Behind the Scenes in Unlocking Disruptive Innovation | LSI Europe '24

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Lisa Carmel 00:05
It's great to be here in Portugal and on this time zone, and I just want to thank Henry and Scott for the opportunity to participate and collaborate on this panel. When we first discussed what should be the topic, we said, let's focus on disruptive innovation, because there are so many startup founders in the audience here that are trying to bring novel, new technologies to the market, and it's a tough path. So let's bring in some of the rock star innovators that have the battle scars to prove it. Before we jump in, though, I just wanted to say that Veranex is very proud to sponsor this event and to participate with LSI on thought leadership and panels. If you're not familiar with Veranex, I just want to say very quickly that we are a full-service med tech-only innovation solutions firm. In a nutshell, we can take a concept or idea for a product all the way through product development, preclinical, clinical, regulatory, market access, you name it, to a cleared product and beyond. This topic today is particularly near and dear to my heart; it's a sweet spot for Veranex, and that's in new, novel, disruptive innovation. I am going to run through quickly the bios of these amazing panelists. If I did the full bios, I'd be here for the full 40 minutes. They're that accomplished. You know Todd Brinton because you probably caught his keynote this morning. He's the Chief Scientific Officer and Corporate Vice President at Edwards Lifesciences. He's recently been in the news as co-founder of Shockwave, and of course, their record-breaking exit. He was an interventional cardiologist serving at Stanford University Medical Center and Palo Alto VA Medical Center, and also served as the Fellowship Director at Stanford's Biodesign Center. We also have Chris Carlson, Executive Vice President of Research, Corporate Development, and Ventures. Chris is responsible for identifying, evaluating, and developing new technologies, clinical indications, platforms, and new business opportunities for Intuitive. Andrew Cleeland, he's one of the troublemakers in this group. He's the CEO of Fogarty Innovation. He has an extensive background in successful exits, RDN and Ardian, to name a couple. He also serves as an advisor to Longitude Capital and Arboretum Ventures. Finally, we have Howard Levin at the end there, saving the best for last, CEO and Chief Medical Officer at Deerfield Catalyst. He's a heart failure transplant cardiologist and a leading expert in creating novel therapies for cardiac, respiratory, neuro, and renal patients. All right, so we want to tackle what the key success factors are for enabling disruptive innovation. We thought we'd start off right here with Todd and talk about how you define disruptive innovation and the importance of a mission-driven mantra.

Todd Brinton 03:55
So we obviously had the opportunity to talk a little bit before putting this panel together. I think we all universally kind of agreed on the idea that med tech is hard. It's really hard. If you're interested in making big dollars, go to tech; it's easier, and that's hard too. But I think the big thing that differentiates med tech from tech is the mission—the opportunity to have a real significant impact. I said this morning, you know, do something that matters, something you can feel really proud of when you go to bed at night. That really is a big part of creating disruptive technologies—being willing to take the risk. Because it's so hard and takes so long, there are so many bumps along the road. If you're not mission-driven about doing something that really matters, you're going to run out of steam. Even in the most successful ventures, you typically will have moments where you think the thing is going to blow up, and you have no chance of going forward. You have to have that passion, that hunger, to want to push it forward. The market's disruptive. What's disruptive? I think it's two axes: basically the size of the opportunity and the impact of the opportunity. People can often think, well, it's too small of a market. I had this debate with two people earlier today. It's not the size that defines it; it's also the impact you can have. You can have a big impact on a very narrow indication that's very disruptive to the space. People often think that the only thing investors care about is big, meaning lots of patients. I completely disagree. There are lots of advantages to being narrow, lots of indications as far as distribution, access, and KOLs. So don't get caught up in that whole thing. Believe in the impact that you can have ultimately on patients. I think that's where the mission comes from.

Lisa Carmel 05:40
Andrew, you spoke very eloquently on why you would choose disruptive innovation versus iterative. Do you want to speak to that?

Andrew Cleeland 05:53
I just want to thank Josh and Todd. The keynote this morning was really inspirational. So well done, guys. Thank you for doing that. I think you've quoted me as saying, you know, why not go big? One of my mentors told me a long time ago that in med tech, it is just as hard to do the small as it is to do the big. To do the ones that have the impact to the ones that have less impact. Given what Todd just said about being mission-driven, having impact really does matter. It matters because it is something that will not only drive you, it will drive your team. When we're looking at what makes a company successful, I think there are two things: being well-capitalized and having a great team. Both of those things are heavily influenced by impact. It's easier to raise large amounts of money if you can have impact, and it is much easier to hire a committed team if you're doing something that has meaning or has value.

Lisa Carmel 07:08
Chris, you were talking about how for big disruptive innovation, you need to better understand and evaluate the market. You mentioned knowing the long-term model. Do you want to speak more to that?

Chris Carlson 07:22
Sure. I think maybe just a follow-on to what we were listening to earlier. I think about opportunities as: are you doing something that's noticeably different? Is it better than the alternatives, and is it hard to copy? If you can have those three things, you've got some sense of what the value you can create in the future might look like. Now the question is, how does that value get distributed? One thing to think about, if you haven't spent a lot of time in a company before, is that value has to flow through the company, right? Your sales and marketing team takes some of that; your R&D team, especially in the early days, takes a big portion of that, etc. Ultimately, some of that has to flow to shareholders. As you're sizing these things up, it's just one double-click to what we were talking about earlier. If you can pay attention to that, and there's plenty left over for the equity holders and for the employees, then you've got something worth pursuing, which is exciting.

Lisa Carmel 08:25
Howard, you were talking about being at the bleeding edge of early innovation. Sometimes at that early stage, big disruption can be seen as unfundable, and it doesn't happen overnight. Do you want to speak more to that?

Howard Levin 08:45
I can confirm it's unfundable. It's like what everybody has said on the panel. You want to go for something that's got a huge impact that will make a big difference. If you're going to do something disruptive, by definition, it's going to have to be impactful, but really, you should make sure it's going to make a big difference compared to the therapies currently available. You're going to have to grind it out because there's usually no roadmap for you to follow for that specific thing. As Andrew said, it's just as hard to do something big as it is to do something small a lot of times, and you shouldn't let it stop you.

Todd Brinton 09:45
I would just add, Lisa, to make a connection between what Andrew said and what Howard said. In some ways, the harder it is to raise capital in the early days, the more prognostic it is that you're doing something disruptive. Andrew said that you need a lot of capital; that's true, but it doesn't necessarily mean it's easy to get that capital in the early stages. You absolutely need a lot more capital the more disruptive it is once you establish yourself. But often the idea, and I don't think there are that many people as talented as Howard, going early. I don't think anything you do isn't disruptive. Frankly, Howard, I mean, you're usually trying to discover new physiology and ultimately come up with new solutions. Most people run from early because no one has done it before. There's nothing to follow, and often people like to follow. A good section of investors follow what's worked for others in the past. Some investors, I think great investors, have a strategy themselves that they're willing to take risks and believe in a team to do something totally different. But those are hard to find. If you're an entrepreneur out there saying, I really think I have something important that I'm doing, and you're finding it difficult to raise capital, you're probably in the right place. If you answer the question of, it's really hard to raise money, I shouldn't do this, that should not be the prognostic decision for you that it can't be done. The more you're disrupting the system, the more you're doing something different, I think the harder it is early. Once you get some momentum and see things, you're going to need a lot of capital to get there once you show that path. I absolutely agree with Andrew.

Andrew Cleeland 11:15
Where's that point? Where do you think that point is?

Todd Brinton 11:19
You've got to get to feasibility. You have to get to the clinic. A lot of times it's clinical; sometimes it's not clinical. Sometimes there's a way to get to feasibility, but those are rare. Mostly it's clinical feasibility. It doesn't mean you have to treat 1,000 patients to get there, but that's usually where the inflection point is, and you have to find a way to push your way through it. I talked to several people this morning; it's just a struggle to raise money. I'm like, Yep, it always has been. It always will be, and it's worth doing.

Lisa Carmel 11:52
This morning, you were talking about Shockwave and your experience in early fundraising. Do you want to share that experience and what the inflection point was for those who missed it?

Todd Brinton 12:05
We couldn't raise money at all. There was just no way to raise money. It was a difficult time; it was actually 2008-2009. The market was obviously recovering, and not unlike where things are now in the capital markets, it was probably worse. We probably went to 30 venture groups, had multiple meetings, but no one was interested at that point in time just because of the timing of the investment cycle. People were holding their capital for their existing investments. If I had evaluated that, I would have thought we had a terrible idea and couldn't get funded, which is what we absolutely did. But I look back in time now and think that it has nothing necessarily to do with the idea or being disruptive; it's just where things are in the markets. I used to say this a lot: if you don't believe in it, nobody else will. You have to be the believer. If you're looking for external validation, you're in the wrong business. You have to believe in yourself.

Howard Levin 12:56
Can I just follow on what Todd said? Just like there are differences in the markets, there are differences in VCs. You can go to 10 VCs, and nine of them say it's the stupidest thing they've seen, and one of them really loves it. It depends on where they are in their cycle. Did they just raise a fund? Are they willing to do an early investment? Are they later in the fund, etc.? Even though I say this somewhat jokingly, I truly mean it. When you start pitching, go to the people you know—the first two or three—who you absolutely know are not going to fund you and will take great pleasure in torturing you and asking you all the questions. You will get to the point where, at the end of those two or three, you start hearing the same things. You know you are prepared to answer questions about all the things you're going to be asked, and it really puts you in a better place.

Unknown Speaker 14:03
I think that's so against what people think the conventional wisdom is, which is to go out to the ones you think you're going to get the best response from. I couldn't agree more with you. You learn.

Unknown Speaker 14:16
Some agree with you. I think that's really important—that you are learning how to pitch. You're learning a story, and the only way to do that is to have folks critique it.

Lisa Carmel 14:30
Yeah. Chris, you were talking about blind spots. Founders' blind spots?

Chris Carlson 14:37
Yeah, sure. I guess the mental model for an innovator in this space—I'm trying to dovetail it into fundraising—is keeping an open mind. On the one hand, you want to maintain your focus; you've got your mission, and I think that's super important. The questions you're trying to solve are very often the most interesting things—the questions you didn't know you were trying to solve or that you weren't aware you were going to have to solve. That's where I think prototyping or debugging everything comes into play. It could be your technology, your feasibility, your preclinical labs, or comparative labs, etc. It can apply to fundraising or even recruiting the best talent. The expectation for me is that the test I'm going to run is not going to work. I'm literally trying to design tests that both show something will work but also show at the limits where it doesn't work. It's those surprises that ultimately lead to the insights that I think lead to the requirements and the products that I'm most proud of.

Lisa Carmel 15:49
Howard, you also talk about in disruptive innovation the disposition you need to have—getting comfortable. You need to be...

Howard Levin 16:01
Genetically deranged. And then number two, you have to be comfortable with being uncomfortable. It sounds stupid, but I can't think of a better way to say it. I'm sure somebody can. It's really, really hard, and you have to be ready. You can't wait for 100% of the information to make a decision.

Unknown Speaker 16:26
Another way of saying the same thing is we call it humble self-confidence. Maybe humble enough to know that you don't know the answers, but self-confident enough to know that you're going to find one. It's not failing, because everybody's going to fail at some point, and there's nothing wrong with that. It's how you respond to that failure. We had this discussion earlier: how do you know when to stop? There is no really good answer. It's great to kill things early if it clearly is not going to work. But you'd rather know if you can, and if you really believe in that, you want to go, go, go, push, push, push. But then you get to a point where you should pivot this way or that way. I think these guys have a lot of experience in knowing when to pivot.

Lisa Carmel 17:31
Todd, you're the master pivoter. It's on your wall, right?

Todd Brinton 17:36
One thing I want to say before I talk about pivoting is that we have a term I used to say when I was teaching at Stanford: you have to get comfortable living in the gray. The world is not black and white. Innovation is not black and white. You have to take a lot of pride in what we do. We make an impact in people's lives through the investments you make, the development you make, whether you're a service provider or an entrepreneur. These are really important things, but the ability to have an impact is what differentiates us from what other people do for a living. That being said, you need to know when to pivot, and often the answer of when is usually in retrospect. You look back and go, well, that was the right decision; I decided to shift. You have to constantly be asking yourself, with the data you have coming in, is it time to adjust? Not just to try and pound something up the hill. I used to say, taking a big rock up the hill, eventually, you get crushed. Eventually, you have to be able to adjust what you're doing to a different market assumption you made that was incorrect. It goes back to something that he was saying: at the end of the day, everything you do should be about trying to get your project to fail. We have this interpretation that failure means bad. I think failure is good. What I mean is test failure, project failure—very good. They are not associated with career failure. Everyone thinks failure is associated with career failure, not doing well. Fail the test, fail the project, move your resources to something else or to a different angle or perspective. That's how you keep going. That's what great teams do. I believe now that I do investing, and I invest strategically outside that; you invest in the team. You invest in their ability to adjust to new information. No one starts and goes, I've got the killer app; it's perfect; I just need a team to build it. It's not going to be what you think it's going to be. You're going to run into something along the way, which means you have to be able to pivot. The teams that recognize that are the teams you really recognize as strong and capable of taking things forward, whether individuals or groups.

Unknown Speaker 19:50
The ability to pivot is so important, right? The pivot is not necessarily a negative; it's not that something's not working. The pivot is based on learning. As the company develops, you're going to be learning, and you may find that the technology isn't working as well as you want. That leads to a type of pivot. You might also learn that the market might be a little different than you anticipated, and that leads to a different type of pivot. One of the things we've all learned, and I think it's a maxim at Biodesign, is don't fall in love with your technology; solve the problem. That might mean that you've learned that the technology you've nurtured along isn't the right way to solve the problem. That's a pivot. We had a classic pivot at Ardian. I hope most of you know that Ardian came originally from this gentleman sitting in the front row. He had a brilliant concept to disrupt the sympathetic nervous system to treat a sympathetically mediated disease, which was heart failure. It was tough to get that funded in the early years. One of the things that unlocked the potential of that was changing from an implant technology to a catheter-based technology. All of a sudden, we were moving from leaving a piece of hardware in somebody to handing this procedure over to someone like Todd, one of these aggressive, reckless types, what we would call rapid adopters. That was a huge pivot. We made a subsequent one later on when we were focusing originally on heart failure, which is a significant problem with major impact, but we realized another sympathetically mediated disease is hypertension, and one in three adults in the Western world has hypertension. The market potential was vast, and it was a much easier disease state to measure blood pressure. Again, being able to recognize what we were looking at and what we were learning along the way forced us to take a different path.

Todd Brinton 22:16
You didn't pivot because the market numbers were bigger. You pivoted because the opportunity to have an outcome that was meaningful was easier to get to a target. People will confuse that and say, oh, it's bigger, so investors will care more. That wasn't the reason for the pivot. It was that you had something very objective that you could hit, that wasn't going to be hospitalizations and take longer to get to.

Howard Levin 22:38
I wanted to touch on something the three of you have all said, and I think the panel illustrates it in different ways. Marc and I are really good at doing early-stage physiology-type stuff, and we can get it through the first 20-30 patients. Have we taken things further? Yeah, but as a founder, you have to realize that you're good for what you're good at. There are things we know we do best, and over time, we figured out it was time to step back and let people who were better skilled for the particular phase take over. Andrew took over Ardian, and his skill set was just better than ours for the time. Do you then need somebody more commercial to sell? There are different skills for different things. It doesn't mean you can't stay with the company; it doesn't mean you can't contribute to the company if you're passionate about it and want to do so, but you have to contribute in your role and not inhibit people from making, you know, being a quote-unquote bad founder for whatever time.

Todd Brinton 24:07
It's a huge factor. It's probably the number one factor I think that people get really too locked up on: if I'm the founder and the CEO, I have to be the CEO forever. I can tell you that's just not realistic. You don't have the capabilities, the skills, or the experience usually to do that. You can still contribute. I was never the CEO of Shockwave; I was the CMO. I spent a huge amount of time there. The idea that I needed to be the CEO or that somebody else needed to be the CEO specifically—we went through multiple CEOs along the way, ultimately to Doug Shaw, who exited to J&J and made one of the biggest impacts in the company. He was someone who had proven he could take a company public before and knew how to scale the business. He was absolutely the right choice at the right time. One of the biggest challenges we all run into is this humility, knowing what you know how to do best, being proud of that, and not thinking that you necessarily need to do it all. It takes a lot of people to get technology across the line to have a big impact on patients. Often we think, well, I'm the only one that can do it. If that's the way you're feeling, I think your path is going to be really difficult.

Unknown Speaker 25:21
Yeah, I haven't seen anyone with that mentality ever be successful.

Todd Brinton 25:25
Great. Chris, do you want to cover team? You work with a lot of startups. What's your strategy on building out the team for startups?

Chris Carlson 25:41
I guess the themes I've seen are that, maybe non-intuitively, early on, you want some of the most experienced and possibly most expensive employees. In general, you can have a few people early in their careers, and even if you're a young founder, you might be early in your career. But finding individuals that are experienced in med tech is crucial. You've got the technology, regulatory, physician, payer, and provider aspects. It's a very complex industry. Paying up and actively recruiting, getting through some painful no's in the process to get those experienced people on board is super valuable. Another trend is that in the early days, it tends to be very clinically and technology-oriented. There will be a reimbursement strategy, etc. Then there will be this crucial moment where you need to think about going to market. That is one big area where the company tends to pivot; it tends to take a more commercial mindset and requires a very different set of skills. Recruiting from the outside, someone who is really good in med tech commercial can pay off significantly.

Lisa Carmel 26:55
We have time, and we always talk, and then we loop back to pivoting. Todd, you told me that you have up on your wall that pivoting is the key to success. Do you have any battle scars or stories about pivoting you want to share? We have time for everyone to share a pivot story.

Todd Brinton 27:22
I think the best example I've heard that Andrew articulated was Ardian. There were some real fundamental adjustments that were really smart and data-based. The best example I can give you, offhand, was pivoting the team. There was a time we needed to make an adjustment in the team. Those adjustments can be difficult, but it's about getting the therapy to patients. I remember going to a conference 15 years ago and hearing John Simpson, who I think is one of the most incredible innovators, say that at the end of the day, it's honestly about patients. I was like, yeah, that guy's made a lot of money; he's been very successful. Is that really true? I've gotten to know John over the years, and that is absolutely his motivation. He literally wants to disrupt and have a very, very big impact on patients. If you stay focused on that, it's not just because it's the cool thing to say or the right thing to say; it really makes a difference. If you do that well, all the other things will follow. This is really hard to do—stay focused on that. That's the biggest takeaway I can have because if you're worried about not making the adjustments you need in the leadership of the team or in getting the best talent you need or in the market assessment you do, if you don't do those things, then you never ultimately get to patients, and that's ultimately where the reward is.

Unknown Speaker 28:52
You've said something so important now, right? If you're a founder and you fail that test—that test being that you are more interested in getting your solution to patients than making money or getting status or something like that—if you genuinely can't answer that question positively, you're going to struggle when things get tough later on. It's a real question you've got to ask: why am I doing this?

Lisa Carmel 29:24
Another question that I've been dying to ask Chris: you've added another $150 million to your venture fund this year. How does disruptive innovation play into your investment thesis with the funds you've just added?

Chris Carlson 29:49
I think investment and building are two sides of the same coin. Again, you're looking for big impact, which is something like the clinical act times the total number of patients you can serve. We're looking to serve patients in an impactful way. If you can do that in a way that's hard to copy, if you're creating value, it kind of works out in the end. That tends to be where we're geared as well.

Unknown Speaker 30:15
Yeah, we need to get them to open that wallet up. You need to get out there.

Unknown Speaker 30:22
Well, yes, Muriel's here. The wallet's open. I did want to say that we've talked a lot about pivoting. I think there's something about perseverance that is taken for granted. I spent the early part of my career at Intuitive on the Ion program, and I thought, oh, it wasn't that bad. Then I was thinking back, and I was like, no, I just kind of forgot. The first 100 physicians—no joke, 100—I had them sign the NDA, and I showed them what I was working on. Every single one said I was crazy. Me and the team collectively, you know, it was Intuitive, right? It had a name brand, had built some stuff, and had a demo, and they were like, this will never, ever work. I was talking to reimbursement consultants, and they said, this is a diagnostic; it will never support the cost of a robot. It will never work. We also had a pre-submission with the FDA, and we explained, hey, we're going to do the exact same testing process that the predicate took. The FDA said, that will never work. In fact, we will not clear the device if you do that testing because it's clear it will never work. The opportunity that presented itself in every one of those interactions was, well, why do you think so? What could I show you that would change your mind? That series of hundreds of interactions led to how we designed our clinical study, which we did in market, which was optional, but we did it; how we did our marketing literature; how we raised money from the board; how we recruited all of our KOLs, etc. That mountain of no's turned into a wonderful set of requirements that holds to this day. I would say, yeah, pivoting—we had some pivots along the way, but in the end, it was the perseverance to the patient at the end of the line that made the difference.

Lisa Carmel 32:28
Todd, I think you gave a master class this morning on perseverance also, right?

Todd Brinton 32:35
I think I said before, if you don't believe, nobody else will. It's not about believing unrealistically, but fundamentally, it's not about believing in the technology. I think it's about believing in the need—fundamentally believing there's an opportunity and some value creation opportunity. Sometimes everyone focuses on the tech, and I think it's really about what you're trying to solve and what ultimately the value in solving that problem can be. Ultimately, simple solutions sometimes are the most eloquent. It doesn't have to be a highly sophisticated solution; it just has to solve the fundamental problem. Sometimes I think we over-invent, we over-create, and think that that's somehow going to move the market in a certain direction. One of the best examples and the biggest growth companies out there is Intuitive, right? They continue to innovate and move the bar. It's not a company that just levels out and says, hey, we got a cool robot. They are continuing to push the limit of innovation. Whether you're in a big strategic growth company like Intuitive or you're an entrepreneur out there, the whole goal is to constantly innovate. The most difficult thing to do is to convince yourself first. Many times people say, I want to convince someone. I say, well, take out your credit card if you believe enough that you're willing to put your own money in your own future. If you don't, then why would you expect somebody else to put their money into it? It's a tough thing to do because it's really about putting your chips in the center of the table. Ultimately, I think that's the test, as you said, that ultimately you're going to put your livelihood there. We call it the valley strapped to the rocket. Ultimately, that's the definition of being an innovator.

Unknown Speaker 34:18
You just solved this for me. We coach a lot of companies, right? The issue around perseverance—there's also the definition of insanity: doing the same thing time and time again. It is a struggle to tell these young companies to believe that the solution warrants an answer. Believe that the problem warrants a solution. That's what I meant. The second one is to take those no's as a way of continuing to learn. You're not just going back and hitting the wall again; you're learning. It's a combination of those two things, which is really perseverance. It's not being static; it's not just hammering ahead. It is believing, as you just said, in yourself and what you're trying to accomplish and learning and adapting.

Todd Brinton 35:15
Great point.

Lisa Carmel 35:19
We have just a few minutes left, and there are startup CEOs in the audience that may be wondering if they're somewhat deranged and/or insane, or a bit of both. You're among good company. I'm just wondering if we want to go down and give some words of wisdom or maybe some things that you wished someone would have told you 20 years ago as an early innovator bringing about disruptive innovation. Who wants to go first?

Howard Levin 35:56
I'll start just to make it easier; elder is the important question. The one thing that I heard from Todd today that stuck out to me was, you know, perseverance is good, and you really need to push through. You may fail; the company may even fail because SGLT2 inhibitors came and took away your market or whatever it is. That doesn't mean you as a person have failed. You can go and do the next one; you can go and do the next one. The key is, if you want to innovate and do something, never give up. You or your company may fail, but again, it doesn't mean that you personally failed. If there was a reason, you had to assess it and understand your contribution to it, but you should never quit.

Unknown Speaker 36:59
That was a good one. I don't know where to go after that. I would say, you know, I was so fortunate early on to have good mentors, good people around. So find those folks. I got to spend time with this guy early on. I think that learning from others is the way to accelerate your learning, and that's what I'll leave it at—find your mentors.

Unknown Speaker 37:26
That's great. Early in my career, my mentor was Rob Young, and he told me that companies come and go, but people stay the same. Circling back to the earlier comment, build healthy relationships with the most badass people you can find, and you may get a chance to swing the bat with them again and again. It's definitely a long game, so have fun and build relationships as you go.

Todd Brinton 37:55
That's a good point. Some of the most successful projects I've ever seen were people who had lots of failures before they had success. I think you learn the most from the failures you have. I don't believe you learn from success; I know that seems a little kooky, but I really don't. I think failure—project failure, test failure—is very good. They are not associated with career failure. Everyone thinks failure means career failure, not doing well. Fail the test, fail the project, and move your resources to something else or to a different angle or perspective. That's how you keep going. That's what great teams do. You want to put together a team of people that ultimately have a collective experience as best you can. Surround yourself with people a lot smarter than you, a lot more talented than you, and ultimately have your best chance of getting a success. Again, success is about getting to the patient.

Unknown Speaker 39:16
I want to follow up on something Chris said. It's super important, and this is really key to folks who are running companies for the first time. You've got to build enduring relationships, not transactional relationships. It becomes very clear very quickly when I deal with folks who want something from me, which is all the time. If this is going to be transactional, I have zero tolerance anymore. What I've noticed is that we've known each other for a long time, and we've built relationships where there is meaning and substance, and that substance then comes back. Who knew you were going to be running Edwards in a couple of years? We'll be able to sell you companies because of the relationships we've built.

Lisa Carmel 40:10
I'm going to summarize really quickly. I think we've taken some great insights. I would say that Howard, your comment about getting comfortable with being uncomfortable, being prepared to pivot, leaning into your blind spots, recognizing that failure is good, and seeking out mentors and people with battle scars like these esteemed panelists is crucial. Thank you so much. Let's give a warm round of applause, please, folks.
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