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Why The Five & One?
Health doesn’t fail women because of a lack of information. It fails because care systems are slow to change, unevenly designed, and rarely built with women’s bodies, lives, or timelines in mind. The Five & One exists to make those systems visible.
Each week, we surface five signals shaping women’s health right now — across care delivery, policy, research, and access — plus one deeper thread worth spending more time with. Not trends. Not tips. The forces that determine what care women can actually get, and when.
In this issue, we examine why iron deficiency is still treated with outdated defaults, how insurance design can block care even when the science is clear, and why a quiet regulatory shift could accelerate osteoporosis treatment. We also look at what changing GLP-1 access means for patients, and close with a deeper look at brain health — and why attention needs to start long before diagnosis
One final note: lifetime membership enrollment closes tomorrow. Lifetime members lock in permanent access to benefits, events, and everything we’re building as this community grows.
01. Iron Deficiency, Treatment Gaps, And A Shift In Care
Estimates vary, but up to one-third of U.S. women are affected by iron deficiency. If you follow 51& Founder and CEO Jodi Neuhauser on LinkedIn, she recently shared her personal experience treating iron deficiency in the U.S. versus abroad. Her conclusion — that IV iron replacement was easier, faster, and more effective than oral supplements for her condition — reflects a growing body of evidence suggesting the U.S. approach is falling short.
The breakdown
Oral iron supplements remain the default treatment, even when patients don’t tolerate them or absorb them well.
Patients are often told to try pills for months before moving to other options, even when labs and symptoms clearly show severe deficiency.
Side effects from oral iron drive nonadherence, reducing effectiveness and prolonging symptoms like fatigue, hair loss, and shortness of breath.
IV iron requires infusion centers, insurance approval, and upfront costs, creating access barriers for patients without strong coverage or nearby care.
The breakthrough
IV iron bypasses the gut and restores iron levels in weeks rather than months, which is critical for women with absorption issues or ongoing iron loss.
Newer IV iron formulations are safer than older versions and avoid the gastrointestinal side effects that often derail oral treatment.
Because IV iron works faster and more reliably, early studies suggest it may reduce repeat visits, prolonged symptoms, and overall cost over time.
02. When Care Is Blocked By Design, Not Medical Judgment
Many people assume that if a safer or lower-cost option exists, insurers will support it. But as Dr. Elisabeth Potter, a plastic surgeon specializing in breast reconstruction, has shown through her public dispute with UnitedHealth Group, insurer contracting decisions — not clinical judgment — often determine where and how patients receive care.
The breakdown
Insurers control access through network status and prior authorization, often overriding clinical judgment.
High-quality, specialized surgery centers can be excluded from networks despite strong outcomes.
Delays and denials shift the burden onto patients and providers to navigate appeals and uncertainty.
The breakthrough
Dr. Elisabeth Potter’s public advocacy pushed insurer contracting decisions into the national spotlight.
Her case reached Congress, prompting direct questioning of UnitedHealth Group’s CEO and putting insurer contracting practices on the public record.
03. Osteoporosis And Why Research Regulation Matters
Osteoporosis affects millions of women, yet treatment innovation has lagged for decades. One major reason isn’t a lack of science — it’s how slowly new drugs have been allowed to move through the regulatory system. A recent change by the U.S. Food and Drug Administration could help close that gap by aligning regulation with existing evidence.
The breakdown
Osteoporosis trials have required years of follow-up while waiting for fractures to occur, slowing drug development and discouraging innovation.
Hip fractures remain common and dangerous, yet treatment options have barely evolved.
Strong predictors of fracture risk, like hip bone density, have existed for years but were not formally accepted by regulators.
The result is delay: women lose bone strength and mobility while the system waits for long-term outcomes.
The breakthrough
The FDA has accepted total hip bone density as a valid way to measure whether osteoporosis drugs work.
Drug makers can now show benefit without waiting years for fracture data, enabling faster and smaller trials.
This change opens the door to new therapies — and earlier treatment, before irreversible bone loss occurs.
04. GLP-1 Access Is Increasing and Here Is What You Need To Know
A shift that could reshape access to weight-loss and metabolic drugs is coming: lower-priced oral GLP-1 medications. After years of high prices, supply shortages, and insurance barriers, pills could introduce competition into a market dominated by injections and expand access for patients who’ve been priced out.
The breakdown
Injectable GLP-1 drugs launched at prices over $1,000 per month, placing them out of reach for many patients.
Many insurance plans exclude weight-loss drugs, require step therapy, or limit coverage to diabetes despite broader metabolic benefits.
Injectable GLP-1s rely on complex manufacturing and cold storage, contributing to shortages and uneven access.
Patients with cash resources, concierge care, or strong employer coverage have benefited most.
The breakthrough
Oral GLP-1s are cheaper to manufacture, easier to distribute, and less vulnerable to supply disruptions.
New competition could put downward pressure on prices across the GLP-1 market.
Early data suggest oral versions may produce more modest weight loss — a tradeoff that could shape who benefits most from wider access.
05. Brain Health, With a Friend
About 1 in 4 people carries at least one APOE4 gene—the strongest known genetic risk factor for late-onset Alzheimer’s. New research also shows that women who carry APOE4 are more likely to develop Alzheimer’s than men.
We’re also learning Alzheimer’s doesn’t look the same in men and women. Its progression, symptoms, and risk factors can differ—pointing to the need for more tailored approaches. As with so many health conditions, one-size-fits-all models leave women with more questions than answers.
This topic is deeply personal for Derek Flanzraich, health founder, writer behind 5HT, and a friend of 51&. His mother was diagnosed with Alzheimer’s at 60, and by 65, their family had effectively lost her. That experience made painfully clear how broken health systems ripple outward—affecting not just patients, but entire families—and how little accessible, trustworthy guidance exists when people need it most.
It’s part of why we’re excited to give space this week to 5HT, Derek’s weekly newsletter sharing five healthyish ways to support a healthier life and a healthier brain. Each issue blends emerging science, unfiltered takes on health trends, and protocols that feel genuinely doable—each with a dose of humor.
In a special edition of 5HT, Derek published an in-depth report on Alzheimer’s and dementia prevention. It breaks down what we know (and what we don’t), explores lifestyle factors that may meaningfully reduce risk, examines early detection tools, and highlights ongoing efforts to slow neurodegeneration.
Because memory shapes who we are—and protecting it deserves attention long before a diagnosis.
+1 for Members: What’s New (and What’s Closing)
We’ve been busy behind the scenes, and several updates will begin rolling out in the coming weeks.
For the first time, members will be able to see the full scope of what their membership includes in one place on 51and.com. An email with activation details and key dates will be arriving very soon.
Membership now includes 27 brand partners representing up to $1,000+ in value, across areas women consistently tell us matter most — cardiovascular and metabolic health, hormonal care, period relief, and telehealth options that fit real life. We started with a $500 value goal. Our next target is $2,000, with more partners on the way.
We’re also launching a new events page designed to make participation easier, with a clear view of what’s coming up across education, community, and policy — no more searching through emails or links.
One important timing note: tomorrow is the final day to secure a lifetime membership. Lifetime members lock in permanent access to benefits, events, and what we’re building next as this community continues to grow.
More soon — and thank you for being part of what we’re building together.