutions that could sort of follow this roadmap, right? You, you have to break those barriers with one example, cause you can’t say no to solve every problem, but if you can create something that completely upends traditional healthcare by putting women at the center, what more could you do? So for me, that’s sort of a life goal. So whatever it encompasses and I encourage you to go to wish that tells you more about what we’re doing. Okay.

Speaker 2 (51:35):

We’ll make sure that we we, we have that on a recording as well, so that they can follow up. So click any more questions, I guess

Speaker 2 (51:48):

You don’t mind indulging us for a few seconds. Yeah, go ahead.

Speaker 3 (51:53):

Do you think there’s a university for and by women to focus on finding tools for problems regarding women say the first part again, do you think, do you think there is a university for and by women? Do you think there’s a need or probably I think the question is probably not framed, right? For and by women to focus on finding tools for problems. Like, I think what they’re trying to ask is, do you think we should set up a university? I had, I would, I would know more, but why not? Isn’t that innovation in and of itself, if you, what do they say if something hasn’t been made, then it’s time to make it? I will say there’s a, there’s a good university. Maybe. I don’t know if they do exactly. You know, the things that I’m talking about, but Smith in Massachusetts has an wonderful engineering program.

Speaker 3 (52:44):

And I give a talk there. In fact, I saw that a hundred percent of the audience were women. And I thought to myself, I’ve never had that experience. And I think that’s what, in a sense, inspired me to come back and have classes that would increase the enrollment of women, you know, how you make it so that women are interested in joining and being a part of your program. We create classes that are engineering based, but then once that would sort of resonate with them. So there is one, I don’t know if they’re working exactly on the problems we are, but I would say, you know, it takes a lot of vacation to start a university. So maybe I would say, start in small buckets and grow on that, on that, on that rather than say, unless, you know, all depends on what you’ve done before. If you feel like you’ve done the things that make you ready for starting a university. Great. But if you want to start something big like that, you need to go through a lot of processes to see where the mistakes and problems occur. So you can quickly iterate and change course, if you need to, before you invest a lot in a bigger entity,

Speaker 2 (53:48):

Just make this a good example. Yeah.

Speaker 3 (53:51):

That’s pretty much it for my end.

Speaker 2 (53:54):

So Naomi, thank you again, I think for, for taking time off from, I know a hectic schedule to speak with us. It’s it’s been certainly eye opening for me. I’ve, I’ve learned more about I mean, I think I’ve seen my first cervix. I was fascinating is that is I think, you know, it’s, it’s, it’s tremendous that how we take so many things for granted. I mean, I was just thinking as we were talking and especially by the tobacco self screening that, you know, normally men are, I haven’t seen one, but most women who actually have that in their bodies, haven’t seen one. And, you know, it’s part of a, sort of a process that they go through a part of that, you know, sort of the health routine and many women haven’t seen it. It says, it’s the person looking in.

Speaker 2 (54:34):

I mean, I think that’s tremendously empowering that, you know, you you’ve taken this unseen organ as you call it and given it visibility. And I think the whole step of sort of taking this and, you know, the analogy being the, the, the book, the, the pregnancy test, you know, eventually if you, if he breaches that standpoint and I wish and hope that it does that, you know, you you’ve taken another thing out of the heart of the hospital setting. And under, let’s be honest, male, male dominated medical community with all of the trappings associated with that. And you’ve essentially given that back into the hands of other people whose bodies, it really impacts. I think that’s a tremendous sort of transformation. And I think you know, we’re, we’re honored to have you and speak about that. I mean, I don’t know. I think I don’t want to speak to you for you, but I’m, I’m thrilled that, you know, you’re doing this and I, I wish you all the very best and you know, keep us informed about anything else that comes up. We’d love to have you back in the show. And and, and let our audience know about additional advances that you may have done. And I must say that that the students at Duke have blessed to have you as a professor, you know, had I come across someone like you. So

Speaker 3 (55:52):

Thank you so much. And I appreciate, you know, being able to share my thoughts. And I mean, I have been totally inspired. I mean, I know at the beginning of the show I was fat or somebody else now I’m fan girling over you. Thank you so many inspiring. Thanks again,

Speaker 2 (56:16):

Have a great weekend. And hopefully cross paths will cross in a, in a physical realm once this pandemic is over.

Speaker 1 (56:25):

Absolutely. Thanks again. Take care. [inaudible].

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