Taiwan has played a role in two recent developments related to advancing the cause of women’s health and well-being.
Systemic Lupus Erythematosus, more commonly known as SLE or lupus, is a chronic autoimmune disease that disproportionately affects women. More than 90% of its sufferers are female, making the disease very much a women’s issue.
This writer has had a deeply personal interest in the impact of lupus. My best friend Kelly was diagnosed with the disease in 2007. Over the last decade she’s taken several drugs to fight the disease, including chemotherapy.
Recently the multinational pharmaceutical giant GlaxoSmithKline (GSK) developed an innovative biologic drug to help relieve the difficulties of lupus sufferers. The company also saw the need to consider the best means of administering the drug to the patient through injection. To relieve patients of the inconvenience of frequent trips to the doctor’s office or hospital for treatment, GSK wished to enable them to inject the drug themselves.
The challenge was that lupus frequently affects a patient’s manual dexterity, making it difficult for her to use a conventional device for the injection. A solution was found when GSK approached a Taiwan-based medical device company (which asked not to be mentioned by name due to corporate policy), which came up with a radically different, easy-to-use subcutaneous injection kit.
During an interview at GSK Taiwan, Dr. Chris Shih, the company’s medical director, sought to explain, in laypersons’ terms, how the disease affects the body, and specifically how the new drug works. Essentially, when someone has lupus, the immune system does not behave normally. Instead it becomes hyperactive, attacking healthy organs and tissues in the body. The cause is unclear, but genetics and environmental factors are believed to play a role.
Since SLE can attack any system in the body, people suffering from it can experience a range of symptoms from mild to severe. Symptoms can include fatigue, mouth ulcers, joint pain sometimes manifesting in arthritis, inflammation, poor blood circulation, low white blood cell count, and even organ failure. A butterfly-shaped rash across the nose and cheeks is associated with the disease, although not everyone with SLE will develop such a rash.
Systemic Lupus Erythematosus has no cure, and those diagnosed with it face a lowered life expectancy. That being said, the disease can be treated in multiple ways, usually focusing on managing symptoms to improve the patient’s quality of life through the use of immunosuppressant drugs, chemotherapy, and anti-inflammatory agents like corticosteroids.
GSK was already manufacturing lupus medication but in recent years it engaged in research to find new treatment options, looking specifically at drugs derived from biological sources. These biologics often need to be delivered via injection, and GSK evolved this procedure into one involving subcutaneous (SC) injection – administered under the skin rather than into the bloodstream as with intravenous (IV) injection.
SC injection allows the medication to be absorbed more slowly. It also enables the patient to inject themselves after appropriate training. Self-injection of medicine is common among those with diabetes or with women receiving infertility treatments.
The special drug delivery device developed in Taiwan has an ergonomic design with smooth corners. The injector is small – the size of a lipstick tube – and can fit easily in the palm of the hand or be conveniently carried in a purse. This delivery device is currently exclusive to GSK’s lupus biologic drug, but there is potential for more drugs to work with it in the future.
People with lupus typically undergo a standard of care involving immunosuppressants and use of corticosteroids to treat inflammation. Standard immunosuppressants suppress the entire immune system, making the patient fragile. GSK’s biologic drug is considered a supplemental treatment. More precise than the traditional drugs, it focuses on the areas of the body where the lupus is attacking and requires lower dosages. Clinical trials have shown that patients using this new drug have seen a reduction in disease activity; others have seen a reduction in side effects common with their traditional lupus medications.
According to GSK, the product with the new subcutaneous injection kit is already being marketed in the United States. In Taiwan, the drug is available with conventional IV injection, which normally requires a hospital stay, but is not yet reimbursed under National Health Insurance. As a large portion of those with lupus are young women, there is concern that the higher price of this drug could impede access to it.
Despite these hurdles, the hope is that this new drug and delivery system will greatly improve the quality of life for those living with lupus, in Taiwan and worldwide. Perhaps even for my friend Kelly.
Creation of the Formoonsa Cup
At the 2017 Taiwan International Beauty and Industry Forum last September, the Taipei World Trade Center was full of stands exhibiting makeup, skin and hair care products, and much more. Numerous booths were selling only eyelash extensions in a seemingly endless variety of colors. Of the 133 booths, one vendor stood out – Salonmates Industrial Co., Ltd., whose founder, Vanessa Tseng, is a young entrepreneur who is changing the way Taiwanese women view their healthcare. The stand is notable for its array of bright colors and cheery fabric designs.
The company’s newest product, the Formoonsa Cup – which Tseng describes as a starter kit designed for younger women who are curious about reusable menstruation products but may be “too timid to try them” – is the centerpiece of the booth and attracts questions from curious onlookers. Tseng hands a visitor a light green box with a charming image on the front: a girl peeking out of a red flower. The words “Formoonsa Cup” appear above her head in Chinese and English.
The kit, decorated with a whimsical variety of cartoon flowers on the inside cover, contains a standard sized cup, a smaller trainer cup, reusable menstruation pad, and small travel bag. The fabric for the bag and pad features designs of happy looking hedgehogs. Though the kit comes with instructions in Chinese, there’s a QR code on the box that, when scanned, provides instructions in English. For women not needing a starter kit, the Formoonsa Cup comes in standard and large sizes.
Salonmates specializes in women’s health products. It was the first in Taiwan to sell tampons with applicators. In 2015 Tseng Googled “menstrual cup” and was intrigued by the concept of a reusable menstruation product. But the utilitarian design of the cups dismayed her. “Why do medical devices have to be unattractive?” she asked herself. Though Tseng was interested in marketing the cups, she knew she didn’t want to be an agent for an existing company, and so decided to design her own products.
At first she was unable to offer the cups on her website as only a selected group of medical devices were legally allowed to be sold online. Convinced of their safety, Tseng launched an online petition that quickly garnered enough signatures to require a government response. After studying the issue, the authorities gave persmission for online sales. She also convinced the government to waive the need for expensive clinical trials since the cup had been safely manufactured and sold elsewhere.
Then came the challenge of financing the venture. Unable to get a loan to begin manufacturing the devices, Tseng again turned for help online. Her proposal to crowdfund her business plan reached its financial goal in just three days.
Salonmates was the first, and is currently the only, company to manufacture reusable menstruation cups in Taiwan. Formoonsa cups are manufactured at precision molding factories and are made of 100% medical-grade silicone.
Education is also a vital part of Tseng’s mission. She regularly visits universities around Taiwan to teach younger women about menstruation and the many options available to them. During her two-hour lecture, she lets students touch various menstruation products to destigmatize them and to emphasize the products’ safety. To date, she has taught her women’s health class to 8,000 women.
Beliefs about menstruation are changing, Tseng notes. While only 2% of Taiwanese women regularly use tampons, the proportion is 35% for college-aged females.
Tseng intentionally designed the Formoonsa Cup and its packaging to appeal to young women. The cup itself stands apart from other reusable menstruation cups on the market with its flower shape. Determined to create an attractive device, she hired illustrator W.Y. Cloudie Chang to create the design, telling her to “make it pretty.” The artist painted a lily of the valley flower icon and presented her with two options – one in red and one in yellow.
Advised to choose yellow to downplay that her product dealt with menstruation, Tseng instead chose red because she liked the forthrightness. “I didn’t want the safe choice,” she says. By taking risks and producing something new, she has not only created a successful business but is also making a positive impact on Taiwanese society.
Formoonsa Cups can be bought at Cosmed or ordered online.