This Girl KAM with Jessica Shull

Liv: Hi Jessica, how are you?

Jessica: Hi Liv, it’s, good to be here.

Liv: It’s fabulous to have you on the show. Thank you for taking the time. I do appreciate it.

Jessica: No problem.

Liv: So, to kick us off, Jess, could you please tell us a little bit about yourself and your background?

Jessica: Certainly. So, I’m Jessica Shull. I am an American but living in Spain and have been working in the digital health/digital medicine pharma space for the past 20 odd years. I have a varied background. I was born in Germany, moved to England, then to the US, and spent some years in South America in Paraguay, working with bees. Then, I did my whole grad school thing and realised that healthcare and the less common side of healthcare was what interested me, and I became a medical illustrator. So, that’s what set off this whole foray and excursion into digital health because when I started my graduate program at the Medical College of Georgia in the US, medical illustration was transitioning from paper, and these silver point,  really cool artistic methods into digital and 3D animation and Photoshop and all these cool things that were all software. I had to very quickly learn how to use all these programs, and it became evident that this was a way to not only create content but also share and learn and increase awareness for patients and physicians. From there, I just expanded and expanded, and now I’m actually the director of Digital Therapeutics at a company called Vicore Pharma, which is a Swedish pharma company. It’s very small but very dedicated, and it’s a great team. Because I’m on the digital side within a very small pharma company, I get to see both sides of drug production as well as digital medicine production, and it’s been just fascinating.

Liv: It sounds fascinating!  I want to delve into your time in Paraguay. Tell me a little bit about what that was like, those three years, and some of the experiences you had that perhaps, shaped your purpose now I wonder?

Jessica: Yeah, I think it really did have a big impact, a lot bigger than I think sometimes. I was sent there to teach beekeeping, which is a valid agricultural endeavor because it’s a country where usually the main crop is cotton. But cotton is a very toxic crop to farm, especially if you are with a hoe and a set of oxen for plowing.

So, you’re down in there with the chemicals, and it’s very bad for people’s health, and they can only get one crop a year. So beekeeping was meant to bring new income, especially to women in the communities because they could go out and find, unfortunately, killer bees, but they’re wild. They go out into the wild, and you have to find them. You catch the queen, and then you can bring the whole hive home, and it produces honey every year, and you can sell one litre of honey. At the time, it was the same price as a hundred kilos of cotton.

With one litre of honey, you could buy milk for a month. It was a really good endeavour, but also because it’s killer bees, people weren’t very into it! I can tell a lot of stories about getting stung and just how that all went… We were working with very basic equipment like chainsaws and mosquito nets. We didn’t have any proper equipment. So, I realised in addition to that kind of work, healthcare was a big issue for people.

I worked with the community where I was living in very rural Paraguay with no electricity, no water, no nothing to develop nursing. That was because I helped them finish a health post that was in the community. We got all the cement, bricks, and everything built, but then there was no one to staff it. So, we had to make a nursing school.

The first class was incoming, and unfortunately, it took long enough to create the school that when I left, the class was still in session, and they graduated after I’d already left. But it was 25 people who had the minimum requirements. They had to have at least a third-grade education, and some of them had high school. They were so dedicated and learned in the space of one year to be a very basic first-level nurse so they could work in their local health communities.

The whole experience there taught me a lot about what’s important in conserving resources, about living without water, and everything was such a learning experience. It also taught me about how health systems work and how some people are left behind and how to broaden access for people. That was really the first hands-on experience I had with that, and I think Paraguay has developed a lot since then. It’s been 20 years, and I’m sure now everybody has mobile phones and the internet. But I suspect at least more than when I was there. I still see similarities in countries like the US where there’s still no access for some people, and it’s really shaped my thinking of medicine.

Liv: So, do you think that has shaped how you work now and the certain projects that you put your passion into? Do you feel that was shaped back in those days?

Jessica: I think it allowed me or gave me a primer, let’s say, on being able to see other people’s perspectives. So I may assume that everyone can look up their medical records on their own, but I know from experience that what I can do is not what everyone else can do. And when it comes to designing clinical studies, it’s about being able to have the patient’s perspective and placing it in context in terms of what city, what country, what system you’re talking about, and how people approach access and whether they can even be advocates for themselves.

Even here in Spain, I have to say it’s a wonderful healthcare system considering the very few resources that they’re given. I worked at a hospital here in Spain for many years, and those healthcare professionals are phenomenal, really my role models. But they don’t have the top line, super-funded resources that the US has access to, but they treat patients well.

However, the patients themselves don’t always know what questions to ask and are sometimes too embarrassed to ask. They believe that the doctor knows best, and they may not even read what the report says. So they don’t advocate for themselves as strongly as they could sometimes. Being aware of all that has shaped a lot of what I’m doing now in terms of patient engagement and understanding a patient.

Liv: And I suppose that’s shaped by different cultures as well, that relationship with their healthcare professional and how accountable they are for their own health.

Jessica: Yeah, I think so. Especially now with access to the internet and Google and Chat, G P T, who knows, there are many more resources, and patients are becoming more aware and savvy. Many more are interested in knowing the mechanics behind a pathology. But it still depends a lot, and I don’t know how it is. It must vary a lot from the US to say Japan or someplace in sub-Saharan Africa as opposed to Norway. Of course, you have differences everywhere as to what people feel comfortable asking and what they can and what they’re given, I suppose, the awareness to ask about.

Liv: So tell me a little bit more about your journey into digital therapeutics and what was it in particular that inspired you to pursue this as your career?

Jessica: That’s a very good question because when I first heard about digital therapeutics, I was in digital health. So this was using continuous glucose monitors and real-time glucose monitoring for the care of people with type one diabetes. And we were doing things like cycling across with these connected monitors to ensure the safety of patients in that way. It was a very visual and physical showcase of what digital tools can do for patients in that sense. But digital therapeutics was something entirely new.

So in 2015, when I first heard of these kinds of products, I thought, “Software? How does software treat somebody?” But if you think about it, especially with AI the way it is now, you can have treatment, and you can have a therapist who is giving you your cognitive-behavioral therapy through your phone. That’s not something that is so foreign anymore.

And I think because I was so involved in aligning healthcare systems, patients, and developers and trying to help the translation happen between the different stakeholders, I thought, “Well, this is so special and so specific. I’ve gotta get involved with this.” So I became involved with digital therapeutics in 2016 as an advisor, and then in 2017 or 18, I think I became full-time. But it’s just the natural evolution, I think, of where digital health is going. And I think all aspects of digital health, for instance, from telemedicine, which is just online video conference medical visits, all the way through to digital therapeutics, are all valid and all have a place in the system. It’s just a matter of organizing and letting everyone understand how it works and that it’s safe, and that we can protect their data no matter where it is. That kind of thing to make it all work more efficiently, especially for national healthcare systems.

Liv: Yeah. So on that note, then, tell me what excites you most about it, looking forward over the next five or 10 years. What are the things that get you really excited for the future of digital therapeutics and digital health in general?

Jessica: Well, I think only now are the big pharma companies, national healthcare systems, and patients themselves becoming fully aware of these products. So I see over the next five years that countries like Germany have already come up with systems to integrate digital therapeutics into their national healthcare systems. But now France is coming online with their reimbursement and adoption policy and framework. The UK already has one, and it’s becoming more and more inclusive and mainstream.

And so in the next five years, I think it will just be second nature. Actually, things happen pretty fast in digital therapeutics. So, I think that’s fairly easy to predict. But I’m hoping as well, and my big hope here is that the way that digital products, including medicinal products such as drugs and digital therapeutics, are evaluated and regulated will change. Everything has to have clinical evidence, and in order to get this evidence, you have to do clinical studies, and every clinical study has to have an endpoint, if not six endpoints. And those endpoints have been the same for about 50 years. So my big hope is that we can work together as a global community and agree on new endpoints and new ways of evaluating products, and come up with ways to evaluate and assign a value based on new kinds of endpoints and health economic outcomes. Because it’s changing so fast, we need to change the way that things are regulated and evaluated as well.

Liv: And do you think there is an appetite for that now?

Jessica: I think so. I mean, it’s never going to be fast. These health bodies, such as the HDA in Europe and the FDA in the US, are not fast moving, but they’re trying and they’re learning. One of the greatest experiences I had during my time at the Digital Therapeutics Alliance was a gathering of about 10 national HTA bodies around Europe, where we discussed the way they view and evaluate products and shared experiences and best practices. So, I think there’s an appetite and willingness, but everyone is so busy, which is part of the problem. We need to make nine-day weeks or something. (laughs)

Liv: Yeah. Good luck with that! So, one of the things that I talk about a lot on this show is the Sliding Doors movie, or more specifically, pivotal moments that have perhaps shaped your personal life, perhaps that have then gone on to shape your career and your life in general. Do you have a specific moment in time that you consider to be your most pivotal?

Jessica: So, yeah, I was thinking about this. I think my first job out of grad school was quite pivotal, just because I was a naive student and really into the artistic side of bio-visualizations. But going into Washington DC and really seeing how funding could work and the interest and the great emphasis that could be placed on creating new kinds of healthcare technology, that was eye-opening. I was responsible for creating a product which was basically a set of arms, but there were three-dimensional arms, and within each arm, I was building veins and arteries and bones, and mapping the skin on each of these models to make it look like an older person’s arm or a child’s arm or a geriatric arm to be tested with a needle that would then pierce these arms. It was like an IV trainer on how to insert an IV. The whole experience was really eye-opening, and that was just the basic product. From there, it went on to other things like tourniquet placement and surgery. Learning all the pieces that were involved was  very eye-opening.

Liv:  Do you ever wonder about an alternative life you might have lived?

Jessica: Well, it’s funny because I still see a lot of my medical illustration colleagues on LinkedIn and elsewhere. One of them, for example, is a fabulous artist who works out of Denver and creates amazing medical-legal illustrations showing what happened to someone in a car accident, such as which bones broke and why. Another friend creates fantastic animations that explain how coagulation works or how a particular surgery may work. While their work is still in the same genre, it’s a bit far removed from what I’m doing now. It’s nice to think about how things could have been, but I very much enjoy what I’m doing. It’s challenging, and I get to learn every day. One of the reasons I left medical illustration was that it involved sitting behind a computer all day, moving pixels around. While you end up with a beautiful creation, it takes hours and hours of computer work.

Liv: Could you talk to me a little bit about gender balance in digital therapeutics and in the industry? Paul Simms recently posted an interesting piece on LinkedIn about female representation. Before you, I also interviewed Francesca Wuttke, from Nen Health. So another significant female in the digital therapeutics world. I’m interested in your thoughts on female representation in that particular part of the industry. Where do you think we are with that?

Jessica: It’s interesting. I don’t really think of myself as female first. I think of myself as what I do and who I’m surrounded by. I never really looked into the breakdown, but I assume there are probably more males than females in digital because that’s how it has always been. However, it’s probably changing. At my company, we’re in pharma, but we’re 80% female, which is really nice. No one minds, and there’s no imbalance the other way. I don’t feel that I’ve ever had a problem or that I’ve had to state my need as a female to be heard more. I’m quite noisy, which helps. However, being in Spain has been a bit different. This country had a dictator for many years and is only just now catching up to where the rest of Europe has been. There’s still a lot of latent machismo, and one job I had was a bit overt. It was a bit shocking because I did not expect that in the year 2015. It has to be addressed, but you move on regardless. That’s not why I changed jobs, but it was something I had to deal with pretty much every day. I think it’s a global issue, not just in digital or medicine. It’s something I’m aware of, and I don’t take for granted that I have a position and a voice that I feel is equal.

Liv: Do you think it makes a difference working in an organization now that is 80% female? Does it feel different in terms of priorities, culture to a way you’ve worked in other places, or do you think it’s almost irrelevant?

Jessica: I think more than the gender balance, it has more to do with it being a Swedish company. I mean, I think I have only worked in a few countries, well, I mean Spain, Italy, Paraguay, the US and Sweden. And so of all those countries, including the US, Sweden is the most honest and real and genuine. So, I think it has a lot to do with just being Swedish, and it’s not just my colleagues, the entire country is very serious, well-run and they do what they say they’re going to do. And I’m sure there are other things that happen in the country, but it’s been such a good experience in general. So, I think there’s a lot to be said for the way that culture is and there’s a big emphasis. I had to read a book about this. It’s called the Nordic Way of Everything because I was puzzled as to the difference. There was a bit of a cultural difference, but I couldn’t figure out what it was. And it turns out that part of it is just this natural tendency toward consensus and wanting to make sure that you’ve asked all the experts and that you’ve looked at all the options before everyone agrees to move forward. And it doesn’t take a long time. They’re very efficient as well. So, it’s a culture that works well. I think for pharma.

Liv: On a more personal note, talk to me a little bit about how you perceive success versus failure and when you know you’ve achieved success, your thoughts around that.

Jessica: Yeah, I think that’s a great question. One of the things that made me leave the US was this constant need to work, and just because you’re at the office, it doesn’t mean you’re successful. And just because you’ve put in more time than someone else does not mean you’ve had a better life or a more successful one. So, I’ve thought about this a lot, and there are things I miss about the US, but that is not one of them. And I think now what I can define as success for myself is more about having this collaborative energy. So, if there’s a project or there’s an idea that we have, and there’s support behind it, and everyone’s interested and collaborates and moves it forward, to me, that’s success. And if you can see it to the end, even better. So, it’s that sort of momentum and alignment with your colleagues and just feeling progress. That, to me, is success. And if you can get this fabulous result or this product or whatever at the end, even better. But I think the failure, on the other side of that, would be just giving up. So, to me, failure is not that something didn’t work out. Like maybe your test fails or maybe your product has to be redesigned. But to me, the failure is giving up, not the fact that maybe it didn’t work the first time.

Liv: Have there ever been moments in your life when you think you have failed in that way? In those terms that you define it or things that you reflect back on that you wish you’d done differently?

Jessica: I do wish, in a way, that when I was in grad school, my program was two years. I got an MS in medical illustration. Had I stayed, I felt like I could have achieved my MD . So I don’t see it as a failure, but I see it as a missed opportunity. I didn’t want to repeat the first two years I had already done of pathology and physiology and histology, etc. So I just shelved the whole idea. But it was interesting because at the same time, my mother was going through medical school. She’s always been a big role model for me. She passed away some years ago, but she went back to school when she was in her fifties and did it, and it was a monumental effort, especially at that age, to go through the study and then also the residency and so forth in the US, especially as an older woman. And so I didn’t pursue it. And yeah, I wonder what that would’ve meant. But I also see the burden that positions can carry and what she had to work through every day. So, yeah, it’s interesting. I don’t know how things would’ve been different, but I definitely gave up on that idea when it was presented.

Liv: Possibly one of those other pivotal moments that we talked about…  What do you think you’re most proud of, Jess?

Jessica: Well, I think there’s a division maybe between what I’m proud of about work, which is, just being, in some cases, a reference for digital health and digital therapeutics. I mean, I like that role. It’s diminished a bit in the last year or so, just because I’m so much on the international scene, like I was in my previous work. But yeah, also just being in this part of the world. I’m in a little town outside Barcelona, and I’ve been here for about 10 years all told, and it now just really feels like home. That, I think, was an achievement and something that I’m proud of. I have no family here, my partner is here, but he’s from here. So that all took learning two languages and really fitting into a new healthcare system and education system and way of living. Like, I know I can’t have lunch at 12 ever; it doesn’t exist. So, that was something I’m kind of proud of. And I’m here to stay. I’m not going to be going back to the US at all.

Liv: So, that leads me on very nicely to my next question for you: What do you think is next for you?

Jessica: So, I don’t know. I think I will be here, but I’m also very mobile. Like, what I love about what happened during COVID is that suddenly everyone’s very aware of how mobile we can all be. Even if you’re at home, you can still interact with groups and organisations, overseas, wherever. So I’m actually defending my PhD thesis this Friday, and when that is done, my plan is to start teaching seminars on digital medicine, wherever it seems interesting. And I’ve had one conversation already with the university. So, I hope that can be a bit more of a percentage of my time moving forward, to start sharing experiences and seeing also what new medical school students see as their role with digital medicine in the future. I also see myself cycling the Canary Islands, so I think that’s definitely on the radar.

Liv: Just chuck that in there! (laughs)

Jessica: Exactly! I’ve got to have those moments too.

Liv: So, on the topic of teaching and paying it forward, is mentoring these new students coming into digital therapeutics something that has helped you through the years and that you want to continue?

Jessica: Yeah, I’m happy to teach when I can. I think in a sense, though, if you teach full-time, you’re no longer in the industry, and you kind of lose sight of what’s current. And so there’s a balance there. And I think I’ve had exceptional luck in having an amazing advisor for my doctoral work. In fact, the whole reason I did a PhD was upon her suggestion. And this all happened when I was working at the Bellvitge Hospital here in Barcelona with the interstitial lung disease department. We were working on a project just looking at a survey of patients with this certain disease, and she said, “Well, you could do a PhD on this.” And I thought, “Whoa, really?” And so I just didn’t really believe it, but she supported me and showed me what’s required and that it wasn’t so unapproachable. And also, her junior staff were amazing with helping me just look at how to utilise data and where the data could come from. It’s in great part to her and the support of that institution that I could do this. So I definitely want to be able to help in that way, but I don’t know… those are big shoes to fill.

Liv: I think being someone that is knowledgeable and passionate is inspiring in itself, so I’m pretty sure those shoes will be a comfortable fit for you.

The last question I have for you is what advice would you go back and give your younger self if you could?

Jessica: Yeah, that’s a great question.  I think about this because when I was in high school looking at what to do for university, and you know, my parents were the type that said, “Okay, university’s up to you. You can go where you want, but you’re paying for it.” In the US, that’s kind of a daunting proposition! But off I went and studied art of all things, of course, and they didn’t say a word, so in the end, it was art, it was art biology. I kind of wish that I had focused a bit more on chemistry and engineering just because now, I mean, unrelated to my work at present, but now what I see is really interesting is the idea of being a water desalination engineer. So I really wish I knew more about that! It sounds flippant, but they’re both areas I really do wish I knew more about, and people ask me now, what could I study to get into pharma or what would be useful going forward? There is actually a worthwhile effort looking into regulatory processes and the legal side of healthcare policy. So it may sound dry, but I think it’s so important, so anyone asking me, I would say, chemical engineering or healthcare regulation.

Liv: And what about women in the industry more generally? What advice would you give?

Jessica: Describing what you do is important because people may think that when they hear the word digital, everything is easy and automatic, but it really is not. And that’s taken a long time to get understood. But yeah, I think having a voice and not selling yourself short is so important, especially as a woman in this industry. So, I really appreciate the existence of this podcast and being able to showcase different perspectives, especially women in the field.

Liv: From my perspective, I’m keen to get that female representation, that voice volume turned up loud. So, I hugely appreciate you coming on, and I would love to hear you speak more about this area because we’ve focused very much on you personally. I would love to hear more about your thoughts on digital therapeutics in the industry in general. A huge thank you for coming onto the show. It has been an absolute pleasure to get to know you, so thank you.

Jessica: Thank you, Liv