Sourcing Innovation: Can Medtech Replicate Biotech’s Asia Playbook? | LSI Asia '25

Adrian Lam  0:05  
Good morning, and welcome to our panel. My name is Adrian Lam. I'm going to be your moderator today. I am wearing two hats today, one as partner at bioworld Ventures, which is a an operating studio based out of Hong Kong, and the other is as president and CEO of a company called core VISTA health, which is bringing a diagnostic technology and ability to diagnose coronary disease and pulmonary hypertension in the outpatient setting. I am delighted to be on this panel and honored and and our main question today is really, you know, exploring the success that we see in biotech in terms of cross border innovation, in terms of transactions, in terms of financings, and trying to trying to understand why, or whether that is applicable to med tech, and any lessons that we can learn from that. And so without further ado, may I ask the panelists to give a short introduction of themselves?

Cynthia Chen  1:09  
Sure. Hi. Good morning, everyone. This is Cynthia Chen from ponovo Medical ponovo, we are a global medical device company focusing on two disease indications, pulmonary hypertension and heart failure. So currently, you were globally structured in us, Singapore, Hong Kong and mainland, mainland China, with three robust global clinical programs ongoing, including two FDA studies. Thank you.

Hanson Gifford  1:38  
Hi, I'm Hanson Gifford. Been in the medical device industry for over 40 years. For the last 27 years, I've led the foundry, where we do a lot of innovation and also look for ideas globally and start a series of companies in a wide variety of clinical spaces, bringing new medical device technologies to market. I'm also a partner at light stone ventures.

Alexis Cheng  2:08  
Hi, I'm Alexis from Cornerstone robotics. So we're a six year company based out of Hong Kong focused on laparoscopic surgical robots. So last year we received an MPA product approval, and this year is our first year of commercialization.

Adrian Lam  2:23  
Great. Thank you very much. Delighted to be here. So you know, going to jump straight into it this morning at the Medtronic panel, actually, we heard that half, I believe, of the global deals this year are actually related to Chinese companies or China innovation, that is definitely a lot of biotech deals. So one thing we want to ask is and explore is, why is it a is it a matter of time in Medtech, or their structural problems there? And maybe we can ask the two innovators first, well, the three innovators, but the ones running companies right now. So Cynthia,

Cynthia Chen  3:04  
well, you know, I think starting the early this year, we've heard a lot of questions from investor asking the same thing, but from a corporate perspective, you know, time alone won't fix what the system was, a system isn't designed to achieve. So what we've been seeing in Medtech is that we have like fundamentally different underlying mechanism as biotech, and just because we just finished this big Series C round, and it's just really hard to find all those risk capitals willing to deploy into globalization, companies with bigger ambitions and goals. For example, when we, when we go out and talk to investors on our global FDA studies, all of them are excited, but only I think. I've already, I've actually met with more than 100 investors for our Series C, and by the end of the day, 10 of them give us, give us a term sheet, and eventually four of them make the final decision. So, you know, I think we see, without enough funding and without enough systematic policy support, it's just really hard to for for med tech innovator to not only focusing on the incremental change, you know, the UV improvements, or to maximize the current treatment eventually to moving the treatment paradigm so it's both time and also both infrastructure problems that we're seeing here. Maybe just

Adrian Lam  4:42  
a quick follow up before we switch to Alexis. You said you met all these investors. You represent a very viable and interesting novel, first in class kind of technology. What is the response for turning you down that you see a lot, is it just I don't believe it, or just tune. New. I don't think too new is a problem, right? What do you what responses do you see?

Cynthia Chen  5:04  
So being the first one, it's good or bad, the most questions that being asked during all our financing process is why Medtronic isn't in this, why Boston isn't in this, and why we are not seeing any of the American company catching up soon. Why a Chinese company? But on the other side of the conversation, we can also see that there are a lot of expectation all of the investors to see that, you know, we will have an Asian leading innovation micro device company coming up to the market soon, but it's just very hard for them to make the first bat on this journey.

Adrian Lam  5:46  
Suppose it's the early bird who gets the worm, but the second mouse that gets the cheese, right? What do they say? So? Alexis, any any comment here about med tech, you know, following that biotech path?

Alexis Cheng  5:58  
Sure. So, so, from our perspective, it's, um, it's a matter of it's a matter of time and process. So of course, in our in our space, in laparoscopical, laparoscopic surgical robots, there's obviously a dominant player in Intuitive Surgical ahead of us, over the last, you know, 1520, plus years. So again, we're also, you know, in our series C round, and we've, we've met a lot of investors as well, to echo what Cynthia, Cynthia just just mentioned. A lot of the questions that we we face are, you know, how, how will a company break out of this dominant sort of landscape and come out as a as a second Dominant Player within this space, right? And within this type of, this type of current, current situation, a lot of investors will look for us for more data, right? More More commercialization data, etc. And that's really something that only time can can bring because, as we're all very aware in the med tech space, it's a very long process to actually get, get through, no matter be r&d or through the whole commercialization cycle.

Adrian Lam  7:08  
Yeah, any comment here

Hanson Gifford  7:10  
as an authority, well as the old guy on the panel, maybe it's worth just taking a moment to look at the history. It was just a few years ago, I don't know, 15 years ago that all of the American, you know, Western companies looked up and said, Wait a minute, there's a huge opportunity in China. We should go sell there. And they got there and they said, This is tricky. And it was taking longer. And all of a sudden there started to be some, some local competitors. And then there were, like so many companies, copying everything that was made in the West very quickly and bringing it to market in China very quickly. And now, I mean, it's really happened so quickly. In the big scheme of things, it takes 20 years to bring, bring a real dramatic new innovation from idea to to really market launch and acceptance, and within less time than that, you have a whole new industry. And yes, there is innovation happening. And you know a lot of it, there is innovation everywhere in the world. There are bright people, there are physicians, surgeons every day who are looking at what they're doing and saying, How can we do it better? It doesn't just happen at academic medical centers or in certain countries or whatever. Every every doctor out there is thinking about how this can be done better. And and Cynthia, your founder, your father, I saw him, you know, 10 plus years ago, I was mentioning yesterday at TCT presenting this idea of pulmonary denervation. So it didn't come out of nowhere. It is the result of innovation that was happening a long time ago and is now reaching fruition. And I'm quite sure there are many more stories across China of that kind of innovation that's been real, real, true innovation, you know, new physiologic insights, you know, that we'll be seeing soon. And so it's, this panel is very timely. It's, it's gonna start happening much more.

Adrian Lam  9:17  
Yeah, I would, I would definitely agree with that. I think there's absolutely the innovation here everywhere, and you see that now. I think there are infrastructure and the ecosystem. I suppose factors that could continue to help, and I think will eventually help more to translate that raw material into into patient impact, right? But it clearly takes a very long journey. You know, now, you know, sort of a related question is, is, you know, in a way you want to, when you develop a new technology, you're obviously going to go for a whole market first, right? You. Uh, you know, for for many, many reasons, but competition is just so fierce in China, and and, and. So how do you kind of balance taking that high risk, innovative strategy, yet there's so much competition you got to survive that first, but also raise enough money and live and survive enough for enough, for long enough to win and then you go abroad. How are you managing that process right now between sort of winning at home and or going straight abroad? Maybe? Alexis,

Alexis Cheng  10:39  
sure, sure. Thank you, Adrian, so So from from our perspective, it's important to move forward on all fronts nowadays, I think winning, winning domestically isn't necessarily enough. Either. You do need to have a go to market strategy on a on a global stage. But of course, as a startup, resources are always limited. Are always very limited. And of course, as as a home base in your domestic market, you'll have more ways to leverage said resources to be able to to move a bit quicker. So yes, from from our perspective, we we always think about what we want in terms of our end goal. So they're there as a, as a, as a co founder and a company, there are always certain shortcuts that can be taken throughout the process of developing your company, you know. So one, one key decision that we've made in our development is we focused on developing everything in house. So this, while it made our process quite a bit longer, you know, the risk quite a bit higher up front. But what it's given us is it's given us the flexibility now to really have high product quality, high product integration, low cost, and also supply chain resilience. So I think this is, this is important to keep in mind, when we balance these, these factors while moving forward on all fronts, keep in mind where the end goal is, and then make sure we're always moving forward and determined towards that goal.

Adrian Lam  12:16  
Yeah, Cynthia, so

Cynthia Chen  12:20  
coming back to Paul novo, I actually agree with Alex says that it's very important, important to go up front to all the markets right now and Pono strategy across the years is we focusing more on precision, but not proliferation. We're focusing more on depth, not breath. We deep dive into two indications, pulmonary hypertension and heart failure. But we march it across all across the continental so because we know from the early experiences that US FDA, CE, they need earlier IP and data validation, so actually begin to prepare for our idea application while we're waiting for our NPA approval, we actually begin our China biggest high failure trial, while we also launched this European pilot study to bridge the gap, the timely gap between all the per all the agency's requirement. So it seems like we accumulated our tremendous data here in China, but we actually march through the march through the company to the next stage altogether. And for us focusing on two indications, not chasing headlines with like 2020 pipelines, it's actually the best way for us to maximize our clinical, clinical capacity, commercial potential, and also execution, efficacy. So we're kind of taking a different strategy here. Is that we're going all across but deep dive into two indication, two pipelines.

Adrian Lam  13:56  
Yeah, that makes a lot of sense. So maybe Hanson as a slightly different flavor to that same question. You are, you know, trying to source, you're trying to identify these unmet needs everywhere, and trying to find develop solutions for that. Do you take a differential view to sort of Asia, you know, versus the domestic market, or is it just the world is just world?

Hanson Gifford  14:23  
Well, different answers for different clinical needs. Obviously, there are some variations across the world. We have typically focused on the US market as the biggest opportunity and the quickest way to access a critical mass. I think we still have a lot to learn about how to access the China market. It is great that the China market is big enough that you can build a very nice business as a. A Chinese focused company. I think Europe European companies, frankly, struggle with that, and they mostly are thinking about, how are they going to get to the US as a way to really build a successful business, rather than trying to just build a home market in France or Germany or something. So it's an advantage here. But overall, I mean a company that that we identified here in Singapore, a lay therapeutics, which has remarkable technology for sustained release of drugs in a bio absorbable form. You know, the fact that that was based here in Singapore. Didn't matter at all. We're working with them. There's a team of of 20 folks here at La Singapore working in concert with a team in the US. So we're 100% flexible. We have a company in in Ireland. So we are, we are really thinking globally the same time terms of real commercial success us approval is is a big milestone for virtually all of our companies. I think that may evolve over time, but, but that's where we are now.

Adrian Lam  16:19  
Got it so for a lay therapeutics, just a follow up question, it's sourced from Singapore, yes. And the first market that you're targeting, targeting is the US. It is okay, yep, and not concurrently or simultaneously doing anything in Asia.

Hanson Gifford  16:36  
You know, it costs so much to run a clinical trial. Of course, you have to pick your battles, and so I think that's, that's the next step. We'll get the initial readout of our first pivotal randomized trial in the US, or phase 2b trial later this month, and I think then we'll start thinking about, how do we address other markets?

Adrian Lam  17:03  
Got it, got it. Are there? I mean, as you as, as, as the foundry, you know, so many innovations have come out from, from your group, in the US, the fundamental tech, you know, tech transfer, and tech not tech transfer, tech innovation translation mechanism is, is is mature, is more mature, and but, and quite, but quite different to other geographies. You know, in China, for instance, not that much innovation comes out in that way, from academia and then you license out through the tech transfer office. Are there any inspirations that we can learn and from what we've seen in the US that you think could work well in this region of the world and what might not work as well?

Hanson Gifford  17:52  
So certainly, and this is even more so in the biotech world, you know, everything seems to come out of academic research labs and go from there. We the foundry specifically has taken a much more broad approach of looking for the best ideas, focusing again, on the anatomy and physiology and how to solve that problem. And we don't care where the ideas come from, whether we invent it or someone else, whether they're at one university or another, we have licensed things from universities across the US, from doctors in England and in France, you know, with La from, from right here in Singapore. So we are, we're very open, and tend to look first at the idea and how it's going to address the need, and secondly at Who cares where it comes from. And there's always a way to make that work. So I don't know if that academic licensing approach needs to be replicated here. If physicians are operating more directly or whatever that's that's fine.

Adrian Lam  19:07  
Yeah. Do you think the infrastructure in Asia is, I mean, obviously it's different in different countries, but do you think that early translational infrastructure is, is? Mature enough right now that you're seeing a lay therapeutics, for instance, that early next step, after you identified the IP, do you see sufficient support and help from the ecosystem, or do we really need to do everything in this back in the back, back at home?

Hanson Gifford  19:40  
So I, you know, I've been super impressed by the Singapore Medtech ecosystem. Obviously, there's been a lot of of academic level research and idea generation. It has taken some time to see those things translate. There's a more recent focus on manufacture. Ring and and operations, which I think will serve them very well. I think those pieces will start to see that come together and and see things translate more more aggressively. Here, you know, in China, the situation is so dynamic. The whole economy is growing so fast. Everything is new. Everything is open to innovation and looking to create the next innovation. If two examples right here, I'm envious. Frankly. You know, the maturity of the US market is maybe not as in inducive of really exciting new things.

Adrian Lam  20:45  
So, yeah, interesting. Maybe back to to Alexis and Cynthia. Do you, you know, as you, as you were, on your journey, or earlier journey, did you feel the infrastructure was mature enough? Did you get enough early support? You know enough pre clinical advisors. You know enough pre clinical research groups that can help you, and could you access the right animal trial centers? Do you did you have access to good board members and advisors? You know, what problems did you see? Or were you pleasantly surprised, as as as Hanson mentioned, maybe Alexis for

Alexis Cheng  21:23  
sure. So LEM, let me start, yeah, I think especially early, early on, when we decided to found, found the company, we did take a lot of lot of time to think about where would be the best place to do this, and some of the factors that we that we thought about were, you know, some of the ones that you just mentioned, because the Medtech space does require a whole ecosystem to really build a successful company. So, I mean, first of all, you need, you know, talent, right? So you're looking at the higher University, universities, higher educations, these type of institutions in in throughout the med tech prototyping stage you require, you know, clinical, pre clinical work. So, you know, animal labs, these types of institutions. So after looking at at these, these aspects, we found really that Hong Kong and the GVA area, so Hong Kong and Shenzhen really were the perfect fertile ground for a med tech startup. Because, you know, Hong Kong has these top universities in the world, right? You have hospital, hospital networks. And then nowadays, we're seeing more and more that clinicians and professors are really willing to also delve into the startup ecosystem, startup space as well. So they get involved with us very early on, to work with us throughout the prototyping process, throughout the pre clinical process, and then, of course, after the R D stage, Shen Jin sort of has the, you know, one of the best electronics, mechatronics manufacturing in the whole world, and that really is, it's a lot easier to have these types of resources available to us throughout this whole process, as opposed to having to discover and create too many, too many things ourselves,

Adrian Lam  23:15  
right? Maybe just a follow up question on that, right? So you have ambitions for out, you know, international markets, right? I believe you're doing some research and trials in Europe.

Alexis Cheng  23:27  
Yes, yeah. So, so we have, we have a trial running right now in the UK, and we're actively moving towards a CE marking,

Adrian Lam  23:34  
right? So my question for you, Alexis, is, you've mentioned, you know, the importance of vertical integration, sort of owning a lot of the supply chain and being able to manage that risk. Well, now obviously, in this day and age with everything fun that's going on, do you have and people talk about dual sourcing, right? How to manage supply chain risk, but if you're doing everything in house, and then you have the dual source as a lot of supply chain, and, you know, manufacturing investment and time like, how do you practically execute that? Right? You can't dual source everything can you. And especially for robotics too, with so many components.

Alexis Cheng  24:19  
Great question. Great question. Yeah, so, so, especially in our field, certain, certain components are actually not readily available, so different from, let's say, for example, the automobile industry, everything is pretty generic. In a sense, you're able to source most components from from a variety of suppliers. But actually, in at least the surgical robotic space, a lot of a lot of the supply chain is actually still being built up. So we're taking a part in this process, you know, working with a lot of these manufacturers to develop these customized parts for surgical robots. And of course, of course. Services together with, you know, testing equipment and the sort. But yes, a lot of times it's actually forced. If you can't find something that can fit your clinical needs, your clinical requirements, then you sort of have to go the in house route. And of course, as a as a startup, especially, you know, a few years ago, not a lot of capital, not a lot of time, no history. It's actually very difficult working with established companies, to to work together with you and providing you know key components. So in that sense, I think sometimes the timeline, the these risk factors, actually force, forces a company to really innovate internally to make it happen. It's not easy, of course, but then once you're able to do it, then you sort of reap all the benefits of that. So nowadays, you know, and you just mentioned political, geopolitical type, macro, macro situations. By having this type of supply chain resiliency, we're actually immune to a lot of that, because we have a lot of flexibility in who we work with, because we still own the core underlying technology to our to our system.

Adrian Lam  26:19  
Cynthia, maybe a related question, I know you also have, you know, international ambitions, and you're taking first steps towards that now, or for some time, do you have to build completely the same vertical, vertically integrated infrastructure, you know, in an outside of China Market? Or is there quite a lot of transferable skill sets and capabilities that that you can leverage? How are you thinking about international expansion?

Cynthia Chen  26:51  
So I think it really takes us some time to figure it out, because unlike many biotech or meta company, ponovo actually started a long time ago, because Hansen mentioned the first time people hear about pad, and that was, like more than a decade ago. And the company was established in 2013 and that's the time that we got our first angel investor in and we didn't go fundraising for the next eight years. So we don't know back to 10 years ago, back to the time that we don't know if we can build a global company, but we but what we know is that because diseases are global, so the innovation to cure this disease, to cure those diseases, should be global too. So what we've been doing for the for all those eight years is that continue to keep the clinical rigor publish as many as data as we can make our presents on all these global conferences. So I remember that back to 2017 that's the first time that we actually presented the first in man study from China to orbit us with Carl Gordon team and urban Matt was like we were very interested. Show us the pivotal trial data and talk to us again in few more, few more years. And like four years later, they joined us as our first investor thing. So I just took us, took us a long time to figure out which pathway we need to go and which market we are prioritizing first. And, you know, an NPA approval actually come earlier than FDA, but we always seen ourselves as a global company with earlier China presents because of the regular regulator approval pass. So coming back to today, you know, we are a 140 people team sitting China, and we have built up a fully functional team to support all our all our global footprints. And currently we're building up a US dedicated clinical team to full speed, accelerate the FDA trials that we're doing right now. So I think our our job is to basically replicate what we've been doing China for the past five years on all other all other Mar markets. I don't think that's actually only due to the geopolitical challenges that we've been saying throughout the years. It's just that we need to have the cultural adaptability to Americanize all the clinical practices in the CAS lab and also the corporate management style that we've been saying in building up to building building ponovo into a global company. Yeah,

Adrian Lam  29:42  
a slightly different flavor to that same question to Hanson, you know you're building allay therapeutics, do you find that managing that project is fundamentally quite different, to say, just a typical project that you've done before, like

Hanson Gifford  29:58  
you're talking about drug. Delivery, no

Adrian Lam  30:02  
professional, yeah, I'm talking about kind of running the project, you know, maybe hiring for it. How you think about, how you think about partnering, you know, that process of growing this baby, is it quite different, or is it kind of just the same, just in a different place?

Hanson Gifford  30:21  
Well, I think in the case of LA, the differences are more in that it is a sustained release drug delivery company, and you think the regulatory quality challenges, pre clinical work in the medical device space is challenging. It's like four times as much when you're talking about drug delivery, and especially sustained release drug delivery. So there's a lot of work that goes into that, and that is being done both in California and here in Singapore. I think in terms of managing the team, we are blessed to have a fantastic team here in Singapore, super responsive, super supportive, super, you know, really just just capable, and so it really hasn't been a challenge. In fact, sometimes it goes better because, you know, the team in California works all day, and then they hand off to Singapore, and they work all night, you know, or all their day, and then back and forth and and things happen even faster. So, right? It could actually be a benefit. It's exciting, yeah, it's great,

Adrian Lam  31:38  
yeah, yeah, yeah. We found the same actually, in a previous experience where, yes, because of that East Coast and Asia time difference, you're basically having the company is working around the clock, so to speak. You know, Now switching gears a little bit to to just what the future, the near future, and what we might find interesting in the near term. I feel like med tech is always a, is always a like, like, there's a presence of battlefields, you know, four years ago is very much structural heart, right? Aortic and mitral and even tricuspid. And then, you know, and then it was litho trypsy, and then then there was denovation, renal, denervation, and definitely recently, is PFA. What do you guys all think has, like, sort of the next big thing, and in terms of med tech, maybe Hanson first?

Hanson Gifford  32:36  
Okay, well, I don't see an overarching, you know, singular focus emerging, if there is one, it is robotics. There's been so much work that's been done, both in the public and behind the scenes over the last 10 years, and we're just going to see a lot of those things in clinical trials, competing, and it'll be fascinating to see how, how that market evolves a lot over the next five years. So that's probably the the epicenter, but I think there's gonna be a lot of new things and and just to come back to the title of the of the talk, you know, can Medtech replica replicate biotechs Asia playbook, which has been a huge source of innovation, new companies, new things over the past few years. I think that's that's not even a question. I mean, just look at this meeting. Look at all the companies here doing great things and and I think, to be honest, the US is up against some challenges. There has been a slowdown in acquisitions, which means a slowdown in money returned to the ecosystem, which means that more of the money ends up being focused on fewer companies to help those get all the way to profitability. And I think Asia is coming with fresh energy, fresh ideas, and also fresh money that will allow them to enter the stage and fill that gap. So yeah,

Adrian Lam  34:18  
a follow up question for the two of you, actually, which is on this robotics topic, I would tend to agree it's, it's obviously very, very interesting now, but there's a juggernaut there, and and that juggernaut seems to be very resilient. And so question for both of you this robotics, is there enough room for, you know, other companies to emerge. And do you see it as, as you know, niche robots more application specific or therapeutic area specific robots, or do you think there's going to be a lot of like, just general surgery robots that can, that can compete?

Alexis Cheng  34:58  
Sure, LEM, let me. Let me. Take, take a take a hack at that, since that's sort of our interest area. So So, of course, the surgical robotics market is huge. So we absolutely believe that there's room for many players within this space. I think you know the dominant player, if you look at their financials, or they have very steady growth still. So I think all signs point towards an unmet need still within the whole global market. And then, of course, I think to your to your second question about what, what role robotics will play, in terms of, is it going to be niche applications? Is it going to be generic applications? It really depends on the cost value proposition that's being made. So of course, if you're talking about higher capital equipment, higher price capital equipment, then it's likely that it needs to cover more of these surgical areas, surgical procedures. Otherwise, it's difficult, from a procedure case volume perspective, from a use perspective within the hospital to justify that type of business case. But then, of course, if you're talking about, you know, cheaper robotics, or lower cost robotics, maybe there's a, there's an argument that can be made where a niche procedure is sufficient for that equation to work out for the for the market.

Hanson Gifford  36:19  
Yeah, I'm seeing, I'm seeing the market going after all of those opportunities, you know, going right after intuitive, going after the robotic surgical assistant market, or a number of companies there, and then specific surgery, you know, robotic cataract surgery, you know. And they're looking at full robotics, not just, you know, haptic, control devices. But you know robotic brain surgery, robotic you know each each area and each area has specific needs, different products. So we'll see, as you made a key point, all of these things do have to prove clinical value and and the healthcare system has to find the money for each of these. Will they? I mean, so far, they found the money for intuitive, and we'll see if they find the money to take the robots everywhere else, right, right? That doesn't make sense to you.

Alexis Cheng  37:11  
I think so. I think so. At the end of the day, I believe there were some talks at today or at this conference that also talked about, sort of the payment schemes behind behind all of this med tech innovations, the reimbursement schemes behind it. That's really key for this, for this industry to keep moving forward, not just in the US, but globally. How are these schemes going to be developed further to allow for these innovative devices, new med tech devices, biotech devices, to really get into the market and have a, you know, healthy, healthy health, healthy economics behind

Adrian Lam  37:52  
it. Yeah, well, we're coming up to time soon, and so I want to leave a tiny bit of time to see if there's anything else that panelists want to add in particular, and if not

Hanson Gifford  38:04  
any questions out there. Yeah, open this to the floor.

Adrian Lam  38:09  
Sure up. Adrian,

Audience Question  38:10  
yes, it's pushing for that's agent cardio intervention. Cardiologists. Use some of your the pilots that you indeed see, sir, you son of products that you can incubate it. Thank you very much. I'm also a partner of Adrian Lam in bio world. So question is, the reimbursement landscape is changing. Health Systems are recognizing that, you know, it's unsustainable. Really, everyone is trying to get into the US as the first market, but then the US is starting to say, hey, let's stop this. We need to reduce prices, reduce costs here. And China has been doing that already ahead of time. India, same thing. Europe is progressive as well. So what's going to happen here? You know, there's less money for innovation. Is there going to be a global slowdown like at this rate, or are we just going to get more efficient? Are you seeing that trend?

Hanson Gifford  39:15  
I think that's a really important question. The US has just allowed prices to be high and pay those high prices and leave it alone. Is that sustainable? I think it's sustainable for a while longer. I think there will be attempts to cut costs in other ways in the healthcare system, rather than directly attacking drug and device prices. I think the the China approach of as soon as there are a whole lot of anyone procedure going to tenders and driving the price down, on the one hand, takes money out of our ecosystem. On the other hand, it makes it a healthy market that is, is very sustainable and important. Lee, it drives the companies to be ever in search of that new innovation, which will still be given a high value. Paul Novo coming to market, you don't have competitors and and hopefully you can keep your prices at a very attractive rate for a long time in China. So even as it pressures the ecosystem, it encourages innovation, I would say, hopefully,

Adrian Lam  40:29  
yeah, any thoughts from Alexis or Cynthia on this?

Cynthia Chen  40:36  
So maybe nothing related to Dr Adrian's question, but more so back to the topics that we have today. So I think, you know, as a as a med tech person here, I don't think we actually need to replicate what we've been saying biotech. It's just a matter of as if Asian med tech company can actually become a global lead in many perspectives. You know, success is not only about the discovery, it's about the scalability and eventually the commercial success. And I think all these non trivial barriers actually make actually, what makes Medtech innovation harder, slower, but deeper, but I think we'll get there.

Adrian Lam  41:25  
Well, we are now at time, so I just want to thank everyone. Thank the panelists. Please give a round of applause, yeah, and thank you very much for hosting us today.