A woman I once admired had died shortly after undergoing surgery for fibroids. So decades later, when I received the same diagnosis, the word carried more than its clinical meaning. It carried a memory. I wanted to understand my options, and that search sent me down a rabbit hole that yielded more questions than answers.

Many years later, I discovered Sonata, an incision-free treatment that uses radiofrequency energy to treat certain fibroids. The procedure was developed by Gynesonics.

Learning that an alternative existed was reassuring. But it also raised a more troubling question: why had it been so difficult to find?

As I looked more closely at Gynesonics, I began to understand how long and uncertain the journey from healthcare innovation to patient can be. A company can develop a useful technology, produce strong clinical evidence and secure regulatory approval and still struggle to attract investors, gain adoption among clinicians and reach the patients who might benefit.

The problem was not simply whether better treatments could be invented. It was whether the companies building them could obtain the capital, commercial support and distribution required to survive.

I began to realise that this was also a story about how healthcare innovation is financed. That realisation eventually led me to write The Billion Dollar Blindspot.

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While researching the book, I encountered company after company addressing a different part of the same problem.

Some were trying to shorten the years women waited for a diagnosis. Others were developing treatments for conditions that affected millions of women but had attracted limited research and investment. Some were revisiting diseases in which differences between women and men had been poorly understood. Others had already built products that worked but were struggling to change established clinical practice.

Women’s health was frequently described as underfunded. That was true but it was incomplete. Underfunding described what had happened. It did not tell an investor what was becoming possible or how to participate in it.

Today, women’s health is already a substantial commercial market. PwC estimates that core women’s health and major adjacent conditions represent a global market of approximately $420–470 billion, projected to exceed $600 billion by 2030.

The opportunity extends far beyond fertility and maternal health. It includes conditions unique to women, conditions that affect women disproportionately and conditions that present differently in women. That means looking not only at fibroids, endometriosis, fertility and menopause, but also at cardiovascular disease, autoimmune disorders, migraine, metabolic disease, osteoporosis, dementia and other areas in which sex-specific differences matter.

At the same time, advances in diagnostics, medical devices, drug discovery, data and artificial intelligence are changing what can be detected, treated and delivered.

The gaps remain real. But those gaps are increasingly producing companies with real products, clinical evidence, intellectual property and commercial potential.

Once I became convinced that something important was happening in women’s health, I could not stop at saying that the sector deserved more capital.

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I have spent more than 20 years making investment and allocation decisions. During that time, I have assessed more than 1,000 managers and fund opportunities and sponsored more than 90 allocations across public and private markets.

Early in my career at Credit Suisse, I helped build a manager-selection and due-diligence framework that supported allocations to hedge funds, mutual funds and private-market funds. I did not know then how severely that framework would be tested during the 2008 global financial crisis.

The framework held up and I went on to evaluate managers and companies within Credit Suisse’s approximately $100 billion multi-asset-class platform and to structure investment solutions for high-net-worth individuals, family offices and institutional investors.

So as I looked at the women’s health opportunity, the allocator in me began asking a different set of questions.

• Should an investor back individual companies, specialist venture funds or some combination of the two?

• In a world where the top ~5% of investments drive ~90% of returns and in a world where at the earlier stages (until around Series B) the good companies look a lot like the bad ones, how do you build a portfolio that makes sense?

• How many underlying companies would be needed before the portfolio was genuinely diversified and where should an investor accept concentration because it reflects genuine conviction, and where does concentration simply create avoidable risk?

• How should exposure be spread across diseases, technologies, scientific disciplines, company stages, regulatory pathways and geographies?

They also became the questions at the heart of the firm we are building.

For the past several months, I have been quietly building Calabar Capital.

Calabar is based on a simple observation: many of the companies shaping the future of women’s health are being built in private markets, but access to them is fragmented.

The relevant companies sit across different clinical disciplines, technologies, stages and geographies. The managers with the deepest access to those companies are similarly dispersed. Even a sophisticated investor would struggle to capture representative opportunity through one direct investment or one venture fund.

Calabar is therefore being designed as a platform that offers access to specialist fund managers, direct co-investments and secondaries from early stage through to pre-IPO. Our focus is women’s health and the healthcare AI and technology infrastructure enabling its development and delivery.

Calabar is currently in formation and we are building it with the same disciplines I used when underwriting another institutional platform: a defined investment process, independent challenge, appropriate governance and an operating structure designed for long-term stewardship.

For me, Calabar is a natural continuation of the work I have done throughout my career: translating complex investment opportunities into structures that sophisticated investors can actually access.

This new chapter will also shape what I write. Here at The Billion Dollar Blindspot, I will continue to write about what is changing in women’s health and why it matters. In my sister publication, Diary of an Allocator, I will write from the other side of the table. It will contain observations from my work of allocating capital over 20 years: what allocators look for when assessing managers, prepare for due diligence and consider an allocation.

Diary of an Allocator

Allocating capital at the intersection of women’s health, emerging managers and venture capital.

By Maryann Selfe

Diary of an Allocator will make more of that thinking visible alongside some field notes from my current work at Calabar Capital.

The personal question that began this journey “what options are available to women like me?” eventually became an investment question: “how should capital be allocated to the companies and managers capable of creating better options?

That is the question I am now working to answer through Calabar Capital.

If you want to follow the companies, technologies and market shifts changing women’s health, subscribe to The Billion Dollar Blindspot.

If you want to follow the allocator’s work behind the capital (manager selection, due diligence, portfolio construction, access and the decisions made when the evidence is still incomplete) follow Diary of an Allocator.

If you are an institutional investor or family office considering the role that women’s health and healthcare technology could play in your private-markets portfolio, I’d love to have a conversation.

And if you are a venture manager investing in these areas, I would also love to understand what you are building. Just hit reply.

My new book, The Billion Dollar Blindspot is now available on Amazon and in bookstores.

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About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing and capital allocation.

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The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

But there is another challenge that is much harder to solve: healthcare is a system of incentives, and even great ideas have to operate within it.

In a recent episode of Blindspot Capital, I sat down with Halle Tecco, one of the pioneers of digital health investing, co-founder of Rock Health, founder of Natalist, co-founder and Chair of Cofertility, and author of Massively Better Healthcare.

Halle has seen healthcare innovation from almost every angle: as an investor, founder, operator, board member and educator. And what makes her perspective particularly interesting is how much her experience building companies changed the way she thinks about investing in them.

Our conversation explored a deceptively simple question: what actually separates healthcare companies that scale from those that don’t? The answer is not simply better technology or more capital.

It starts with understanding the problem deeply enough to build for the healthcare system that actually exists (its incentives, reimbursement structures, workflows, stakeholders and constraints) rather than the system we wish existed.

And for investors, that has important implications for how we evaluate healthcare businesses.

We talk about:

• Problem before product: why the strongest healthcare companies start by becoming deeply embedded in the problem rather than searching for healthcare applications for new technology

• What venture capital changes: why taking VC funding fundamentally changes the growth expectations, time horizon and eventual destination of a company

• Aligning margin with mission: how business models can reward better outcomes rather than simply more activity and why incentive design matters in healthcare

• Why good companies still fail: the role of founder adaptability, market timing, capital, changing conditions and luck and why failure does not necessarily mean the underlying idea was poor

• What operating teaches investors: why Halle says building and running a company gave her a very different appreciation for the difficulty founders face

• Where healthcare opportunity is moving: why Halle is watching full-stack healthcare services businesses using AI and other technologies to deliver better services and outcomes, rather than simply selling another software tool

Perhaps the most important idea from the conversation is that healthcare does not change simply because a better technology arrives. Systems produce the outcomes their incentives encourage.

For founders and investors, understanding those incentives may be just as important as understanding the innovation itself.

🎧 Watch the full episode on YouTube

1. New estrogen data reopen an important question about menopause and brain health

A new study published in Neurology examined data from 21,462 women and found that estrogen-only hormone therapy use was associated with lower rates of dementia and less Alzheimer’s-related pathology.

Among women whose brains were examined after death, hormone-therapy use was associated with 35% lower odds of Alzheimer’s pathology after adjustment for factors including age, education, genetics, race and hypertension. It was also associated with 39% lower odds of a clinical dementia diagnosis.

But the findings need substantial qualification.

This was an observational study, so it cannot establish that estrogen prevented dementia. More importantly, women in the study who had used estrogen began treatment at an average age above 70, which is very different from modern menopause practice, where hormone therapy is generally initiated much earlier.

The researchers themselves caution that the findings may therefore not translate directly to women using hormone therapy today. Read More

What I find Interesting

What I find interesting here is how much we still don’t understand about estrogen and the ageing female brain.

Women account for a disproportionate share of Alzheimer’s disease, and menopause represents one of the most significant biological transitions in a woman’s life. Yet the relationship between declining estrogen, hormone therapy and long-term cognitive health remains remarkably difficult to pin down.

This study adds another piece to that puzzle, but it doesn’t resolve it. In fact, the age of the women taking estrogen makes the finding particularly interesting. If estrogen use beginning much later in life is associated with lower Alzheimer’s pathology, what exactly are we observing? Is there a biological effect from estrogen itself? Are there characteristics of women who received estrogen that aren’t fully captured by the analysis? And would we see the same relationship in women starting hormone therapy around menopause today?

Those questions matter because there is a danger of moving too quickly from an association like this to a much more attractive conclusion: that estrogen might protect women against dementia. We simply don’t know that yet.

But I don’t think the appropriate response to uncertainty is to dismiss the finding either. It is to recognise how important the unanswered question is.

We have become much better at thinking about menopause in relation to symptoms, bone health and cardiovascular health. Brain health may ultimately prove to be another important part of that picture, but the science still has some catching up to do.

For me, that is the signal here - a major area of women’s health where the biology is important, the patient population is enormous, and still, some very fundamental questions remain unanswered.

Maryann Selfe is an institutional investor, Founder and CIO of Calabar Capital, and author of The Billion Dollar Blindspot.

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For informational and educational purposes only. This is not financial advice or an investment recommendation.

1. Early menopause plus social disadvantage appears to compound long-term health risk

New research published online today in Menopause, the journal of The Menopause Society, suggests that social disadvantage is associated with significantly worse long-term health outcomes among women experiencing early natural menopause.

Researchers analysed 19,912 women with early natural menopause in UK Biobank, with mortality findings externally validated using US NHANES data.

Women in the most disadvantaged group had higher observed risks of all-cause mortality, cardiovascular disease and dementia than those in the most advantaged group. Among the individual social factors examined, unemployment showed the strongest association with mortality and dementia.

Importantly, this is observational research. It identifies associations; it does not establish that social disadvantage (or any individual factor such as unemployment) causes these outcomes.

Read More — The Menopause Society

What I find Interesting

What I find interesting about this research is the interaction between biology and environment. Early menopause is already associated with higher long-term health risks. This study suggests that those risks don’t exist in isolation: the social and economic circumstances surrounding a woman may meaningfully influence the trajectory that follows.

For me, that raises a much broader question about how we think about women’s health. We tend to separate biological risk, clinical care and social determinants into different buckets. But the patient experiences all three at the same time. The opportunity may therefore be in understanding how those factors interact well enough to identify which women need earlier or different intervention.

There is still a lot we don’t know. This is observational research, and social disadvantage is associated with poorer health outcomes more broadly. But if combining reproductive history with other risk factors improves our ability to identify women at elevated cardiovascular or cognitive risk, that could eventually have implications for screening, prevention and care pathways.

2. AbCellera’s menopause data show the category becoming a real pharmaceutical market

AbCellera has reported positive Phase 2 results for ABCL635, its experimental non-hormonal treatment for moderate-to-severe vasomotor symptoms associated with menopause.

In the 92-patient trial, women receiving ABCL635 experienced an 83% reduction in moderate-to-severe hot-flush frequency after four weeks, compared with 33% for placebo. The placebo-adjusted reduction was 5.3 hot flushes per day. AbCellera shares rose sharply following the announcement.

ABCL635 targets the neurokinin 3 receptor (NK3R), part of the same biological pathway that has already produced approved non-hormonal menopause therapies from Astellas and Bayer.

But there is an important difference in how AbCellera is approaching the market. While existing therapies are oral medicines taken daily, ABCL635 is a long-acting antibody being developed as a once-monthly injection. Read More

What I find Interesting

What I find interesting here is that we are beginning to see something that women’s health has historically had too little of: genuine pharmaceutical competition.

For decades, the menopause treatment conversation was largely framed around hormone therapy: whether women should take it, who should take it and what the risks were.

We are now beginning to see a much broader therapeutic market emerge, with multiple companies targeting the neurokinin pathway and competing not simply on whether they can treat hot flushes, but potentially on efficacy, tolerability, convenience and how the treatment is delivered.

That changes the investment question. Once several drugs can address the same problem, scientific novelty alone becomes less important. What matters is whether a new entrant can create a sufficiently differentiated product profile to change physician prescribing or patient preference.

ABCL635’s once-monthly injection is particularly interesting in that context. Some women may prefer the convenience of monthly dosing; others may strongly prefer a tablet. We don’t know yet how that trade-off will play out commercially, and cross-trial efficacy comparisons need to be treated carefully. But the bigger signal for me is the evolution of the category itself.

Menopause therapeutics are beginning to look less like an underserved niche and more like a competitive pharmaceutical market. And when that happens, the question moves from “Is there a market?” to the much more interesting question: “Who is going to win it, and why?”

3. Private biotech M&A is accelerating and it isn't just a few mega-deals

Jazz Pharmaceuticals has agreed to acquire privately held Actio Biosciences for up to USD 1.32 billion, comprising USD 820 million upfront and up to USD 500 million in potential milestone payments.

Actio is developing treatments for genetically defined neurological diseases. Its lead clinical programme, ABS-1230, targets KCNT1-related epilepsy, a rare and severe genetic epilepsy for which there is currently no approved disease-specific therapy.

The Jazz transaction is interesting on its own. But the broader private-biotech M&A data make it considerably more interesting. According to HSBC Innovation Banking data reported by BioPharma Dive, there were 19 acquisitions of private venture-backed biotechs in the first half of 2026 - already more than the number recorded in the entirety of each of the previous five years.

And it isn’t just deal volume. The median value of those acquisitions reached approximately USD 950 million, around three times the levels seen in the early 2020s.

What I find Interesting

What I find interesting is that here is what this is beginning to tell us about the exit environment. There are several possible reasons. Big Pharma has significant revenue approaching patent expiry and needs to replenish pipelines. Some therapeutic areas have a relatively limited number of differentiated clinical assets. And acquiring companies privately may allow strategic buyers to secure those assets before they reach later stages of development.

I don’t think we can say yet which of those forces is doing most of the work. But from a venture perspective, the direction is important.

If private companies can increasingly find strategic buyers before requiring an IPO, and if both the frequency and value of those exits are improving, that potentially changes the economics of the entire venture pathway.

1. Women’s health investment hit a record but Series A remains the bottleneck

Women’s health companies attracted a record USD 1.55 billion of disclosed equity investment in 2025, up 41% from USD 1.1 billion in 2024, according to W Group’s first Global Women’s Health Investment Report. The capital was spread across 85 companies and more than 30 countries.

But there is a more interesting number underneath the headline.

Around 35–40 women’s health companies raise pre-seed or seed rounds each year, while only 20–25 progress to Series A. So while more capital is entering the sector, there remains a visible financing bottleneck between early validation and institutional scale. Read More

What I find Interesting

The USD 1.55 billion headline is encouraging. Regarding the drop from seed to Series A, I’d love to offer a nuanced view and somewhat controversial opinion. Not every seed company should raise a Series A. Venture capital is supposed to be selective.

The question I am keen to understand is simple:

Are good women’s health companies that have achieved the milestones we would normally expect at Series A struggling to raise capital at a higher rate than comparable healthcare companies? If the answer is yes, we have a financing gap.

If the answer is no, what we may actually be seeing is something else: company formation in women’s health growing faster than the number of companies ready for institutional capital.

Those are two very different diagnoses and they require very different solutions.

2. Another USD 100 million flows into AI-enabled drug discovery

Aureka Biotechnologies announced a USD 100 million Series B yesterday, bringing the company’s total funding to nearly USD 200 million.

Aureka combines AI with high-throughput biological experimentation to discover protein therapeutics and describes its ambition as building a “biological world model” for drug discovery.

The distinction here is important: this is not simply a software company applying AI to existing biological data. Aureka combines computational models with its own experimental infrastructure and data generation.

What I find Interesting

There is so much capital going into AI drug discovery that I increasingly think the question “How good is the AI?” is the wrong first question.

Nowadays, even asking whether the company has proprietary data may not be enough. I think the real question is whether that proprietary system produces better drugs, faster or with a higher probability of success.

A closed-loop wet lab, proprietary biological data and an AI model may be difficult to replicate. But complexity isn’t the same thing as competitive advantage.

Eventually the platform has to demonstrate that it changes the economics of drug discovery.

Does it improve hit rates? Reduce optimisation cycles? Identify targets others miss? Increase the probability that a molecule survives the clinic?

And then there is another question I find particularly interesting: if the system discovers a successful drug, where does the value actually sit? in the platform or in the molecule? That distinction matters enormously when deciding whether an AI drug-discovery company deserves a platform valuation.

3. The FDA rejected a promising radiopharmaceutical because of manufacturing

The FDA has issued ITM Isotope Technologies Munich a Complete Response Letter for ¹⁷⁷Lu-edotreotide (ITM-11), its investigational radiopharmaceutical treatment for gastroenteropancreatic neuroendocrine tumours.

What makes the rejection particularly interesting is what the FDA didn’t object to.

The agency identified no concerns with the clinical or nonclinical data package or the therapy’s safety profile. Instead, it cited Chemistry, Manufacturing and Controls (CMC) issues and matters relating to a third-party commercial manufacturing facility that must be addressed before approval.

That is notable because the Phase 3 COMPETE trial had reported median progression-free survival of 23.9 months with ¹⁷⁷Lu-edotreotide versus 14.1 months with everolimus. Read More.

What I find Interesting

We tend to think about biotech risk in terms of the science: Does the drug work? Is it safe? Will the trial succeed? Well…here, apparently, the clinical package wasn’t the problem. It was manufacturing.

That is a risk. But I think there is another way to look at it.

The thing that makes a modality difficult to manufacture can also be the thing that makes a successful company difficult to compete with.

Radiopharmaceuticals require isotope supply, specialised facilities, quality systems and time-sensitive logistics. Those look like operational complications when they go wrong. When they work, they can become infrastructure competitors cannot easily reproduce.

So “Can this drug be manufactured reliably at scale?” isn’t simply a diligence question. It may be part of the moat.

The investment question therefore becomes not only whether management has solved the manufacturing problem, but whether solving it creates an advantage that compounds across the rest of the pipeline.

4. Menopause is moving into neurology but the evidence is still remarkably thin

A new roadmap published yesterday in Nature Reviews Neurology argues that menopause remains significantly under-recognised as a contributor to brain health and that our understanding of how the menopausal transition interacts with neurological disease remains limited.

Earlier menopause has been associated with a greater risk of cognitive decline, but researchers say it remains unclear how the menopausal transition affects the subsequent risk or progression of specific neurological conditions.

The authors identify major gaps in research and call for greater investigation into the relationship between menopause, the brain and neurological disease. Read More

What I find Interesting

The more we learn about menopause, the clearer it becomes that its effects extend well beyond hot flushes and reproductive symptoms. But I think investors need to be careful with the next leap.

A biological relationship does not automatically create an investment category. If menopause is associated with changes in neurological risk, I want to know what that knowledge allows us to do differently.

Can we identify a subgroup of women earlier?

Does it change how a disease is diagnosed?

Does it reveal a therapeutic target?

Does treatment during the menopausal transition alter the subsequent neurological outcome?

Until we can answer questions like those, we may have important science without an investable intervention. And I think that distinction is particularly important in women’s health right now.

5. Healthcare outperformed again but I wouldn't make the Fed the investment thesis

Healthcare had another strong session yesterday.

The Health Care Select Sector SPDR Fund (XLV) closed 1.67% higher, while the iShares Biotechnology ETF (IBB) also advanced.

What I find Interesting

That continues the healthcare rotation we have been watching over recent weeks, alongside stronger biotech financing, increased M&A activity and improving investor appetite for the sector.

The next major macro test comes tomorrow with US inflation data, which will influence expectations for the Federal Reserve and, by extension, the discount-rate environment facing long-duration assets such as biotechnology.

Three developments I’m watching today: new ovarian-cancer biology, almost USD 500 million raised through two biotech IPOs, and Big Pharma’s increasingly urgent search for pipeline assets.

1. New ovarian-cancer research points to what happens after chemotherapy

A new study in Nature Aging has identified a potentially important mechanism in the way ovarian cancer spreads following chemotherapy.

Researchers found that chemotherapy-induced senescent ovarian-cancer cells can release metabolic signals (including fructose) that appear to reduce cell adhesion and make neighbouring cancer cells more capable of detaching and spreading.

In preclinical models, a high-fructose diet was also associated with greater tumour dissemination. However, this is early research so it’s too early to conclude that dietary fructose causes ovarian-cancer progression in women.

What I find Interesting

A lot of focus when it comes to cancer therapeutics is whether a cancer treatment kills the tumour. But this research raises another question that I find fascinating: “What biological environment does treatment leave behind?”

If chemotherapy kills cancer cells but also changes the surrounding environment in ways that help surviving cells disseminate, then the effect of treatment doesn’t necessarily end when the chemotherapy does.

Now, this is preclinical research so we are a long way from knowing whether this mechanism matters sufficiently in humans to become a therapeutic target. But conceptually, it changes the question from simply: “Did the treatment kill the cancer?” to: “What did the treatment do to the biology of what survived?” That is a much more interesting question.

2. Two biotech IPOs just raised about $500 million

Latigo Biotherapeutics and BlossomHill Therapeutics completed US IPOs on Friday, raising approximately USD 496 million between them. Latigo raised USD 345.6 million after selling 19.2 million shares at USD 18. BlossomHill raised another USD 150 million. Both offerings were upsized.

Latigo is developing non-opioid pain medicines targeting sodium channels. BlossomHill is developing oncology therapies and expects to allocate around $70 million of its proceeds to its lead EGFR programme. Read More

What I find Interesting

The fact that biotech stocks are rising is interesting but the fact that companies can actually raise hundreds of millions of dollars in the public market much more interesting. Because this is where market sentiment starts becoming financing infrastructure.

But I would be careful with the conclusion. The IPO window is opening but is not open to everyone. In the first half of 2026, 68 venture-backed biotechs raised more than $9 billion. That sounds great until you see that roughly two-thirds of those rounds went to companies that already had drugs in human trials, and 76% of the capital went into rounds of $100 million or more.

So capital is returning, but it isn’t returning equally and I think that’s the more interesting signal. Investors are still willing to take extraordinary risk in biotech. What they appear less willing to do is finance too many layers of uncertainty simultaneously.

3. Big Pharma's patent cliff is becoming biotech's M&A opportunity

Biopharma acquisition activity is running at one of its strongest rates in years. By midyear, 38 biotech acquisitions had already been announced (the fastest start in at least seven years) and almost two-thirds were worth $1 billion or more.

Behind that activity sits a very large problem for the pharmaceutical industry. Drugs generating an estimated $200–300 billion of revenue are expected to lose patent protection by 2030. Big Pharma needs replacement assets and increasingly, it is buying them.

What I find Interesting

Pharma has always bought innovation so the interesting thing isn’t that Big Pharma is acquiring biotech. It is the urgency with which some of those buyers may need to acquire it.

Patent cliffs are unusual because the problem is both enormous and reasonably predictable. Management teams know which products lose exclusivity and when. They know roughly how much revenue is exposed and they know their internal pipelines.

Which makes me wonder whether the most important consequence for venture investors is strategic scarcity for the right asset: If several pharmaceutical companies need to fill similar pipeline gaps at roughly the same time, a genuinely differentiated clinical asset could become worth considerably more to a strategic buyer than its standalone financial value might suggest… just some food for thought!

1. Women’s health raised more than $120 million across 17 disclosed rounds in July

A newly published funding roundup by Everything Startups identified more than $120 million of disclosed financing across 17 women’s-health startups in July, spanning the US, UK, Germany, Estonia, Canada and India. The largest disclosed round was Rejoni’s $25 million financing for its Juveena Hydrogel System, designed to prevent intrauterine adhesions following gynaecological procedures. Read More

What I find Interesting

What I find quite interesting is the mix. Diagnostics and monitoring were particularly active, while the largest disclosed round (Rejoni’s $25 million financing) was for a medical device designed to prevent intrauterine adhesions following gynaecological procedures.

This is what the institutionalisation of women’s health looks like. For years, the category was disproportionately associated with fertility apps and consumer products but that is changing. We are beginning to see an investable ecosystem across therapeutics, diagnostics, medical devices, clinical infrastructure and enabling technologies.

This matters for investors because it changes the portfolio-construction question. You can increasingly diversify a women’s-health portfolio not just across diseases, but across business models, technologies, development stages and types of risk.

2. Grail is about to test one of the biggest assumptions in cancer diagnostics

The FDA will convene an external advisory committee on 23 September to consider Grail’s premarket approval application for Galleri, its multi-cancer early-detection blood test. Grail shares rose about 5% after the meeting was announced. Galleri uses molecular signals and machine learning to screen a single blood sample for signals associated with more than 50 cancers.

What I find Interesting

Multi-cancer early detection could create an entirely new screening category. The potential opportunity could be enormous because if we see widespread adoption, this could change how asymptomatic populations enter the cancer-care system but… (and this is a big but), the evidence is complicated.

In a major UK trial, Galleri failed its primary endpoint of significantly reducing overall late-stage cancer diagnoses, although some secondary results were encouraging (by the third screening round, stage IV diagnoses for 12 particularly deadly cancers were 26% lower).

But here is an uncomfortable question at the heart of the diagnostics boom (and not necessarily related to Galleri): What if finding more disease doesn’t actually improve health? The investment case begins when earlier detection changes what happens next; for example:

• Can we treat the cancer differently?

• Does the patient live longer?

• Do we avoid more harm than we create through false positives, unnecessary investigations and overdiagnosis?

• And ultimately: will the healthcare system pay for it?

In diagnostics, outcomes create the market, and that distinction is going to separate some very impressive technologies from some very valuable companies.

3. The “picks and shovels” healthcare thesis has a blind spot

Oxford Biomedica fell more than 24% on Friday after cutting its 2026 revenue forecast because of operational delays and customers postponing programmes.

This came despite what looked like improving fundamentals: 2025 revenue had increased 31%, the company achieved its first positive operating EBITDA and contracted backlog had reached £204 million.

What I find Interesting

I like the “picks and shovels” thesis in healthcare, you know, the CDMOs, CROs, diagnostic infrastructure and specialist manufacturers because they diversify individual drug-development risk.

But there is a blind spot in it. We often say infrastructure is attractive because you don’t have to pick the winning drug. True…but risk doesn’t disappear. It moves.

• From clinical risk to utilisation risk.

• From molecule risk to customer concentration.

• From trial failure to programme delays.

Oxford Biomedica can have a £204 million backlog on paper. But if the biotech company behind that order delays its programme because its financing hasn’t closed, the manufacturer’s revenue moves with it. So I increasingly ask a different question when looking at healthcare infrastructure: “What has to go right for that backlog to become revenue?” The answer tells you where the risk really sits.

4. Healthcare AI has an 8,500-trial reality check

A large analysis examined 8,532 AI-related clinical trials across 32 medical specialties.

• Only around 30% used randomised controlled designs.

• Approximately 38% remained retrospective validation studies,

• while another 21% were prospective but did not allow the AI to influence clinical decisions.

Only 184 trials involved semi-autonomous or closed-loop systems.

What I find Interesting

8,532 AI clinical trials sounds impressive until you look under the hood of that number;

• A large proportion are still retrospective (meaning the AI is being tested on data that already existed, rather than being used with real patients as care is happening)

• Many prospective studies don’t allow the AI to influence the clinical decision.

• Only a tiny fraction involve semi-autonomous or closed-loop systems.

And that tells us something important about healthcare AI. The hard part isn’t getting an algorithm to predict something. The hard part is getting a clinician to trust it enough to act differently, and then proving that acting differently makes the patient better. So this is increasingly how I think about healthcare AI:

Algorithm → validation → workflow → decision → outcome → reimbursement.

Every step removes another layer of risk and, in my view, every step should earn another layer of valuation.

There are thousands of healthcare AI companies but far fewer have crossed the distance between prediction and clinical consequence. That distance is where the investment opportunity sits.

5. Biotech is starting to behave as though the capital cycle is turning

Biotechnology outperformed again on Friday. IBB gained roughly 2.45%, XBI approximately 1.83%, versus about 0.59% for the S&P 500.

The move followed surprisingly weak US employment data, which reduced expectations of another Federal Reserve rate increase. The next major test is US inflation data.

What I find Interesting

I wouldn’t say biotech is back (or at least not yet) but something more interesting may be happening. The transmission mechanism that finances biotech is beginning to reconnect.

• Public valuations are recovering.

• The IPO window is opening selectively.

• Pharma has a very real pipeline problem, with patent cliffs forcing strategic buyers back into M&A.

• And weaker employment data may finally be taking some pressure off the cost of capital.

But these are not the same signal. A biotech ETF rally doesn’t mean an early-stage company can raise its next round and a handful of successful IPOs doesn’t mean the IPO market is open to everyone. And (seriously), pharma buying assets because it needs to replace lost revenue tells us more about pharma’s balance sheet than it does about venture fundraising. The question is whether these separate developments begin to feed into one another.

M&A creates exits. Exits create distributions. Distributions improve venture fund DPI. Better DPI gives LPs a reason (and the all-very-important liquidity) to recommit. And eventually, that capital finds its way back to the companies at the beginning of the cycle.

That is the part I’m watching. Because a good week for biotech stocks is interesting but a functioning transmission mechanism from public markets back into venture capital is something much bigger (and more interesting).

But this week, I am making an exception. The minute I read the Novo Nordisk announcement, I knew I was going to be clearing my calendar to unpack it. So here we go! I’ll give you the facts first and then get to my opinion later.

On July 31, Novo Nordisk announced that Ziltivekimab (I know its a mouthful but please bear with me), a drug it paid up to USD 2.8 billion to acquire, had failed a major clinical trial.

The trial was called ZEUS and it included 6,376 people with heart disease, kidney disease and high levels of inflammation. Half of the people received Ziltivekimab. The other half received a placebo. Researchers followed them for up to four years.

But lets talk about Ziltivekimab for a minute.

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Ziltivekimab was designed to block IL-6, a protein that helps to drive inflammation in the body. This matters because inflammation can make the fatty plaques inside the arteries unstable and if one of those plaques breaks open, it can create a blood clot that causes a heart attack or stroke.

IL-6 is one of the proteins that drives this inflammatory process and when IL-6 activates the liver, the liver produces CRP (C-reactive protein). People with high hsCRP (high sensitivity C-reactive protein) levels tend to have a greater risk of heart attack and stroke, even when their cholesterol is normal.

Novo’s theory was straightforward: blocking the IL-6 inflammatory pathway would make dangerous cardiovascular events less likely.

There were good reasons to test the theory. Genetic studies had linked IL-6 signalling to coronary heart disease. An earlier trial of a different anti-inflammatory drug had reduced cardiovascular events, and in a smaller study called RESCUE, Ziltivekimab had lowered hsCRP and several other inflammatory markers by remarkable amounts.

The ZEUS trial was designed to answer the next (and much more important) question: would those biological changes actually prevent heart attacks and strokes?

The drug succeeded at the first part re - biological changes. It reduced hsCRP by as much as 92%. But regarding the second and more important part of the question re - prevent heart attacks and strokes, the results were clear. That dramatic reduction in hsCRP did not lead to fewer heart attacks, strokes or cardiovascular deaths. The results were almost identical in the drug and placebo groups.

Why the failure hit Novo so hard

For Novo Nordisk, the financial consequences were immediate. The company said it would record an impairment charge in the third quarter (basically write down the value of the asset), and its shares fell by close to 10%.

But the market reaction was about more than one failed drug. This was an important opportunity for Novo outside of its obesity and diabetes business. So investors were doing two things:

First, they were repricing their expectations for potential future revenues from Ziltivekimab and Novo’s growth trajectory. And second, they were also treating the results from ZEUS as evidence against the broader biological approach. This explains why companies like BioAge Labs who is pursuing a related inflammatory mechanism, lost 65% of its value in one day.

That broader conclusion (about the biological approach of this class of drugs) may eventually prove correct. But one detail deserves closer attention.

Only 27.5% of the people in ZEUS were women. Heart disease is the leading cause of death among women worldwide. Yet a trial now influencing how investors value a multibillion-dollar area of drug development was conducted in a population that was almost three-quarters male.

That figure is striking, but please allow me to add some context.

ZEUS did not study everyone with heart disease. It studied a narrower population with atherosclerotic cardiovascular disease, chronic kidney disease and elevated inflammation. In a recent real-world study of a similar population, women represented 25.9% of participants.

So the 27.5% figure does not prove, by itself, that ZEUS enrolled too few women relative to the population eligible for the drug but it does fit a much broader pattern in cardiovascular research.

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This is the pattern not the exception

A 2025 review examined 1,079 cardiovascular trials conducted between 2017 and 2023. Together, those trials included almost 1.4 million patients and women represented 41% of participants.

But even that figure hides the scale of the problem. Some types of trials, including those involving obesity and pulmonary hypertension, enrolled more women than men. But trials for some of the deadliest forms of heart disease included far fewer women:

• Women represented only about 30.8% of participants in coronary heart disease trials.

• They represented roughly 22.1% in trials for acute coronary syndrome

• and heart failure trials were not much better with 37.4% female representation.

So, this is the pattern and clearly not a new problem. One study examined 60 trials of cholesterol-lowering drugs conducted between 1990 and 2018. The results are stark: in the early 1990s, women represented 19.5% of participants. By 2018, that percentage had risen to 33.6%.

Even government-funded trials show how headline numbers can hide the problem. One study examined cardiovascular trials funded by the US National Heart, Lung, and Blood Institute between 1965 and 1998. At first sight, women represented 54% of participants in trials. But that figure was pushed up by two enormous studies that enrolled only women: the Women’s Health Study and the Women’s Health Initiative. When researchers removed those two all-female studies, female participation in clinical trials actually fell to 38%.

ZEUS did not break the pattern. But whether women were underrepresented relative to its specific eligible population is a separate question.

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Why ZEUS does (and does not) tell us

ZEUS was designed to test whether Ziltivekimab reduced cardiovascular events across all 6,376 participants. Meaning the trial was large enough to detect a 20% reduction in risk if it showed up. The result was clear: the drug did not reduce cardiovascular events across the overall trial population.

That conclusion includes the women enrolled in ZEUS. It would therefore be wrong to say that the drug was not tested in women. But the topline result does not answer a different question: did women and men respond differently?

Approximately 1,750 women participated. Whether that produces a meaningful result depends on the number of events among women, the hazard ratio, the confidence interval and whether there was a credible interaction between sex and treatment. Novo has not yet published those details.

This means we do not yet know whether the negative result was entirely consistent across women and men. And even if a more favourable result appeared in one subgroup, it would need to be treated cautiously because ZEUS failed its primary endpoint (but that’s another point).

What this means for investors

or investors, three lessons stand out.

First, ZEUS provides strong negative evidence against ziltivekimab in the population studied. It is reasonable to reduce the value assigned to the drug and weaken confidence in the mechanism.

But deciding that the same conclusion applies to every patient group, clinical setting and related drug is a broader investment judgement. That should be informed by the full results and not only the headline.

Second, trial demographics are investment information, but percentages cannot be interpreted in isolation. Investors need to compare trial participants with the population that would actually be eligible for the treatment. They also need to understand whether the trial was designed to examine differences between women and men.

The drug failed overall and that is clear. Perhaps the real investment question is how much further that conclusion should travel.

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These ideas are at the heart of my new book, The Billion Dollar Blindspot. You can find The Billion Dollar Blindspot on Amazon.

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References

1. Swerdlow DI, Holmes MV, Kuchenbaecker KB, et al. “The interleukin-6 receptor as a target for prevention of coronary heart disease: a Mendelian randomisation analysis.” The Lancet. 2012;379(9822):1214–1224. Full text | DOI

2. Ridker PM, Everett BM, Thuren T, et al. “Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease.” New England Journal of Medicine. 2017;377:1119–1131. PubMed | DOI

3. Ridker PM, Devalaraja M, Baeres FMM, et al. “IL-6 inhibition with ziltivekimab in patients at high atherosclerotic risk (RESCUE): a double-blind, randomised, placebo-controlled, phase 2 trial.” The Lancet. 2021;397(10289):2060–2069. PubMed | DOI

4. Rivera FB, Magalong JV, Bantayan NRB, et al. “Participation of Women in Cardiovascular Trials From 2017 to 2023: A Systematic Review.” JAMA Network Open. 2025;8(8):e2529104. Full article | Open-access version | DOI

5. Khan SU, Khan MZ, Raghu Subramanian C, et al. “Participation of Women and Older Participants in Randomized Clinical Trials of Lipid-Lowering Therapies: A Systematic Review.” JAMA Network Open. 2020;3(5):e205202.
   Full article | Open-access version | DOI

6. Kim ESH, Carrigan TP, Menon V. “Enrollment of Women in National Heart, Lung, and Blood Institute-Funded Cardiovascular Randomized Controlled Trials Fails to Meet Current Federal Mandates for Inclusion.” Journal of the American College of Cardiology. 2008;52(8):672–673. PubMed | DOI

Disclaimer & Disclosure

This content is for informational and educational purposes only.

“Why do we wait until adulthood to fix what could have been prevented by the first 1,000 days of nutrition?

Yes, it was a question about infant nutrition that sent her down the rabbit hole but it was also a question about maternal health, biotechnology, and an industry that had prematurely settled for “good enough”. Your messages to me in response to that story told me that you loved that story.

Then I asked Bonnie Marcus to talk about ambition, age and what it means to continue navigating the workplace as a woman over 50….and you responded again

And then, two weeks ago, Professor Sandra Kooij shared her work on ADHD in women and how hard it is to get funding and attention to something that affects so many lives, you wanted more of that too.

On the face of it, these three articles don’t have much in common: infant nutrition, workplace ambition after 50, an under-funded slice of women’s health. But look closer and there is a pattern.

Each one takes you behind the headline and introduces you to the person and the work: what they’ve seen, what they’re trying to change, and the challenges and obstacles in their way. None of them treats the subject like a market opportunity first.

That tells me something about what you actually want from this newsletter. Not just to know what’s happening in women’s health, but to hear from the people building it, researching it, funding it, changing it. I’ve heard you.

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There’s over 20,000 of you here - investors, founders, healthcare operators, and people who just want to understand what is changing in the world of women’s health from a capital perspective.

You’ve read, shared, questioned and paid for this newsletter. Somewhere along that journey, this stopped being about one person writing about an overlooked corner of healthcare and became an actual community. And I think that community deserves the best stories and ideas across women’s health that’s out there.

There is an incredible amount of knowledge and stories across the women’s-health ecosystem.

• … from founders who are learning what it really takes to build companies in categories that markets and healthcare systems do not yet fully understand.

• … from investors who are seeing patterns in what gets funded, what struggles to attract funding and how todays’ investment frameworks are being adapted to fit an emerging category.

• …from researchers are uncovering sex-specific evidence gaps and emerging risks that the wider market may not yet know to look for.

• …from operators and industry leaders are navigating the less or (in)visible barriers that determine whether a promising innovation ever reaches patients.

• and from people around the world (who rarely get press coverage) building and developing women’s-health markets under very different clinical, cultural and economic conditions.

These stories need to be heard, not just because they can show us what's actually changing, but also because they can potentially help us understand the women’s-health market better than any glossy report or funding report could.

It takes hours each week to research, write, and produce at this level. Consider becoming a free or paid subscriber to support my work. Thank you.

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I'm opening the newsletter up to other voices

Starting today I an opening up this newsletter to the people building, funding, researching, and pushing forward the women's-health economy directly and not just filtered through my interviews.

• Maybe you're a founder or operator who learned something important that never made it into the pitch deck.

• Maybe you're an investor who's noticed where capital keeps flowing, or where it keeps getting stuck.

• Maybe you're a clinician or researcher who can explain what a piece of new evidence actually means for patients or product development.

• Or maybe you work somewhere that barely registers in international women's-health coverage,

• Or you've watched a regulatory or reimbursement mess up close, or something in your own life exposed a failure (or an opportunity) that the people deciding what gets funded need to understand.

You don't have to be a polished writer. You just need something worth saying.

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What I'm actually looking for

You can write about what you’re building, but the piece has to hold up on its own. The pieces that work are built on something you actually earned, an argument you can back up, or a part of the market that only comes into focus because of where you’re standing.

It shouldnt be a press release dressed up as thought leadership. If in doubt, here’s a test: “would this still teach the reader something if we cut the company name and the ask to buy, invest, or participate?”

Every contributor gets a byline and bio. Plus I’ll work with you to edit and fact-check before anything goes out, and contributed pieces stay clearly marked apart from my own reporting.

How to pitch us

Just reply to this email with your name, role, and organisation; your idea in one sentence; a few sentences on the argument; why you’re the right person to write it; any research or data behind it; and any commercial interest I should know about. That’s genuinely it, no full draft, no formal proposal.

I can’t run every pitch. But if there’s something you know that this community needs to hear, reply and tell me.

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These ideas are at the heart of my new book, The Billion Dollar Blindspot. You can find The Billion Dollar Blindspot on Amazon.

Order Your Copy

About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing, Healthcare AI and capital allocation.

Explore the research · Discover the book · Learn more about Maryann

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

She didn’t hesitate. Researchers already knew the study they wanted to do. The proposal was simple. The study would compare three approaches for women with ADHD entering perimenopause: stimulant medication, hormone replacement therapy (HRT), and the combination of both to answer the questions:

• Which treatment works best?

• Which symptoms improve?

• When should one be preferred over another?

Then she told me something I wasn’t expecting. They had already applied for the funding but the proposal had been rejected. When I asked why, she paused before giving the answer she had been given.

“It was considered not relevant for society.”

I kept coming back to those five words, not because I doubted that research funding is competitive; every year, excellent ideas fail to receive support. What I couldn’t understand was something much simpler. How does a scientific question become important enough to deserve an answer? That was the question I found myself trying to wrap my head around.

Not whether the study was right or whether the study would succeed, but something more fundamental: who decides which research questions matter?

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Over the past few weeks, this series has followed a simple question.

Why are women with ADHD still entering a healthcare system that struggles to meet their needs?

In Part One, we traced that story back to diagnosis itself. ADHD became defined around the behaviour of hyperactive boys, leaving generations of girls to grow up without recognising themselves in the condition.

In Part Two, we followed the story beyond diagnosis. Women were finally being recognised, but they were entering a treatment system that had been developed largely without considering the biological questions unique to women.

That led me to a conversation with Professor Sandra Kooij, one of the world's leading experts on ADHD in women and lead author of a landmark 2025 international review on hormonal transitions and ADHD across the female lifespan. I wanted to understand why these gaps still existed. Instead, I left our conversation thinking about something else entirely: the reason she had been given when the study was rejected:

“Not relevant for society.”

It takes hours each week to research, write, and produce at this level. Consider becoming a free or paid subscriber to support my work. Thank you.

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One possibility for the rejection was that the funding committee was right. Perhaps studying treatment options for women with ADHD simply is not an important scientific question, although the evidence suggests otherwise.

ADHD affects an estimated 2–5% of adults, and increasing numbers of women are receiving ADHD diagnoses in adulthood, many only in their thirties, forties or fifties after years of going unrecognised. Increasingly, clinicians have also begun to notice another pattern: many of these women report that their symptoms fluctuate during periods of hormonal change.

That observation is no longer confined to individual consulting rooms.

Research has shown that women with ADHD are substantially more likely to experience premenstrual dysphoric disorder (PMDD), postpartum depression and more severe menopausal symptoms than women without ADHD. These are not isolated conditions. They represent recurring stages of a woman’s life where changing hormone levels appear to interact with attention, mood and executive functioning.

The scientific community has already recognised this.

Earlier last year, an international collaboration led by Professor Sandra Kooij reviewed the state of knowledge on ADHD in girls and women across the lifespan. The authors concluded that hormonal transitions—including puberty, the menstrual cycle, pregnancy and perimenopause—appear to exacerbate ADHD symptoms and mood disturbances.

At the same time, they found that pharmacological research addressing these hormonal changes remains limited and called for longitudinal, sex-specific studies to develop more individualised care.

That is an important distinction. Researchers are no longer asking whether hormones matter in women with ADHD. They are asking how that knowledge should change diagnosis, treatment and care.

Professor Kooij’s proposed study was not attempting to answer a speculative question. It was attempting to answer a recognised one.

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The assumption most of us make is that once medicine recognises an important question, the search for an answer simply begins. In reality, there is another step in between. Questions do not become evidence on their own.

Before a single patient is recruited, before the first blood sample is taken and before the first result is published, a question must first survive a very different process. Someone has to write the grant application. Experts have to review it. Funding bodies have to decide whether it deserves support and only then can the science begin.

This is easy to overlook because we tend to think of scientific knowledge as something that accumulates naturally over time. In reality, every clinical trial exists because, at some point, a group of people decided that one question was more important than the hundreds of others competing for the same resources.

Evidence, in other words, is not produced by science alone. It is also shaped by the decisions that determine which science gets done.

That was what made Professor Kooij’s story so striking. The scientific question already existed. The study had already been designed. The researchers were ready to begin. What stood between the question and the answer was not another scientific breakthrough. It was a funding decision.

During our conversation, Professor Kooij said something that stayed with me.

“A real taboo is something you don’t even realise is there.”

At first, I thought she was talking about ADHD.

She wasn’t.

She was talking about something much larger: what it means to be a woman living with hormonal fluctuations that influence almost every organ system throughout life, and how little of that reality is still reflected in medical knowledge, diagnosis and treatment.

ADHD is one place where that gap becomes visible. Research tells us that women with ADHD are substantially more likely to experience worsening mood, anxiety and emotional symptoms during the menstrual cycle and in the days leading up to it. Yet many women assume these experiences are simply part of being a woman. They often do not realise that what they are experiencing is part of a pattern increasingly recognised in the scientific literature.

As Professor Kooij explained, many women cope with these symptoms quietly. They continue working. They reorganise their lives around them. They also rarely compare experiences with other women and therefore don’t recognise that millions of others are describing remarkably similar patterns.

The result is that what is, in reality, a widespread clinical phenomenon is often experienced as millions of separate personal and individual struggles. The problem exists at population scale, but it is lived in isolation.

That matters because problems that remain largely invisible can also appear less urgent. When the true burden is dispersed across individual experiences rather than recognised collectively, the need to investigate it can be underestimated.

Professor Kooij believes this is one reason that research into the interaction between ADHD and women’s hormonal transitions has progressed so slowly. Not because the symptoms are uncommon, but because much of the burden has remained hidden in plain sight.

Professor Kooij challenged another assumption. Many people think of ADHD as a psychiatric condition. She doesn’t.

Increasingly, she sees it as a condition that affects—and is affected by—many different biological systems. Hormones, the immune system, connective tissue, cardiovascular health and reproductive health all appear to interact with ADHD throughout a woman’s life.

That has an important consequence. Women do not experience these systems separately. A woman going through perimenopause is not experiencing hormones one day, ADHD the next and cardiovascular changes the day after. They are happening at the same time, in the same person, and influencing one another.

Medicine, however, is organised differently. Psychiatrists specialise in ADHD. Gynaecologists specialise in reproductive health. Cardiologists specialise in the heart. Immunologists specialise in the immune system. Each specialty is essential. But some of the most important questions in women’s health sit at the intersection of several of them.

Take Professor Kooij’s proposed study. On the surface, it was about ADHD medication. But it was equally about hormonal changes during perimenopause and how those hormonal changes influence treatment response. It wasn’t purely a psychiatry question or purely a gynaecology question. It belonged to both.

And that is where the difficulty begins.

Research funding is organised in much the same way as medicine itself. Most grants are reviewed within specialist fields, and questions that fit neatly within a single discipline have a natural place to be evaluated. Questions that span several disciplines often do not.

Perhaps that is one reason important questions in women’s health can remain unanswered for so long—not because they lack scientific merit, but because they do not fit neatly into the way scientific research is organised.

I spend much of my time thinking about capital allocation. Most people assume that capital allocation in healthcare begins when investors decide which companies receive funding.

In reality, it begins much earlier. Long before venture capital backs a new therapy or a pharmaceutical company develops a new treatment:

• Someone has to decide which scientific questions are worth answering.

• Someone has to fund the laboratory, and the (pre-) clinical trial.

• Someone has to generate the evidence

and only then can new knowledge emerge for entrepreneurs to build new products and for investors to finance them.

Seen through that lens, research funding is not simply an administrative exercise. It is the first capital allocation decision in healthcare. Every grant awarded is an investment in one possible future. Every grant declined is a decision that another question will have to wait.

Over the past few weeks, this series has followed the same story from three different perspectives. First, we saw how generations of women with ADHD were overlooked because the condition was defined around the behaviour of boys. Then we saw that, even after women began receiving diagnoses, many entered a treatment system that still lacked evidence for the questions their biology raised.

Now we arrive at a deeper conclusion.

Sometimes the missing evidence is not the result of scientific disagreement. Sometimes researchers know exactly which questions need answering. The harder question is whether we choose to invest in answering them.

Perhaps the greatest blind spots in medicine are not created by what science fails to discover. Perhaps they are created by the questions society never chooses to fund.

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These ideas sit at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

References

• Faraone SV, et al. The World Federation of ADHD International Consensus Statement. Neuroscience & Biobehavioral Reviews. 2021. DOI: 10.1016/j.neubiorev.2021.01.022.

• Young S, et al. Females with ADHD: An Expert Consensus Statement. BMC Psychiatry. 2020. DOI: 10.1186/s12888-020-02707-9.

• Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research. 2021.

• Kooij JJS, de Jong M, Agnew-Blais J, et al. Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women’s Health. 2025. DOI: 10.3389/fgwh.2025.1613628.

• Ter Beek, L. S., Böhmer, M. N., Wittekoek, M. E., & Kooij, J. J. S. (2023). Lifetime ADHD symptoms highly prevalent in women with cardiovascular complaints. A cross-sectional study. Archives of women's mental health, 26(6), 851–855. https://doi.org/10.1007/s00737-023-01356-7

• H3 Network: Head, Heart & Hormones

• Personal interview with Professor J.J. Sandra Kooij, July 2026.

• Valedictory Speech - Professor Sandra Kooij

About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing, Healthcare AI and capital allocation.

Explore the research · Discover the book · Learn more about Maryann

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

Over time, you stop reading individual reports in isolation. You begin reading them against each other, looking for contradictions, blind spots and patterns that only become visible when different pieces of information collide.

Two reports landed on my desk over the past few weeks.

The first was Silicon Valley Bank’s latest Innovation in Women’s Health report. The headlines were encouraging. Investment continues to flow into women’s health. New specialist funds are being launched. The ecosystem continues to mature.

The second was PitchBook’s latest Venture Monitor, which showed that three established venture capital firms accounted for almost half (48.1%, to be precise) of all venture capital raised during the first half of 2026... and no, they were not women’s health-focused.

Individually, neither report surprised me.

Together, they made me question whether we’re looking at women’s health investment through the wrong lens.

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The narrative surrounding women’s health has changed considerably over the past five years. For a long time, the conversation centred on neglect, lack of research and lack of funding.

Today, the narrative is more optimistic. Funding remains modest, but it is increasing. New companies are being founded. Dedicated investors are emerging. Large healthcare companies are beginning to size up potential acquisition targets.

While all of that is true, institutional investing teaches you to ask a slightly different question.

As allocators, we are trained to think in proportions rather than absolutes. Growth, by itself, tells us very little. Context tells everything. A market can double in size and still remain materially under-allocated.

Women’s health is no longer an emerging scientific curiosity. It sits at the intersection of some of the largest structural forces reshaping healthcare: demographic ageing, precision medicine, artificial intelligence, diagnostics, fertility, longevity and the growing recognition that sex-specific biology matters across almost every major disease area.

If those trends continue, and I believe they will, then women’s health is not simply another healthcare vertical. It becomes one of the defining investment themes of the coming decades.

Which brings me back to one of the starkest observations from the H1 2026 venture fundraising environment; Just three established venture capital firms accounted for almost half of all venture capital raised during the first six months of the year. In other words, fundraising remained highly concentrated among a small number of established managers.

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At this point, it’s worth explaining what institutional investors mean by an emerging manager.

Broadly speaking, these are independently owned investment firms still in the early stages of building their institutional business. Most are raising Fund I, II or III. Many are led by highly experienced investment professionals who have left established firms to build specialist platforms of their own.

This matters because the vast majority of specialist women’s health investment firms today are still at that stage. By institutional standards, many women’s health funds are emerging managers.

That, in itself, isn’t unusual. Every successful investment firm started as an emerging manager. Sequoia once raised Fund I. Andreessen Horowitz once raised Fund I. Every manager trusted with billions today had a first institutional investor.

Every institution now considered “blue chip” was once asking someone to believe before the track record existed.

But this is where the two reports began to collide in my mind.

Institutional capital overwhelmingly allocates to established managers. That is neither surprising nor wrong. It’s a feature of prudent fiduciary investing. Track record matters. Governance matters. Operational resilience matters. The ability to manage capital through multiple market cycles matters. These are exactly the characteristics institutional investors should evaluate.

But it also means that for a category like women’s health—which remains a relatively young investment category—many of the managers with the deepest domain expertise are still in the early stages of building institutional businesses and are therefore largely invisible to institutional capital.

That, I believe, is the conversation we are still not having.

Women’s health is often discussed as though the primary challenge is getting more venture capital into the sector. I wonder whether that is only half the story. Because venture capital is just one layer of the capital stack.

If women’s health is genuinely becoming one of healthcare’s defining investment themes (and I believe it is) then eventually the sector will need to attract not just venture capital, but long-term institutional capital; the long-term pools of capital capable of supporting the sector as it matures like pension funds, endowments, sovereign wealth funds and family offices.

But that requires us to zoom out.

The opportunity itself has never been clearer. Women account for roughly half of the world's population and make around 80% of healthcare purchasing decisions, yet continue to experience measurable gaps in research, diagnosis and treatment. At the same time, advances in precision medicine, artificial intelligence, diagnostics, genomics and longevity are transforming our understanding of sex-specific biology across almost every major disease area.

From an investment perspective, that combination represents one of the largest structural opportunities in modern healthcare. This is no longer simply a conversation about women’s health. It is a conversation about the future of healthcare.

And if that future is as significant as many of us believe it to be, then perhaps we should be asking a different question. Not simply, “Is capital increasing?” But, “Is capital increasing at a scale that reflects the opportunity?” Because those are two very different questions.

I’ve spent enough years sitting on investment committees to know that they lead to very different conversations. The first is about innovation. The second is about institutionalisation. One asks, “Is there an opportunity?” The other asks, “Can institutions responsibly access that opportunity?”

The distinction may appear subtle but I don’t think it is. In fact, I suspect it may become one of the defining questions for specialist healthcare investing over the next decade.

I don’t yet know the answer. But I increasingly believe we’re asking the wrong question.

So let me leave you with the one I haven’t been able to stop thinking about since those two reports landed on my desk.

If specialist women’s health investing is still largely being led by Fund I, II and III managers, and institutional capital overwhelmingly allocates to established firms, how do we create the conditions for women’s health to become an institutional investment category?

Subscribe now

These ideas sit at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing, Healthcare AI and capital allocation.

Explore the research · Discover the book · Learn more about Maryann

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

For years, I thought my aunt died from diabetes. That was the story our family told ourselves. She had developed gestational diabetes during pregnancy, then life moved on. She had her baby. The pregnancy ended. The diagnosis disappeared into her medical history like a chapter that had served its purpose.

No one suggested that pregnancy had revealed something important about the decades still to come. No one spoke about long-term cardiometabolic risk. No one explained that the pregnancy itself might have been the first signal of a biological trajectory that deserved to be watched carefully for the rest of her life.

Years later she would develop diabetes. Then came the complications which eventually took her life. Looking back now, I no longer think the defining medical event in her story was the diagnosis that appeared years later. I think it was the one that came first.

Her body had already told the healthcare system something important. The system simply didn’t yet know what to do with the information.

That, increasingly, is what precision healthcare is supposed to change.

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Precision health is often described through the language of technology. Genomics. Artificial intelligence. Biomarkers. Wearable sensors. Personalised therapies.

Those technologies matter, but they are not the essence of precision medicine. Its deeper promise is much simpler. It is the idea that medicine should become better at recognising meaningful biological differences before those differences become avoidable harm.

If that is true, then precision healthcare faces an important test. Can it recognise biology that changes over time? Because that is exactly what women’s health asks it to do.

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Picture two patients. Both are fifty years old. Both have identical cholesterol, identical blood pressure and identical weight. Run them through a conventional cardiovascular risk calculator and they receive exactly the same score.

What the calculator cannot see is that one woman entered menopause two years ago while the other has not yet begun the transition. From the model’s perspective, they are identical but biologically, they are no longer the same. The model has nowhere to put that.

That single sentence reveals something important.

Much of medicine has become remarkably good at measuring biological differences between people. It is still learning how to measure biological change within the same person.

That distinction may define the next generation of precision healthcare.

To understand why, it helps to look at one of medicine’s greatest success stories. Modern oncology rarely treats cancer as a single disease anymore. HER2-targeted therapies are prescribed only when a tumour expresses a specific protein. BRCA-directed therapies follow a genetic signature rather than a diagnosis code.

This is precision medicine working exactly as intended. A measurable biological variable determines who receives which treatment. Outcomes improve because the match becomes more precise. But there is something important about these variables. They are largely static. Once measured, they remain informative for years.

Female biology is different because it unfolds through biological time. Across a lifetime, the same woman moves through adolescence, reproductive years, pregnancy, postpartum recovery, perimenopause, menopause and older age. These are not separate medical stories. They are chapters in the same biological narrative. Each chapter alters physiology, changes risk and provides new biological information.

Precision medicine’s first generation became exceptionally good at recognising fixed biology. Its second generation must learn to recognise biology that changes over time. That is a much harder problem.

This is not simply an observation from outside the medical profession. Cardiology itself has acknowledged it.

The American Heart Association’s dedicated guidelines for cardiovascular disease prevention in women, published in 2011, did not incorporate menopause as an independent cardiovascular risk factor. Menopause appeared largely as a period of possible vulnerability rather than as a transition requiring changes in risk assessment or management.

Yet the evidence already showed that the menopause transition is associated with measurable changes in lipid metabolism, vascular function and cardiometabolic risk that cannot be explained by chronological ageing alone.

Age has always been part of cardiovascular risk models. Biological transition was not. That difference matters because age moves in one predictable direction whereas biology does not.

It took until 2023 for major cardiology guidance to begin explicitly addressing pregnancy, lactation and menopause as transitions requiring specific clinical consideration. This is genuine progress. But it also reveals something larger.

One of medicine’s most data-rich and scientifically sophisticated specialties needed more than a decade to begin integrating one of the most common biological transitions experienced by half the population.

This was not because women were invisible. Cardiovascular disease in women has been studied for decades. The blind spot was more subtle. Medicine had evidence What it lacked was a way of modelling biological time. It knew biology changed. It simply didn’t yet know how to organise care around that change.

That distinction matters far beyond cardiology. Women’s health is often treated as though it were another clinical specialty alongside cardiology, oncology or endocrinology. It is not. Women’s health is one of the clearest demonstrations that biology unfolds across a life course.

Pregnancy is not merely an obstetric event. It can become an early warning for future cardiovascular disease. Menopause is not simply the end of reproductive life. It reshapes metabolic health, bone health, brain health and vascular risk.

The point is not that women experience different diseases. It is that biology itself changes in ways medicine increasingly needs to recognise, measure and respond to. That is why women’s health should not be understood as a niche within precision healthcare. It is one of the clearest tests of whether precision healthcare is becoming genuinely precise.

The implications extend beyond medicine. Every time science learns to measure something it previously overlooked, new opportunities emerge to build diagnostics, biomarkers, therapeutics, care pathways and entirely new companies around that knowledge.

Markets follow measurement and capital follows markets. Wherever biology becomes more visible, innovation follows. Women’s health therefore represents more than an overdue correction to historical blind spots. It offers one of the clearest windows into where precision healthcare is heading next.

The question is no longer whether medicine will become more biologically precise. It already is. The more interesting question is who recognises the implications early enough to build around them. That is where this series goes next.

These ideas sit at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

The Women’s Health Capital Thesis Map

1. Part I: The Women’s Health Capital Thesis

2. Part II: Why Women’s Health Is the First Test of Precision Health — You are here

References

1. American Heart Association — 2011 guidelines never incorporated menopause as a CVD risk factor

   Mosca L, Benjamin EJ, Berra K, et al. “Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update.” Circulation. 2011;123:1243–1262.
   https://www.ahajournals.org/doi/10.1161/CIR.0b013e31820faaf8

2. The 2020 AHA scientific statement confirming the gap and discussing menopause transition’s cardiometabolic effects

   El Khoudary SR, Aggarwal B, Beckie TM, et al. “Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association.” Circulation. 2020;142:e506–e532.
   https://www.ahajournals.org/doi/10.1161/CIR.0000000000000912

3. Independent confirmation in 2020 that no AHA/ACC women’s CVD prevention guideline has been issued since 2011

   JACC State-of-the-Art Review, “Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women.”
   https://www.jacc.org/doi/10.1016/j.jacc.2020.03.060

4. The 2023 Chronic Coronary Disease guideline finally addressing menopause, pregnancy, and lactation as risk-relevant transitions

   Blazoski C, Kim YJ, Spitz J, Blumenthal RS, Sharma G. “Sex and Gendered Approach in Chronic Coronary Disease Guidelines: One Size Does Not Fit All.” JACC: Advances. 2024;3(6):100859.
   https://pmc.ncbi.nlm.nih.gov/articles/PMC11286996/

5. HER2-targeted therapy as the static-biomarker precision medicine example

   “Deep Learning-Based Prediction of Molecular Tumor Biomarkers from H&E: A Practical Review.”
   https://arxiv.org/pdf/2211.14847

   ---

About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing, Healthcare AI and capital allocation.

Explore the research · Discover the book · Learn more about Maryann

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

What happens when an entire healthcare market has been built on evidence, systems, and investment assumptions that were never designed to see women properly?

That question has taken us from menopause and ADHD to diagnostic delay, fertility, chronic pain, longevity, healthcare financing, and the capital structures that determine which innovations ever reach women in the first place.

Over the last three years, this newsletter has grown into a global community of readers thinking seriously about women’s health, healthcare innovation, and the systems that determine what gets funded.

You have replied with your own stories. You have sent articles to friends, colleagues, doctors, founders, and investors. You have helped turn what began as a newsletter into a serious conversation about the future of women’s health.

I write because I love doing it but I also want to be transparent: each essay takes at least three to four hours to research, write, edit, and fact-check. The deeper pieces often take much longer. If this work is going to remain rigorous, independent, and increasingly useful, it needs a more sustainable foundation.

And I want to begin by giving those members something I have not published elsewhere—a bonus chapter “The Hidden Infrastructure Thesis” from my book, The Billion Dollar Blindspot.

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The Hidden Infrastructure Thesis

The bonus chapter of the book The Billion Dollar Blindspot asks a question most investors still miss:

What if the most valuable asset in a women’s-health company is not the product, but the infrastructure it has had to build because no one built it before?

The chapter follows the real-life stories of three founders confronting three different absences:

• A hormone-health company discovering that the data required to personalise treatment simply did not exist and deciding to build the dataset itself.

• A fertility-monitoring company spending fifteen years building something harder to measure but equally valuable: proof that the market is real.

• A cervical-cancer diagnostics company learning, through a supplier crisis, that quality systems and regulatory discipline are not administrative overhead. They are what allow a medical company to survive contact with the real world.

This chapter flips the investor lens. Instead of asking only, “Does the product work?” it asks:

• What infrastructure has this company built alongside the product?

• What would it take a competitor years to replicate?

• Which datasets, regulatory systems, clinical partnerships, quality frameworks, and market proof are becoming the real source of defensibility?

That distinction matters. Because in women’s health, founders are often not simply building businesses inside an established market. They are building the data foundations, regulatory pathways, operational systems, and legitimacy that other healthcare categories inherited from decades of prior investment. For the investor who can see that infrastructure early, the signal set changes.

Join as a founding member for $120 per year locked in for the first 250 members.

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Until next time,

Disclaimer & Disclosure

This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.

It aimed to treat the human body. But for much of its history, the body it studied first and treated as the reference point was male.

That did not always mean women were absent from research. The deeper problem was that female biology was often treated as a variable to be excluded or controlled for, rather than a source of information to be understood.

As a result, treatments were developed with an incomplete picture of how sex and life stage might alter response. Symptoms that presented differently in women were missed and conditions that evolved differently across a woman’s life were diagnosed late.

The consequences run through the full arc of a woman’s life: from hormonal health to cardiovascular disease, autoimmune disease, brain health, bone health, mental health, cancer, chronic pain, and ageing.

But a new paradigm is emerging. It is being driven by the convergence of scientific progress, new diagnostic and data capabilities, ageing populations, and the rising cost of treating disease too late.

Its consequences will reach far beyond medicine. They will reshape how healthcare is designed, how risk is understood, and where capital looks for the next generation of growth.

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The old model of healthcare was built for a world of scarcity. Scarcity of data, diagnostic tools, computing power and longitudinal information about what happened to a person between one appointment and the next.

The practical response was to build systems around averages: standard pathways, broad populations, late intervention, and treatment after disease had already declared itself.

But that model is beginning to change. Genomics, biomarkers, more sensitive diagnostics, AI-enabled pattern recognition, wearables, remote monitoring, and new care-delivery models are making it possible to see disease earlier and with greater specificity. The ambition is no longer simply to treat a condition once it becomes obvious. It is to understand risk, monitor change, detect deviation, and intervene before a health problem becomes expensive, disabling, or irreversible.

This is what we mean by precision health—healthcare designed around the biological differences that determine who gets sick, how disease presents, what prevention looks like, and which treatment is most likely to work. Women’s health is one of the clearest tests of whether that transition is real.

Female biology affects disease risk, symptom presentation, progression, and treatment response across the life course.

Hormonal transitions can alter cardiovascular risk, bone density, cognition, metabolism, immune function, sleep, and mental health.

Pregnancy can reveal future cardiometabolic risk. Autoimmune disease disproportionately affects women. Chronic pain is more prevalent in women, yet has often been poorly understood and inadequately treated.

The National Institutes of Health now explicitly treats sex as a biological variable that should be considered in study design, analysis, and reporting. But policy recognition is not the same thing as full scientific integration. A recent National Academies review concluded that sex differences remain inconsistently implemented across research design and practice.

That gap is where the opportunity begins. When biology becomes more legible, markets once treated as peripheral become visible as infrastructure problems waiting to be solved.

A New Class of LPs is Forming

The capital signal is already visible. Over the past several years, private capital has begun to look at women’s health differently. The conversation has moved beyond whether the category is “investable” at all.

Increasingly, the questions are about access: which managers have real specialist expertise, where the strongest science is emerging, how to assess clinical and commercial maturity, and how to build exposure without reducing a global healthcare transition to one narrow theme. That shift is producing a new class of healthcare LPs.

It includes family offices looking for differentiated long-duration healthcare exposure; wealth managers responding to client interest in prevention, longevity, and healthcare innovation; entrepreneurial families with operating experience; healthcare executives; foundations; catalytic-capital providers; and next-generation capital stewards who see health not simply as a social issue, but as a structural economic one.

The Great Wealth Transfer which is currently ongoing through to the year 2048 matters here too. While the transfer of wealth to women does not mean that women who inherit or create wealth will automatically allocate to women’s health as capital decisions still remain shaped by mandate, risk appetite, family context, governance, and access.

But it does increase the number of people who hold, influence, or advise capital while also having direct experience of fertility care, pregnancy, chronic pain, menopause, caregiving, diagnostic delay, or the fragmented reality of healthcare systems.

This changes what they notice. It changes what they ask. It changes which questions reach private banks, family offices, investment committees, and advisers.

Investable before Institutionalisation

By now, the commercial case for women’s health is becoming harder to ignore.

There is growing scientific understanding. New companies are being built across diagnostics, therapeutics, care delivery, devices, data, and longevity. Private capital has begun to move into the category. And the underlying demand is not speculative: women are living longer, managing more chronic disease, and spending more years navigating healthcare systems that were not designed around their biology.

But recognition is not the same as access. A family office may see the opportunity and still struggle to answer a practical question: where, exactly, should we put capital to work?

That is because the category has developed faster than the infrastructure through which large pools of capital typically invest.

Institutional allocators typically invest through structures they can assess and govern: managers with long track records; vehicles that can absorb meaningfully sized tickets; benchmarks; portfolio-construction logic; and comparable data so that the opportunity can be evaluated alongside other healthcare allocations.

In women’s health, those structures are still emerging. This is not a reason to dismiss the category. It is a description of where the category sits in its development.

Climate investing offers a useful, limited parallel. The climate thesis was recognised before specialist managers, reporting standards, benchmarks, policy frameworks, and institutional familiarity had matured sufficiently for broad allocation. The thesis came first. The infrastructure followed. Capital scaled once it had credible routes through which to participate.

Women’s health is on a similar journey of capital formation, though not an identical one.

What the Biology Actually Does

The opportunity in women’s health is global, fragmented, and cross-disciplinary. It does not sit neatly inside one clinical category, one geography, one company type, or one investment stage. It stretches from diagnostics and therapeutics to care delivery, medical devices, data, ageing, and adjacent health technologies.

The expertise required to understand it is similarly dispersed. It often sits with specialist managers who have built relationships with founders, clinicians, researchers, hospitals, regulators, and local healthcare systems. These managers have developed the pattern recognition to identify a meaningful platform; the clinical networks to understand whether a therapy is genuinely differentiated; or the local knowledge to see where a care model can move from a promising service into durable infrastructure.

The strongest expertise is often held by these specialist managers that are relatively young in terms of track record, geographically dispersed, capacity constrained or too small for large institutional tickets. For larger allocators, that creates an access problem.

In this case, the answer is not simply to put more money into women’s health. The answer is to organise capital around specialist expertise: through disciplined manager selection, diversification across geography, clinical category, stage, and business model, governance, and institutional-quality portfolio construction.

The Question Capital Now Faces

Healthcare is becoming more precise. Private capital is beginning to seek exposure. The ownership and influence of wealth are changing. Yet the institutional architecture remains unfinished.

Women’s health is not a niche investment theme. It is where the transition to precision healthcare, the emergence of new healthcare LP demand, and the unfinished architecture of institutional capital meet.

The question is not whether this market will become more visible. It already is. The question is how we build credible routes for capital into the women’s health market.

The Women’s Health Capital Thesis Map

1. Part I: The Women’s Health Capital Thesis — You are here

2. Part II: Why Women’s Health Is the First Test of Precision Health — Read Next

These questions sit at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book recently reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

References

1. National Academies of Sciences, Engineering, and Medicine, Review of NIH Structure, Policies, and Programs for Women’s Health Research (2025); NIH Office of Research on Women’s Health, NIH-Wide Strategic Plan for Research on the Health of Women 2024–2028.

Disclaimer & Disclosure

This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.

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You are twenty-eight weeks pregnant when the email arrives. It comes at an unremarkable moment: between meetings, in a supermarket queue, or while you are waiting for the kettle to boil. The subject line is easy to miss.

Important update about your health plan.

Inside, there is a sentence that changes the shape of your pregnancy. Your OB/GYN is longer be covered by your insurance. Not because you moved, or because your doctor retired, or because anything about your pregnancy changed. But because two large organisations are negotiating a contract.

Suddenly, the doctor who knows the miscarriage you do not like to speak about, the scan that frightened you, the question you asked only after your partner had left the room, may no longer be available to you, unless you can afford to pay far more to stay.

For the insurer, it is a network negotiation. For the provider group, it is a reimbursement dispute. But for the woman reading the email, it is the prospect of beginning again with someone new, halfway through the most consequential medical event of her life.

That is not a consumer inconvenience. It is a rupture in care.

A recent dispute involving Capital Women’s Care, a large US OB/GYN network affiliated with Unified Women’s Healthcare, made that rupture visible. During negotiations with UnitedHealthcare, patients were informed that their clinicians could fall out of network. For women already under their care, the practical choice appeared brutal: find another doctor mid-pregnancy or face potentially significant out-of-pocket costs to remain with the clinical team they trusted.

The dispute was ultimately resolved but it revealed a question far larger than one contract, one insurer, or one provider group:

What happens when the infrastructure of care becomes bargaining power?

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Why Scale Enters The Room

To understand why women’s health practices are consolidating, it is important to begin with the pressures facing the practices themselves. The image of the independent doctor’s office is reassuring: a local clinic, a familiar receptionist, a physician who owns her practice and answers to her patients. But independence has become increasingly difficult to sustain.

Behind the consultation room is an expanding machinery of administration: insurance claims, coding, compliance, payroll, cybersecurity, electronic records, staffing shortages, regulatory reporting, and the constant negotiation of reimbursement rates. A small practice may be clinically excellent and still lack the capital, systems, or bargaining capacity required to survive in a healthcare economy built for scale.

For an OB/GYN practice, the demands can be even broader. Care does not stop at the consultation. It may involve ultrasound, laboratory services, hospital coordination, fertility referrals, maternal-fetal medicine, mental-health support, menopause care, and increasingly, digital tools that allow women to access care outside the narrow hours of a traditional clinic. Each layer requires people, technology, working capital, and time.

This is why larger platforms have become attractive to many clinicians. They can centralise billing and administration. They can recruit staff across a wider network. They can invest in electronic systems that a single practice could not justify alone. They can build integrated pathways across fertility, pregnancy, postpartum care, gynaecology, and menopause rather than leaving women to assemble their own care from disconnected providers.

That is the promise of scale. And it is a promise worth taking seriously. But scale is not neutral. Its consequences depend on the incentives behind it.

The Architecture Behind The Platform

This is where the conversation about private capital in healthcare usually collapses into caricature. Either private equity is cast as the villain: a financial machine that sees a clinic only as a line item to be optimised. Or it is cast as the saviour: the only source of capital and operational expertise capable of modernising a fragmented system.

Both stories are too easy. Capital is not a single force. It arrives with a design. It has a cost. A time horizon. A return expectation. A governance structure. It may carry debt. It may require an exit by a particular date. It may reward revenue growth, margin expansion, acquisition pace, or clinical outcomes. It may give doctors meaningful authority over care decisions or reduce them to employees inside a system whose priorities are set elsewhere. Those choices are not technical details buried in transaction documents. They are the architecture of the platform.

A care group can use capital to strengthen the clinical enterprise: to hire more physicians, invest in diagnostics, reduce administrative burden, modernise systems, and give clinicians the resources to spend more time doing the work only they can do. Or it can use capital to assemble assets rapidly, load the business with obligations, and make financial engineering the central source of value creation.

From the outside, both may present the same language: innovation, efficiency, access, growth. Both may have sleek websites. Both may announce new locations. Both may describe themselves as patient-centred. But the language of a platform does not tell us what its incentives are.

Its ownership architecture does. The relevant question, then, is not whether a women’s-health platform has private capital behind it. It is what that capital requires the platform to become. That distinction matters in every corner of healthcare. It becomes especially visible when the patient cannot simply choose another provider.

The Patient Cannot Step Out of the Negotiation

Most commercial relationships contain an exit. If a bank changes its terms, you can move your account. If a mobile provider raises its prices, you can change your contract. If a supermarket stops stocking what you buy, you go elsewhere.

The inconvenience may be real. But time is usually on your side. Healthcare does not work like that. And pregnancy makes the difference impossible to ignore.

A pregnancy has its own timetable. The next appointment is not optional because a contract is unresolved. A scan cannot be deferred until a new clinic has capacity. A woman managing gestational diabetes, pre-eclampsia risk, a complicated fertility history, or the memory of a previous loss cannot simply wait for the market to settle itself.

Nor is a clinician interchangeable. Medical records can be transferred. A chart can list blood pressure readings, test results, medication, and dates. But it cannot fully carry the accumulated knowledge of a relationship: what a patient has been afraid to say, which symptoms were dismissed elsewhere, how much reassurance she needs before a procedure, or the precise moment a clinician knows that something is wrong.

This is why the language of “choice” can be misleading in maternity care. Choice assumes comparable alternatives, available at the right time, within reach, covered by insurance, and able to take responsibility for a patient immediately. Often, those conditions do not exist.

The imbalance is not that one side has acted maliciously. Provider groups need reimbursement that allows them to retain clinicians and deliver care. Insurers have a responsibility to contain costs for their members. The imbalance is more basic. The institutions can negotiate. The patient cannot suspend the need.

And when a system treats continuity as a negotiable variable, the risk does not remain with the parties at the table. It moves through the system until it reaches the person with the least power to absorb it.

The Question Capital Must Answer

For years, the women’s-health conversation has rightly focused on what is missing. The diagnostic tests that do not exist. The conditions diagnosed too late. The therapies never developed. The research questions that were never asked because female biology was treated as a complication rather than a starting point. Those gaps remain enormous. But as capital begins to move into the category, another question becomes unavoidable:

What kind of infrastructure is that capital building?

Not simply:

• how many clinics were acquired?

• Or how quickly did revenue grow?

• Or how many patients entered the platform?

But:

• who owns the relationship between a woman and her care?

• What protects clinical judgement when commercial priorities tighten?

• What happens to continuity when a contract fails, a strategy changes, or a platform is sold?

• And which outcomes are important enough to sit beside margin, growth, and return on invested capital?

These are not peripheral questions for a mature women’s-health market. They are the questions that determine whether a category becomes more capable or merely more financialised.

The answer begins upstream. A capital allocator chooses a manager. A manager chooses a strategy. A strategy chooses an ownership model. And an ownership model decides, often quietly, which trade-offs become acceptable when growth, reimbursement, staffing, and patient care pull in different directions.

That is why capital allocation is never only about what gets funded. It is also about what gets normalised. Women’s health needs investment: in science, in clinicians, in care delivery, in technology, and in the systems that allow women to receive support across the full arc of their lives. But it needs capital with a longer view of value. Capital that understands that continuity is not a soft metric. That clinical autonomy is not a branding claim. That access is not merely a route to revenue. And that a care platform should be judged not only by what it can consolidate, but by what it can hold together.

Because when care becomes leverage, the cost of getting the architecture wrong is not borne by the people negotiating the contract. It is borne by the patient waiting for the phone to ring.

ADHD Series : The Part 3 of an investigative series examining ADHD in women, late diagnosis, perimenopause, hormonal influences on cognition, diagnostic bias, women's brain health, and related healthcare innovation and investment opportunities continues next week.

That question sits at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book recently reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

Disclaimer & Disclosure

This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.

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She was 56 years old when she was finally diagnosed with ADHD.

The diagnosis arrived the way late diagnoses often do. Not as a revelation but as a reckoning. Decades of compensating. Decades of systems: the lists, the alarms, the overpreparation, the private terror of forgetting something important. Decades of believing, in the way women who have never been told otherwise tend to believe, that the effort required to function was a character flaw rather than a neurological one.

The diagnosis changed that. It gave the thing a name and then came the prescription. The drug was Vyvanse—lisdexamfetamine, sold in the UK and Europe as Elvanse, the same molecule under a different name. Her doctor was attentive. The dose was standard. She filled the prescription and took the first tablet the way you take anything you have been waiting for without knowing you were waiting for it.

What happened next, she did not expect. The medication made her sleepy. Not mildly tired, but deeply, dangerously sleepy. Then one afternoon, driving home from a weekend away with friends, she fell asleep at the wheel. It was noon. She woke as she crossed the double yellow line on a two-lane highway, her car moving directly towards a truck. The truck swerved. She swerved. They were both, as she later described it, very lucky.

When she told her doctor what had happened, he said something that has stayed with her ever since:

“That side effect is an indicator you have classic ADHD.”

She had not thought to ask (and no one had told her to ask) whether the medication had been specifically studied for how it behaves in women. whether the evidence behind her prescription had asked what happens when this drug meets a hormonal environment that changes every month or whether anyone, at any point in the drug’s development, had designed a study around that question.

A few weeks ago, another reader left a comment that stopped me mid-scroll:

“Please look into Elvanse and how different sexes respond.”

That comment received eleven likes because beneath it sits a much larger question:

The story of women and ADHD is usually told as a story of recognition. Women were missed. Women masked. Women compensated. Women were finally diagnosed.

That story is true but it stops one chapter too early.

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Lisdexamfetamine did not arrive yesterday.

Vyvanse was introduced in the United States in July 2007 for children aged six to twelve and approved by the FDA for adults in April 2008. In the UK, NICE guidance offers lisdexamfetamine alongside methylphenidate as a first-line pharmacological option for adults with ADHD. When adult women now arrive at diagnosis — in their thirties, forties, fifties — the treatment pathway is already there. The drug, the dosing range, the prescribing guidance, and the clinical habits all exist.

This is the strange asymmetry of the moment. Women spent decades outside the diagnostic frame, and when the frame finally widened, they entered a treatment system that had already been built, already calibrated, and already closed.

The assumption, often unspoken, is that once the diagnosis is correct, the treatment question is mostly technical. Start low. Titrate. Monitor response. Adjust. But this assumes that the evidence base has already asked the questions that matter for the patient now sitting across from the clinician. In the case of women with ADHD, that assumption deserves scrutiny.

The Questions The Trials Did Not Ask

Read more

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Imagine spending forty years believing something is wrong with you. Not seriously wrong but just enough wrong that you notice it.

You buy the planner. Then another. You create elaborate systems to stay organised. You write lists, set reminders, colour-code calendars, and leave yourself notes around the house. You arrive early because you’re afraid of being late. You overprepare because you’re afraid of forgetting. And you work twice as hard as everyone else to keep all the plates spinning.

From the outside, people think you have it together but inside, you are exhausted. You wonder why ordinary life seems to require so much more effort for you than it does for everyone else. Then one day — often in your forties or fifties — someone asks a question that stops you in your tracks.

Have you ever been assessed for ADHD?

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At first, the suggestion seems absurd. ADHD is what little boys have. Not women with careers. Not mothers. Not executives. And certainly not the person who spent decades holding everything together through sheer force of will.

And yet, increasingly, that is exactly what is happening.

Women in their thirties, forties, and fifties are being diagnosed with ADHD in record numbers. For many, the diagnosis arrives with an unexpected mixture of emotions: relief, because finally there is an explanation; grief, because no one noticed sooner; anger, because years spent blaming yourself can never be returned. Running through almost every one of these stories is the same phrase in different forms.

But what if it wasn’t?

A few weeks ago, I wrote about Ambien, a sleep medication prescribed to women for nearly two decades at doses calibrated almost entirely on male data. It took regulators the better part of twenty years to acknowledge that women metabolised the drug differently. The lesson was not that researchers were malicious. It was that assumptions, once embedded in systems, become invisible. And once invisible, they stop being questioned.

The more I read about ADHD, the more that pattern began to feel familiar. For decades, the public face of ADHD was a young boy who couldn’t sit still; disrupting class, forgetting homework, bouncing off the walls. He was the child teachers noticed. The child parents worried about. The child researchers studied.

But what about the girls? The ones who daydreamed quietly, compensated, internalised and learned to hide their struggles instead of acting them out. If the condition was defined around the children who were easiest to notice, what happened to everyone else?

The question most coverage asks is: why are so many women being diagnosed now? The answer offered is usually awareness. Social media. Reduced stigma. Better clinician training. Those explanations may be true, but the more stories I encountered, the less convinced I became that this was the whole story.

Many women who receive late diagnoses describe not a gradual increase in awareness but a sudden collapse. A point in their forties when the systems that had held everything together for twenty years seemed to fail all at once. The lists stopped working. The calendar couldn’t keep pace. The effort required to function began exceeding what was available.

For a significant number of women, that moment appears to coincide with perimenopause. That coincidence is not random, and it is not well understood.

But it points toward something the awareness narrative misses entirely: that for many women, the real question is not why they are being diagnosed now.

The real question is what changed in their biology that made the invisible finally visible. Perhaps the real story is not that women are suddenly developing ADHD. Perhaps the real story is that they were always there and we never learned how to see them.

Over the coming weeks, I’m going to follow that question wherever it leads.

• Into the history of ADHD and how it became known as a boys’ disorder.

• Into the experiences of women who spent decades undiagnosed.

• Into the emerging science of hormones, cognition, and midlife brain health.

• And eventually, into the capital markets themselves.

Because if millions of women have been invisible to a diagnostic system for forty years, the implications extend far beyond medicine. They touch research priorities, innovation, healthcare delivery and investment.

Most of all, they force us to confront a possibility that sits at the heart of every blind spot. Sometimes what appears absent was there all along.

The first piece drops next week. If you have a personal experience with ADHD (medication, diagnosis or treatment), I’d love to hear from you.

Series Overview: This article is Part 1 of an investigative series examining ADHD in women, late diagnosis, perimenopause, hormonal influences on cognition, diagnostic bias, women's brain health, and related healthcare innovation and investment opportunities.

That question sits at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book recently reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

Disclaimer & Disclosure

This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.

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On a summer morning in July 2002, phones began ringing in doctors’ offices across America. Women who had taken hormone therapy for years wanted answers. Should they stop? Had they put themselves at risk? Was the treatment they had trusted suddenly dangerous?

The questions were triggered by findings from the Women’s Health Initiative (WHI), one of the largest studies ever conducted on women’s health.

By evening, television news anchors were warning viewers about hormones. Within weeks, prescriptions were being cancelled. Within months, one of the most common treatments prescribed to midlife women had become something to fear.

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The message travelled quickly. Far more quickly than the nuance. What began as a complex scientific discussion about risks, benefits, age, timing, and patient selection was gradually compressed into a much simpler narrative:

Hormones are dangerous.

For many women, that became the only message they ever heard. More than two decades later, we are still living with the consequences. Yet the most important consequence may not be what happened to hormone prescriptions. It may be what the episode revealed about how we think about women’s health.

For much of modern medical history, estrogen was viewed primarily through the lens of reproduction. Its role seemed obvious. It regulated menstrual cycles, supported fertility, enabled pregnancy and prepared the body for childbirth. When reproductive capacity ended, the assumption was often that estrogen’s most important work was largely done.

Women’s health, consciously or unconsciously, became organized around reproduction. It was a reasonable assumption. The question is whether it told the whole story.

But biology has a habit of refusing to fit neatly into our categories. Over time, researchers began discovering that estrogen was doing far more than helping women conceive children. Estrogen receptors were found throughout the body—in the brain, blood vessels, bones, muscles and in the heart.

Then we learnt that it helped maintain bone density, influenced vascular health, interacted with the cardiovascular system, played a role in cognition and brain health, and affected muscle mass and metabolism.

The reproductive role of estrogen had always been visible. Now what scientists were beginning to discover was everything else.

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A new study published this month offers another clue that this broader understanding may be correct1. Researchers analyzed health records from more than 3.7 million postmenopausal women in South Korea and followed them for approximately ten years. The scale alone is remarkable. Over the course of the study, more than 48,000 women were hospitalized for heart failure, giving researchers an unusually large dataset from which to examine patterns. What they found was striking.

One study does not settle a scientific debate. Nor should it. Science advances through accumulation, not headlines. But when viewed alongside a growing body of research, the findings point in a consistent direction.

The effects of estrogen appear to extend well beyond fertility. The hormone may be influencing systems that shape cardiovascular health, resilience, and long-term outcomes throughout a woman’s life.

For most of human history, this question would have mattered far less. Life expectancy was shorter. Many women simply did not live long enough to spend decades beyond menopause. The years after reproduction existed, but they occupied a much smaller portion of life.

That is no longer true. Today, women can expect to spend more than a third of their lives in the postmenopausal phase. Pause on that for a moment. Not a brief chapter between middle age and old age but decades.

For many women, the years after reproduction may last longer than the years before it—a span of life longer than many people once lived altogether. Yet much of modern medicine still reflects assumptions formed in a different era. An era when women simply did not spend thirty, forty, or fifty years beyond menopause.

The demographic reality is changing but the underlying model has not, and that mismatch is becoming harder to ignore. It is beginning to show up everywhere. In cardiovascular disease, osteoporosis, cognitive health, metabolic health, in frailty and mobility, and in the growing realization that longevity looks different in women than it does in men.

The question facing medicine is no longer simply how to support women’s reproductive health. It is now how to support women’s health across the decades that follow reproduction, and the distinction matters. Because once those decades move from the margins to the center of the conversation, entirely new questions begin to emerge—new research priorities, new therapeutic opportunities, new markets and perhaps most importantly, a new understanding of what women’s health actually means.

Whenever our understanding of a problem changes, opportunities emerge. Not because the world changes overnight, but because we begin to see parts of it that were previously hidden.

For decades, women’s health was largely viewed through the lens of reproduction. That framing shaped research agendas, clinical priorities, innovation, and inevitably, it shaped where capital flowed. The result was a healthcare ecosystem that became attuned to fertility, pregnancy, and childbirth while devoting comparatively less attention to the decades that followed.

Yet those decades are no longer a footnote. They are becoming one of the defining health challenges and opportunities of the 21st century. The implications extend far beyond menopause itself. They touch cardiovascular disease, bone health, cognitive decline, metabolic health, mobility and healthy aging.

In other words, some of the largest health challenges facing women later in life may be connected to the very biological systems we once viewed primarily through a reproductive lens.

That realization is beginning to change the conversation. Researchers are asking new questions. Founders are building new companies. Clinicians are revisiting old assumptions, and investors are starting to look more closely at categories that were once dismissed as niche.

What makes this moment particularly interesting is that the opportunity was not created by a scientific breakthrough alone nor by a new technology. It emerged because demographics changed while our assumptions remained the same. Women did not suddenly start aging differently. We simply reached a point where millions of women were spending thirty, forty, and even fifty years beyond reproduction, forcing us to confront questions that had been hiding in plain sight.

That question sits at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book recently reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

Disclaimer & Disclosure

This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.

A few years ago, a health diagnosis sent me into the healthcare system in a way I had never experienced before. The moment itself was not dramatic. It was just a conversation in a doctor’s office that left me unsettled.

What unsettled me was not the diagnosis itself but was the realization that many of the treatment options being offered for a condition affecting millions of women still felt strangely primitive and almost medieval.

I remember sitting there thinking: how is this possible?

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We live in a world of genomic sequencing, robotic medicine, and billion-dollar biotech platforms. Entire industries are being rebuilt around precision technology. Yet for many conditions that affect enormous numbers of women (as I would later come to find out), the innovation curve often seemed to flatten somewhere decades earlier.

At first, I assumed I simply did not know enough. So I started reading....and reading....and reading.

The deeper I went into the research, the stranger the disconnect became. For decades, women had been routinely excluded from clinical trials. Drug dosing frameworks were often calibrated on male biological baselines. Symptom recognition models were built around how disease presented in men. Entire diagnostic systems treated the male body as default and the female body as variation.

The consequences were not abstract. They shaped everything from cardiovascular outcomes to autoimmune disease recognition to how pain was assessed, studied, and treated.

Because capital fixes things. That is what it does, when it is correctly allocated. It finds unmet need, prices the risk, funds the solution. Markets are imperfect, but they are not indifferent. When a problem this large (affecting hundreds of millions of people, with documented economic consequences running into the trillions) remains this underserved, the reason is not that no one noticed. The reason is structural.

Something in the architecture of how we identify opportunity, how we evaluate risk, how we build conviction has produced a systematic blind spot.

I had spent two decades inside that architecture. And I began to understand that the same forces that excluded women from clinical trials for decades had done something else that no one was writing about clearly: they had created pattern-recognition failures in capital markets.

When you omit half the population from the foundational research, you don’t just create knowledge gaps. You create mispriced assets. You create exits that don’t get modelled. You create categories that sophisticated investors walk past because the mental models they’ve built don’t have a place to put them. That was not a health story. That was an investment thesis.

Every time I spoke to an investor who was curious about women’s health, I received the same question in slightly different forms.

• Where do I start?

• How do I evaluate these companies?

• What does good look like here?

The case studies were scattered. The frameworks that worked in enterprise software or consumer fintech didn’t translate without modification. The risk profiles were different, the regulatory pathways were different, the exit landscape was different and no one had assembled the map. I kept thinking: someone needs to write the book I wished I’d had at the beginning of this. Eventually it became clear that I was waiting for someone who was perhaps not going to arrive. So I wrote it.

What started as curiosity slowly became obsession….then responsibility. The book was written in airport lounges between meetings. On late nights after work. In highlighted studies spread across my desk. In voice notes recorded after conversations with founders, scientists, physicians, investors, and women trying to navigate healthcare systems that often did not seem designed around their realities.

Some chapters came easily. Others took months because I was trying to articulate something I could feel intuitively but had not yet fully learned how to name.

• How do you explain that one of the largest growth markets in healthcare was hiding inside incomplete data?

• How do you explain that a category dismissed for years as “too niche” may ultimately become one of the defining healthcare investment opportunities of the coming decades?

• How do you explain that the issue was never simply women’s health itself, but the invisible assumptions underneath the systems evaluating it?

Over time, the book became something larger than I originally intended. Not just an argument about healthcare, but a framework for seeing blind spots differently.

One of the unexpected gifts of this process has been realizing how many people around the world were quietly asking similar questions.

• Women trying to understand why their symptoms were dismissed for years.

• Founders building solutions while hearing repeatedly that the market was “too small.”

• Investors sensing opportunity but lacking the mental models to evaluate it confidently.

• Healthcare professionals frustrated by systems that seemed reactive instead of preventative.

The conversations started connecting across countries, industries, and disciplines. Which is why, when I thought about launching this book, I knew the first event could not simply be local. The people who shaped this thinking are everywhere, around the world.

Sometimes the largest opportunities are hidden not because the data is missing, but because the people interpreting the data were trained not to see it. That is what this book is about. And it is almost in your hands.

On 27 May, I’m hosting a private conversation with some of the people who have lived this arc; operators who have built and exited in women’s health, and an investor who has backed multiple companies in the space. We will be talking about what it actually takes to build in this category, what the reimbursement and adoption curve looks like from the inside, and where the capital opportunity sits right now.

It is not a panel. It is a practitioner conversation and the kind that usually happens behind closed doors. If you want to be in the room, you can request an invitation below.

Request an Invitation

Disclaimer & Disclosure

This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.

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A few years ago, I heard the words from a doctor that sent me on a journey.

It happened at a doctor’s appointment and I remember walking out of that appointment with a realization I could not shake. At the time, what unsettled me was not the diagnosis itself. It was the realization that many of the treatment options for conditions affecting millions of women still felt strangely behind. Almost primitive compared to the sophistication we now expect from modern medicine.

We live in a world of genomic sequencing, AI-driven diagnostics, robotic surgery, and billion-dollar biotech platforms. Entire industries are being rebuilt around precision technology.

And yet in many areas of women’s health, the innovation curve seemed to have flattened decades earlier.

Share The Billion Dollar Blindspot

At first, I assumed I simply did not know enough. So I started reading. Then reading became research and research became obsession. The deeper I went, the stranger the disconnect became.

For decades, women had been routinely excluded from clinical trials. Drug dosing frameworks were often calibrated around male biology. Diagnostic systems were built around how disease presented in men. The consequences shaped everything from cardiovascular outcomes to autoimmune disease recognition to how pain itself was studied and treated.

And then a different question emerged:

Why hadn’t capital fixed this? Because capital usually finds inefficiency. It identifies unmet need and it prices opportunity. So why had one of healthcare’s largest markets remained systematically under-researched, underfunded, and under-modeled for so long?

I had spent more than two decades inside private wealth and institutional finance. I had watched how investors build conviction, how frameworks shape allocation decisions, and how entire categories become visible or invisible depending on the assumptions underneath them.

And I began realizing something I could no longer unsee: When you exclude half the population from foundational research, you do not just create medical blind spots. You create investment blind spots. You create entire categories that sophisticated investors struggle to evaluate because the mental models they inherited were never designed to see them properly.

That became the foundation for my book The Billion Dollar Blindspot.

This book was written late at night after work. In airport lounges between meetings. Across highlighted studies spread across my desk. Inside conversations with founders, scientists, physicians, investors, and women trying to navigate systems that often did not seem designed around their realities.

One of the most unexpected parts of this process has been realizing how many people around the world were quietly asking similar questions; Investors sensing opportunity but not quite sure how to evaluate it. Founders building important companies while repeatedly hearing the market was “too niche.” Healthcare professionals frustrated by systems designed to react instead of prevent. Women trying to understand why their symptoms had been dismissed for years.

In nine days, on May 26th, I’ll be hosting a global virtual launch conversation joined by three founders featured in the book, bringing together readers, investors, operators, and healthcare professionals from around the world to explore what becomes possible when one of healthcare’s largest overlooked markets finally begins attracting the attention, innovation, and capital it deserves.

The event is free, virtual, and global because the community shaping this conversation already spans the world.

Reserve Your Spot

And because this community helped shape the book itself, I wanted to make the pre-ordering a participatory experience. So I created a set of pre-order bonuses reserved specifically for early supporters of the book and this growing community.

Bonuses include an extra chapter featuring the stories of three amazing founders building infrastructure in women’s health, priority invitations to future conversations and events, and a live investor Q&A session for readers who want to go deeper into the thesis and investment landscape.

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If you’ve been following this journey for a while, I would genuinely love for you to be part of launch week.

Sometimes the largest opportunities remain hidden not because the data is missing…but because the people interpreting the data were trained to miss them. That is what this book is about. And in nine days, it will finally be in your hands.

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Three years ago, I started writing what I thought was a report. It became a book. Today, The Billion Dollar Blindspot is available for pre-order.

Disclaimer & Disclosure

This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.