Nurx: breaking down barriers to women's healthcare
Digital healthcare company Nurx started out providing birth control delivery, and has since evolved into a women's health network.
When Nurx was launched in December 2015, co-founders Dr. Edvard Engesaeth and Hans Gangeskar had the goal of eliminating barriers to essential healthcare, starting with reproductive health.
The platform connects patients, healthcare providers, and pharmacies, helping Nurx to offer personalised care efficiently. Providers are able to see the patient's health history on the platform, so that when they are asked questions via the messaging system they have contextual information.
After the initial success of their birth control service, Nurx started prescribing and delivering PrEP - medication to prevent people at risk of HIV from becoming infected - so that patients could complete the blood work required to get and stay on PrEP without going to a lab.
"From there we began offering home testing for sexually transmitted infections and home cervical cancer screening, followed by herpes treatment" explains CEO Varsha Rao. "We launched migraine treatment last fall because so many of our existing patients suffer from migraines, and we learned that the pandemic was making it worse due to stress and extra screen time."
Care tailored to women
Migraines disproportionately impact women and are often caused by hormones. Given Nurx medical team's expertise in hormones, this seemed like a natural evolution from the care they were already providing.
The same applies to acne and so-called 'maskne', acne that appears when people wear masks wrapped tightly around their face for long periods of time. Nurx began offering acne treatment in March 2021.
Rao explains that health conditions such as these, that particularly affect women, can be served especially well by telemedicine. "Women too often face barriers when trying to access healthcare, and that’s especially true of reproductive health needs" she says.
"Many in-person providers won’t prescribe birth control without a check-up or well woman visit, which can be quite expensive without insurance and in most cases is clinically unnecessary. If medically appropriate, Nurx allows women to get only the care they need at that time — whether that’s a prescription, STI testing, or cervical cancer screening via the HPV home tests recommended for women over 30."
Breaking down barriers
Aside from cost, women can also face logistical and geographical barriers. "Studies show it takes an average of 24 days to get an in-person appointment, and the appointment itself can take two hours when you factor in transportation and wait time" Rao says. "This may be simply too long for women who don’t have paid time away from work or have childcare needs. When it comes to birth control specifically, more than 19 million women in need in the US live in contraceptive deserts, and around 1.5 million live in a county without a single health centre offering the full range of birth control methods."
Additionally there can be huge barriers in terms of shame or stigma. "If you live in a small town, the doctor or pharmacist could be somebody you know from school or church. We’ve heard from many Nurx patients that, in the past, medical providers have questioned their need for birth control or have shamed them for having sex or not wanting to get pregnant.
"Nurx can break down all of these barriers" Rao says. "There’s no need to make an appointment. Women can access care any time and asynchronous telehealth allows them to message back and forth with a medical provider in a low-pressure way, by asking a question whenever it occurs to them. Nurx helps by making healthcare affordable, with transparent out-of-pocket pricing for medication, low medical consult fees, and no added costs like transportation, parking or childcare.
"Many contraceptive deserts are in Southern states like Texas and Alabama, and 40% of Nurx patients live in the South, so we hope that by creating access to healthcare from anywhere it is helping the people who need it most."
Long haul Covid, the brain and digital therapies
It is estimated that around 10% of people who get Covid-19 develop long haul Covid, a debilitating condition that can last many months and cause breathlessness, exhaustion and pain.
Research is underway to find out who is more likely to get it and how to treat it. Here neuroplasticity expert and owner of Harley Street Solutions in London Ashok Gupta tells us how the condition affects the brain.
What is long Covid exactly?
Long Covid is when patients who have experienced Covid-19 go on to have continuing symptoms for weeks and months afterwards. These symptoms can include breathlessness, exhaustion, brain fog, gastric issues, pain, and post-exertional malaise. It is estimated that around 10% of Covid-19 infections may result in developing long haul symptoms, and in the USA, this may be affecting over 3 million people.
How does it affect the brain?
Here at our clinic, we hypothesise that it is due to a malfunction in the unconscious brain, creating a conditioned response that keeps the body in a hyper-aroused state of defensiveness. At the core of this hypothesis is the idea that we are here because our nervous system and immune system have evolved to survive. We are survival machines!
When we encounter something such as Covid-19, the brain perceives it as life threatening, and rightly so. And in the era of the pandemic, with more stress, anxiety and social isolation, our immunity may be compromised, and therefore it may take longer for the immune system to fight off the virus and recover.
If the brain makes the decision that this is potentially life threatening and we get to the stage where we’re overcoming the virus, a legacy is left in the brain; it keeps over-responding to anything that reminds us of the virus. Even if we’ve fought off the virus, the brain will react in a precautionary way to stimuli reminiscent of the virus.
The brain may get stuck in that overprotective response, and keeps stimulating our nervous system and our immune system, just in case the virus may still be present.
What symptoms does this cause?
These signals cause a cascade of symptoms including breathlessness, extreme fatigue, brain fog, loss of taste or smell, headaches, and many others. And these are caused by our own immunes system.
In the case of long-haul Covid, symptoms in the body get detected by a hypersensitive brain which thinks we’re still in danger. The brain then chronically stimulates the immune and nervous systems, and then we have a continuation of a chronic set of symptoms.
This isn’t unique to long-haul Covid. Many patients develop chronic fatigue syndrome, sometimes known as “ME”, for example, after the flu, a stomach bug, or respiratory illness. Covid-19 may be a severe trigger of a form of chronic fatigue syndrome or ME.
How does long-haul Covid affect mental health?
Anxiety is a very common symptom in long haulers. It can be frightening to wonder about what may be happening in your body, and what the prognosis is going to be for one’s long term health. Reaching out for support for mental health is crucial for long-haulers.
How does neuroplasticity treatment work for long-haul COVID patients?
We have been working with patients for two decades with a brain retraining programme using neuroplasticity or “limbic retraining.”
We believe that through neural rewiring, the brain can be “persuaded” that we are no longer in danger and to come back to homeostasis. But to be very clear, we are not saying it is psychological in any way, but we believe there are novel ways of accessing the unconscious brain.
We recently worked successfully with a 56-year-old male with long-haul Covid, who prior to contracting Covid-19 in March of 2020 was running half-marathons and cycling, but afterwards he struggled to get off the sofa for months. Within 3 months he’s now back to 100% and running half marathons again.
At our clinic, we train the patient to be able to recognise those subtle unconscious danger signals on the periphery of consciousness. This, coupled with supportive techniques and the natural hallmarks of good health such as sleep and diet help prepare the patient to respond to perceived threats that might trigger the response.
The natural state of our brain is to default to protection. The brain prioritises survival and passing on our genes to the next generation, over any other impulse. It cares more about that than you feeling healthy and well. Protective responses are evolutionary, and are the right thing for the brain to do – it’s survival.
What digital therapies or apps are proving effective at treating long-haul Covid?
It seems that long haul patients are availing themselves of many online therapies and services, including meditation apps and wellness websites. We have an online neuroplasticity “brain retraining” video course called the “Gupta Program” which hosts 15 interactive videos and many audio exercises. This is proving very popular with long haul patients, and we are currently conducting a trial to test the effectiveness of this therapy.
What is the danger of leaving long-haul Covid untreated?
The longer it goes untreated, we hypothesise that it may become more entrenched in the brain, and become chronic in the longer term. Therefore we advise all patients to get help and advice as soon as possible.