Beating the Odds: Perseverance, Triumph, & Lessons Learned from the Leaders of Sofinnova MD Start & ExploraMed | LSI Europe '23

Transcription

Scott Pantel  0:00  
Good evening, everybody, welcome to our fireside chat, I don't know where the fire is, we could call it a seaside chat, whatever it is, is going to be a great session, I want to thank everybody for enduring a long day, we got some really good stuff lined up, beginning with this session, and we're gonna have a beautiful dinner downstairs. You know, one of the things that LSI works really hard at doing is shining a light on the innovators and the investors, and all of you the people that are building our industry, we want to shine a light on the stories that define our industry. And we want to do that, so that we can all learn from each other. And so a big component of this panel, we're going to talk about some triumphs, I think, right. And we're also going to talk about some of the challenges that come along with those trials. And so I think there's a lot to be learned. I want to thank Josh for joining us, Anne for joining us, and sharing their experiences and their stories. And I want to thank our friend, and partner, Roger here for moderating another amazing session. Right? We're expecting an amazing session. Just so you know. So with that, I'm gonna turn it over and enjoy the evening. Let's get after it.

Roger Brooks  1:21  
Okay, thank you, Scott. And thanks, again, for putting on an amazing conference with what such an amazing team. I'm Roger Brooks, founder, creator of RBrooks group retained C suite search firm. And I'm so thrilled to have both Anne and Josh here, who are two of the most incredible innovators in our industry. And we're going to start out with maybe a brief introduction, but I think their introduction will get phased through the process. And so maybe kind of a brief introduction, and then we're going to start out with talking about innovation. And each one has their own model, and organization. So they're going to talk about their philosophies around innovation, how they think about it, and then we're going to move into some of their success stories. And then at the end, we're going to save, we're going to try to save 5 10 minutes for questions. So think of your questions and raise your hand and we'll get to you. Maybe we'll start off with Anne from MD start.

Anne Osdoit  2:28  
Good evening. Yeah. So you want me to introduce myself?

Roger Brooks  2:31  
Yes, introduce yourself. 

Anne Osdoit  2:33  
Sure.

Roger Brooks  2:33  
And there are so many things to say, I could do it for you. If you want me to take a stab at it. 

Anne Osdoit  2:40  
We can compare notes. Okay, so hi, everyone. My name is Anne. And I'm a partner at sofinnova partner. I'm mostly the CEO of Moon Surgical, which is an incredible surgical robotics company. I've always wanted to be a doctor. But I'm not a doctor. I am a biomedical engineer by background. But I've, you know, basically found a way to work and interact with physicians on a daily basis and spend a lot of time in hospitals, understanding their problems, and then trying to build solutions to address those. So that's my passion and happy to share some successes and failures tonight.

Josh Makower  3:19  
I'm Josh Makower I'm entrepreneur, inventor, investor, the co founder of Stanford Biodesign, which we started about 23 years ago to train the next generation of innovators. I'm also still a chairman and founder of Exploramed where we continue to create new companies and special partner at NEA.

Roger Brooks  3:48  
And both have been friends for a long time. In fact, I like to think I'm a Joshin oh, gosh, we should know the year. It was 19. A long, long time ago, he hadn't even graduated from medical school yet. But so let's let's start with, there are so many amazing things I can say about both of these individuals. And you can always find their profiles online, but I think a lot of people know already a lot about them. So let's start with MD start, which is based out of Paris. It's an Can I call it an incubator or innovator? And so give us your philosophy for MD star. What's it all about? And how do you think about the companies that you pull through the process?

Anne Osdoit  4:32  
So MD start is a medtech company builder. You know, it's a hybrid structure between a seed fund the team of entrepreneurs and an incubator, and we are, you know, focusing on identifying issues that clinicians and providers have, generally generally speaking, and then developing solutions to address those. We have a very a specific way of doing that, which is our own filter, which is that we rely and build on ideas that other people have, we typically don't do the ideation part we interact with clinicians who have concepts that can tackle some of their daily limitations. And we partner with these clinicians, we build companies around them. And then we have a very systematic de risking approach in the early stages of these ventures.

Josh Makower  5:30  
Pretty cool, I would say, notionally MD Start and Exploramed have a lot of similarities. The one difference, of course, is that we use effectively the Biodesign process, to invent and create the solutions that we find as a result of the rigorous need finding, and that we teach our students at Stanford, we actually practice this, here, we practice it and Exploramed, we basically start with a blank slate and a big problem, and then try to understand it better on our unrounded to inventing a solution that is novel, and has the potential to be a company.

Roger Brooks  6:09  
And he doesn't say that lightly, there's a book out there called Biodesign, as anybody raise your hand, if you've seen the book on bio design. Oh, that's fascinating. Okay, so if you haven't seen it, it's it's a, it's a, it's a great tool takes everything and kind of helps lay it out. So let's, let's move into some of your success stories now. So what I heard and does, and, and in our group tends to work on the clinical side work with clinical innovators, who are solving unique problems, where I think Josh is program works with, I don't want to say just engineering teams of people who are, are studying the problems, and they're both both successful ways to do it. So why don't you talk about some of the companies you've been close to, and talk about that success story and how it all came to be.

Anne Osdoit  7:08  
So for me, you know, one of the greatest successes is seeing a project and a therapy, getting into the clinic, you know, it's probably one of the early milestones that you can achieve, where there's a significant amount of de risking that has occurred already, there's a lot to be dealt with in the future. But, you know, at least in my shoes, it's one of the most satisfying moments in what we do. It's one of the main reasons why we do it. And and just bringing those innovations to patients, you know, I've seen myself in the room during for 4 first in human, you know, procedures for for different companies. And there's just nothing that compares to that. And, you know, in the MD Start portfolio, we have brought, you know, numerous companies into the clinic. And I think that in itself, today is a first, you know, successful achievement.

Roger Brooks  8:06  
What did you highlight a couple of the companies you've been close to, and and tell us about how it started? And then what happened to it? How to how to end? 

Anne Osdoit  8:20  
Yeah, I'll give an example of a company where, you know, we have the CEO who here in the audience, May Health, which is focusing on polycystic ovarian syndrome. So, you know, women affected by infertility, initially as a as an indication due to polycystic ovarian syndrome. And this is a project that, you know, had been around for, you know, a number of years and had looked for funding but did not have initial prototyping work, did not have, you know, initial proof of concept and was dormant in a way so, you know, through our network, we, we identified, there was an opportunity there, basically, someone told us, Hey, you should look into Ziva at the time. I mean, the, the company has changed names so many times now, but at the time, it was Ziva Medical. And, you know, we started looking into it. I think we had a genuine interest for women's health. And, and, you know, realized how prevalent this syndrome was, I mean, it's about one out of 10 women, if not more, and the difficulties they were facing. And, you know, we started small rights, we basically started using, you know, off the shelf devices doing ex vivo work in my kitchen, with Manuel who's there in the audience, then went through, you know, of course, all the preclinical derisking, regulatory derisking, et cetera. But you know, the most important to me is if you fast forward by, you know, only four or five years, we now have, you know, 10s You know, you know, 10 Babies 10 to 20 babies, you know, underway or who have been born from women who have benefited from this treatment. And the company is developing outstanding clinical results and has an approval from the FDA to initiate its pivotal study. So the speed at which, you know, you can develop things, when you do it in a very structured and systematic way is, is amazing.

Josh Makower  10:32  
So, my most people focus success I like I like what you focused on, because that's a very good milestone. You know, some people focus on success as like sort of the ultimate exit the IPO or the big acquisition. And, you know, we've had, we've been fortunate to have a few of those. But I actually, when I'm with my teams, I really talk about success looking very differently, which is something that is, is actually equally as hard to achieve, but also much more durable, which is creating a group of people that you have worked with a team, all focusing with a common goal, and sharing that flow, that energy that comes from achieving something that really has never been done before. And the the fulfillment that you see by accomplishing various milestones together, and all of that. And many times these exit events, which by others might seem as a success, actually can come with a lot of heartache, because the team is now going to be broken up and it's going to change. So I often get when my teams get together, and we're having those moments I said, Folks, this is what success looks like. It's actually what we're doing right here, this dinner right now, all of us focusing on something together and sharing a common vision. That actually is what success looks like.

Roger Brooks  11:55  
Well, well put. And what I don't want to forget about is the enormous successes these these two people have had, either them or their firms that they played part of which I'm not going to hit them all from the top, but how many were built billion or close to a billion becomes Corvelle, which comes from Sofinnova, and then a Clarant and then Neotrack, and Shockwave and ReCor and the list can keep going on. But they'd have a lot of experiences with with seeing things through. Now, I want you to both think about a company that people think of, like, wow, that was such a success story. But you know, differently. And because you were in the inside, you didn't quite see it go so smoothly. So share with us a bit about the company, and then the challenges that were faced, and then bring it back to Lessons Learned for the audience about, you know, the perseverance it takes to succeed. And how all these successful stories have a lot of perseverance, they had challenges, they had things that could have stopped them along the way. So pick your favorite ones.

Anne Osdoit  13:26  
I mean, I would say that it's never entirely smooth, right? By definition, what we're doing is category creation, at least that's what we like, right? I mean, it's not what everybody does, but we like to pioneer therapies that are going to completely change the way patients are managed. And when you do that, there is an inherent, basically doubt. When you speak to people initially, it's just part of human nature, right. I mean, they're going to be enthused and sort of convinced, but there is also a lot of reluctance here to change. And, and this is true from, you know, investors and, you know, some clinicians and people you're trying to hire. I mean, it's true, pretty much, you know, across the board. So I think all of these companies that used you know, the ones that I know, and that you've cited have been through some of these moments of great doubt. And it often materializes through, you know, financing crisis or difficulties. Right. I mean, you have something that, you know, has been very, you know, well thought and systematically de risked you have some initial proof, but nobody's willing to jump and, you know, trust you with that idea. And, you know, I think a lot of companies share that story.

Josh Makower  14:51  
Yeah, for us. I think. There's lots of good examples. In fact, I don't know, personally have a single Success that hasn't gone through the valley of death. The one example that I, you know, that comes to mind that is knee attract, which was my co founder, Ted Lamson would say was a 12 year overnight success. Where..... Well, first, I can just I mean, I'm going to try to condense this because there were so many moments where it's like, it didn't work, or we had a problem, or we had something that go went completely sideways, our first version of the device did not work. The second version of the device did work. And we finally got some decent clinical data. And we took it to the FDA, right in the middle of the worst time at FDA, around the 2008 timeframe, where they had decided that they were going to change their whole mindset on medical devices. And we began at that point, just trying to get an IDE started in the United States, after probably, I don't know, three 400 patients treated in Europe already. We want we found ourselves in a, in a dire situation with the FDA, where, you know, the first letter that came back to our IDE submission, had maybe 30 questions, some of which required restarting and read redoing animal studies for a particular variable that they were interested in, which we fought for a while about, and then finally said, Okay, we'll do it. And then, you know, a year and a half later, show back up with that data, all the studies done. And this FDA says, you know, thank you for doing all this to our complete satisfaction, you've answered all our questions, we have 30 more questions for you. And it just went like this for about three and a half years, and literally about 30 plus million dollars worth of investors money went into just keeping the company going over that time. It was a disaster. I mean, it was just so many difficult moments where, you know, I, my, my mentor, John Neera, who is a board member, representative, and NEA, at the time, would just come to me and say, like, is this thing gonna work or what I mean, like, it's kind of work, John. And I think that sort of underlying sort of one of the with the through lines as your investors, their understanding and patience, but also belief, is what sustained us because there was every bit of a moment to give up and turn away. And it took us literally three and a half years to get finally to begin our IDE in the United States. After that, it wasn't like it was all smooth sailing from there. But but those moments were critical to be able to surpass that, that and just finally get the chance to prove it, you know?

Anne Osdoit  18:01  
Yeah, we have a very similar example with one of our companies LimFlow that probably got five disapproval letters from the FDA on its IDE, and you have to keep the company afloat. For in our case, it was two and a half years. Their issue was around this preclinical model, finding something that replicated below the knee, you know, and made sense. And, yeah, I mean, the company got FDA approval last week, right? So you get there, but it takes, you know, years, and you don't plan for that in any business model. You don't plan for waiting two to three years for an approval to start a study from the FDA, you don't plan for a version of your device, just simply not working in the clinic, you plan for things that are going to take, you know, maybe, you know, more money and more time, but not these complete cycles. Because you would never raise money if you did, right. So you kind of have to, you know, pretend it's going to be okay. But in reality, it's not. And so working with the right people is is everything in these instances.

Roger Brooks  19:05  
You always have to have a game face on I imagine. So you when you guys run into your challenges with with your companies where something's not quite going right? You go back to I call it a living document, but you've got something you go back to right? Where you're constantly pressure testing what you're doing. And you're asking, Are we should we keep doing this? Tell us about that. What what do you want? What would you suggest to anybody with the company? What do they need to have in place so that it can they can keep doing a gut check to make sure they should continue on?

Anne Osdoit  19:45  
I think, you know, it's not necessarily necessarily a document or a set of specifications or assumptions. I think it's the people in the science that you go back to it's you know, do you have a group that's going to be able to overcome this Challenge, do you have a group that is okay with working in this environment? Because that's pretty much the daily life of a startup and can trust you as a leader or whoever the management is to solve it together? And and then do you have the actual data to support your thesis, you know, the thesis that was behind the company in the first place. And, you know, looking back at this data or generating it, if if you need to

Josh Makower  20:30  
Yeah for us, it actually is I wouldn't necessarily document but it is a thing. And it's part of the biodesign process, which is to create this thing that we call the needs specification. Some people call them need criteria, which is, what are we trying to achieve? It's a summary across all the stakeholders of what actually is the outcome that we believe is transformational, and that we've invested so many months and of energy years, sometimes in developing that then becomes our sort of, you know, golden vision that we're always shooting for, and keeps us focused through these challenges. And the question we're always asking is, have we learned anything about this, that is untrue, if we still believe it's possible, and we still see the evidence that it's achievable, that gives us the reason to believe and allows us to persevere. And I totally encourage everybody here to have one of those in basically a real vision of what you're shooting for, in the details of what needs to move people to do this instead of what they're doing today. And if you still believe that's possible, that can get you through those moments. Because there's all these challenges. So many challenges, clinical enrollment, and money raising and building your team and overcoming doubt. But that that to us sort of is the is the through line that, that we can see through to, to sort of an ultimate goal, and gives us confidence that it's going to be there. And then after 12 years with Nia track, and you know, I bought another company right now, MoxiMed finally got their FDA approval several months ago, but after 10 years of work, I think those are the that gets us through all of that, because we still believe that's going to have a transformational outcome for patients. And that's evidenced in the data, but it does take a long time sometimes. 

Roger Brooks  22:23  
So fast forward that with you know, you have it with your management team, your senior team, your employees, let's talk about the investors and the board members, how do you bring that forward? Especially when times are good things are going right? How do you keep bringing that forward? So that when something's not going right there? Like you they go back to the same space? Is there a like, to me repeating it at every board meeting? Or is there a process to help keep your investors locked in to that same thing?

Josh Makower  22:59  
I mean, I think choose, choosing your investors very wisely is so so fundamentally important. You need to work with people who share the same beliefs and values that you do, and are willing to persevere. I think we all would love, you know, I think investors love a quick exit, you know, all those kinds of things that probably this probably isn't the right space. In fact, healthcare in general probably has the right space for that. But but if you're here, there's probably another reason for being here. But having those investors that will stay with you, when the when the going gets tough is really what it's all about. And the way you can tell that is look at their track record, you know, you know, look at the background, see what they have persevered and to ultimately arrive at a conclusion, that's a great way to find people that are ready to, you know, strap in for the journey and and stay along for the entire ride.

Anne Osdoit  24:05  
I agree. No, I think you can see it from I mean, experience, people will know, right, that this is part of the life of a startup. And they'll have demonstrated that they can, you know, help in new situations. 

Roger Brooks  24:19  
So this isn't necessarily a plug for LSI. But I call it when I before I do search work for a company I look at who's got their money into it. And I call it a sophisticated investors. So there could be investors who are really smart. They can be very, very smart people. Maybe they made their fortune and oil and gas or some area but they're not a sophisticated med tech investor. They haven't lived through all the trials and tribulations, right. And those are the people that seem to get it when something doesn't go right. They'll they'll be standing by your side, which is more likely to be an investor here at LSI, because they get it, they're interested. And so pay attention to those people who have a lot of passion and interest around medical devices. Otherwise, you mess up your cap table. And I, you know, we can probably talk forever about all these really, really good companies out there that had the right idea. They were on the right track, but they didn't have the right investment group.

Josh Makower  25:27  
And the other thing to mention is like, the great thing about meetings like this, and congratulations, Scott, on this event, and building LSI, to be able to accomplish such a fantastic meeting. So congratulations, to you and your team. But one of your greatest resources, everybody is standing right next to you, this community is what is so powerful, to be able to help each other, we're all trying to do the same thing. There are very few moments where we have direct competitors in this group. But even when you do, we're really are trying to do something really good. And I found just coming up as entrepreneur, that the greatest resource of my colleagues, who can tell me, how did you navigate that, and I find this community in particular to be tremendously generous, because of that shared goal.

Roger Brooks  26:18  
And just to build on that, that becomes, when you're facing those problems, don't hesitate to reach out, because everybody wants to help. Right? And you as a CEO, you're helping other people, but they want to help you as well. So don't don't hesitate to do that. Anne and Josh would love to help. But my goodness, I don't know how they do it. They have got more irons in the fire. But I can email them and they respond within 30 seconds. I don't know how they do I must be AI. Yeah. And so how about once you hit one more thing around? advice around perseverance, how to get through the tough times? And then we'll we'll turn it over to the audience for a couple of questions from from the audience.

Anne Osdoit  27:11  
Yeah, so perseverance, you know, I think Josh, you know, nailed it. I mean, you have to pick the people, right? Whether it's on your leadership team, or in your investors or on your board, I don't think you can prepare people for what goes wrong. I mean, you can to some degree, but it's more of a mindset, and, you know, a willingness to, you know, not panic and work constructively on solutions together. I think another part of it is empowering people, you know, in your, in your leadership team, you have to, you know, basically get give people an opportunity to voice ideas and different options. And, you know, this makes you much better as a leader for basically navigating through these issues. And, and so I think, to some degree, being transparent, on the challenges within the leadership team, within the company, with your board, goes a long way, right? Because everybody is here to help. And, you know, some of your board members will have faced similar issues, they will have someone in their Rolodex, who could help on something, but in particular,

Roger Brooks  28:20  
Don't surprise them. Is that what you're saying? 

Anne Osdoit  28:21  
Exactly, exactly, I think be you know, and there's no point in being complacent about things, you need to just face the facts. And, you know, be forthcoming about what doesn't work, right. If you if you really want to get help.

Josh Makower  28:37  
Ya know, I'd see many great innovators here, and you know, this. But every day, there's another reason to give up right in front of you. It always just comes right. And just being able to have the, and you all, many leaders here to many CEOs here, you know, that you see your team sees it. But what makes the difference is to be able to accept those things, learn from failures, learn from mistakes, just pick yourself up and keep on going. And to keep your team focused on that vision, and where we're going and why it matters. Make it a simple message. keeps everybody focused to get to the ultimate goal.

Roger Brooks  29:29  
I'll put Scott, do you have another mic out there by chance? Okay. Okay. Great. Raise your hand if you've got a question.

Ana Maiques  29:41  
So Josh, nice to see you. Again. I just wanted to mention as an entrapreneur, you haven't mentioned but when I visited the BIOS Design Center in Stanford, I didn't know about the pediatric device consortium. And as an intrapreneur, it has saved our lives. I mean, the amount of the advice pay by the FDA, by the US funding to help intrapreneurs with the knowledge of your center is phenomenal. I mean, we have reimbursement advice, regulatory usability from the best minds that have done it before. So, first thank you to you and the biodesign. Center. And what are the lessons learned? Why don't we have more concert years? What are the lessons learned from this consortium here that we can extrapolate to other domains or even in Europe? So what did you learn from there? Thank you. 

Josh Makower  30:34  
Thank you for those comments. Look, I mean, Biodesign, many fellows here, you know, is powered by people who just want to give back, right? So sometimes, pulling together consortia is really the extra thing that you do, you know, many of our faculty are already with their startups or with their jobs, but they take extra time from their schedules to do this, because they care about the next generation, they care about helping others. And I believe, like I said, in this community, there's a lot of that sentiment. And so I think if we tap into that and coalesce it, you can, you can just create these these things that benefit the whole community. And I think it's, it's, it's a great thing to do. So I encourage it. And it just takes that, you know, one or two people to sort of come together to decide to spend a focused amount of time just helping each other. That's what that's basically where it starts. Another question?

Almog Aley-Raz  31:41  
Hi, Almog from Corneat. So where you talked about the FDA pushing back on it submission, requesting all of these science exercises and request for additional tests and animal trials? We've been through that. And as an Israeli company, you know, when the FDA asks you do, but what we realize is that you can actually push back on that we've just, you know, worked with a US consultant, who worked at the FDA, and he just pushed back on that, and we got our first device approved. Do you see a lot of these cases around? I mean, it's,

Anne Osdoit  32:13  
Yeah, I can comment on that, because I was on a call yesterday with a fellow surgical robotics company, strategizing on how we would answer similar questions that we got from the FDA. Yeah, I think, you know, when, when you're in a process with the FDA, there are, there are moments in the process, where it's about getting into that dialogue, and pushing back and arguing. And then there are other moments in the process where you have less of an opportunity to do so. But even though, I think, you know, basically, benchmarking and working with experienced consultants who have that, you know, experience from from other companies in the same space goes a very long way. Because in a way, it's the Group of Companies that do similar things to your company that are going to define the new standard for what the FDA is willing to accept or not, right. And so if everybody just does what the FDA says, then the bar keeps getting higher and higher. But if there's, and that's where the peer to peer aspect and sharing can be extremely powerful, right? It's basically, you know, if people have learned from each other with these more reasonable approaches, and go back to the FDA, you can accomplish a lot. So yes, this happens all the time. And I think it's very powerful, essentially. Right.

Almog Aley-Raz  33:38  
Yeah, we were actually, you know, we're avoided a second animal trial by convincing them to use Israelis and Europeans as models. 

Anne Osdoit  33:48  
That's great.

Josh Makower  33:48  
Might not put it that way. Now, I mean, you can push back until you can't push back anymore. I mean, it's not, that doesn't always work. But you can make a lot of headway. I mean, recognizing that these are people trying to protect other people. And you have to sort of get to the root of what what is the source of their concern, and try to get them another way to be feeling comfortable about it, because they're in there, in this position, they tend to not have as much experience as you might have. And so they're afraid, you know, so how do you how do you release them from that fear and try to give comfort them with whatever data or explanations you can, it's not as much about an argument it's more about providing

Anne Osdoit  34:34  
alternatives and helping them with options.

Henry Peck  34:39  
Thanks, guys, for the fantastic fireside. I'm Henry from LSI. And at LSI USA 23 And Dana Point, I got to moderate a panel with Josh DiFonzo from Lux and Madera, and Dennis McWilliams from Sante and the panel was about how kind of the two hats of being an entrepreneur and executive and a venture partner kind of change your perspective on both sides, how you think about venture, how you support portfolio companies, how you conduct diligence. And then on the flip side, how you build your own company, how you build your own team, how you position it with investors. And we have a very similar setup with both of you. Anne with Sofinnova and MD Start and Josh, with NEA. I'm very curious to hear, from your perspective, how does that play in your current role with Moon surgical and the companies you've built and continue building? How does that dual hat affect both sides of your work?

Anne Osdoit  35:28  
That's a great question. I would say it's a challenge from an agenda standpoint. That being said, you know, I'm an operator by background by nature, you know, at my heart, you know, I couldn't see myself doing anything else. And then building companies, I have a very hard time at the end of the day has if I have not produced something, and feel very frustrated, so I would say, you know, people ask me, Hey, how do you manage the CEO job and the investor job? I'm like, how do you manage without the CEO job? I mean, really, I can't I can't imagine that. But you're right. It's, I think, having that visibility on what's expected from the other side, being on these boards, and, you know, in a position where you're trying to help CEOs and entrepreneurs, solve problems, you know, is immensely, you know, helpful in understanding what's expected from you. And, and I think we're leveraging that every day at Moon Surgical, of course.

Josh Makower  36:33  
I think, you know, as a learning, you know, sort of up and coming entrepreneur, for me, was fantastic to be able to sit on the other side of the table and understand that perspective. And I think the concept of sort of the triple win you're going for winning with patients, you want to win for your team, and you want to win for the investors. And if you can do all three of those, it's a win. That's what a win looks like. We can't always accomplish that. But it nothing ever gets sacrificed if you don't win with the patients first, right? And if you don't reward your team, for a win for the investors, then you're not doing it right. They're not going to work with the investors again, right. So all three parties have to win. And understanding what that win means to each is really important. And being inside seeing, like how investors look at is super helpful to achieve that.

Anne Osdoit  37:29  
Yeah, I think there's probably a general just lack of awareness of what the constraints of an investor are. And, you know, it's just the way things are, and we had a CEO workshop last week, with with our CEOs and some of the leadership members were, you know, alto and PEP Yanique attended. And I think just hearing him share some of the current challenges and opportunities, but also just, you know, what, what, what success means to him, was extremely, you know, basically precious to our CEOs to adjust basically their asks and the way they interact with investors. Yeah, well, you know, I think when you're an investor, you're not investing your own money, right, you need to raise funds. I mean, that's a pretty basic thing, but it happens every three to four years, it's very similar to, you know, a company raising money, which means it's, it's, it's extremely painful, especially those days. And, and it comes with a lot of complexities. It then drives a notion of lifecycle when you're in a fund, so you need to understand where the investor is at, when they do the investment in your company. What those timelines are going to look like what the constraints of the people in front of you are, and how that people is going to be measured on success. And, you know, there's not a lot of opportunities to discuss that in a board meeting, you're discussing about the company, but I think having those, you know, more informal discussions where you can, you know, get a better, broader and this understanding, can be very helpful.

Josh Makower  39:15  
And I just say to add on to that, it's about trust. If you trust your resolve about who you bring on your team, bring in investors that you trust, and then you should bring them into your world share with them the challenges so that they can, you know, be with you on the same side of the table, trying to solve them. They have different tools than you do but all working together. That's that's the best I think it's sometimes people view their investors as sort of like the enemy. Maybe, you know, there does squeeze out whatever they can get out of it. That's not a good relationship. If that's the case, you may not be chosen well. But, but it really is about bringing your investors onto your team and exposing them to your challenges and making them all collectively are challenges. And then it's a lot easier to solve those problems, especially when you can view it for their eyes and what tools they have is worldview.

Unknown Speaker  40:08  
Hey, Evan, from Icarus is thank you guys for a great talk. You mentioned something really interesting that every company you've seen that was successful passed through the valley of death, right? What is the difference between those that are successful? And those that aren't? And what can an early stage company do to prepare for that stage?

Josh Makower  40:29  
I mean, just from my perspective, remember, I talked about that needs spec, then that we create in the beginning, the moment that you realize, whatever, whatever technology is not going to do it? Or that you got it wrong? That's the moment that I say, okay? No, no, there's, we were not going to make it that could ideally happen early, really early. And that's what we're really trying to do, we sort of switch and explore, we go in this mode of, you know, unbridled creativity and come up with as many ideas as we can. And then we flip that instantly, like how we kill this thing, what's gonna make it fail, you know, and then we just focus on making it fail. So it could fail fast. But sometimes, the answer doesn't come fast, sometimes it comes really late. And then you have to look at the data. And I'll give an example, in my own experience of when one company that we shut down after investing, you know, 40 $45 million, and it was at a company called Vibrant. And we did our clinical study, and we looked at the data halfway through, and it's like, we're not going to get there, we're not going to produce the outcome that we really dreamed was possible. And we're going to come way short of it. And then we don't see a way to actually fix it. That was the moment that we decided we're done. We're never going to shut this one down. So that's the moment for at least for me that I know, that isn't that should not proceed.

Anne Osdoit  41:57  
Yeah, I think we should recognize that. It can be hard from a CEOs hat to do that, right? Because by definition, you fall in love with the project and invest, you know, days and nights doing that. And, you know, going back to the earlier question, I think that's also where, you know, collectively solving for issues and looking at things traits. And also, in our case, wearing our you know, more investor hats can be very, you know, helpful.

Josh Makower  42:26  
And I know, we got to wrap up, but I'll throw one more thing at you. When I was one of my first companies achieved a not great outcome, but it was an outcome. And I figured, like, but we, you know, we did the best we could, and we could achieve that thing. Anyway, I was wondering, like, what am I gonna do with my life, because I'm obviously not a good entrepreneur, I gotta do something else. And I ran into the founder of NEA in the lobby. And he, he was like, So what are we going to do next? I was like, You're gonna, you're still gonna work with me after that, after that performance is like, Oh, yeah. I mean, we're investing in you. That's the long term view. I like we actually think what you're going to do next is going to be even better, like you learn from this. We want to do it is next, because of the way we work together. Because like I said, we brought brought them on the side. The next one was a Clarent and the next one was Neotract. And so I learned from that experience that like, investors, those of you who are investors, those of you who are entrepreneurs, you want to be working with people who are really investing in you, because that's actually going to produce the best long term results.

Roger Brooks  43:43  
Okay, all right. So round of applause for Josh and Anne for sharing their thoughts. Really, really appreciate it.