Why Emerging Medical Technology and Solving Big Problems is so Alluring
John Keane is the Co-Founder and CEO of MindRhythm where they are developing an interesting technology to help diagnose stroke early, when treatment decisions can have a big impact on patient outcomes. In this episode, John discusses why emerging technology is his true calling, what types of people are drawn to it and how he identifies them for his teams, how someone giving him a break made all the difference in his career, what it’s like to be a first-time CEO, how his two companies, in completely different industries, have so much in common, and his philosophy on serving customers.
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Episode Transcript
This transcript was generated using an automated transcription service and is minimally edited. Please forgive the mistakes contained within it.
Patrick Kothe 00:32
Welcome. As we progress through our careers, we learn more about what we like, what we're good at, and then where we want to spend our time. Some of us like turnarounds, some of us enjoy being front runners. Some of us like startups, some of us like dealing with established markets and products. And some of us enjoy emerging technologies. JOHN Kane is my guest today. And john likes the challenge of emerging technologies. He's led teams with existing technologies and products, but found that his heart really led him to build and develop new things, new teams, new products, and new markets. John's a co founder and CEO of mind rhythm, where they're developing an interesting technology to help diagnose stroke early when treatment decisions can have a big impact on patient outcomes. JOHN contributed to the success of many companies in the medical space, including Marion, Maryland, where he got to start Baxter I flow, Integra, lifesciences, clearpoint, masimo, and zol. He's also owner of an instrument company that's outside of medical device. And that's a true passion for him. I'll let him explain what that's all about in a couple of minutes. JOHN, and I discuss why emerging tech is his true calling. What types of people are drawn to it and how he identifies them for his teams? how someone giving him a break made all the difference in his career, and why he looks to give other people breaks. What it's like to be a first time CEO. How is two companies in completely different industries have so much in common? And his philosophy on serving customers? Here's our conversation. JOHN, welcome. To get us started. Can you give us a little bit of a background and how you found yourself in medical device?
John Keane 02:43
Sure, Pat Thanks for having me. It's an honor to be here. You know, I kind of got into medical devices, I would have to say, sort of by accident. It wasn't like something I actively sought out. I've been in medical sales, my entire professional career. It's sort of led to medical devices. And it really meant to lead to medical devices through a desire to work with new technologies. So my specific background was I was a student at Boston College. And a friend of mine was working at Newton Wellesley hospital, which is part of the partner system massgeneral Brigham women's all that it's one of their community hospitals, but a good sized Community Hospital. And I took a part time job there really just, you know, for spending money during school. And I became fascinated with the entire medical environments. Just you know, I worked in labor and delivery, I worked in the operating room and you know, turning over the rooms and wasn't the most glamorous job in the world. But I was fascinated with the medical aspect of it. And I had always always been drawn to medicine, anatomy and physiology biology courses, but never really wanted to be a doctor. I you know, I wasn't the best student either. So I don't think I was going to end up being a physician. But I really liked being in and around the environment. And I was friendly with the pharmacist at the hospital. And he told me that this is pharmaceuticals were very big at the time. And he told me that the pharmaceutical reps seem to really enjoy their jobs and they seem to do very well. And one of the companies was recruiting on campus. He gave him the card for the manager I called him and we hit it off and I started out and turned out to be one of the best companies I ever worked for Marion laboratories, which was Ewing Kauffman, the Kauffman Foundation was really a terrific experience, but they were launching new products at the time. And so I kind of jumped into the deep end of not just working with something that was available, but with new technology, and seeing everything that goes into effecting change in medicine on every level, both from the physician level, the administrative level, the nursing level, the insurance companies, the approvals, and I just really liked it and I liked working with it and I thought this is a way to be involved. With medicine and having an impact on society having an impact on healthcare and patients, and, you know, while working in business, and I came from a business household so that the two things kind of worked out. And I think as most people know, it's kind of a natural evolution. You either stay in pharmaceuticals your entire career, or some people make that jump from pharmaceuticals to med tech, in some form, whether it's capital equipment, or devices in order to really be more hands on be more involved in things. And I made the jump by going from pharmaceuticals into anesthesia, which is kind of both. And then from there, I've been in devices since
Patrick Kothe 05:39
let's, let's talk about that for a minute. Because, like you, I started off in in pharma, and spent a couple of years in in that area. And it didn't fit my personality as well as devices did. I was not kind of a molecule guy in selling concepts. I was more a hands on type of salesperson, I enjoyed being able to walk somebody through the use of the product, as opposed to, you know, the theoretical advantages on the pharma side. Was that kind of what what drove you or were there some other things that drove you to the device side?
John Keane 06:16
I think it's absolutely what you just described, I learned a great deal in pharmaceuticals, I learned the value of building trust, developing relationships with physicians and the staff. And those things were very important. But at the end of the day, a lot of the discussions were exactly as you described, they were theoretical, they were research driven, and which I appreciate that the research driven because it's medicine, but they were mostly theoretical discussions. And I wanted to be a part of everything that was going on. And that meant being in the operating room. And so I spent a number of years in the LR, again, the medical side of it also intrigued me. So being an anesthesia, I was able to go into virtually every type of surgery you could imagine. And then when I made the bridge into the surgical side, I had experience in most of the different types of cases, and I could speak the different languages of the different specialties. I felt like it was a natural progression. And what I learned in each of the areas helped me for my next step.
Patrick Kothe 07:19
So let's talk about the next steps, because coming up in different parts of an organization gives you different perspectives. So you're coming up from the sales side of things, what did sales teach you as you started moving your way up in organization.
John Keane 07:35
So I think the single most important thing that I took from it is that unless a person has a customer facing role in some capacity, whether it's sales, or clinical support or customer service, you really don't know exactly what's going on in the field in what the appropriate thing for that particular customer for patients for the hospital, you don't know unless you're living it. When you're in the field. If you're a open minded thinking person, you were working with their needs, and it starts with the patients. And then it's the caregivers, supporting the case, patients, and then we support them. And in my opinion, the office should support the people in the field. To me, that was the most important thing that I learned. And I learned also, that when I would go to meetings later, when I was in management, when there were people who didn't have that direct contact, they didn't have the right context for making the best decisions for the business, which is really the best decisions for the patient and for hospitals.
Patrick Kothe 08:41
That's really a good Good point. When you're looking at it from different prisms, I think it really helps you to understand why you're making a decision. Are you making it from the customer standpoint, that's your background? Are you making it from a financial standpoint is that your background? Is that regulatory is that your background? So really, to keep a focus on the customer, is really a good thing to be able to do because that's why we exist.
John Keane 09:10
I completely agree with that. And you know, you make the point about viewing things through our particular lens of experience. And those those are important as well. You want the financial person looking at things through a financial perspective and the legal person looking at things through the legal perspective. But ultimately, as business leaders, the decisions should be made, taking all of that into consideration and making a decision. From a business perspective, that's right for the company. But my belief is when things are done correctly, what's right for the company is what's right first for patients and then second for the users of the products, which is the hospitals, the physicians, the nurses and the staff.
Patrick Kothe 09:51
So as you're moving up within organizations and within companies, what track Did you take did you go through regional sales manager Sales Manager, take me through the track of your career progression.
John Keane 10:05
I actually didn't go through a career track per se. One thing that I haven't brought up, which is, I guess a skeleton in my closet is, when I was younger, all I really wanted to be was a rock star.
Patrick Kothe 10:18
And many of us are that way. So even those of us who didn't have any challenge,
John Keane 10:26
I was actively playing in bands, we were doing the whole record contract touring thing. And I tried to balance that with a professional career and being a sales rep is an easier way to do that, then because you're not in an office and the hours are more controllable. It was challenging because being an anesthesia rep, my hours were like, five in the morning till three in the afternoon with the active hours. So it allowed for playing in a band. But I was awfully tired sometimes when I went in because the you know, the the shows relate at night and and a lot of traveling. So I actually turned down a number of opportunities in my life to move on into management. Partly because of that, and partly because I really enjoyed being in the field. You know, there are some people who they view sales as a stepping stone in order to go into management or to go into senior management. And I never felt that way. I really enjoyed being in the field. And the best salespeople are very highly regarded by the medical people that they interact with. They provide a tremendous amount of value. And really, they're the lifeblood of the company. Other than new product development. It's the sales team that's really driving the business. So I was always very proud to do that I didn't feel the need to move into management, I really only got into management, as the music career was kind of dying down. I was looking for a new challenge more than anything else. And I took a position in Tegra company neurosurgery company I was working for at the time, had purchased radionics, a very highly regarded stereotactic company. So radiosurgery image guided surgeries, they're tactical that just developed a relationship with the general manager of that division just because just because we did, and they had an opening for a global director position, and he took a chance on me and put me directly into that role. So you know, we all need a break like that in life, you need somebody that's going to believe in you and look out for you. And he took that chance and I fell into I absolutely loved it I global responsibility, work with tech support the reps throughout the world. And it was just, it was a lot of fun.
Patrick Kothe 12:43
Was that your first time managing people it was? And so you went from being a solo practitioner to to managing people? How many people did you manage in that position?
John Keane 12:54
So I kind of remember I had direct reports of around 30 or 40 people indirect of about 120 130. And then a dealer network of another 60 dealers a show around the world.
Patrick Kothe 13:09
That was a huge chance that somebody took on your Why did he take that chance?
John Keane 13:15
You know, I asked him that one time. And he said I just I invited him to an appointment that I had in Boston that I thought he could help with. And he said I just I liked the way you interacted with the customers the professional way that you interacted strong knowledge of medicine, just a very easy way of engaging and you seem logical. And you you actually had suggestions for how we could grow and develop the business and not many people are willing to make those suggestions from the field level. I think perhaps later, he might have regretted my desire to make suggestions for how to change grow the business. But regardless, he he took that chance on me and I did my absolute best to make him happy he made that choice. And we're still very good friends today. He's a CEO of a major publicly traded company, he's done extremely well.
Patrick Kothe 14:14
I think it's really interesting because as you're making hires of different people that the easy way out is to say I'm going to look for somebody who's got experience in our industry who's got experience doing the job that that I'm hiring for, and that has already mastered that position. And that's one way to go about it. But what you end up doing is you're hiring somebody who may not be as motivated to perform. If you take a chance on someone and you're looking at them from standpoint of these are the skills that I need for that position and they can learn the rest. They can learn the industry, they can learn some other things. You're tapping into the potential of some But not the past of somebody and I see so many people hire past they hire a resume, then they're not hiring for the future. Can you talk to me a little bit about your philosophy on hiring after somebody gave you that big chance?
John Keane 15:15
You know, that's a, that's a really good point. And I've seen that over and over throughout my career that the default position is to hire someone based on their background. And you know, I need somebody as a cath lab Rep. So I'll hire a cath lab rep, or I need somebody for urology, or someone with urology background. And there's nothing wrong with that. I mean, certainly the relationships are there, the product knowledge is good. All of that helps. But all of that can be learned. And you run out of friends and family and Rolodexes pretty quickly. And the skills that I think makes somebody successful, are independent of that. And perhaps that's what Chris saw on me. I don't know, but certainly what you just described, is what I do, I almost, I don't want to say I don't look at resumes, because there's a certain background that, you know, kind of needs to be there. But for me, I strictly it's what does the person have to say? Where do they come from? What are they made of, and what drives them. And if you have somebody who's passionate, cares about what they're doing is really motivated. Self, you know, self starter, assertive, you can teach everything else, you know, if you know, if you got an honest ethical person, you're gonna do okay,
Patrick Kothe 16:37
let's just take a little bit further into your career. So Integra first real big job, and then you moved into a couple other positions, real briefly tell us kind of work where you went after there.
John Keane 16:50
So I went from Integra to a company called MRI interventions, which is now known as clear point, which is, you know, that'd be an example of I was partly hired away because of my background. So I worked I focused in stereo taxi. And this was a company that was focused on real time MRI guided Sergio taxi. And this this was a startup, it was a chance to work with something brand new, and I just jumped at it for that.
Patrick Kothe 17:15
the lure of the startup
John Keane 17:18
it's I just Is it difficult is it is it risky? Sign me up? Let's go
Patrick Kothe 17:24
Yeah. So no one else is making millions I want mine to
John Keane 17:29
Yeah, so for me that the the money aspect is never been the primary motivator. I mean, I like to be paid just like everybody else does. But in the roles I had, they were highly compensated roles and you're live conservatively invest, you can you can make money. And I mean, we all want to get that lottery ticket. But for me, it was just working with new technology, and doing something new and this is for Parkinson's and we got we got to work with some of the things I was working with are just being used in humans now where they're doing convection, enhanced drug delivery, and gene therapy for Parkinson's. So in we were in animal trials at the time, so I went from there to Massimo Massimo is a company that had a pulse oximetry division with emerging technology inside of a larger company. And they were looking for more of more of a startup mentality. From there, I went to Seoul with a similar situation. And another large company where the theme being the large companies typically struggle with emerging products. And they they tried to create specialty sales forces or license with small other companies that can do it. But it's it seems to be a fairly common challenge much of the larger companies. From there, I went to a company called oranum, which was an opportunity to move into a CEO, CEO role. They were going through some management, turnover. And it was a position to be in a decision making capacity, with the possibility of moving into that CEO role. And I had learned at that point in my career, I become frustrated with coming into situations that weren't working well. And being asked to turn them around and make them work well kind of learned the hard way that there's a lot of infrastructure in place that makes it difficult to turn those things around. And I was really looking for an opportunity to just do something from scratch, and put together a team of people I had met over my career who I admired, who had good skills with a similar motivation, similar passion, and build it from the ground up and do something really important in medicine. And that's how I arrived at mind rhythm and that that's what we've been doing. I
Patrick Kothe 19:47
think that's really important to have enough. self reflection, enough enough understanding of yourself to know what you're good at and what you want to do. Some people love the term Around stuff, they love taking structures and breaking them apart and building them back up. Other people want to build it from scratch themselves. It's it's really understanding what you're good at and what interests you.
John Keane 20:15
Yeah, that's well said. And, you know, I think one of the skill sets required that perhaps, is not one of my strengths is, there are a lot of people when you're in those environments that don't necessarily want change, and change is necessary, and walking him down that pathway. And for me, I would rather just have a group of people that are all have the same viewpoint and saying, Okay, I know we're looking at a force, but we're gonna cut down trees and build a road. And we're gonna do it together. And to me, that's, that's more enjoyable.
Patrick Kothe 20:52
Absolutely. So I want to circle back to something that you started to talk about earlier. But and that's your passion for music. So what what were you were that were you the the lead guitar? Or were you the drummer? Or were you the singer? What were you.
John Keane 21:07
So I played the drums since I was a little kid. I played the guitar not well. I'm essentially a drummer. And I played my whole life and drumming is just something, it's another passion. And if you talk to any drummer, you know that the next question is probably, how did you get involved in drumming, and I don't think any drummer can tell you because we were all banging on pots and pans with wooden spoons when we were little kids. And it seems like we're all like that. And so I've been, I played the drums my whole life.
Patrick Kothe 21:38
So you're not only played the drums, and we're in bands, but you also got involved on the business side. So tell me a little bit about how you got involved in drum making.
John Keane 21:52
So Well, the good news is I don't actually make the drums myself, otherwise, they would not come out well. So this is actually kind of an interesting story to ties a few things together. I love music. And as as my music career was winding down in meaning, as an act of professional career, you reach a certain age where you just, it doesn't make any sense to keep going for record contracts. And, you know, I was more focused in med device. And but I found that I missed music. And as I was working with these various turnaround situations, you know, a lot of the meanings can be very challenging and difficult, whereas music was always just fun for me. And a friend of mine, I was having dinner with him one time. And he said, Young used to be so passionate about music, and you sound so frustrated right now. And, you know, what would you like to do? And I said, Well, I would really like to own the noble and cruelly drum company. And so they they make the drums that I play. And they're in Massachusetts, where I live in a very small company, and they made the drums for the Civil War. And they make these modern high end drums on the same equipment that was used for the Civil War. It's a family owned business. And they're, they're not business people. They're high end craftsmen. And so long story short, ended up partnering with them to take my business skills and my friends marketing skills, and their knowledge of building just world class instruments to kind of expand the brand. So I've been involved with that company since 2015. Obviously, you know, working in emerging med tech, I'm not the feet in the street there. I'm not working there everyday. So we've hired some really highly capable people that are running the show. And the company is experiencing a, like a renaissance in the 80s and 90s. They were like the drug company. And they had some challenges going into the early 2000s in the companies coming back quite a bit. So I get to do the fun stuff. I get to go to the concerts and meet, meet the celebrities and all of that. It's a lot of fun.
Patrick Kothe 23:57
So when you say the drum company, you're not talking about you know, buying a drum kit for for your 14 year old kid, you're talking about high end, right? Yeah, I
John Keane 24:07
mean, if you have a spoiled 14 year old kid, then yes, we're the drug company for for that kid. But, you know, in reality, a drum purchase even the most expensive ones like like we make most drummers keep their drum sets for life, you know, that they don't wear out or unless they get in a fire, you don't take care of them. You can have them for life. And it's not like med tech, you know, I feel like our drums by medtech standards are free. I drop sets, you know, three to $5,000 but then you got to get symbols and other things to go with it. So it gets expensive, but, you know, over 2030 years, it's not that expensive of a purchase.
Patrick Kothe 24:43
So what artists that our listeners would know, us use your drums.
John Keane 24:49
If you talk specific specific endorses probably our most famous endorsers Phil Collins. He's been an endorser for years, but pretty much everything that you heard, recorded in the 90s was recorded with noble and Cooley drums, everything from Pearl Jam, to Van Halen, to Green Day to sound garden to jazz artists. And a lot of them a lot of the artists that use our gear I can't name because they are they have endorsements with other companies. But then they buy noble and Cooley gear to record with. So it's just kind of an interesting robot, I would say that virtually every professional drummer owns at least one piece of our gear.
Patrick Kothe 25:27
So it sounds like your focus is on med device. And then this is your, the fun side of your personality, a second career a second interest.
John Keane 25:40
Yeah, I mean, I could have made it a first interest. But I am passionate about medical technology, too. They're both passion projects for me and I, I personally don't see a lot of difference. between the two. From that perspective, I'm passionate about emerging medical technologies and improving healthcare. And I'm a drummer, and I love music. And I'm passionate about music, to the only way I'm able to make noble and Cooley, kind of like where I just get to do the fun part is because there are such good people working there. And they are really making sure that the company is going very well. And it's a nice position for me to be in because they check in with me and say, This is what I'm doing. This is what I'm thinking of doing. And the conversations are always like, Great and run with it. And so it's a lot of fun. There's an interesting dynamic that happens is that I find most people like music. And not many people are involved in music behind the curtain, so to speak. And then most of the musicians aren't behind the curtain in medicine. So much of the time when I'm out doing medical technology discussions and of talking about music with people, a lot of the time I'm out with music discussions, I end up talking about medical devices with people. It's just interesting. And I think most people are interested in both topics on some level, so they overlap rather nicely. And I've been asked to that, you know, med tech is a really long way from custom drums. And I say, well, not from a business perspective, from a business perspective, it's the same thing, you make a good product, you listen to your customers, you take care of them, you remain objective, you listen to feedback, you support them, and you think of them first. And you you incorporate what they want. And you look out for them, and you'll get business. And it's to me that did the same thing, whether it's somebody going on stage for a concert, or whether someone's walking into the operating room to take care of a patient or somebody's going out on an ambulance to save somebody's life.
Patrick Kothe 27:45
I think that may come from your sales background. It's the needs. It's identifying what the needs are and making sure that you're, you're living it through the customers, customers viewpoint, and then providing answers and solutions to what your customers are looking for.
John Keane 28:01
Yeah, that's I guess I hadn't thought about it from that perspective. But that is what we do. Right? We, we get that information we and we try to solve problems for them. And if you're doing it well, you solve problems and you get business.
Patrick Kothe 28:16
So john, several times in this conversation, you started to talk about emerging technologies. And that's your passion is emerging technology is not necessarily you know, something that exists, that you're making the you know, the third version of, of a product, this is an emerging new new type of product. Is that what fires you up? Is that what really interests you about medicine?
John Keane 28:42
Yes, yes, I mean, medicine in general, as a topic interests me. But I've worked with products that are, you know, me to products or better versions of what's already out there. And I mean, I've total respect for that. I think it's great that there are existing technologies that people are continually improving and making better to improve medicine. And I think there's value in other companies coming out and making products more economical, affordable and available. I think that's great. But from a personal perspective, it's what's going on tomorrow is what excites me. And that I would like to be a part of. And so anything that's not available today, that has the potential to have a significant impact, on some level is going to be of interest to me. And I've had the good fortune of being involved in some of some of these things. And, you know, when you go into a trial where they're injecting gadolinium into a primate to get the pathway for where to put the genetic material for a movement disorder, you know, under an NIH grant, and it's like 10 years out, I'm watching the future here. And it's, it's great to be around intelligent creatures. Creative, forward thinking people of all types, right? So from the researchers, the physicians, the the, the investors, you know that that believe in it. And it's just that's where I like to be.
Patrick Kothe 30:13
Let's explore the difference between emerging technologies and the meat two type of things from a number of different different standpoints you looked at it from from an interest standpoint, let's look at it from a people standpoint for a second. As we were discussing earlier, you some of us are pharmaceutical people, some of us aren't. Some, some people are emerging tech people, some people aren't. So when you're hiring people or managing people, how do you identify whether somebody is going to be more geared towards emerging tech or more geared towards a me two type of situation,
John Keane 30:54
I think it really is a personality type. Some people are very phlegmatic and deliberate, and plotting in the way they approach things. And there are certain activities that really benefit from that type of personality. In engineering, in particular, you you want to make sure that every step of the process is right down to the minutiae. And so you want that type of personality. In working with new med tech, there's so much uncertainty. And there's so much resistance to new medical technologies from an infrastructure standpoint, from a cultural standpoint, from human behavior standpoint, that if somebody is not passionate about it, on some level, they're not going to be successful. And they not just because nothing, they don't have the ability to do it, it'll, they'll get too frustrated. And they, they'll quit, there'll be like this too difficult. It's not fun. And there are many things in life like that music being a good example, that the road to success is so challenging, that unless you don't absolutely love what you're doing, it's not worth it, it's not worth the money. It's not worth the prestige, it's only worth it, if you really love doing what it is on some level. And, you know, it could be working with new technology, it may not be working with it from a medical standpoint, just you med tech, but the passion needs to be there. I think it's also important that people are flexible and open minded. A very common pathway towards bad decisions that I see are people who get one input, they make a decision, they act on it. And then because it's their decision, they're emotionally tied to it. And they, they can adapt. And I learned from my dad, actually, it was a very successful business person. He used to say, reserve your judgment till you get all the input that you can get, and you're never gonna have everything, and then make a decision and act on it. And if it doesn't work, take what you learn and adjust. So the two of those things, I think, are a really important. And then the third thing I think I would add to it is something that everybody has to learn, which is working with new medtech really isn't about the medical technology, because most physicians want to learn about new stuff, they're intellectually curious. That's why they went into medicine. And it's not like you're trying to get them to spend their own money on a new car, they get to try something that the hospital is going to pay for. So they tend to be very open to it. The real challenge is the entire infrastructure. And until people learn that they get tripped up quite a bit.
Patrick Kothe 33:38
So when you're talking about the infrastructure, what are you what's, who specifically, are you talking about them?
John Keane 33:45
Well, I guess for med tech, the most common would be the hospital's supply chain, the infrastructure. So materials management, value analysis, all the different committee meetings, you need to go to the buying groups, the ID ends, all of that. And depending on where your product touches, it may need to go to all of these different reviews. And so really, that the reps job is to manage a very complex process, getting all the different sides working together and kind of like channeling them in the pathway that you want them to go, while not being perceived as being pushy, and a problem person. And that's just specifically on the sales end of thing from a clinical end of things. You know, the clinical person needs to be passionate about what they're working with and wanting to help the medical staff deliver better care to their patients through whatever is now available to them. And then the people internally, the development team, they need to be the type of personality that Okay, we're working on this. We brought it out into the field and nobody liked this particular piece. erupted. And we need to change it. And it's not that you guys did something wrong, you did what we asked you to do. And we were wrong. And but we now need you to change it. So everybody needs to have that flexibility and a willingness to work with, you know, less than full budget and less than full staff. And because it's always like that, and I tell my sales people, and this is sometimes perceived as a negative, but they always come back to me later and say it's a positive, I say, until you give up all hope and optimism, you're not trained. And the idea, of course, is, obviously working with new technology, you have to be optimistic, or you're not going to do it. But from an expectation standpoint, that everything is going to go smoothly, you have to take the attitude that nothing's going to go smoothly. And how can I mitigate that before it happens. And I think that's a key component to success.
Patrick Kothe 35:51
You talked about on the sales side, introducing a new product that is revolutionary or emerging, that doesn't exist. So you've had experience of bringing products out, that may have been the fifth product in that category, everybody knows the category. And now you've got a slightly better version of something that's in that that category. And now we're talking about emerging tech, nothing, that category doesn't exist, you're new, you're the new category that that's moving in. So from a sales standpoint, in your experience it if we look at a couple of different areas, we look at the physicians, we look at the value analysis committee, and we look at the idea from those three, three groups. Is it more difficult to do the fifth product in the category? Or is it more difficult to do the emerging tech?
John Keane 36:50
emerging tech is the most difficult, but they're actually all difficult, as you know, they're, they each present their challenges, and they each present their opportunity. So if you're the fifth products, and in particular group, what you're typically dealing with is something's going to be entrenched in is going to have strong clinical buy in from certain factions in the hospitals, a physician group, the nursing the our staff, or I see whatever it is, then, but you'll have materials management, probably working with you, if you have a lower cost item, you know, because they'll always going to be looking to lower their costs. And if you have something that can roll out across multiple hospital types, you can have the idea in working with you what I think makes emerging tech more difficult, there's no precedent in this. So therefore, there's no existing pathway for adopting it. And that pathway typically means a change in clinical practice, which means changing the minds of very bright people who've been very successful doing things the way they are up until now. Then it's not budgeted for. And there's no process for bringing in. I mean, there's a process for bringing new technology into hospitals. But you have to go through all of that. And there's no specific process for this particular item. So somebody has to champion it. And that's difficult. And then the hospital runs as a business. And it is a business. And so they are not looking to spend money on things that are not going to improve the bottom line in some manner. I have found that it's far easier to convince hospitals to buy things that have reimbursement associated with them. So they can see revenue generation than it is to convince them of technologies that will save reduce readmissions or reduce costs length of stay. every rep out there has a paper that says that reduce like the state and nobody buys into that. And so that makes new technologies challenging. The one thing that can be a savior for new med tech, which I feel like I'm working with now, but it's not very common is if you have a product that solves a need, that is a widely held belief that is a problem. And there is no alternative. That makes it much much easier. And but that's the only place.
Patrick Kothe 39:20
Well, that is a great segue to start talking about your current company. So can you introduce us to your company and what you guys are doing and what challenge you are trying to, to solve.
John Keane 39:34
Mine rhythm is a company. It's we call ourselves a brain wellness company. But right now we're focused specifically on stroke triage pre Hospital in the mid 2010 to 2015. thrombectomy was developed as a treatment for large vessel occlusion stroke. For those on this that are outside med tech specifically. It's adapting essentially cardiac catheterization equipment to be used in the brain to go in and to pull a large clot out of a large vessel in somebody's having that type of ischemic stroke, up until that happened, if you had one of those strokes, whatever you got at the end of your stroke is what you had, there's really nothing really that could be done with a TPA was not particularly effective. So the outcomes were very severe and life changing. And once thrombectomy came out, there were only you know, at the time, a couple 100 places in the country that could do throwback to me. So now the problem has moved to pre hospital where patients in this is going on today, a patient is suffering what appears to be a stroke. 911 call is placed paramedics show up, they have to assess whether a patient is having a stroke, and then they have to send them to the hospital. If they are sent to a hospital that cannot treat large vessel occlusion with a thrombectomy they need to be transferred to a facility that can so in rural communities that could be several hour transport. But even in urban communities, the transfer time from a hospital, a block away can be a couple hours. And in in stroke. That is the morbidity is extremely high and the mortality is rather high. So the difference between getting a thrombectomy in time and not getting one can be the difference between walking out of the hospital Two days later, or being permanently disabled in a nursing home. It's that dramatic Hall of joy. One of my colleagues, his wife died of a stroke. And he focused his effort on stroke technologies. And he developed something that can identify a large vessel occlusion in an inexpensive disposable headset used in an ambulance setting. he researched it with my other colleague, Dr. Wade Smith, who's a professor of Neurology at UCSF who has spent his career in stroke treatment was instrumental actually in the thrombectomy trials. So we thought developing something that could was optimized for the pre hospital environment to give paramedics an objective measure that they could use to identify a stroke, would allow hospital would allow the ambulance crews to dispatch a patient directly to a comprehensive Stroke Center, which is more likely statistically to be farther away from the closest hospital or primary stroke center that can't treat them. But now they have an objective measures very similar to the STEMI program for myocardial infarction, the most of your types of heart attacks, they do the same thing based on the ECG, the ECG. So we're, we're mirroring that model in stroke. And we hope to improve outcomes in stroke with the technology.
Patrick Kothe 42:45
So explain a little bit about what the technology is based on and what what the product looks like.
John Keane 42:52
So it is based on accelerometry, which being a non technical person, to me, sounded like a 1950s. Reagan type thing. But they're actually very commonly used sensors. They're, they detect motion in particular acceleration. They're used in everything they're used in, in iPhones, iPads, helicopters, submarines. So like when you use your iPhone, and you pick it up, and the light goes on, that's the accelerometer telling it, it's detecting that motion. So Paul Lovejoy had a lot of contacts with Navy personnel. And so they deal with a lot of signal processing. And they suggested that he looked at accelerometers to detect stroke, put it on the head, because you could detect changes in motion based on changes in blood flow. That was the original theory. So that's what he and Dr. Smith did. What they discovered, I don't want to say by accident, because they were doing active research, but they were looking for asymmetry in a stroke, you know, the blood dropping off on one side of the head, what they found was every person has a normal head pulse, kind of like your normal heartbeat. And when you have a different cerebral event, that changes, and there's a very significant signature imprint for a large vessel occlusion. We also detect other six. So concussion, migraine seizure, you know, different brain events will detect just like an ECG will detect other things. But we're a small company and we wanted to focus on the area of what we felt was the greatest need that we can also definitively prove because the gold standard for diagnosing a large vessel occlusion stroke is a CT angiography, which is essentially right every time so we can compare against that and get our sensitivity and specificity. So we've two published papers to that regard. And now we're doing a pre hospital trial to demonstrate that it works in the environment that it will be used. We are going for de novo. Because there isn't that accelerometry is not used for anything. So we're automatically a de novo. But we also believe that with med technology in order to be adopted, you really need to show that it works so that it, it's not just a question of getting cleared by the FDA, it's a question of convincing the end users that they can rely on this. And when making a life and death decision. And in our minds, that meant doing a study where it needed to be done. So from that perspective, we're doing our study in two parts. One is right going on right now we're open label, we're collecting the data. We're refining the algorithm, we're seeing how well the device performs. We're getting feedback from the paramedics so that when we do part two, after our FDA pre sub, where we expect to have agreement with the FDA, this is what we're hoping to do. Do you agree? Yes. And then we're going to execute on that trial.
Patrick Kothe 45:37
So john, assuming that it, it works, assuming that it is successful? What does the world look like? When your product is out there? assuming that it's out there have regulatory clearance for the device? How does medicine change or how does people's How are people's lives impacted when your technology is available?
John Keane 46:01
The ideal scenario, in my mind would be that it's on every ambulance in every emergency department on every add every defibrillator. So anybody who's suspected of stroke has this device placed on their head, they get the reading, and they can be dispatched directly to a hospital that can treat them. And while they're in route, the MS crews are in contact with the stroke team. So that we minimize the time the treatment, that alone will have a profound effect on everything related to stroke. So it can be the difference between dying and not dying, or being permanently disabled, are completely fine. So that's number one. Number two, their loved ones and the impact on them for the rest of their lives. Three, the providers, the insurance companies won't be paying for their health care for they're in a nursing home for 2030 years as a disabled person, not able to work. And that should reduce cost to society. So we should just improve stroke care across the board, and then we'll move pre stroke, we'll move into stroke monitoring.
Patrick Kothe 47:07
How many people is this gonna affect?
John Keane 47:10
Oh, millions and millions around the world. In the US alone, there are 100,000 strokes a year. stroke is the number two or number three killer in the United States. And it's the most highly morbid, and it's the most expensive disease in the country.
Patrick Kothe 47:26
So if you've got 800,000 people, you're going to be doing tests on a lot more than 800,000. Because they're trying to ascertain, is this a stroke? Is this not a stroke? How many people are at the top of the funnel? Do you have an idea how many people are at the top of the funnel? That would be be candidates to have this more or less triage done out in the field?
John Keane 47:48
Sure, that's a great question. I think in the in the immediate, there are twice as many stroke alerts. So those are patients who are strongly suspected of having stroke, not just Oh, it could be a stroke. So you've right there, you can double it. But when you get into stroke mimics such as migraine, hypoglycemia, drug overdose seizure, you're up into a couple million more. So it's, and that's just in the US. And then when you go outside the US strokes actually a much bigger problem outside the US than it is in the US and in Australia that the federal government is actually outfitting commercial airliners with CT scanners. And they're flying them to areas where people are having strokes to transport to get a CT on the plane and then transfer them back to the hospital to take care of them in Ireland, they have to comprehensive stroke centers in the entire country. So it could be six, seven hours before in elvio patient even gets to a place that can treat them. And by then they're essentially outside the treatment window. So I expect to see it would affect billions and millions of people globally.
Patrick Kothe 48:54
And what does a product look like? What's the training associated with being able to administer the test?
John Keane 49:00
The product looks like a smaller version of the headsets You and I have on right now to do this, through this podcast. Again, we tried to optimize this for the MS environment. What they want is something that's lightweight, easy to use, disposable gives them a go no go decision. And so it's a self contained headset. Think of like a tiara is an accelerometer on each side. At the moment there are two ECG leads because we're showing the synchronization or lack of synchronization with the heartbeat because that's part of what what happens. So the paramedics put on two ECG leads to put on the headset. They hit the button. They ask a couple EMAS questions, you know, are you do you suspect stroke and the patient have asymmetric arm weakness type things. They hit go. And in maximum of 90 seconds, they'll have the determination. Designing the device make the call as soon as it's confident so we've seen it make the call and as little as 2025 seconds but it's it's extremely lightweight, it's disposable, it's really easy to use training is half hour with the paramedics, we haven't had anybody have difficulty using it, the ECG leads for them are easy because they put on 12, lead ecgs all the time. So putting on two plus a ground is easy, probably 30 seconds put on. And again, we going back to my point about listening to customers, we design this with input from everybody from the stroke teams, the emergency physicians, the eat, but mostly the EMF crews. First thing they say when you tell them that you have something that they can use for stroke this great something else, I got to carry up three flights. And then we show it to them. They're like, Oh, this is awesome. This is great. And they universally embrace what we're doing.
Patrick Kothe 50:44
Sounds like such a needed technology and a problem that really needs to be solved. So really, good luck with the with this one could have a major impact on healthcare system. So john, is this is this the first company that you've taken as a startup as CEO? Oh, yes. Yep. Okay. So tell me a little bit about what it's like to be CEO of emerging tech company. What what are you doing now that you didn't have to do in previous roles?
John Keane 51:20
All the single biggest thing is raised money. You know, this was a ground up company. And I've never done fundraising before. So you know, once again, I just jumped into the deep end on something. I knew nothing about fundraising. When I started this, I couldn't have read a cap table. You know, all the different positions and safes and convertible notes. It's a whole different world. And the language is different. My very first investor call, one of the first questions I was asked was, what's the TAM for this? I had no idea what a Tam was. You know, I,
Patrick Kothe 52:00
so it really was, you know, for our listeners, that's total available.
John Keane 52:05
So yeah, so it's nice to know that there are others out there besides myself, who doesn't know what that he don't know what that means. But it really I had gone from an area where I had a lot of confidence in what I was doing a lot of expertise to a world where I had no expertise. And I very fortunate in Polish boy, who I've mentioned before, who invented the product is also very, very knowledgeable in cap tables in business startups and the culture of the investment world, he spent a tremendous resource to me. And then it's made it a lot easier. I have a good friend of mine, Kyle York, who, coincidentally, we met when he was 16 years old under age at his brother's frat party, seeing my band play, and all these years later, he's a very successful tech investor. And he's helped me quite a bit with that, too. So that, to me, that was the biggest change in what investors want to hear the story, you know, they believe in improving healthcare and improving patient lives. But really, their job is to make smart investments for for their, whether it's themselves or for their family office or for their VC firms. So there are a lot of the the Numerix, the financials that need to be addressed in those discussions that I was really knew what doing and I like to think I've gotten somewhat better at it over the past year, but it's changed. So to me, that's the big thing, the biggest thing.
Patrick Kothe 53:28
So different size companies, different technologies have different asks different amount of money that they're going to need, how much money have you guys raised thus far? And? And what is going to? What is it going to take to bring it to the market?
John Keane 53:43
We've raised two and a half million, we still have quite a bit in the bank, we've managed to make a lot of progress on a very low spend. And Oh, and speaking with you offline, you've managed to do this yourself have with different technologies for let very low spend. It's there's a bit of an interesting dichotomy in the investment world where some of the firms they don't even want to get involved unless they're going to spend 10 or 20. Put 10 or $20 million in so the the New England puritanical Hey, we're not spending a lot of money isn't necessarily a selling point for investors of that size.
Patrick Kothe 54:17
Yeah, we can have a whole nother discussion on raising money and how to do it and who to talk to and whether it's angels or VCs and valuations and, and all of these different things. That's that's a whole different thing. But I think what you said is some things that you don't understand you'll learn it, you'll bring you bring the expertise and and to do it, but you're the driver of the technology driver of the company, and using other resources to supplement areas that you don't have expertise in.
John Keane 54:51
Yeah, absolutely. And, you know, to that point, I should probably make a comment about the team that we've put in place. In the beginning. It was just Dr. Smith Paul. myself. And we learned very early on that we had a shared philosophy of wanting to make sure that we did everything right, not just from a professional and from an integrity standpoint, but also because doing things right in the end is usually the fastest and least expensive way to go, rather than go the cheap, quick route and make mistakes that everything else. And we've been very fortunate to put together a team of people of like minded thinking, that are very passionate about what they do that are also really, really good at what they do. So we've been able to make a lot of progress, again, in a rapid amount of time. Because Because of that, and we also we've made decisions to about what do we develop in house, what do we outsource, and we work with our regulatory partners are very good, we work with an outsourced product development company starfish, out of Vancouver, and they're very, very good. You know, they're an independent firm, but they it's the same type of people they have the passion for, for developing new technologies. And it's just it's been a lot of fun. I think that contributes to our early rapid development. And I think ultimately, it's going to be what ensures that we're successful.
Patrick Kothe 56:17
Oh, john, we'll be watching you, and pulling for you guys solving solving a big problem. JOHN, as we wrap up today, is there any message that you'd like to deliver to listeners?
John Keane 56:31
Yeah, I guess, um, you know, if anybody out there is thinking of getting into medical technology, it's a really rewarding place to be, you know, if you're, if you're not a medical person, you can have a significant impact on mankind's by working with new medical technology, because the work that you do, you could be saving somebody's life that you'll never meet, you'll have a significant impact. And you will, you'll just know that you're doing it based on the good work that you're doing. And that, that adds to the value of the job beyond, you know, the title that you can get the amount of money that you can make the exit of a startup, it's a really rewarding place to be. It's a very, very challenging place to be. So if you do get into it, and you're finding that it's really difficult, I'll say what my first boss said to me, I think you probably feel overwhelmed right now. And I said, Yeah, actually, I do. He said, Well, it's always gonna be like that. So you get used to it. But it's, it's really, really challenging. But it's the challenge that makes it interesting. And if it were easy, it probably wouldn't be all that important. Sometimes the degree of difficulties directly related to how important it is that you're working on. So it's a really rewarding place to be I've enjoyed it, we'd love to have you because it's, we need more people working in this space.
Patrick Kothe 57:57
Jon's figured out what he's good at, and what he enjoys, and then who he wants to work with. I hope you know those things about yourself too. Or you're working to get there. A few of my takeaways. First, john described the similarities in a medical device company in a drug company. He said, from a business perspective, it's the same thing. You make a good product, you listen to your customers, you take care of them, you remain objective, you listen to feedback, you support them, you think of them first, you incorporate what they want. And you look out for them, you'll get the business, fantastic words, that anybody in the sales industry or anybody who's providing products can live by. The second thing that he said was, the road to success is so challenging. unless you absolutely love it. It's not worth the money, or the prestige. It's only worth it if you love it. And he was referring to music, or your career and medical device and the type of company that you're going to work for. The last thing that struck me was when he said doing things right in the end is usually the fastest route to go. It's not only something that you live by, in terms of your integrity, but there's an added benefit there. It's usually the fastest route to go. Thank you for listening. Make sure you get episodes downloaded to your device automatically by liking or subscribing to the mastering medical device, podcast and Apple podcast, Spotify, or wherever you get your podcasts. Also, please spread the word and tell a friend or two to listen to the mastering medical device podcast as interviews like today's can help you become a more effective medical device leader. Work hard. Be kind
