Innovating at the Intersection of Drugs and Devices | LSI Europe '25

Steve Pham  0:05  
Okay, I think we'll do the standard thing and kick this off with introductions. Why don't you guys go first, and then I'll be the humble moderator. Introduce myself last.

Hubert Birner  0:15  
So I get started. My name is Hubert Birner. I am managing partner of TVM capital and life sciences. We are one of the longest standing European based life science investors, having a big interest in biopharmaceuticals as well as Medtech. I think that's why I'm here today for the latter part, and I'm very excited to speak again on a panel at LSI. Great to be here.

Carolina Aguilar  0:42  
Thank you. My name is Carolina Aguilar. I'm the CEO and co founder of INBRAIN Neuroelectronics, and we've been in the field for five years. It's about brain computer interfaces using an advanced material called graphene that can deliver real time petition neurology.

Anita Watkins  0:59  
Hey, good afternoon. Anita Watkins, I'm the managing director for Rex health ventures. We are the corporate venture arm for UNC healthcare. We invest all across health care, the health care spectrum, but particularly excited to be here again at LSI, focused on med device and now therapeutic intersection.

Steve Pham  1:19  
Great. I'm Steve Pham. I'm a clinical assistant professor in emergency medicine at UCSF, a serial medical device, investor, innovator and operator in the space. I was previously building digital stethoscopes at Echo health, as well as currently working on a patch called proton intelligence for continuous potassium monitoring. But my normal day job now is, I'm Chief Digital medicine officer at Zs associates. My role at ZS and a lot of what our business is is trying to help pharma and life science companies overcome go to market frictions. Sometimes it's in the clinical development phase, and sometimes it's on the post market approval, but a lot of times, what I end up doing is bringing deals to investors and innovators, such as the folks we have up here. So think that's why I was asked to moderate this panel. I think to kick things off I, you know, I wanted to first start by talking about, sort of where we are with the intersection between life science and med tech, where in particular is the innovation occurring? Are we seeing I'd love to sort of hear sort of the diversity of opinions here. A is it that we're replacing drugs by more targeted interventions. Are we co combining or CO developing, you know, drug delivery or other types of devices that help support medications getting where they should be, or making a better impact synergistically? Or are we just a way to get more drugs into humans without directly delivering it. So, for instance, improving the upstream funnel, such as diagnostics, I'll stop there, but I think that's where I'd like to start. What do you guys say?

Anita Watkins  3:14  
Yeah, I'm happy to jump in. I think those are three really great examples, but there's so many more. One of the spaces that I'm really excited about, we just invested in a company called reprieve cardiovascular that is taking a well known drug in the heart failure space and essentially automating the clinical administration of that drug based on the labs and the Vitals. It's a closed loop system, and at least what we saw in the feasibility data is a two day length of stay reduction and improvement in readmission. So it's a win win for the patients. So what I'm really excited about is the ability to automate using med devices to automate the administration of drugs that we know are safe and we are needed, but to take that clinical burden off and the patient actually having better outcomes.

Carolina Aguilar  4:15  
Yeah, the way we are looking at it is, you have a disease that has a continuum of care, you have an early diagnosis, you have when they are chronic, and you the neurodegenerative, for instance, like Parkinson's disease. After diagnosis, there is a very long journey until you have several alternatives and drugs start stop being effective, right? So this is where actually devices could reach. For pharma that period where actually you could deliver incremental revenue if you don't have the right molecule. But then recently, what we're seeing is that devices, for instance, we wear our brain, compete the faces and Bioelectronics, and we have a collaboration with Merck where actually. The technology like ours, put in the vacuole's could actually manage organs, and they could be all a therapeutic target that could be synergistic with drugs or a replacement of drugs, in some cases, in very large indications. Think we just saw the FDA, the FDA, approval of set point medical in rheumatoid arthritis, that is a very real current example of what this can do.

Hubert Birner  5:28  
Yeah, I guess the the other aspect that you may not have covered is that the world is moving to new modalities in pharmaceutical treatment, away from just simple small molecules or or antibodies. Remember the mRNA era we went through together. Cell therapy has a renaissance right now, and I think these new modalities are very important drivers of device innovation. Because, I mean, if you simply take, for instance, cell therapy used to be super complicated to have this ex vivo productions and all of that. And now we are seeing more and more mini factories, the bad side solutions that make these therapies more accessible, more acceptable, and also more usable by the by the physicians and the patient. And I'm actually very confident that that this intersection, especially as we moving into very exciting new modalities, is a huge field also for investment for us going forward. Yeah, because this complete an uncovered fear. At this point, I thought,

Steve Pham  6:45  
yeah, I think this is a great diversity of examples, right? So, you know, Anita, I think, you know, reprieve is very interesting to me too. I've worked in the heart failure space. I see these kinds of patients all the time. And I think the class that I would call that would be like closed loop medications powered by devices, right? And the larger sort of super set beyond that would be effectively letting a set of devices detect and then make decisions, almost in an automated way, right? That's essentially the closed loop I'd be curious to see. Like is that affecting your investment strategy of how you you know, it seems like it's the first investment in this kind of closed loop fashion. How do you how do you think about investing in these kinds of devices? Because what's interesting here is that the CPT code is probably where you're going to reimburse. It's not there's no drug incentive, no no pharmaceutical manufacturer is making that much money off of Lasix, except for auto injectors, which is another kind of closed loop, right? So I'm curious, how does that affect your investment strategy?

Anita Watkins  7:46  
So I think the there's a couple of things there. So we've, we've invested, over the years, in companies that were pursuing both a new device and a new drug indication, really, really hard to do, especially when you're running two parallel regulatory processes. We've also invested in companies that we're looking at new modalities, micro needles. I mean, we all saw five, six years ago, the micro needle patches. I think where, where I'm most interested right now. And this is really across the board as we look at a health system. So for those of you that aren't familiar, the UNC is the University of North Carolina Health System. It's a very large health system on the east coast. In North Carolina, we're never going to be able to hire enough to meet the demand of the patients that we're seeing. So looking at automation and all kinds of applications within the health system, and drug delivery and payment patient treatment being a really important one. So if, if our investment lens has changed, it is definitely over the years, pushing more towards looking for that automation that's going to a patient outcomes has to be at the for first and foremost, has to be the intended outcome of the company to improve those patient outcomes, and certainly to to reduce the amount of time they are within they're in the hospital, but anything that can automate what is now a quite heavy MIT, as you've treated the Patient very, very intent, time intensive for the clinic, yeah.

Steve Pham  9:23  
And you know, what's interesting is that your investment lens is on the health system side. And you know, this is still a business, right? And previously, if you are prescribing lasix or you're injecting it, that's actually a loss of money to you, right? You're losing money on every single stock in every injection is nurse time, etc. Now it sounds like you could flip that model and generate revenue through CPT, or, I don't know if there is a strategy beyond just saving time on

Anita Watkins  9:53  
the goal. The the initial goal will be to for the patients to be able to go home sooner. Right now it's seven to nine. Days for every patient. So not only is the health system losing money on each patient, but that patient's quality of life is obviously being dramatically impacted from a length of say, and then you also increase the risk of hospital borne infections. And I mean, these are very, very sick patients, so there's a lot of win wins on this type of investment for us,

Steve Pham  10:22  
yeah, well, that that makes me excited, because I'll win here, too. And so, you know, in the same theme Carolina, like, how do providers and health systems win with, you know, a BCI or the future of a brain computer interface? You know, a lot of this stuff can happen outside the hospital. So I'm curious, Yeah, where's the where are the wins for you?

Carolina Aguilar  10:42  
Yeah. So there are two angles to look at that. I mean, on on one hand, what we are seeing is that in the past, Medtech has been very mechanical. We had pacemakers. We had implants in our body that were not capturing data or not giving data back to patients to empower them and have better outcomes. Now we are going to have extremely intelligent implants that are going to be diagnosing and treating like a mini neurologist in your body and the whole body real time, and not actually giving you the data on your status or even the recommendation that you have to actually do to get better, and that can be paid by outcomes, I think, at some point, and this is our goal, is to be paid by the outcomes that the systems generate, and not by the systems. And if you can do that, the I mean, the value equation is outcomes that matter to patients divided by cost. So we increment the outcomes, and then we are more efficient, because these patients don't have to come back to programming or to re evaluation as often as the others. Then there is efficiency gains. And on top of that, we are avoiding, for instance, falls or other complications that translate also in long term savings. So it's better outcomes efficiency, short term savings and long term savings. I mean, say, no brainer Never better.

Steve Pham  12:10  
Said, yeah, yeah, a lot of those kinds of outcomes, like pharma, doesn't have the Reach for right like this. The reason I'm sticking on this kind of thinking is that the value that's generated by Pharma is usually captured only by pharma, right, which is why Pharma is, you know, they hand their pound gorilla, right? And usually dwarfs med tech. But what I'm looking for are ways to think about value that's generated by Medtech that's unique, that Pharma would never be able to touch and you know, one thing that you point out here that along the same theme, is this cell and gene therapy. I do a lot of work in that space. It's much more becoming an engineering task, right? It's it's the stack is becoming not so much. Even though it's med tech. It's not necessarily like built for purpose therapeutic, it's more like an engineering manufacturing technology to then build your finals therapeutic. I love to hear sort of where the wins you're finding on the revenue generation outcome side, like our provider systems, health systems. Why do they buy into this? Because it's a very expensive task.

Hubert Birner  13:24  
So I think, as a prelude to the answer the I'm pretty excited, actually, right now about the multiple device applications then can help control the application of pharmaceuticals, yeah, take a simple example. A couple of LSI ago, I was approached by a few guys who had this new kind of sensor you put under your arm to measure your insulin on a on a minute basis, on your iPhone. Oh, yeah. And and then it's kind of a speed of light. This thing is moving on. Then now there's new technologies that link your insulin level to a implanted device that injection the medication that's needed, and at the same time to now I'm trying to answer the question, what this really does is creating A really exciting awareness for the patient of of causality, of things, how they work together. Because in the old days, you took a drug in the morning at seven or before breakfast, and that was it. You had no clue, actually, what's happening. What are you doing? Right? And in a time when you're married to your iPhone, you see a lot of these kind of and just, just take the next generation. We are the old guys. I don't design the old guy. This is a very important element to become more data driven and causality driven. And I think that is where medicine is going. And I see a lot of activity now in the European healthcare systems, obviously in the US, they are there ahead of us already. But. But take some very slow healthcare systems like Germany or France, right? They are embracing using technology reserve the speed of light, because they they see a lot of costs that can get out of the system by integrating device diagnosis and therapy. And we asked, we just at the beginning of it, right? I mean, another, another great example is now take the new diagnostic technologies for early Alzheimer, for instance, right? They have been, they had been irrelevant as long there was no drug to treat the early stage Alzheimer or to define exactly what is even diagnosing. It with diagnosia. What does it really mean? Right? And what makes me kind of really excited is, is that the more we move on in in exciting drug development, the more pharma understands that they are dependent on the device industry, or, yeah, to be actually be really successful, because all of a sudden, it's not just against altimers. It's a very specific,

Steve Pham  16:05  
targeted approach and and this is the precision we will need at a very affordable and transparent cost. And this is why I think we adjust. We should talk again in 10 years, it will be pretty as you said, we'll have a lot of stuff implanted in our ears, in our foot, in our butt, right? Or nowhere to make our life and the life of our doctors much easier, right? So, yeah, well, so I hope I answered your questions. Well, no, yeah, and I'd love to follow up on that data piece, because I think that's really important. Because pharma doesn't have or generate data, right? Like no, but they are the most sophisticated consumers and acquirers and buyers of data far more than any other class that I've seen. And what that tends what that and they generate the most revenue, right? And so what ends up happening is then they need to come knocking on med tech store, investors, doors, other people's doors, to get the data that they need. And I think the next round of questions I'd like to ask is, how is it perceived on the med tech side when pharma comes knocking, you know? I so I used to run M A for Roy Evan, for medical devices, and I, you know, and I'd sat on both sides, and I also operated with an echo. So I've built devices, and pharma came to us, and then I was pharma, and then I came to med devices. My personal opinion is that pharma does a really bad girl. I think we we come asking for a lot from med tech and other ecosystem partners. We kind of demand a lot, and then we ghost and never lead to any revenue or deals, etc. And that's a lot of my work at Zs now, is, how do I make those deals happen? So I'm curious, like you know, on the Medtech side of each of your businesses, and we can start with Anita. You must have a broad purview of a lot of your portfolio companies. When has pharma successfully knocked on a door of your Medtech and you know, led to something meaningful? Or do you have to be the investor that arranges the handshake, perhaps between two different portfolio companies, or you bring in the bigger whales? And I'm curious

Anita Watkins  18:15  
so So historically, within within our companies, it has been a pharma first company, you know, and typically it's a phase 2b, to a asset, and then they're looking for a way to better administer it. And it has been, I mean, it's not been easy for any of the companies. I mean, one of my companies, it was a new drug and a new device. And FDA does not have a pathway, you know, for companies trying to solve for, I mean, and the unmet need they were trying to solve for is nuisance bleeding. So everybody that's on a blood thinner, you get a Nik. I'm sure you, anybody in years experience this, hours later, you're still bleeding. Well, this was development of a simple device and a reformulation of a known drug, TxA, that works. I'm sure you used it in the EP reformulation event drugs, where you can just hold the drug on. Can I get a free sample, exactly the regulatory pathway to get that done, and then also the complications that came about within the clinical trial, because you it essentially is a drug clinical trial of how to administer the drug certain cases, you know the data was confounding, because is the device keeping the drug from working as it should, or is the reformulation causing the drug not to work as it should? And so the difficulty around regulatory pathway, you know, that has to be out there in this conversation. It's something that if we want to get to the point of 10. Years from now, of having the ability to administer drugs very easily and safely for patients, FDA has got evolved their processes. But on the other side of that, we have seen really great partnerships of especially in our ecosystem, where you have a lot of med device and you have a lot of therapeutic if just a lot of talent that you can bring together and essentially create a company around. None of my companies to date have Big Pharma has come in and said, I want you to develop a device for this, mostly because that's not where we're investing in and vice versa, where our companies have needed big pharma to be at the table because they're they've got their own assets that they're developing.

Steve Pham  20:47  
Yeah, yeah. So it sounds like a lot of it is working independently, not even really thinking about Pharma. And I think that's the way Medtech should be right. Like, you should not be built for purpose for pharma, unless you're like a cell and Gene kind of manufacturing process where you're you need to solve a problem on the on the therapeutic side, I'm curious, Caroline, that you know, with with INBRAIN, you know, you mentioned Mark kg, and not to be confused, the other Mark, we always have to say that that's a pharma, right? Traditionally, a pharma. And I'm curious if you could sort of provide insight on why they wanted to partner, or why you would think if they didn't reveal that to you, they may not have Yeah, I think

Carolina Aguilar  21:34  
there's a couple of angles here. So first of all, we wanted to unlock the 400 billion market that there is behind Bioelectronics and neuro electronics, and I've been working in Medtronic for 13 years, and it's been way too small market compared to the opportunities. So we were thinking, how do we do that? And what is beyond what it's been done by Medtronic, personal, scientific and adult. So that was one line of thought. On the other hand, think Mark kVA, it's a very different pharma company, because they have electronics as well. They had all the screen and semiconductors, so they are already on the verge of the electronic side. And they were also thinking, Okay, we it's getting more and more expensive to develop new molecules, and there is this other wall here that we have not explored, that can have a huge opportunity. So they were going around the world to do a search about how to do precision neurology in a way that it was really precise. And we happen to have this micro metric technology where actually we can be ultra selective on this one nerve that we're intested, that is the vagus nerve, that happens to manage most of our core organs. So they they wanted to explore that, and they actually knock on our door. Is a process, I can tell you another day. This is a funny story, but basically everything fit together. The deal was very pharma style.

Steve Pham  23:05  
No, this piece, yeah, yeah.

Carolina Aguilar  23:07  
So, you know, you can have a supply scene path, you know, eventually you can have an acquisition path. But it was always very fair. Otherwise, we'll never have done it. From the beginning, we were being born. Actually, it was four years ago, so it was literally when we were founding INBRAIN, but the deal was actually so fair, and they've been always so fair, that it was totally worth it. And at the board, we decided we're going to make another company calling nirvia that is going to hold this collaboration, different IP, different legal entity, and all very clean, in case it doesn't work, but it's been four years. A lot of great preclinical work, a lot of great data, and now they are in Doug Ling down towards humans, hopefully, you know, this is a big success story, because it makes sense. You know, now we can modulate targets that we didn't think that we could modulate with that sensitivity, and no drugs, so no side effects, right?

Steve Pham  24:08  
And I love this story, because, you know, Pharma is not usually humble, right? And if you look at a lot of pharma pipeline, they assume that what's undruggable can be druggable in the future, right? So this is actually quite a humble move, you know. And what's also interesting about this story is that, you know, my experience on the other side is that life sciences tends to end up not necessarily destroying that devices, but but when they they come knocking, they can influence the med tech company in a negative way, right? Distract from the original investor thesis. They can also, you know, provide incentives, oh yeah, let's throw a few million dollars here. But you know, if, if you need to grow and hire to capture that million, and it takes you away from the original products, you know, but you're the rare success story, so I'm happy to, well, we always

Carolina Aguilar  24:58  
thought about the platform. Company. And I know some people hate it, some people love it, we decide this was the way to go to actually unlock those 400 billion opportunity by just coupling different sensors, maybe some ASICs, or, you know, specific electronics, but common data labeling, data. Architecture and data is very important here, by the way, and and Mark will benefit. Mark AJ will benefit very much in the in the future, for for that data as well, which is what pharma you naturally don't have.

Steve Pham  25:35  
So, yeah, nice call back to the data thing. Hubert, so I'm curious, like, what are, you know, keeping in with the theme here, any stories or examples where Pharma has, you know, successfully knocked on any of your med tech companies or synergies or deals.

Hubert Birner  25:56  
I think the, I think the the prominent fields is neuro and diabetes, for obvious reasons, and what we are, I'm following a company which I haven't investment yet, but it's becoming more interesting the longer we go. They they are in this whole field of neuro stimulation, right? And neuro stimulation had a kind of a bad connotation for what I mean, at least, at least when we were studying medicine, was like, kind of a little bit voodoo, right? You had, I thought it was science fiction. It was that's, that's a much nicer way of putting it than voodoo, yeah. But honestly, I think the field is moving on and and it's becoming more and more credible, and the trials that are done, the effects they see, on top of administering drugs and having all these additional features, a little bit like what you guys are in a related field is, is very exciting and and I was surprised that I look I read a little bit up coming up to this panel Last year, about $300 million went into companies that do neuro stimulation. Who do you have guessed it's, it's amazing. I've heard this number, yeah, it's amazing. And across across Europe and the US, right? It's still growing, and it's still growing and and people see a real benefit, and there's a legitimate benefit in that, right? So, so that is one. I want to point out that that that CNS in general, is a field where we see more of that CNS also has been a field that has been plagued by by lack of cooperation by the patients, by lack of by lack of visibility for the physicians, what actually happened to them. And then I think smart devices will take away a lot of their uncertainty, especially in fields like schizophrenia and feels like depression, right? And when you know yourself, that is something I really look forward to. And I believe that is, that is all part of the same picture. Is it's an area that there. And used to say there are devices actually they can be like a, like a, like a medical treatment. Oh yeah. So, so neuro is, for me, probably the place to be in the future. And now the other one I, I, as I said on our call when we had this preparation, is I'm pretty fascinated with the speed of light the whole diabetes world is going now, yeah, and, and, you know, take, take the anti obesity syringes and all of that. This would be even more automated, as you said, right? I mean, having a syringe once a week, you're going to have a device that that just delivers whenever it's necessary. It's monitored, shows by up in a doctor's office, shows up on your iPhone, and you're not even there yet, because we will see a lot of ability also to measure the side effects, the negative side effects of trauma. Will hate that. No, seriously, they'll hate it. But I think the patients owe an answer to that, right? And there are very well known side effects of of Watson peak or man jar, or, let me just spell it out, right? I mean, it's like, like nausea, lack of sensitization. People lose the ability to to of taste and all that kind of stuff. And the benefit for that for the patient of a safe drug, safety is also buried in the use of proper and smart devices. Yeah, that, don't forget, that is a something I really look forward to, because it will make us use these exciting new drugs more responsibly.

Steve Pham  29:38  
Yeah, I'm fond of saying that to really know what the incentives are behind the the what's driving decisions on pharma, look at where they're not spending money. I have never worked a project related to uncovering side effects for any of my life science clients. Anita, I think you want to say something about the. Yeah, the neuro

Anita Watkins  30:00  
so the on the neuro stem side one of one of our other recent investments I'm really excited about, and this isn't treatment, but it is replacing Pharma. It's a company called synaptrix, where it's a neurostem device stimulating the sciatic and femoral nerve prior to TKA, and the patients are seeing up to 20 days of pain relief. So no opioids, no, yeah, no anesthesia, not anesthesia. And, yeah, yeah, I get it. And that, to me, is really exciting use of neurostem where we can take patients off of opioids. I think that when I one of the things that just occurred to me is one of the reasons probably Herbert and I were probably selected, is because we're some of the few funds that are investing in that intersection. So in addition to FDA needing to create some more flexibility in the regulatory pathways, we need more funds that are willing to look at this intersection, because a fund I'm raising money for one of my companies right now, and the response we're hearing is, well, we're device, yeah, we don't, we don't really play in that space. Or we're biotech, we don't really play in that space. And I think we need to see to really advance these technologies, because there is an incredible opportunity here. We need more funds that are willing to cross over that intersection.

Steve Pham  31:28  
Yeah, I love that. I think, you know, this leads to sort of the last topic I wanted to talk about, which is sort of where you see the future of these two right? Like, I'm already excited, because I'm a doctor, and even though a lot of the technologies that have been mentioned on this panel are going to replace some piece of me, that's great, it frees me up to do even better, greater things. Can spend time with the patient. Yes, that's that's what I see in the future. But I'm curious, you know, and then to follow on on the regulatory thing, one piece that I would add to the future, which I think, hopefully will happen for med devices. But on the digital health side of things, there's a recent regulatory guidance on something that FDA has put out on something called Peters, which is prescription drug utilization, something something Rs. Anyways, the idea is, like, prior to this classification, if you built an app, you were either in this weird dichotomy of SAM D or not, and what people were realizing is, if you're a digital therapeutic, and you have to go through the same phased studies that a pharma Life Science asset has to do to prove that you're a therapeutic, you might as well Just not invest in that company to start right? But now you have not only a guidance on how to do this without having to do a full clinical study. In many cases, P doors can be achieved with completely without a study, and it has to be done with a drug, by the way, so it's wrapped around the drug, so it's kind of like a combination. So you have a SAM D slash digital app wrapped around the drug. Not only that, they have built an incentive for pharma to play nice, because it will extend pharma exclusivity of the patent by two to three extra years if you achieve this. But you have to be first in class, which, you know, creates an arms race, right? So I think that there will be a future of this for devices as well. It just seems natural to me that a diagnostic or a monitoring technology or a drug delivery system can also work in the same kind of way. So that's what I'm projecting for the future. For to answer that regulatory question, maybe Caroline, if you can talk a little bit about what you see for the future, wait, you know, yeah, I think

Carolina Aguilar  33:47  
the future, actually the present, is about convergence. I mean, I'm seeing semiconductors, advanced materials, biology and AI, coming together for very long. I got VCs telling me this is technology looking for an application, but technology has been driving the world. I mean, who needed a computer? Who needed an iPad? You know, we there were not needs. You know, the need was created because of the technology being able to do things we could never dream of doing before. And this is happening on on med tech now, which will be more tech med in the future. So I think the future will be more tech Med, and would be converging and and creating synergies between Meg and Med and devices in ways we've never seen before, as well, and in a much more productive and outcome driven way. Because, you know, we've seen patients having enormous complications because of the fluctuations drugs take. You know, with with technology, these fluctuations will disappear. They will make, you know, a seamless transition, you know, from one drug or one treatment to the other. They will empower patients. They will reduce costs for the healthcare systems. And hopefully, you know, will make us still more humans, because we will be less, less dependable and less, you know, we'll have less anxiety, because there will be something in our bodies or outside taking care of us in a much more productive way. Awesome.

Steve Pham  35:19  
I love that vision, hopefully, though, was still me in the picture as a doctor, somehow we will converge as well. Yeah, I'll be part of it. I'll be a cyborg too. It's that has already happened, by the way, Aug medics with the glasses, ambient scribes, but you were with curious to hear your vision.

Hubert Birner  35:36  
So my my view of the future is that the 21st Century is gonna deal, on the pharma side with some of the massive problems we've had in history of mankind, like we had the antibiotics in the last century, we will solve a lot of the cancers by the end of the century. I don't wanna sound like John F Kennedy, but that's a real belief, yeah, and, and will, you're on the way to crack some of the real bad brain diseases like Alzheimer's, ALS and anything that's out there, right? So, and we need Pharma. Pharma will have a important place out there. And will, will drive innovation, however, to bring down innovation to patients will be heavily dependent on the Medtech industry, and the Medtech industry has not realized that, yet they need to wake up right? And I think a key element will be how the Medtech industry is going to lobby the payers to include them in the delivery or in saving money on not spend too much money, and all these very expensive drugs, that will definitely make a difference. But I think the med tech industry needs a better lobby. That's my point. Yeah, a better, a better lobby. A better, a better, a better understanding what actually their places in the values when you value because right now they look at that. I mean, you go to these conferences here, and I go to a lot of biopharmacons like you do. And you know people here, they're very close and very close society, but they, they don't think big enough, in my view, right? Yeah, and I think this is what needs to change in med tech. And the Medtech entrepreneurs and the Medtech investors, including ourselves, including myself, need to find smarter ways to do exactly what you said is, you know, how do we how do we bring these technologies together and create more time for the doctors to deal with the patients? And that is my vision for the future. Is where we have wonderful technologies on the Medtech side. And if you go out there, there's like, like, 200 AI driven companies there that I would like to meet with me. I can't meet them all right, but, but, but using their technologies in the right way, also to help deliver drugs or to help deliver therapy, is the future, and we need to think much more in a much more integrated fashion, right? And as I say, I like, I like the tech med part better than the med tech part. And yeah, and then the next part is the tech med pharma, right? Yeah. So, yeah, that's what

Steve Pham  38:14  
it is. So I yeah, I'm so I give a lecture specifically about this topic at Berkeley and UCSF, and I call it med tech as a service, because actually, I think the piece of value capture that Medtech traditionally does not do well is in actually delivering the care right? They build a widget, they sell it as a widget. Maybe there's razor blades with maybe we sell somebody else will deal with it, and there's no and what happens is, you give it to the users who may not be best trained on it, or you need to send field force, sales force out there training them every year. And that's expensive, that's crazy. That needs to be spent because you're giving the service up to somebody else, you doctor do do it this way, and as a doctor, that's frustrating also for me, because if I didn't get that training or retraining or materials on instruction manuals, all this stuff, the value I'm able to capture or deliver from the device gets diluted. And on top of that, there's all sorts of other issues of data interpretation. Let's say there's data that gets generated from it. Am I the best doctor who knows how to interpret that? No, you probably have doctors internally, inside each of the med tech companies that know way better what the signals, what the data, what you're supposed to do with that. And so, yeah, I love this vision, because it's it to me. It's like this thing I've just been banging the drums on for several years now, which is like part of my French but like also Medtech companies need to grow some balls and deliver some service, like stop just being a widget anyways. So hopefully that's controversial enough to inspire last call

Anita Watkins  39:59  
from an investor. Perspective saying med tech services, you just reduce the margin and the end value. I know this is why. This is why Peck med pharma,

Carolina Aguilar  40:11  
when you have our billion and trillion med tech companies.

Anita Watkins  40:14  
So, yeah, I mean just to vision of the future. I do think, I mean, we've touched on so much here, but I do think delivering care, and I'm very focused on how a health system delivers care, but delivering care in a way that really does take the clinician out of it. Is it can is got to be the way of the future. We're not going to hire enough we're not going to train enough people.

Steve Pham  40:44  
So any last comments? Carolina, well, we

Hubert Birner  40:49  
had a whole nother topic, which obviously didn't have time to you want to tell, I just, I just say it, and then we'll do it next year. Okay? And you know is, is, how can we use medical devices to make drug development more effective and cheaper? Huge topic. I do that next year, keep it underneath, but I think there's a huge opportunity. Yeah, it's a huge opportunity out there for that. And we didn't have time to cover it, but, but, you know, if you are CRO or a combined group of CROs, and you bring this all properly together in a standardized patient's population, so you can take a lot of systems out of clinical trial work. I think that is a topic for us as investors.

Steve Pham  41:35  
Caroline, the last comments,

Carolina Aguilar  41:37  
I think we're out of time. No thank you. And hopefully together we'll we'll make it okay to the billion range. All right. Thank you. Good job. Thank you. Thank you so much. Thank you.