Why Instacart’s new CEO is also launching a women’s health startup

Fidji Simo knows firsthand how difficult it is for women to have their health concerns taken seriously.

Instacart’s new CEO has been afflicted by common women’s health problems for most of her life—and for most of that time, she’s been fighting to make doctors listen to her. As a teenager, Simo started experiencing the symptoms of endometriosis, the gynecological-tissue disorder that affects one in every 10 women and often first manifests as period pain. But it took her until age 29—after a miscarriage, and more than a decade of doctor’s visits—to get her symptoms actually diagnosed.

“Women are told at a very young age that atrocious pain during a period is completely normal and you just have to suck it up,” says Simo, who is profiled in the October issue of Fortune. “Whereas, if any man had the pain of endometriosis, we would have solved it by now!”

Today she aims to be part of that solution. For the past year, as she oversaw Facebook’s flagship app and then made the jump to Instacart this summer, Simo has been quietly helping get a new women’s health startup off the ground. The Metrodora Institute, a for-profit clinic with a nonprofit foundation devoted to research and advocacy, is expected to open in Salt Lake City next summer. Its stated mission is to advance women’s health equity, with a focus on treating people with what its founders call “complex neuroimmune disorders.”

Those include endometriosis, migraines, chronic fatigue syndrome, and another condition that Simo now suffers from: POTS, or postural orthostatic tachycardia syndrome. It’s a lesser-known disorder involving the autonomic nervous system, which regulates blood circulation, heart rate, and gastrointestinal functions, and which often makes it difficult to stand up for long periods of time. POTS affects up to 3 million people in the United States, 80% of whom are women. Early symptoms include fatigue, nausea, or lightheadedness—but, as Simo experienced when she started trying to get a diagnosis, doctors often dismiss these ailments as just the inevitable consequences of being female.

“I was fainting constantly, I was feeling weak, and I went to see this neurologist. He said, ‘Sweetie, you’re just a tired mom,’” Simo recalls. “It was infuriating.”

That’s an experience that will sound all too common to many women attempting to navigate the health care system, as study after study (and endless lived experiences) has shown. “There’s a lot of stigma and dismissal of these complex disorders that affect women,” says Dr. Laura A. Pace, Metrodora’s CEO and cofounder.

People suffering from these autoimmune disorders are “much more likely to be told that they have a mental health condition” than to have a doctor “really look at what the biological basis [of their complaint] is,” adds Pace, a neurogastroenterologist who studies rare diseases and who was previously an assistant professor at the University of Utah’s School of Medicine.

Laura Pace horizontal
“There’s a lot of stigma and dismissal of these complex disorders that affect women,” says Dr. Laura A. Pace, Metrodora’s CEO and cofounder.
Courtesy of Courtney McOmber

Simo ditched the doctor who told her she was just tired, and eventually wound up at the Mayo Clinic. There, she found a physician who was able to diagnose her POTS—and who advised her on what she could do to make a bigger difference for others with the disease. “It was so stunning that there was very little research and very low funding” for “rare” conditions like POTS, which still affect millions of people, Simo recalls.  

The Mayo Clinic physician introduced Simo to Pace, who wanted to start a practice that would take a more holistic approach to treating complex diseases, instead of expecting patients to rely on a patchwork of different specialists concentrating on different symptoms. “Women’s health for a long time has really just focused on reproductive health,” says Pace. “For women, a lot of our primary care physicians are actually our gynecologists, and they actually aren’t trained to really be thinking about the whole system. The same doesn’t happen for men.”

Simo agreed to join forces with Pace and Pace’s husband and cofounder, James Hemp, a former research associate at the University of Utah and now Metrodora’s chief scientific officer. Over the past year—while she was overseeing a 6,000-person team for Facebook, joining Instacart’s board, and eventually taking over the grocery-delivery startup—Simo spent her weekends figuring out how to get a new health care business off the ground. She hired a Stanford University grad student to tutor her in biology; she set up meetings with Silicon Valley biotech investors and entrepreneurs; and she’s helped raise more than $15 million in grants and private funding. Simo also recruited two high-profile members for the Metrodora foundation’s board, which she will chair: Anthony Philippakis, the chief data officer at the Broad Institute of MIT and Harvard; and Carol Suh, partner at biotech-focused VC firm ARCH Venture Partners. (Nor did Simo’s day jobs suffer, her colleagues say: “Her work ethic is off the charts,” notes Instacart founder and now–executive chairman Apoorva Mehta.)

Now Simo and her cofounders have lined up four more physicians and one clinician to join their startup. They have also leased two floors of a building in Salt Lake City for Metrodora’s clinic and headquarters. Pace, who was already based in Utah, says that Metrodora wanted to be in between the coasts and close to a large airport, so that the clinic would be physically accessible to as many patients as possible across the nation. The startup, which will also research cures for long COVID, has a potential clientele of more than 20 million people who suffer from its target neuroimmune disorders, the founders say.

Whether it can treat all of those potential patients—and provide more equitable care to women of all races—is another question. A for-profit clinic based in Utah, which will require most of its patients to travel for treatment, risks serving only wealthy women with disposable income and access to high-quality health care. “Not everybody’s going to be able to afford to come see us,” Pace acknowledges. “So we’re going to have a huge telehealth component.”

Metrodora will also accept “as many insurance plans as possible,” unlike some specialist clinics that don’t accept insurance and only provide concierge medicine, she adds. And Metrodora is setting up payment plans to allow patients to pay for their care over time, “because we understand that the cost burden to some of these families is astronomical,” says Pace.

The startup is named for a fifth-century Greek physician credited with authoring the first known medical text written by a woman: On the Diseases and Cures of Women. (Simo’s company shares a namesake but no other ties with Chelsea Clinton’s venture capital firm, Metrodora Ventures.)

The clinic will operate as a for-profit, but Metrodora will also have a nonprofit foundation to pursue its research and advocacy. Simo, until this summer the most senior female product executive at Facebook, is taking a decidedly Silicon Valley approach to these operations: Patients can opt into sharing their medical data with Metrodora’s “biobank,” which the clinic’s software engineers will analyze to look for patterns in the data. Metrodora also intends to share this data with academic researchers and potential biotech partners working to study, prevent, and cure these diseases.

For Simo, the ultimate goal is both big-picture and deeply personal: “It’s giving the industry a blueprint for how women should be treated in the medical world,” she says. “If you start believing women, and you start believing that they’re not crazy every time they say they have pain somewhere, you can improve health outcomes.”

But, she acknowledged during an August interview, she also wants to help her 6-year-old daughter avoid some of the pain she’s suffered. It’s unclear whether POTS is hereditary, although it often runs in families—and Simo doesn’t want to take any chances. Its symptoms usually start manifesting in teenagers, so Simo is giving herself a hard deadline of 10 years for Metrodora to succeed.

“For me, personally, it’s very simple,” she says. “It’s finding a cure before my daughter develops it.”

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Fidji Simo is one of the rising star execs on Fortune’s 2021 40 Under 40 and Most Powerful Women: Ones to Watch lists.

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