Speaker 1: Last week, the Supreme Court started hearing the case about
Speaker 1: abortion access in Mississippi. And this all started because Mississippi
Speaker 1: put a law in place that said you couldn't terminate
Speaker 1: your pregnancy after fifteen weeks.
Speaker 2: Well, that's in direct contradiction with Roe v. Wade, right,
Speaker 2: which says you can terminate a pregnancy up until twenty
Speaker 2: four weeks, which is considered the point of viability, or
Speaker 2: when a fetus can survive outside the womb.
Speaker 3: Right.
Speaker 1: And this is so monumental because this is the first
Speaker 1: time since nineteen seventy three. So when Roe versus Wad
Speaker 1: happened that the Supreme Court is hearing a case that
Speaker 1: questions if it's constitutional to ban abortion before viability.
Speaker 2: This feels like a lot is on the line.
Speaker 1: Yeah, this could change everything, And it seems like we
Speaker 1: are in a time machine because I never thought that
Speaker 1: in my lifetime that we would go back to this
Speaker 1: way of thinking and have to go through court systems
Speaker 1: again about women's reproductive rights.
Speaker 2: Yes, and you know, I've seen a lot of chatter,
Speaker 2: you know, I like to scan the way. I've seen
Speaker 2: a lot of chatter about like, oh, well, you don't
Speaker 2: have to worry about abortion if you are taking birth
Speaker 2: control and this and that, but baby, we need to
Speaker 2: talk about birth control.
Speaker 1: Absolutely, because not all that glitters is gold. It's not
Speaker 1: some magic pill that works for everybody the exact same way.
Speaker 3: So we have to talk about this.
Speaker 1: Welcome to Dope Labs, a weekly podcast that mixes hardcore science,
Speaker 1: pop culture, and a healthy dosa friendship.
Speaker 2: Reproductive rights have been under attack in the United States
Speaker 2: and with the recent abortion legislation in Texas.
Speaker 3: Right, it's not just Mississippi.
Speaker 1: Texas has also put some laws in place, so they
Speaker 1: have the Texas Heartbeat Act. And in this act, it
Speaker 1: says that you can't terminate a pregnancy after six weeks,
Speaker 1: So you only have six weeks to terminate your pregnancy.
Speaker 2: And that six weeks is not from when you know
Speaker 2: that you're pregnant. We need to be really clear. It
Speaker 2: is tricky because the six weeks is from the date
Speaker 2: of your last minstral cycle, so a lot of people
Speaker 2: don't even know that they're pregnant six weeks out.
Speaker 3: That's right.
Speaker 1: So this week we're talking all about birth control specifically.
Speaker 1: We wanted to understand how it works to prevent pregnancy.
Speaker 1: Some of the issues or side effects around birth control
Speaker 1: and how people can be empowered to find the best
Speaker 1: option for them.
Speaker 2: Let's get into the recitation. Okay, so what do we know?
Speaker 4: Well, we know not all.
Speaker 2: Birth control is created equal, right, you know there's a
Speaker 2: lot of different types.
Speaker 1: Yes, me and all my friends have all had a
Speaker 1: different one and have different thoughts about each of those things.
Speaker 2: Yeah, the pill, the ring shot, iud's condoms, even spermicide
Speaker 2: seems like that's making a comeback.
Speaker 4: I recently saw ad for that.
Speaker 1: Do you remember that episode of Seinfeld where Elaine was
Speaker 1: talking about the sponge. I had no idea what that
Speaker 1: was when I was watching Seinfeld as a kid, but
Speaker 1: it was birth control and she was trying to get
Speaker 1: her hands on her favorite type of birth control, and it.
Speaker 3: Was like she was looking for drug. Really, it was
Speaker 3: very funny.
Speaker 4: Now I'm gonna have to go back and look bit it.
Speaker 4: What else do we know?
Speaker 1: We know that birth control is an important topic because
Speaker 1: half the population is looking for ways to decide.
Speaker 3: Or control when they get pregnant.
Speaker 4: Or if or if so.
Speaker 2: What this boils down to is that birth control is
Speaker 2: affecting a lot of the population.
Speaker 1: Yeah, so many people just think of birth control as
Speaker 1: something that people with uteruses are thinking about, when really
Speaker 1: it can be partners that are thinking about it. So
Speaker 1: it really does affect way more than just the person
Speaker 1: with the uterus. Yes, but it seems like a lot
Speaker 1: of people that don't have a uterus are making decisions
Speaker 1: about it, sticking the non uterus in our business and
Speaker 1: telling us what we should be doing with our uterus.
Speaker 2: We also know there isn't a birth control pill for
Speaker 2: men right now, so what's going on with that? So
Speaker 2: what do we want to know?
Speaker 1: I think for me, it kind of starts at the
Speaker 1: base and I'm a little bit embarrassed.
Speaker 4: This is a safe space.
Speaker 3: I don't really know how birth control works. You're just
Speaker 3: counting on it to work.
Speaker 1: I think I kind of understand how the ring and
Speaker 1: the pill work, but iud's I know there's different types,
Speaker 1: and I think that's the part that I'm like, chemically,
Speaker 1: what is going on with these contraptions that we could
Speaker 1: possibly be putting inside of our bodies.
Speaker 4: That's a good question.
Speaker 2: And then just as deserving of conversation is what are
Speaker 2: some of the side effects?
Speaker 3: Right?
Speaker 2: What are some of the issues that come along with
Speaker 2: adding these things to your body? You know absolutely, because
Speaker 2: we already know that there are side effects.
Speaker 3: I think we've all heard. I just want to know
Speaker 3: what are all of them?
Speaker 2: Yeah, and piggybacking off what you just said, we know
Speaker 2: there are tons of issues, and the issues are different
Speaker 2: for different types of birth control. So how our doctors
Speaker 2: to who gets what and when? And is the birth
Speaker 2: control you got back in the day the same birth
Speaker 2: control you should be using later, like people in birth
Speaker 2: control for a long time.
Speaker 1: Yeah, and our bodies are changing. We know that, right,
Speaker 1: isn't one size fits all. Sometimes I feel like you're
Speaker 1: going to the doctor and they just got the birth
Speaker 1: control in a candy jar and they're just like here,
Speaker 1: now go halfway. And then I think another really good
Speaker 1: question is what is the future of birth control? I
Speaker 1: can't imagine that we all gonna just be doing the
Speaker 1: same thing.
Speaker 3: I hope forever.
Speaker 1: I hope that there's some advances in the technology so
Speaker 1: that there aren't these issues that we're gonna be talking
Speaker 1: about that persist with people whoever uterus.
Speaker 3: Right, I feel like this is ripe for disruption.
Speaker 1: Oh, absolutely, absolutely, all right, let's jump into the dissection.
Speaker 2: Our guest for today's lab is doctor Elizabeth Rousseau.
Speaker 5: I am Elizabeth Rousseau.
Speaker 6: I am founder of AIDA, and I got my PhD
Speaker 6: in human genetics at Duke University.
Speaker 1: So me and Zakiah both went to Duke with Elizabeth.
Speaker 1: Not just all we were there at the same time
Speaker 1: and we might have met each other.
Speaker 2: No, we actually know Elizabeth, yes, very very well. We
Speaker 2: graduated from the same program. All right, we have the
Speaker 2: same degree. So I am really excited to talk to
Speaker 2: her today. Yes, and she's one of our very very
Speaker 2: smart friends. So buck Lynn, so you can know you
Speaker 2: hear us say, Elizabeth is doctor Ruzzo. Yes, put some
Speaker 2: respect on her name. Let's start with the basics. So first,
Speaker 2: there's ovulation. That's the release of an egg from your
Speaker 2: ovary down the fallopian tube. So when that egg is fertilized,
Speaker 2: it implants in the side of the uterus. If there
Speaker 2: is no fertilized egg in that house, the uterus just
Speaker 2: comes crashing down. It shares the lining, and that's the
Speaker 2: twenty eight day cycle that we know is a mistral cycle,
Speaker 2: and so that lining being shared, that's a period.
Speaker 1: We know that birth control is a really important part
Speaker 1: of reproductive health for so many people, and we know
Speaker 1: it prevents pregnancy, but how exactly does it work.
Speaker 6: The highly effective methods work by either preventing ovulation or
Speaker 6: by preventing the sperm from successfully fertilizing the egg, which
Speaker 6: is usually via thickening of the cervical mucus.
Speaker 5: So, with the exception of the.
Speaker 6: Copper IUD, they all work by adding low levels of
Speaker 6: exogenous hormones. And these are specifically synthetic forms of either
Speaker 6: estrogen or progesterone.
Speaker 4: All right, so let's break that down.
Speaker 1: Okay, good, because there are some words in there. I
Speaker 1: don't I'm not sure.
Speaker 2: So Elizabeth said that all of these, except for the
Speaker 2: copper IUDs, work by adding exogenous hormones. XO means outside
Speaker 2: in genous. You know, word genus is the origin, so
Speaker 2: originating from outside the body.
Speaker 3: My girl speak Latin. She speaks Latin, y'all.
Speaker 2: And so all we think about it, we're saying, like progestin,
Speaker 2: that's just a synthetic version of progesterone. Hormones are chemical messengers,
Speaker 2: and they're like long range chemical messengers. They can travel
Speaker 2: through the bloodstream, reach different organs. They're important, and they
Speaker 2: all serve different purposes often and I think it's a
Speaker 2: really delicate dance of the different hormones, which is why
Speaker 2: you often hear people say, oh, it's a hormonal imbalance
Speaker 2: because they're coregulated and some are blocking others, some amplify others,
Speaker 2: and it happens at different times depending on different things
Speaker 2: that are happening in your body.
Speaker 1: It sounds like a symphony, like those strings come in
Speaker 1: at the right time to drown out those woodwind instruments.
Speaker 3: There you go.
Speaker 2: So some of the hormones that these different breath controls
Speaker 2: add in are estrogen and progestin. Let's start with estrogen.
Speaker 2: This is something that's pretty cyclical. It follows the menstrual cycle.
Speaker 2: Estrogen thickens the lining of your uterus. That's saying, hey,
Speaker 2: get thick there's an egg that might get fertilized and
Speaker 2: it needs to be implanted into the side of here, right.
Speaker 1: It's trying to make that environment right for the fertilization, Yes,
Speaker 1: the fertilization right, okay.
Speaker 2: Right, And so hormonal birth control can prevent pregnancy by
Speaker 2: preventing ovulation. And that's just simply humpty dumpty coming tumbling down.
Speaker 2: That's an egg tumbling down through the uterus. Right, and
Speaker 2: so you can prevent ovulation or you can say, all right,
Speaker 2: in the cervix. You know, if we're thinking about what
Speaker 2: reproduction is, what fertilization of an egg is, You're gonna
Speaker 2: have to have sperm that can move through the mucus
Speaker 2: on the cervix to fertilize an egg. So if you
Speaker 2: make that mucus very thick, the sperm can't move through, right,
Speaker 2: and so it's not able to enter the uterus, and
Speaker 2: it's not able to fertilize the egg.
Speaker 3: It's like quicksand for the sperm.
Speaker 2: Yeah, the sperm is just not strong enough. Or another
Speaker 2: way is to thin the lining of the uterus to
Speaker 2: prevent the egg from even attaching to it. So slipping
Speaker 2: slide records no egg attaching to the uterine lining, right,
Speaker 2: if you want to remember it.
Speaker 3: Those are different ways.
Speaker 1: Okay, that was a beautiful breakdown of how all this works.
Speaker 1: Doctor Russeau also mentioned the copper iud, which is a
Speaker 1: non hormonal type of birth control.
Speaker 3: So how does that method.
Speaker 6: Work that one releases copper ions into the uterus and
Speaker 6: makes it inhospitable for sperm and can potentially also prevent
Speaker 6: implantation of the egg.
Speaker 2: So, like we said before, there are so many types
Speaker 2: of birth control. The pill, the patch, the shot, the implant.
Speaker 2: Those are all hormonal types of birth control.
Speaker 1: Non hormonal types include the copper ud using condoms in
Speaker 1: the Fertility Awareness method also known as FAM, or the
Speaker 1: rhythm method. This involves tracking changes during the menstrual cycle
Speaker 1: to predict when you ovulate.
Speaker 2: And the ways to use the different methods also vary,
Speaker 2: so for the pill you take it daily at the
Speaker 2: same time every day, whereas with the patch that's every
Speaker 2: week you're applying a new patch.
Speaker 1: So birth control has proved to be extremely effective at
Speaker 1: preventing the fertilization or implantation of an egg in the uterus,
Speaker 1: but it also has some reproductive health benefits beyond preventing pregnancy.
Speaker 2: I think the point we really need to make clear
Speaker 2: is that just having a uterus makes you susceptible to
Speaker 2: all kinds of things.
Speaker 1: Yes, like uterine fibroids, pcos PMDD, endometriosis.
Speaker 2: Yes, And so I think it's easy to think of
Speaker 2: birth control as just providing agency about when you will
Speaker 2: or will not have a fertilized egg, but it's also
Speaker 2: medicine for those other conditions that come along with having
Speaker 2: a uterus.
Speaker 4: Right.
Speaker 1: Birth control can't cure these issues, but they do help
Speaker 1: alleviate some of the symptoms that come with them.
Speaker 6: It's also used as medicine to treat chronic reproductive disorders
Speaker 6: in women, everything from menstrual cramps to fibroids to pcos.
Speaker 1: Yeah, I've known people who are having issues with their period.
Speaker 1: I knew someone that had their period consistently for like
Speaker 1: six months, and so the prescribed medication to help regulate
Speaker 1: it was birth control, And they had to go kind
Speaker 1: of like back and forth with their doctors trying to
Speaker 1: figure out the right dosage and things like that. But
Speaker 1: eventually they got to a solution, which they were really
Speaker 1: happy about.
Speaker 2: I'm glad it worked out for them. There has been
Speaker 2: so much conversation about fibroids, and these are not just
Speaker 2: one off issues, right. So uterine fibroids, which are like
Speaker 2: growths on the uterus. By the age of fifty, almost
Speaker 2: two thirds of all women will have experienced uterine fibroids.
Speaker 3: Right.
Speaker 2: And then, even when we know how many women are
Speaker 2: going to have fibroids, there are still disparities within those groups.
Speaker 2: So for black women, between the age of eighteen and thirty,
Speaker 2: about a quarter of them will experience uterine fibroids, compared
Speaker 2: to six percent of white women in that same age range.
Speaker 1: And then PCOS, which is polycystic ovarian syndrome.
Speaker 3: That's a condition where your ovaries produce.
Speaker 1: An abnormal amount of androgens, which is male sex hormones
Speaker 1: that are usually present in women in only small amounts.
Speaker 1: Having more of those hormones, it starts to produce little
Speaker 1: cysts on your ovaries.
Speaker 2: And so endometriosis something that we often hear about and
Speaker 2: the difficulties related to this. When you're pregnant, that's when
Speaker 2: that uterine lining that we talked about earlier grows outside
Speaker 2: of the uterus. Oh my gosh, okay, and so that
Speaker 2: can be really painful.
Speaker 1: And then PMDD is pre menstrual dysphork disorder and it's
Speaker 1: a lot more severe than what we call PMS.
Speaker 2: So now that we have a solid understanding of first
Speaker 2: how birth control works, second the different types of birth control,
Speaker 2: and third the additional health benefits of birth control, let's
Speaker 2: talk about how you actually get it, how is it prescribed?
Speaker 2: So first things first, how many different brands or versions
Speaker 2: of birth control do you think are currently on the market?
Speaker 1: TT okay, I feel like there's probably more than I think,
Speaker 1: maybe more than fifty, but less than a thousand. I'm
Speaker 1: just gonna give a wide range. I like that very easy,
Speaker 1: Thank you.
Speaker 2: Yes, I mean it's hard when you really think about it,
Speaker 2: because it feels like there's a lot of different categories
Speaker 2: and it has to be more than one brand in
Speaker 2: each of those categories, right.
Speaker 1: Yeah, Because you know, when you go into any drug store,
Speaker 1: you got talent all, then you got ibuprofen, and then
Speaker 1: you got the CVS brand, you got this other brand
Speaker 1: and children's brand, all these different types of things. So
Speaker 1: I'm like, is birth control like that?
Speaker 5: All?
Speaker 3: Right?
Speaker 4: So how many are there on the market.
Speaker 6: It's one hundred and eighty one, so the vast majority
Speaker 6: of those are in the category of pill. But even
Speaker 6: within pill, there's multiple different kinds. So for example, some
Speaker 6: have both estrogen and progestines and some are progestin only
Speaker 6: or commonly called the mini pill.
Speaker 4: I feel like your guess was good.
Speaker 3: It definitely fell within the range that I had said.
Speaker 3: Thank you.
Speaker 2: I appreciate that, and you're right, I mean, it's not
Speaker 2: quite a set of menifit, but birth control that includes
Speaker 2: you know, brand names as well as the generic options
Speaker 2: too that might be more affordable.
Speaker 1: Yeah, and the mini pill, which is progestin only, is
Speaker 1: typically given the people who are breastfeeding or at risk
Speaker 1: for blood clot And all of these methods have different
Speaker 1: levels of effectiveness. After abstinence and sterilization, the implants and
Speaker 1: id's are the most effective methods of birth control, all
Speaker 1: about ninety nine percent effective or better.
Speaker 2: And that makes sense because both of those have a
Speaker 2: lot less room for human error. Once it's in, it's
Speaker 2: in well for the most part. Methods like the pill
Speaker 2: of the patch. Now that's going to require you to
Speaker 2: stick to a regular schedule and to always remember to
Speaker 2: take whatever your method is or to apply your method,
Speaker 2: and that is way more susceptible to human error.
Speaker 1: There is one time I forgot to put my own
Speaker 1: shoes on when I was leaving my apartment in grad school,
Speaker 1: and I didn't realize until I turned on my car
Speaker 1: and stepped on the break.
Speaker 4: You put your foot to the pedal because.
Speaker 1: It's like, this does not feel right, hm, So you
Speaker 1: already know things are getting for god Ton.
Speaker 4: So that gets us to the question of which method
Speaker 4: is best?
Speaker 1: For real, the best method is one that fits your lifestyle, right,
Speaker 1: But I don't know if doctors are asking those specific
Speaker 1: lifestyle questions like are.
Speaker 3: You a forgetful person?
Speaker 2: Right?
Speaker 3: Have you ever gotten to your car without your shoes?
Speaker 3: You know what I mean?
Speaker 2: Because that is crazy levels of forgetfulness to me, right, yeah,
Speaker 2: and something that even if you are forgetful person, you
Speaker 2: might not even consider it because it's your day to.
Speaker 4: Day life that might not feel forgetful to you.
Speaker 2: I mean, yes, no shoes, but like oh man, where
Speaker 2: you're having to say like did I turn off the stove?
Speaker 4: Did I turn off to this?
Speaker 3: You know? Right?
Speaker 1: And maybe taking something every day and you set your
Speaker 1: alarm on your phone and it's easy for you and
Speaker 1: so it's no problem at all. But some people want
Speaker 1: to be able to take breaks, like with the pill
Speaker 1: and the patch.
Speaker 4: Yeah, that makes complete sense.
Speaker 1: Some people might be sensitive to hormonal changes, so they
Speaker 1: don't want to opt for birth control that will change
Speaker 1: their homeowned levels, so then they opt for you know,
Speaker 1: things like condoms, the rhythm method or the copper UD.
Speaker 2: So when you consider all this stuff, there's so many
Speaker 2: options to pick from. One hundred and eighty one different ones.
Speaker 4: It seems.
Speaker 2: How are doctors deciding who gets which type of birth control?
Speaker 5: It's complicated, right.
Speaker 6: The average contraceptive counseling appointment in the US is thirteen
Speaker 6: minutes thirteen minutes, and so doctors kind of prescribe based
Speaker 6: on what they're comfortable with, what they've seen work in
Speaker 6: their practice, and anecdotally a lot of them are like,
Speaker 6: you know, I kind of have a couple favors. I
Speaker 6: start with those. If they don't work, we go back
Speaker 6: to it. And so this creates this process of women
Speaker 6: and their doctors going through potentially years of trial and error.
Speaker 6: The majority of women try for or more methods, with
Speaker 6: the main reason that they quit being unwanted side effects.
Speaker 1: So you heard that, right, Years years just to figure
Speaker 1: out the right birth control. A lot can happen in
Speaker 1: a year, and imagine having to go through that.
Speaker 3: That's so frustrating.
Speaker 6: Certain ones have different pros and cons right, Like, some
Speaker 6: of them are also known to and have FDA approval
Speaker 6: for being used in the treatment of acne. Some are
Speaker 6: great at managing heavy menstrual bleeding, and others aren't. If
Speaker 6: a patient comes in with like a this is my
Speaker 6: main complaint or issue or concern on top of preventing pregnancy.
Speaker 6: Then yes, doctors kind of know which of the bins
Speaker 6: to pull from.
Speaker 1: Doctor Russeau told us about the US Medical Eligibility Criteria
Speaker 1: or US MECH for contraceptive Use, which lists out some
Speaker 1: dangerous combinations of birth control and patient criteria.
Speaker 6: So, for example, if you're a smoker over thirty five,
Speaker 6: you should avoid combined oral contraceptives because they increase your
Speaker 6: risk of blood clot and stroke things like that.
Speaker 2: But even with that said, it's really a crapshoot and
Speaker 2: there's no way to predict the possibility of unwanted side effects.
Speaker 1: Yeah, cause, I mean I feel like most people are
Speaker 1: walking into the doctor and just saying, hey, I need
Speaker 1: birth control, and you might not even necessarily know to
Speaker 1: think about some other things that might affect your reaction
Speaker 1: to a certain type of birth control. I know I didn't.
Speaker 1: I just said, hey, looking for the birth control. You
Speaker 1: got some here.
Speaker 2: So when we talk about these side effects, they really
Speaker 2: span the total range of something that feels inconvenient like
Speaker 2: a headache or nausea, to full blown migraines, changes in
Speaker 2: period weight gain, changes in your mood, or sex drive,
Speaker 2: blood clots, high blood pressure. I mean the list goes on, right,
Speaker 2: even when you look at when there's a birth control
Speaker 2: commercial at the end, when you know, when the person's
Speaker 2: talking off fast and they're telling you all the side
Speaker 2: of us, so you're staying in the really you can't
Speaker 2: even catch onto it and the bla blah blah blah blah.
Speaker 3: Yeah, all those things I listened in there.
Speaker 1: They're like depression, suicidal thoughts, and I'm like, wow, uh
Speaker 1: what you know.
Speaker 3: It's just crazy.
Speaker 4: He's my only options?
Speaker 3: Why why is this happening?
Speaker 2: So I think this is the tricky part, right, This
Speaker 2: feels like a catch twenty two t T Yeah, because
Speaker 2: on one hand, we have birth control that you're taking
Speaker 2: to alleviate certain symptoms and feelings that you have, so
Speaker 2: migrains or changes in period mood.
Speaker 3: Yeah.
Speaker 4: But on the other hand, if you don't have.
Speaker 2: The right combination of birth control, or if the birth
Speaker 2: control you have isn't right for you, you can then
Speaker 2: get these exact same.
Speaker 3: Side effects from the birth control.
Speaker 2: Yes, it's like a mixed bag, like hmm, maybe it's
Speaker 2: a treat, maybe it's a trick.
Speaker 1: I don't know, honestly. In twenty fourteen, Mark and Call,
Speaker 1: the company behind the new which is a hormonal form.
Speaker 3: Of birth control.
Speaker 1: They settled at a court for one hundred million dollars
Speaker 1: after facing thousands of lawsuits alleging injury and death from
Speaker 1: serious side effects like blood clots, strokes, and heart attacks
Speaker 1: from folks that were using maneuvering.
Speaker 2: And that's the part that makes it really terrible. Right overall,
Speaker 2: you think of birth control as this thing that gives
Speaker 2: you more agency and control over your body and your health, right,
Speaker 2: but then it's coming along with these really serious side effects,
Speaker 2: and some of them, like we said, are not just
Speaker 2: one off, right, these are long term side effects.
Speaker 6: So that's where I think we really could use improvements
Speaker 6: and just take this big data approach that we're taking
Speaker 6: to try to understand, Okay, this group of people were
Speaker 6: on the same birth control, half of them felt great
Speaker 6: and half of them felt miserable. What is different about
Speaker 6: their underlying biology? And can we save that group of
Speaker 6: people who felt miserable from going on the wrong one
Speaker 6: in the first place.
Speaker 1: So that really makes me think, like, why is it
Speaker 1: so complicated? It seems like drug companies and healthcare providers
Speaker 1: could be doing a better job with this? Is there
Speaker 1: funding going into R and D for better birth control?
Speaker 6: This is a stat I heard recently that blew my mind.
Speaker 6: So a typical drug, fifty percent of the profits from
Speaker 6: that go back into R and D for improving that drug, right,
Speaker 6: because you can always.
Speaker 5: Lower that blood pressure a little bit more. Birth control
Speaker 5: two percent goes back to R and D two percent.
Speaker 2: Now, why are we getting the short end as the stick.
Speaker 3: I can think of one very large reason.
Speaker 2: I feel like just because the method is effective at
Speaker 2: preventing pregnancy, like, that's not it. We still can work
Speaker 2: on some of these other things over here. We just
Speaker 2: rattled that list off very fast on the commercial.
Speaker 1: For real, And I mean that's what's being done with
Speaker 1: other drugs. Like Elizabeth was saying, when you think about
Speaker 1: blood pressure medication and all these different types of drugs,
Speaker 1: I feel like they're constantly getting better. They're always trying
Speaker 1: to make sure that your blood pressure is going to
Speaker 1: get even lower, even lower with each iteration. But it
Speaker 1: doesn't seem like the same type of energy is being
Speaker 1: brought to birth control.
Speaker 3: Right.
Speaker 2: And like Elizabeth said, if people are getting off of
Speaker 2: birth control because of the side effects, that means the
Speaker 2: birth control isn't effective because they're not taking it right.
Speaker 4: That's introducing more gaps.
Speaker 3: Come on, folks, what's not clicking Steven?
Speaker 2: And we said at the top, where's the disruption? This
Speaker 2: is your mama's birth control? Like this feels like the
Speaker 2: same birth control over and over. Where's a new birth control?
Speaker 3: Right? We got retro birth control.
Speaker 6: Yes, there are people trying to work on male contraceptives.
Speaker 5: For example, some of those clinical trials.
Speaker 6: Were stopped pretty early because men were complaining of waking,
Speaker 6: acne and mood changes, So imagine that. Unfortunately, it looks
Speaker 6: like a lot of the other things where if you
Speaker 6: look at you know, prostate cancer versus breast cancer research dollars,
Speaker 6: turns out sexism and it's reflected in all aspects of
Speaker 6: our government and budgets.
Speaker 1: It's just wild to me that men are complaining of
Speaker 1: these side effects, you know, gain mood changes, acne, when
Speaker 1: these are the exact same side effects that everybody else
Speaker 1: has been dealing with taking birth control.
Speaker 4: Right, It's like, oh, you don't like that, neither do I?
Speaker 1: You know, Like, have you seen the TikTok where the
Speaker 1: girlfriends are showing the birth control pamphlet? Yes, their partners
Speaker 1: are reading through the birth control and they're like, what
Speaker 1: the heck.
Speaker 3: Is all this stuff?
Speaker 4: They are shocked.
Speaker 2: They cannot believe how many side effects come along with
Speaker 2: taking birth control.
Speaker 1: If you've seen a birth control pamphlet, you know that
Speaker 1: it is the size of a city block and the
Speaker 1: type is very, very tiny, and it has all of
Speaker 1: the chemicals, how to take the birth control, all of
Speaker 1: the side effects, and everyone's blown away. And then the
Speaker 1: men they're complaining about these things, and I'm just like, wow,
Speaker 1: but it's okay for.
Speaker 3: Us to go through all of that. Hmm. That's that's
Speaker 3: very interesting.
Speaker 4: Mm hmm.
Speaker 1: Let's take a break and when we come back, we're
Speaker 1: gonna talk all about how Elizabeth and her company Aiden
Speaker 1: are shaping the future of birth control.
Speaker 2: We're back, and before we dive back into our dissection
Speaker 2: with doctor Elizabeth Russeau, what are we going to be
Speaker 2: dissecting next week?
Speaker 1: Next week, we're talking about HIV. It's been around for decades,
Speaker 1: but recently there's been huge strides in developing an HIV vaccine,
Speaker 1: and we're gonna get into it with doctor Christine Daniels.
Speaker 2: Also, starting next week, Dope Labs is going to be
Speaker 2: exclusive to Spotify, So if you're listening to us from
Speaker 2: somewhere else, go ahead and sign up for free on
Speaker 2: Spotify and follow us there so you can make sure
Speaker 2: you catch next week's episode plus all the other stuff
Speaker 2: we have in the pipeline this semester.
Speaker 3: You don't want to miss it. So what are you
Speaker 3: waiting for? Just do it? Just do it.
Speaker 2: Let's get back to today's lab. So we're talking to
Speaker 2: doctor Russeau, and this is all about birth control. In
Speaker 2: the first half of the dissection, we focused on what's
Speaker 2: not working with current birth control methods. Sure, if taken correctly,
Speaker 2: they can be effective at preventing unwanted pregnancy, but they
Speaker 2: also introduce a host of unwanted side effects to the patients.
Speaker 2: Many patients have to go through a cycle of trial
Speaker 2: and error, leading to a really frustrating experience trying to
Speaker 2: find a birth control that works for their bodies. The
Speaker 2: average person tries four different birth control methods before finding
Speaker 2: one that actually works. And that feels like a terrible
Speaker 2: shooting rate for a product that's been on the market
Speaker 2: since nineteen sixties, and.
Speaker 1: For medication that is as old as my parents. At
Speaker 1: least they should be doing way better than that.
Speaker 2: In twenty nineteen, Elizabeth founded Aiden, a company on a
Speaker 2: quest to revolutionize how birth control is evaluated and prescribed.
Speaker 6: People have very passionate opinions around birth control, right. They
Speaker 6: either think it's great and they need it and they're
Speaker 6: so glad we're trying to solve something that hasn't been
Speaker 6: addressed before, or they've had a bad experience, or they're
Speaker 6: in that unfortunate category of struggling with fertility and they're
Speaker 6: really angry and they're like, my birth control is the devil, right,
Speaker 6: And so I get it. I mean, I wouldn't have,
Speaker 6: you know, switched my academic career to work on this
Speaker 6: if I wasn't also passionate about realizing that we need
Speaker 6: a better.
Speaker 5: Standard of care.
Speaker 1: Aiden uses an approach that's called precision or personalized medicine.
Speaker 1: So our first question about Aiden is what is precision medicine?
Speaker 6: Precision medicine or personalized medicine at its most basic level,
Speaker 6: is just accepting something that I think we all know,
Speaker 6: which is that one size does not fit all.
Speaker 5: Right. We are complicated, we are different.
Speaker 6: Why would you think our insights would respond the same
Speaker 6: to different drugs?
Speaker 3: Exactly?
Speaker 1: Different medication affects people differently, and it shouldn't be one
Speaker 1: size fits all.
Speaker 2: So understanding what AIDEN is designed to do, how does
Speaker 2: it work, what does it look like? What is the
Speaker 2: ideal AIDEN workflow that would lead to better birth control experiences?
Speaker 6: How it works is you get a test kit sent
Speaker 6: to your home and you spit into a tube for
Speaker 6: saliva that we used to extract your DNA, and you
Speaker 6: also provide a drop of blood from your finger that
Speaker 6: we use to analyze the hormone levels of these six
Speaker 6: different hormones.
Speaker 1: Doctor Ruzo gave us two examples about how the data
Speaker 1: collected from the kits will improve health outcomes for people
Speaker 1: who use birth control.
Speaker 6: The first is that we're looking at genetic risk for
Speaker 6: experiencing blood clot. So there are a couple of well
Speaker 6: known sites in the genome that, if you have them,
Speaker 6: increase your risk for experiencing blood clot five to twelve fold,
Speaker 6: depending on which site you're looking at. But if you
Speaker 6: happen to have one of those genetic markers and you're
Speaker 6: on a birth control that's known to increase your propensity
Speaker 6: for experiencing blood clot, that risk goes up to like thirtyfold,
Speaker 6: So it's a really massive risk and it's not currently
Speaker 6: checked in the standard of care.
Speaker 2: That's a huge risk, and quite frankly, I'm shocked that
Speaker 2: they're not checking for this.
Speaker 3: Honestly, why isn't this part of it.
Speaker 1: If I have to go to the doctor to get
Speaker 1: a prescription to get the birth control, why are they
Speaker 1: doing this to figure out if I'm at risk for
Speaker 1: any of these things.
Speaker 2: It just seems like it should be pretty natural, right.
Speaker 2: Doctor Riso gives us another example. The second example looks
Speaker 2: at risk for depression.
Speaker 6: Which, as you probably all know, is a complex disease,
Speaker 6: meaning it's not just about a single site in the
Speaker 6: genome or just about your genetics. It can also be
Speaker 6: about environment. But there's been a lot of great work
Speaker 6: done in the genetics of depression. So we've used a
Speaker 6: new technique called polygenic risk score, which you can think
Speaker 6: of as basically a cumulative risk for experiencing depression, and
Speaker 6: we're using that to try to help people who are
Speaker 6: at a high risk for depression to not further exacerbate
Speaker 6: that by adding a drug, specifically a birth control drug
Speaker 6: that's also known to increase the likelihood of experiencing depression.
Speaker 1: Could you imagine if everyone could have a personalized birth
Speaker 1: control method that was safe and effective without the risk
Speaker 1: of side effects, without that trial and error process.
Speaker 4: That would be ideal. That would be ideal.
Speaker 6: I mean, honestly, our mission is really to make scientific
Speaker 6: discovery more inclusive and to be the world's most patient
Speaker 6: centric precision medicine company. So even though we're starting with
Speaker 6: birth control, I really see us as doing precision medicine
Speaker 6: in an area that hasn't been well studied before, which
Speaker 6: is endrochronology plus genetics. So what we're doing with our
Speaker 6: first product, which is the birth Control Test, is we
Speaker 6: are looking at both your genetic predisposition as well as
Speaker 6: your hormone levels, together with self reported information on your
Speaker 6: own medical history and preferences.
Speaker 2: ADA analyses six hundred thousand sites in the genome and
Speaker 2: six different hormone levels to find the best birth control.
Speaker 1: By adding hormone analysis to this process, AIDEN is able
Speaker 1: to get a more precise picture of someone's medical chart
Speaker 1: and predisposition to certain side effects. They're also able to
Speaker 1: continue analyzing hormone levels over.
Speaker 6: Time because we know that these hormones change, not just
Speaker 6: throughout the course of a cycling month, but throughout somebody's lifetime,
Speaker 6: as you move from puberty to menopause, they look quite different.
Speaker 6: And we also know that there are sort of these
Speaker 6: broad reference ranges that don't take into account things like
Speaker 6: weight and age and ethnicity that we all know play
Speaker 6: into what somebody's.
Speaker 5: Quote unquote normal is.
Speaker 6: So our goal is to help make those more personalized
Speaker 6: in a way that would also unlock our ability to
Speaker 6: be predictive about what somebody's disease state might look like.
Speaker 2: The other mission for AIDEN is just broadening the research
Speaker 2: that's currently available when it comes to birth control, which
Speaker 2: up until now has been underfunded, which we talked about
Speaker 2: a little bit earlier, and is just generally lacking.
Speaker 6: And to your question about you know, what's the data
Speaker 6: that's out there, what does it look like, it is lacking.
Speaker 5: It is severely lacking.
Speaker 6: So a lot of our preliminary data, you know, we
Speaker 6: are standing on the shoulders of other scientists who have
Speaker 6: cared to focus on this, who have done work to show,
Speaker 6: for example, that certain kinds of birth control are more
Speaker 6: associated with depression, and that certain kinds of birth control
Speaker 6: increase propensity for blood clots. Things like that. When we
Speaker 6: went to start a lot of the preliminary data was
Speaker 6: me like mining databases that were out there and trying
Speaker 6: to clean it up to make sense of like what
Speaker 6: do we know?
Speaker 5: What are the patterns that we see?
Speaker 1: And that also means including everyone in the research, including
Speaker 1: women and people of color.
Speaker 6: I think as of twenty eighteen, it was something like
Speaker 6: eighty percent of genome wide association studies were done only
Speaker 6: on individuals of European descent, which just limits our power
Speaker 6: to understand the biology in everyone.
Speaker 5: We're hurting everyone by the way that we're approaching this.
Speaker 6: So I think part of our mission is, like I said,
Speaker 6: to make scientific discovery more inclusive. And that's not just
Speaker 6: about paying attention to women, although we really need to
Speaker 6: do that because women weren't required to be included in
Speaker 6: clinical trials until nineteen ninety three, which has led to
Speaker 6: this massive medical research gender gap. But it's also about
Speaker 6: making sure that we have diverse representation in the samples
Speaker 6: that are there to continue to make discoveries that actually
Speaker 6: benefit everyone.
Speaker 1: Women weren't required to be in clinical trials until nineteen
Speaker 1: ninety three.
Speaker 4: That's very recent.
Speaker 1: What that means is that you could have whole trials
Speaker 1: go through and the people that are doing the research
Speaker 1: know the effects that it has on men, but they
Speaker 1: don't know the effects that it has on women, and
Speaker 1: then they end up being prescribed to everybody, so then
Speaker 1: it could possibly be negatively affecting women and they have
Speaker 1: no idea.
Speaker 2: Yeah, Doctor Russell mentioned that birth control is really just
Speaker 2: the first step for Aiden. We wanted to know, wes Nix,
Speaker 2: what does the future of Aiden look like?
Speaker 6: The short term step is for birth control. We get
Speaker 6: more and more specific about how we can make recommendations.
Speaker 6: So I'm not out here saying on day one for
Speaker 6: every single person, I'm going to get you on the
Speaker 6: right birth control of the first time, because we just
Speaker 6: do not have that data. We're going to try our best,
Speaker 6: but we're also going to learn as we go and
Speaker 6: make our recommendations more and more specific. People go on
Speaker 6: birth control, often in their teens to treat PMS or
Speaker 6: PDD right like, they potentially could start their journey with
Speaker 6: Aiden and stay with us to understand their hormones over time.
Speaker 4: It feels like this was really illuminating.
Speaker 2: You know, there are things that just get taken for
Speaker 2: granted or that become the status quo and it's just like, ah,
Speaker 2: just leave it like it is. And this is a
Speaker 2: place where we don't need to leave it like it is. Yeah,
Speaker 2: somebody needs shake the.
Speaker 1: Table, honestly, and there's a lot of people doing a
Speaker 1: lot of really important work to make sure that that happens,
Speaker 1: and that the laws that are put in place are
Speaker 1: put in place to give women more agency and more
Speaker 1: freedom to make a choice with their own bodies. And
Speaker 1: so when we do have that freedom, a company like
Speaker 1: Aiden is giving us the ability to get those medications
Speaker 1: and have it work to our benefit and not to
Speaker 1: our detriment. In the background, another good point that Elizabeth
Speaker 1: raised is our bodies changed over time. When you think
Speaker 1: about how long folks are on birth control, birth control
Speaker 1: that worked for you at age sixteen might not be
Speaker 1: birth control for you at age thirty six or forty six.
Speaker 5: You know.
Speaker 1: Yeah, my body lotion that I was using at that
Speaker 1: age would not It's changed. Okay, I need pure vasiline, Okay,
Speaker 1: some mut tourize this crusty body. I can only imagine
Speaker 1: what's going on on the inside.
Speaker 2: I think something that's so important that Aiden is doing
Speaker 2: is collecting stories from people, yes that made it really real,
Speaker 2: and it made me think back on my own experiences.
Speaker 2: How many things just get pushed under the rug or
Speaker 2: dismissed because it's not the experience of the majority.
Speaker 1: Yeah, and so with her collecting these stories, she might
Speaker 1: even be able to shine the light on something that
Speaker 1: might be a shared experience between a lot of different
Speaker 1: women and they just had no idea it was linked
Speaker 1: to their birth control. This type of research is definitely
Speaker 1: going to improve the quality of life of so many.
Speaker 5: People birth control odysseies, we're calling them.
Speaker 6: So if you go to our website, you can go
Speaker 6: to our stories and submit your own birth control odyssey
Speaker 6: to help destigmatize, help people feel less alone in their experience.
Speaker 6: I've learned so much from these stories. I'm blown away
Speaker 6: by how no two story are the same.
Speaker 3: All Right, it's time for our one thing. What's your
Speaker 3: one thing this week? Ze?
Speaker 2: My one thing this week is actually an app. It's
Speaker 2: called to doist TODT. I found this app while reading
Speaker 2: about digital productivity. Because if you're like me, you have
Speaker 2: a notebook and maybe another smaller notebook and a series
Speaker 2: of sticky notes and a calendar you're trying to keep
Speaker 2: in emails and bookmarks and read it later and it
Speaker 2: was too much stuff and so to do this is
Speaker 2: a place where I can kind of consolidate all of
Speaker 2: my things and keep my day on track.
Speaker 3: I love that.
Speaker 1: So my one thing is a food item, and it's
Speaker 1: probably my favorite comfort food right now, and it's a
Speaker 1: breakfast bagel from this place called Call your Mother. If
Speaker 1: you live in the DC metro area, you all know
Speaker 1: about it. You may not have been there, but if
Speaker 1: you are in the area, or if you're planning on
Speaker 1: being in the DC metro area, you should definitely look
Speaker 1: for or Call your Mother location. I think they have
Speaker 1: like four or five locations now. They just opened one
Speaker 1: near my house and it is a gift and a curse.
Speaker 1: My favorite thing to get there is the Sun City Bagel.
Speaker 1: It's an everything bagel with cheese, eggs, bacon, and siracha
Speaker 1: jam and it is perfection. It is a struggle for
Speaker 1: me to not go there every single day.
Speaker 2: That's it for Lab forty one. What did you think
Speaker 2: about today's lab? Do you still have questions? Call us
Speaker 2: at two zero two five six seven seven zero two
Speaker 2: eight and tell us what you thought, or give us
Speaker 2: an idea for another lab. We could do this semester.
Speaker 2: We like to hear from you. That's two zero two
Speaker 2: five six seven seven zero two eight.
Speaker 1: And don't forget. There's so much more for you to
Speaker 1: dig into. On our website. There'll be a cheat sheet
Speaker 1: for today's lab, additional links and resources in the show notes. Plus,
Speaker 1: you can sign up for our newsletter check it out
Speaker 1: at Dope labspodcast dot com. Special thanks to today's guest expert,
Speaker 1: doctor Elizabeth Russo, founder of Aiden.
Speaker 2: You can follow her on Twitter at sequin Lab coaked.
Speaker 2: If you want to sign up for early access to
Speaker 2: Aiden's birth control tests, you can learn more about Aiden
Speaker 2: science at Aiden dot com a d y n dot com.
Speaker 1: Aiden is on Twitter and Instagram at Aiden Health. So
Speaker 1: that's at a d y n h e a l
Speaker 1: t h. Dope Labs is a Spotify original production from
Speaker 1: Mega Own Media Group.
Speaker 2: Our producers are Jenny Ratlitmast and Lydia Smith of WaveRunner Studios.
Speaker 3: Editing in sound design by Rob Smerciak.
Speaker 4: Mixing by Hannes Brown.
Speaker 1: Original music composed and produced by Taka Yasuzawa and Alex
Speaker 1: Sugier from Spotify.
Speaker 2: Our executive producer is Gina Delvack and Creative producers are
Speaker 2: Baron Farmer and Candace Manriquez Rinn.
Speaker 1: Special thanks to Shirley ramos yasmin of Fife, camu Elolia,
Speaker 1: Till krat Key and Brian Marquis. Executive producers from Mega
Speaker 1: Own Media Group are Us T T Show, Dia and
Speaker 1: zik Ll Watley. But sometimes you know what happens to me,
Speaker 1: My brain switches up urethra and uterus.
Speaker 4: And are not the same.
Speaker 3: No, you pee out of you urethra.
Speaker 4: Yeah, I know, not saying you know, I never can.
Speaker 2: I'm like, I just pull a U word down when
Speaker 2: I'm talking, just not umbrolla