Latecomer to science brings a woman’s insight to cure most common health issue

Life could have been quite different for Ruth Maher. She might now be edging toward retirement from the Electricity Supply Board (ESB). Instead, she changed her career focus and country of residence to scratch the science itch that had lurked since school. It has culminated in a series of academic achievements and at least one commercial success – a medical device that treats a condition which affects more women than hay fever.

It was curiosity that pushed Prof Maher into the world of science and physiotherapy. Not uniquely back in the last 1970s, her girls’ secondary school did not offer the choice to study science. But when opportunity beckoned in her 30s in America, she grabbed it and has since proved how accurate her instinct was all along.

And a chance meeting with the dean of physiotherapy at UCD Brian Caulfield, at a conference gave her the opening to develop a device that has potential to help millions of women worldwide. Her unique use of ultrasound to look into stress urinary incontinence (SUI) was remarked upon at the conference and she was invited out to UCD.

There, in the space of a week around 2008, Maher developed what is now called Innovo, a non-invasive, long-lasting solution to bladder weakness and other disorders associated with pelvic floor muscle problems that this year won the Irish Times Innovation of the Year award.

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The device is similar in style and feel to a pair of cycling shorts and works by strengthening and rebuilding the pelvic floor muscles. It works through electrodes that sit on the front and back of the thighs into which pulse patterns are sent via a programmable handheld device.

One in three women suffers from SUI. In addition to having to live with the condition, most women don’t talk about it. According to Maher, 25 per cent of women wait seven years before speaking to a clinician while 75 per cent don’t take any action at all. Maher also noted that activity levels fall for women in this group, leading to weight gain and issues with self-esteem and confidence.

“If it was a man’s problem and you were a golfer and you leaked every time you hit the golf ball, you wouldn’t be playing much golf,” said Maher, adding that, these women almost feel obliged to reverse into their shell to ensure their life is modified as best as it can be to avoid leaking.

The problem isn’t limited to women post-childbirth or to inactive women. Men too can use the device to treat urinary incontinence – typically following prostate surgery.

And Maher’s product targets another niche – female army paratroopers. When they land, their pelvic floor muscles aren’t strong enough to avoid leaking and, by consequence, they limit their fluid intake.

Describing the problem, Maher turns to an analogy. “It’s like a sprinter coming out of the blocks. Those muscles have to come on when you cough or sneeze or bend over.”

Widespread as it is, how did Maher manage to get interested in the field of SUI given its relative lack of publicity?

“I just wanted to stop women leaking in their pants. A lot of my friends had it and I’d seen lives and relationships ruined. The other thing that’s important to know is that 63 per cent of these women are leaking during sex. So it ruins intimacy and it ruins relationships and they’re depressed.”

Armed with the knowledge of the problems SUI causes, Maher set about developing a solution. The only competitor product currently on the market is a vaginal probe which Maher described as “hideous” and “very uncomfortable”. Consumer compliance with those devices was also very low because of the discomfort, meaning that many women weren’t being successfully treated.

Knowing there was a better way to do it, Maher moved to validate her research.

A study in UCD brought together a set of women, healthy other than the fact they suffered from SUI. The study required them to fill their bladder and then exercise, doing jumping jacks. The pads they were wearing would be examined to determine the severity of the leakage. Anything above two grams of leakage is considered stress incontinence. And the range is quite large. Some women can lose “their whole bladder when they cough or sneeze”.

But the extent of the loss doesn’t really matter, Maher says. “Most women are in the mild or moderate category but it doesn’t matter if they’re leaking, it just matters that they’re leaking. You can’t even have a good belly laugh.”

During the eight-week validation study, women had to use the device four times a week for 30 minutes. After the very first treatment, Maher started to see results, although they weren’t terribly significant initially. After four weeks, the trial had an 86 per cent cure rate and after eight weeks there was a 96 per cent cure rate.

One woman told her this was like “winning the lottery”. “I don’t have to carry big pads, I can wear white jeans again, I can wear nice clothes and I don’t have to plan my visits to know where all the bathrooms are,” the woman said.

Green card

From Dublin, Maher graduated from secondary school in 1980. The school didn't teach science so she wasn't able to pursue her interest at that point. Instead she joined the ESB, working across a variety of positions. In 1995, Maher was seconded to the World Bank in Uganda.

It was at that time that, along with her husband, she learned she had been successful in securing a green card to legally live and work in the US after years of applying. The decision to leave the ESB was essentially made overnight.

“My friends were saying ‘are you mad, you’re in a pensionable job’ and I said ‘I’m not happy, I’m not doing what I want to do’. I had an itch that wouldn’t go away . . . I was always interested in the body and anatomy.”

Her love of science had really started with a love of sports. Maher represented Ireland in the javelin, played soccer and did powerlifting.

Even when she and her husband received their green cards, the initial plan wasn't to pursue science but to work for utility company Georgia Power upon moving to Atlanta. But Maher stumbled into Georgia State University and saw an ad for a physical therapy course. That very day, Maher got an academic adviser.

She subsequently rifled through her undergraduate degree in two and a half years – all made possible, ironically, to the financial payout from taking “early retirement from the ESB”, at the age of 33. She never did work for Georgia Power in the end.

After graduation, Maher completed a full-time three-year programme in physiotherapy. She worked in hospitals and acute care centres as well as with some footballers and WWE wrestlers. She quickly discovered she didn’t want to work with sports people who “got so much of everything”.

Instead, she started treating people with back pain and started teaching women how to do exercise to avoid leaking. That was when she discovered SUI.

Soon after, she knew she wanted to learn more about the condition and enrolled in a clinical doctorate with Simmons University in Boston from where she would do her work remotely. She also opened a practice focusing on pelvic floor dysfunction and pelvic pain.

Ageism

But around 2007 she got a bit homesick and she and her husband returned to Ireland. Maher didn’t manage to break into academia as a career in Ireland but she did pursue another doctorate, this time with UCD. Still, academia was nagging at her and that, coupled with the prospect of high rents and the inability to get a mortgage on account of her age, pushed her and her husband back towards the US.

“I found it difficult to settle back in, Ireland had changed a lot . . . I found things moved too slowly here, it took too long even to get a phone in my practice,” she says.

The decision was made easier by the speed at which things operate in the US . She applied online for a mortgage from Wells Fargo and almost instantly got one having never gone near the bank. "There's no ageism [in the US], I think there's blatant ageism here," she said. Her quality of life, too, is better. "You'd want to see the house we got for $290,000. It's 3,600sq ft (335sq m), three storeys and detached . . . I can focus on the things I love and not worry about bills."

Shortly after moving back to the US, Maher got a call advising her that Bio-Medical Research Limited (BMR), a company based in Co Galway which developed the Slendertone, wanted to commercialise her device.

The company created to ultimately bring the device to market was Atlantic Therapeutics, which was eventually spun out of BMR with about €15 million in growth capital financing. Investors include venture capital firms Seroba Life Sciences and Earlybird Venture Capital. Atlantic also received a loan from Silicon Valley Bank. Earlier this year, it raised an additional €28 million.

But first there was a period of inaction. Maher had given up on it. Then, Steve Atkinson, chief executive of Atlantic Therapeutics, called her and started the project in motion again. She went over to a design company in England to get the product designed into shorts and Innovo was cleared in Europe in 2011.

The US Food and Drug Administration cleared it in November 2018 and it will soon be available for sale over the counter there, an important milestone given the way the US healthcare system works. Maher describes the US system as a “wealthcare system” that isn’t patient focused.

Maher avoids the money side, but the business case for her product is clear. The product sells for $479 in America where a supply of pads for one year alone can cost up to $600. That’s not to mention the other side effects of SUI. In Ireland, an Innovo starter kit is priced at €399.

For herself, Maher as inventor receives royalties for each device sold but the intellectual property for the device rests with UCD, which licenses it to Atlantic Therapeutics. It is not an unusual position when working with universities that have the financial clout to spend money on intellectual property lawyers.

She serves as a clinical adviser to Atlantic Therapeutics but is not an executive of the company. Nor is she a shareholder.

Her device isn’t limited to just helping those with SUI. Prolapse and faecal incontinence are two other treatable conditions. Bizarre as it may seem, Maher seems to get quite a lot of joy talking about varieties of incontinence. “I do because there’s hope for them,” she says when I put this to her.

Appointed professor at Philadelphia College of Osteopathic Medicine, Maher is not resting on her laurels. Her device can bring its users no shortage of relief but Maher is now busy tinkering with new inventions from her US home while working in academia. She describes herself as "implicitly happy".

And at a time when career could have been winding down had she stayed with the ESB, Maher appears to be just getting started. “My husband says I’ll never retire and he’s right. I love my job.”

CV

Name: Prof Ruth Maher

Age: 57

Position: Professor at the Philadelphia College of Osteopathic Medicine and clinical adviser to Atlantic Therapeutics.

Lives: From Dublin, she is living in Atlanta, Georgia.

Something you might expect: Maher is a sports nut, having represented Ireland in the javelin. She's a season ticket holder for "major league" rugby franchise in Atlanta – Rugby ATL – and supports Chelsea in soccer.

Something that might surprise: Although her recent past has been full of academia, Maher never felt stimulated at all in school. She wanted to go to Mount Temple in Clontarf, which had a science lab, but her mother wouldn't let her because it was mixed and non-denominational. She told Maher that she'd be distracted all the time. "So I was stuck with the Holy Faith sisters in Killester. Three honours is what I got in my Leaving cert. I hated it to be honest," she said.

QUOTES:

“If it was a man’s problem and you were a golfer and you leaked every time you hit the golf ball, you wouldn’t be playing much golf.”

“There’s no ageism [in the US], I think there’s blatant ageism here.”

“I just wanted to stop women leaking in their pants. A lot of my friends had it and I’d seen lives and relationships ruined.”

“It ruins intimacy and it ruins relationships and they’re depressed.”

“It just matters that they’re leaking. You can’t even have a good belly laugh.”

“I don’t have to plan my visits to know where all the bathrooms are” - patient.

“I found it difficult to settle back in, Ireland had changed a lot...”