Medsider: Learn from MedTech and HealthTech Experts

Why Focusing on Pain Killers is Imperative for Medical Device Startups: Interview with Daniel Hawkins, CEO of Shockwave Medical

April 05, 2017 Scott Nelson
Medsider: Learn from MedTech and HealthTech Experts
Why Focusing on Pain Killers is Imperative for Medical Device Startups: Interview with Daniel Hawkins, CEO of Shockwave Medical
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Medsider: Learn from MedTech and HealthTech Experts
Why Focusing on Pain Killers is Imperative for Medical Device Startups: Interview with Daniel Hawkins, CEO of Shockwave Medical
Apr 05, 2017
Scott Nelson

Daniel Hawkins is the President and CEO of Shockwave Medical. He began his career in marketing and business development roles for Advanced Cardiovascular Systems, otherwise known as ACS, which is now part of Abbott Vascular. Following ACS, he held senior roles in general management, marketing, and business development with a number of private and public...[read more]

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Show Notes Transcript

Daniel Hawkins is the President and CEO of Shockwave Medical. He began his career in marketing and business development roles for Advanced Cardiovascular Systems, otherwise known as ACS, which is now part of Abbott Vascular. Following ACS, he held senior roles in general management, marketing, and business development with a number of private and public...[read more]

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Scott Nelson:   0:08
Welcome to Med Cider, where you can learn from experienced medical device and med tech experts through uncut and unedited interviews. Now here's your host, Scott Nelson. Hey there, ladies and gents, welcome to another edition of Med Cider Radio brought you from the W. C. G studios here in Minneapolis. If you're new to the program, Med Side of radio is where we learn from med tech and other health care thought leaders through uncut and unedited interviews. Just a few quick messages before we get started. First, I sent out a free email newsletter about once per month, highlighting my favorite med tech and or health care related stories that once that I personally get a lot about you from, I don't send the newsletter out very often. But when I do, I really try to make sure it's valuable. So if you're interested, head on over to met cider dot com and enter your email address as a bonus, I'll send you a free e book on the strategies I personally used to make connections at conferences. I think you'll find the book pretty useful. And while you're online, head on over to iTunes and radar show a five star rating would really help us out. Second, for those of you that subscribe to the email newsletter, you're probably aware of this. But I recently joined the MedTech practice of W. C. G, a fully integrated marketing agency. So if you're looking for some marketing help, there's a few reasons you should consider our firm first were entirely focused on Med tech. Second, our wheelhouse is analytics, which drives all of our recommendations. And third, we're fully integrated, which means you don't have to source capabilities from another shop. So if you have a project in mind that you'd like to discuss, hit me up that Scott at med cider dot com again that Scott at med cider dot com. And lastly, speaking of marketing to generate more awareness for some of these interviews, I've recently started using a pretty unique system called pan optic stacking from the team over. Reach Fire digital. I know Pan optic stacking. It sounds sophisticated, right? Well, to be honest, it sort of is, But let me try and explain. First, they validated some of my messaging in real time and developed an automated customer pathway based on my audience. Europe met cider, then utilizing something called eco marketing. They're using behavioral targeting to move that same audience through a customized online journey. After executing my personalized pan optics back, I'm already seeing a really nice impact, and I'll share some of those results in future episodes. So if you're interested in learning more about the system, the team over reach fire. Digital has agreed to build a custom pan optic stacking blueprint for the 1st 15 men cider listeners that respond to this message. They normally charge 2500 bucks to build one blueprint, but because they're big fans of med cider, they're giving it to our 1st 15 listeners for free. So go to reach fire. Digital dot com Ford slash med cider again us. Reach fire digital dot com Ford Flash Med cider Grab that blueprint okay onto the upset. On today's program, we have Daniel Hawkins, who is the president and CEO of Shockwave Medical. He began his career in marketing and business development rules for advanced cardiovascular systems, otherwise known as a CS, which is now part of Abbott Vascular. Following a CSL senior roles in general management, marketing and business development with a number of private and public companies. Daniel started the marketing department at Intuitive Surgical, or he guided product feature development for The Da Vinci Surgical Robot and developed key foundational marketing strategies for the company. He has also held senior leadership and or founder rules with Indo Logics in Caliber Medical, which is now part of J and J. Daniel has an MBA from Stanford, A. B s and economics from Wharton and is a named inventor on over 100 patents and applications here. A few the things we're gonna learn in this interview with Daniel, how his early upbringing gave rise to his entrepreneurial spirit. Why focusing on painkillers is imperative for med tech startups Daniel's early experiences at Intuitive Surgical and some of the most important lessons he learned commercializing the first surgical robot, a question every med tech entrepreneur should ask themselves. Does your product have natural pull the importance of removing complexity and constraints when making key decisions? How Daniel and his team came up with a concept for applying little trip see to arterial plaque Daniel's approach to raising money for shock wave and how he was able to convince early investors during a tumultuous economic time in Daniel's favorite business book, the CEO he most admires and what he tell his 30 year old self. So without further ado, let's get to the interview with Daniel. Hey, Daniel, welcome to the Met cider program. Appreciate you coming on.

Daniel Hawkins:   4:16
Certainly very happy, too.

Scott Nelson:   4:18
All right, so let's get started with Shockwave. You co founded the company you're currently running with John Adams and Todd Brighton back. And I think the 2009 time frame really to address what it seems like is, you know, is an unmet need when it comes to a peripheral vascular disease or prefer arterial disease. And however you want to find it. But you know, when you look at the peripheral landscape, it's, it would seem, from an outsider's perspective, would be flooded with, you know, sort of a wide variety of different treatment options, you know, from self expanding Stens to plain old balloon angioplasty, a threat to me, drug coated balloons, etcetera. So I'm curious, you know, if you want to take us back to that time frame now, what did you see in the peripheral space? That sort of lead led to this concept that you're developing a shockwave now,

Daniel Hawkins:   4:59
sure happy to sew for perspective. In 2009 drug hooded balloons were emerging. They were not yet in the four that they are today. Back then, predominantly, there was hearing versions of scoring balloons i e. The inches core balloon, other types of specialty balloons, high pressure balloons and directed me. Then, of course, there were stents of one expandable and Celtic standing. The challenges with all of the non stent technologies will say is they're really not addressing, and this is what we identified in 2009. They are not addressing the fundamental issue of calcification embedded in the vessel. Wall balloons put pressure on the calcification, but really overstretched the soft tissue on the side of the other side of the vessel and then create vessel injury that ultimately leads to a healing response that everybody calls restenosis. Or, if you really injure it a lot acutely, then you end up having to put in a stent. The other reason to put in a stent is because those fundamental technologies can't take a blockage in the vessel that might be 70 75 or 80% blockage and get it down to under 30%. If it is calcified, those technologies struggle mightily to be able to do that, and really 30% residual blockages. What is a clinically meaningful markers? So what happens then is in the pudding instance after ectomy showed capability of reducing the volume of black in the vessel. But there are a lot of risks associated with after ectomy, and quite plainly its mechanism of action is to grind up the inside of a vessel. And that's a lot of injury that gets a lot of injury response and that then ultimately leads to restenosis. What we realized with Shockwave is that the physics of high pressure, high speed pressure ways, I should say, is completely different than constant high pressure that you get in regular balloons and high speed pressure waves, travel through the soft tissue and do not disrupt it. Do not create the injury that is very common with either scoring balloons or high pressure balloons, but it actually creates cracks in the calcification. You can think of them a little bit. As expansion joints, we create a crack at a very low, constant pressure in a balloon. Non violative pressure in a blue. And then we inflate the balloon just a little bit, frankly, gently. And what we're doing is expanding those cracks and therefore were able to get a large vessel woman without the injury that everybody else gets and were, in fact, getting step like results without stents.

Scott Nelson:   7:42
Great. Now let's let's kind of set the stage for the audience. And Daniel, if you will, you're the CEO of Shock Wave. You raised a $45 million Siri's see this past November, and we're recording this in early 2017. Received FDA clearance last fall of September. I think, to be specific again to set the stage for the audience where you at with respect to clinical data and mercial ization.

Daniel Hawkins:   8:02
So we are seeing Mark in Europe. We are FDA cleared in the United States around the time period of the financing. We had six months results in our second purple vascular study in 60 patients done in Europe and New Zealand. 17 or 18 different operators and we were at that point had achieved a 30 day outcome in our first corner and study using little plastic for the treatment of coronary vascular disease, Progress stent placement. Lastly, we had begun our early commercial activities in Germany and the purple vascular space. So from the standpoint of regulatory and commercialization is, well, data gathering that that was where we were, that

Scott Nelson:   8:46
that's great. And we're certainly gonna come back to shock wave and really dig into sort of the early times, you know, at the company and how you sort of got it to where it's at now. But let's take a step back and really rewind the clock and focus a little bit more on your early career. So what first brought you into the med tech space?

Daniel Hawkins:   9:01
So I actually grew up in a medical household. Medical. An entrepreneurial household. My dad is a primary care physician, hung a shingle immediately after medical school and started his own practice that, you know, frankly, was in the first floor of the house we lived in in West Philadelphia. I grew up in Philadelphia, Pennsylvania, and his practice was on the first floor. Ours was a house that was exposed to health care very early. If you treated a lot of Department of Public Assistance patients and one of the jobs that me and my brother my sisters had was to make sure the coating on the DP A forms was correct. We were in and around that regularly was a small business house, if you will. I went on to personally doing some small business related things and everything from door to door sales of literally clippings from a holly tree in our backyard around Christmas time to in college operating soda machines to put myself through Wharton undergrad. I became along the way a bit fascinated with the combination of science and medicine. Didn't really know what to do with any of it. But I had always been scientifically minded, attracted to chemistry and biology in high school and the like. But I was really driven to go into business because I was fascinated with how businesses get created and was fortunate enough to be accepted. A warden undergrad. It was intending on pursuing a premed and Warton undergrad simultaneously until the dean of both schools suggested I might want to reconsider that thought quite a bit of work so ultimately opted not to do that. But really, I held onto the goal of somehow combining business in medicine and ultimately discovered what is venture capital. I didn't know it existed at the time and ended up joining out of Warton, a leveraged buyout house that had about 50 year, 60% of their business in venture capital and was attracted to the deals that were involving MedTech. The prospect of being able to to move the clinical needle on millions and patients versus one of the time that my father did was compelling for me, very compelling. What was not compelling is staying in the financial being, no engineering, kind of an environment of he willing leveraged buyouts. And I ultimately elected to go back to business school and was fortunate to get into Stanford. And following Stanford, I looked immediately at Medical Technologies Med Tech Med devices as an area

Scott Nelson:   11:29
of

Daniel Hawkins:   11:29
interest. At that time period, angioplasty balloons were $600 apiece hadn't been invented yet in the hottest areas back in 1993 were orthopedic san interventional vascular. I was fortunate to get a position in marketing at A. C S advanced cardiovascular systems. It was a division of the Eli Lilly at the time. I joined there pre promo shots then, so that was a long time ago The first indication of that stent was abrupt. Closure threatened abrupt closure that comes from high pressure dilation of a vessel due to calcium and the either studies intravascular ultrasound studies in the mid nineties confirmed all of that and and really that lead the groundwork for what I later traded on when I came up with the notion for what is now little plastic to avoid those deceptions and see if we'd get better results long term. But I became fascinated with the space back in 1993. I've stayed in it and been involved in fortunate to be involved in the number of significant startups along the way.

Scott Nelson:   12:31
So such a great story, looking back and sort of pecking those dots, even even to you're here early days, growing up, watching your your dad, who's a physician sort of run his own business right at home. So very cool to hear that story. And, you know that serves as a sort of a nice segue way into my next question, which is really about sort of the ark of your career. You know, looking at you know, the first you know, sort of operational role. If you want to call it that at a C s, which was later sold to guidance. You're at Culebra, which I think is how that how that's pronounced, which was acquired by J and J than Omni Cell and then, you know, intuitive surgical. So I'm sure you know, this question is a little bit broad, so to speak, but I'm sure sure, you've learned a ton across those those experiences with those no early stage med tech companies. But are there a few things that really stand out? Or, you know, Sam, examples or situations you recall that really had a profound impact on your career and you know that you still look back on that enables you to make certain decisions. Now, even a shock wife.

Daniel Hawkins:   13:25
Yeah, they're absolutely are. You know, you don't realize when you're in the midst of career shifts, if you will or shifts in your experience. I should say that the meaning of those. So I think it's very appropriate to look back at some of those. Fundamentally, what I discovered more than anything else is useful in Med tech is to focus on the true needs, not the ones, not the desires. If he will not. The vitamin pills you need the painkillers, the ones that are so fundamentally needed on are solved by technologies that are fundamentally effective while avoiding a bunch of the issues you might otherwise want to avoid. In our case, avoidance of vascular injury by way of example, they become, if you will intuitive no pun intended to the name of that company. But that is the place where I, in fact, learned that the intersection of focusing on true needs and keeping the usability the function of whatever technology it is very, very simple. Those two together will drive adoption at Intuitive Surgical. The robot was incredibly complicated. It started off. I'm sure many more parts now, but it started off with 2700 parts from the bomb on the bill of materials. It had 1.1 million lines of suffer coat. Now, mind you, this is back in 1999. So that

Scott Nelson:   14:55
was a

Daniel Hawkins:   14:56
watershed of activity, right? So that's a lot of complexity. But in the end, what it waas something the surgeon looked into stall the operative field, put their fingertips into the tip of a controller and move their hands like they're operating with their fingers. But what we really did is used complexity to make the experience simple. Now, what problem did we actually solve? The problem we solved in that particular example is we allow the physician to operate in an open surgical environment, but do it through the size of a choker. Pro car based surgery or minimally invasive surgery is fascinating stuff, truly enabling. However, there were lots of compromises and what the position needed to do, and therefore their capabilities, because of the restriction of that tiny hole intuitive, removed of restriction that was a painkiller, and they made it incredibly easy to use. And that's the reason why it ultimately cook off. I've got a fundamental belief that great products were purchased and not sold. If you create a fantastic product, users will come to you. And of course, it is your job to sell properly, and you've got to do all the marketing and everything else. But the great products have pulled to them. If you know you're working with the technology, any company, when there is that whole when the activity is more than you can handle, that is exactly what we had an intuitive surgical. And frankly, it's exactly what I'm seeing here at chocolate. One of the other things that I've learned more than really anything else. Mistakes made early or changes in judgment made that point. A. By the time you get to point D you learn what mistake you made back at point A. But you're a mile away from where you should be. You've gotta start early when you're making a decision and to go down on essential path, you've got to check your core assumptions. Make sure the correct ones and they're the relevant ones before you proceed. One of the things I find more often than anything else is when there's a disagreement among very bright, experienced people about a direction or a pathway to go down. Very often, they're operating under different court assumptions. So one of things I will often do is get back to what your assumptions. They'll list, Um, and I'll say, Take away that constraint, Take away that other constraint. Now what would you do? And meanwhile, I will know in love the back of my mind, how to get rid of those two constraints. And now we're in a very different solution set. That's exactly how we ended up with the device that we did that intuitive because my engineers were saying there was a constraint we couldn't do. We couldn't get more than one emitter in a balloon. I asked him to remove a couple of constraints. Now it's limitless. I didn't know how to solve it. They did. All I really did was remove that constraint. So those were some of the more significant elements that have popped up now and again throughout career. And there's certainly more examples of us

Scott Nelson:   18:05
really good points and a CZ. You sort of answer that question. Was Johnny on several notes Really good anecdotes toe to kind of pull through? You know, the concept of of really solving for a painkiller versus something that's just fits, you know, a superficial need. I think that's great. And it seems like you've got a knack for sort of stripping away the complexity. You know, not only in you know, product or even messaging per se, but even sort of like the way you you explain that latter part of the answer. With respect to removing constraints, you know, simplifying the challenge or problem ahead and removing those constraints. It seems like maybe I'm not sure if that's a you know, something that just comes natural to you or something you've learned over time. That certainly seems to be an important lesson for sure. It's

Daniel Hawkins:   18:44
something I actually learned watching Fred Mall through a decision process. So if if I can, I'll share a little bit of an anecdote from one of the earlier that the company moments that intuitive surgical. There's

Scott Nelson:   18:56
a whole group

Daniel Hawkins:   18:57
of us that 78 thereabouts. I think it grew at 1.2 12. That would meet every Tuesday morning, and we would run through critical elements in the way towards our milestones. The meeting was called a Critical Path meeting. They were representatives from each of the subsets of the technical areas. My knew we had a large order mechanical, smaller, the mechanical software vision we had electrical. All of those subsystem groups would have a representative, and sometimes one would represent two or three of those functional areas. There was always marketing that was me. The CEO is always there. At the time it was Lonnie Smith, the current CEO. Gary Good heart was always there. He was a senior member of the engineering team, and, of course, Red Ball was there. There were a number of times during that that we would have things pop up and we saw them through and you'd leave the meeting a little uncomfortable or maybe a lot of comfortable in two meetings later, we'd have a solution for it. We thought we were pretty far along, frankly, quite far along, stuttering down to our final design, if you will. And Fred came into the meeting, I'll never forget this day and said, I think we have a problem. I think our vision system is inadequate. That was a very material statement to make at that point, because we were marching along with a set of Presumptions and a discussion ensued for 45 minutes to an hour. The meeting ran long that day. We had it up ordering and food. The issue was very fundamental, and this gets back to what I described. Keep it incredibly simple. Make the user experience simple. For a physician to be able to trust a robot, they need to be able to see perfectly be able to discern tissue edges in the different tissue planes, and the resolution was not there. The problem is that there was no existing camera system at the time that could solve the problem. We literally had purchased one of every camera system available worldwide, and none of them was good enough. Friend put out there that we should create a rope as if we didn't have enough to do right. Fred put out there. We need to create our own and then a discussion came through and said What makes us think we could do that? And we we were concerned about it. It was a hand wringing time period that one of the folks in the room said something that triggered something in Fresno. Fred said, Wait a minute isn't the real reason why none of these cameras work because they need to make him lightweight because the procedures, or an hour or two hours long and a human has to hold it. We don't have that constraint. We can make this thing £30 because we have a robot holding. The second that statement was made, everything changed. 100% of the goal was to get optics and we removed Wait, and when that happened were able to fast forward to the best vision system available laproscopic vision system available on the market that you'd never use in any other system other than into it, because it weighed way too much. But we didn't care. In the second we were able to make that and put it in the system. It became crystal clear what you were looking at, and the physician community raved about the vision system and their sense of control and accuracy. Fred was 100% right, that that was a need, and he was 100% right to test the assumption.

Scott Nelson:   22:31
Such a great story often tried to ask for examples of certain things that you've learned along the way, and I didn't even have to answer that are asked that question. You answered it for me with that great example. But I think it really helps, you know. And I sincerely hope that it helps you know, the folks that are listening to this really get a good idea of of great decision making in process, you know, to that concept of really stripping away all of those assumptions and trying to really understand the core the core problem. But such a great examples to let you know for the sake of time. Let's let's shift to kind of necessarily the current day. But, you know, Kurt, company in shock wave. Can you take us about? You were an entrepreneur in residence at three. Arch. I think when you came up with a concept for, you know, applying a little trip, see to arterial plaque. Daniel, can you kind of give us an idea of sort of what you were doing at the time? That sort of induced that that light bulb moment, if you will. And then in parallel, I guess with that, maybe help us understand. You've got this great idea, which seems, like, really has leg. How did you begin alongside? You know, John and Todd to really build out this initial prototype.

Daniel Hawkins:   23:30
Sure. Yeah. So the late, bold moment was after a series of of different events. John Adams and I were busy in Bellevue, Washington, trying to come up with the next great thing. John is a fantastic experience. He's one of the very first engineers. In fact, he ran engineering departments at Medtronic back in the early pacemaker days. Great understanding of electrical engineering. He happened to be working on identifying the root cause for a product failure, and part of that investigation had him put the two leads for a pacemaker in a beaker full of water to test what happened out in the field of an arc happening between those two beakers between those two leads. As it turns out, he created listen trips, but he didn't know what it was at the time. He ended up researching and discovering it. But what he definitely discovered is when he did that, he shattered the beaker. And there was, you know, 30 or 40 ounces were the water all over a high voltage stable. So we realized he had a problem and he figured out ultimately that it was a little trip. See, he shared that anecdote with me, and while I found it interesting because I'm technically interested in learning, you know, different technical things. There was no particular utility at that time. That's forward about six months, and I happened to be looking at the angioplasty market. My job is an entrepreneur in residence towards toe look at unmet clinical needs and with John either invent or in license technology to solve those needs. And then three Arch in Prospect at the time would fund a company around that. If if everybody agreed, I happen to be looking at angioplasty and came across some specialty balloons that cleans that they were able to with differential pressure, crack calcium. And I'm not a physicist. I'm not a scientist, but again, being scientifically minded and frankly, taking a page out of some of the learning I got from John that didn't make good sense, physics wise to me. And I started wondering what would actually crack the calcium. And then I remembered, John broke the beaker with electricity. So I looked at Lissa trip, see a little bit, and I frankly just drop some bread crumbs between The two suggested it to John, and I asked him if he thought it would work, and he said, Not only will it work, it'll work great, and the pressure waves will be so fast. They're faster than the speed of sound I came to discover. I've learned I should say there so fast they won't pop the balloon, so we built a very crude prototype. John spent 3/4 of the day putting wires down the length of the standard angioplasty balloon into the fluid in the base of the bloom. And then we drilled a hole in a piece of chalk and tried it out. It worked great from there to how we got to a first man. Along the way, Todd Britain joined us to help guide us clinically. We identified the opportunities in the peripheral vascular space as an area of interest initially, and then we created a prototype that leveraged a lot of existing technologies. We were able to do it quickly and cheaply because we leveraged those technologies. But that is not a small effort, right? So I managed all that process from a position of CEO of the company back in the early days. But I really was program managing it all. We did not have a VP of engineering at the time. We had two engineers and the technician John Adams in Seattle. I was at that point I was down in the Bay Area. We had done some work up in Seattle, but it became clear that we were not gonna be ableto attract the catheter engineers we needed. So we was down to the Bay Area. But our initial catheter work was really borrowing off of existing lifted trip see technology and building a balloon around it, which is exactly what we did. Todd's role in all of that was to help us with the clinical view of the performance requirements as well as, of course, very much Help us with designing the protocol for first and man and developing the relationships with the clinicians along the way. John helped keep us pointed straight technically. And I served, if you will, is program manager and had a marketing and CEO and all of that together to drive the creation of the first prototype of the bills the testing, the verification, the animal testing and the like, which in the animal testing Todd did directly. And once we finished all of that, we went into the clinic and had a very successful

Scott Nelson:   27:56
for some

Daniel Hawkins:   27:56
inexperience.

Scott Nelson:   27:58
And then, if we fast forward into sort of the life cycle of shock wave, I know in a previous interview you did with MedTech strategist, you mentioned the decision to move into the peripheral space, you know, against the advice from your investors, and I think if my memory serves me correct. You initially initially have this idea sort of to treat arterial plaque, and we're maybe even positioning it for the use another vessel beds, but then wanted to move into the peripheral space, you know, against, like I said against the advice from your investors. So sometimes, like those types of decisions, you know, it's it's somewhat easy to gloss over. But if you could take us back to serve that decision making process and you know when you've got your your investors saying one thing that you're a core team believes in it in a different approach, how did you approach that? And where did you end up landing?

Daniel Hawkins:   28:42
Sure, So for clarity, the statements around you shouldn't start with appropriate. It's a graveyard of dead technologies. Those actually were from a number of investors that passed on the idea in 2008. Between 2008 and 2009 we actually acquired the intellectual property out of the incubator because three arch in Prospect did not move forward with the idea. That was a very difficult time for start ups, and nothing really was getting funded. So we acquired the intellectual property personally and then move forward from there. So the thought to not go into peripheral came from really a number of folks it away. Having said that, it was definitely a departure. There was a departure from the conventional wisdom. As an entrepreneur, you gotta listen to advice that other people have and you've got to gather all the dating it possibly can, and then very often you need to deliberately not follow it. This is exactly one of the circumstances. Why did we do that? Well, fundamentally, it was gonna be difficult to create a device that had left a trip, see in it and make it deliver a ble. Make it small enough to get through the vasculature through a blockage and be able to deliver the therapy. Purple vessels are bigger. It's gonna have inherently be easier to create one. Because of the risk profile, peripheral vasculature had a greater chance of 5 10 K pathway versus a P M. A pathway. Chances are because there's such an enormous need in the periphery and devices current devices back then are still the same ones today. Being traditional balloon special, the balloons, after activity in stamps, have such poor results in calcium that we had a very wide margin of potential benefits, so we were able to go halfway to optimal. Given how wide that margin waas, we would be incredibly successful in the coronaries. The margin is a lot tighter because devices have gotten better and the like. Not that they could necessarily deal with calcium particularly well. But the burden of proof is immediately higher in the coronaries because of it, because of how good all those devices are and how large studies have been et cetera in the periphery, we had greater opportunity to be able to create a solution that we could show in and with a relatively speaking lower bar of activity. We could show a benefit. That's the reason why we chose that. And you're right. It was against the advice of of many, many very smart people, and they had great reasons for doing that. But we trusted our gut and forged on the path we thought was right.

Scott Nelson:   31:16
Hearing you explain that it sounds sounds very clear, very simple. And I'm sure it wasn't but back to your kind of your concept of really stripping away everything to really the core. You know, the core assumptions in addressing each and every one of those. I think that kind of speaks to me. Maybe that process that you followed even early in the early days of shock wave. But I love the fact that the founding team, you know, believe so much in what they developed in its ability to address any in the market that you sort of, you know, you run with that against maybe the device of other folks so very cool to hear that story. So let's fast forward just and spend a few minutes just talking about the financing for shock wave. And I know you. You know, there was a lot of interest in your most recent rounds of financing, which wasn't pretty pretty stark difference. It sounds like from your early days of shock wave back in that 8 4009 time frame. But I'd like to ask you really kind of a couple questions first. I know you have in your most recent rounds. You raise money from sort of several different types of investors from traditional B C's two large strategic STO crossover investors. So I'd like to get your take on that and sort of the thought process around, getting that variety of investors involved and then really, anything that you can add. That sort of really helped you solidify that investor interest as well. She could speak to that. That would be great.

Daniel Hawkins:   32:24
Sure. So when we were raising, I guess we'd have to rewind to the Series B Round. The first institutional investor was Sophie Nova out of Paris. They were the first money in core valve and great visionary group. They were our first institutional investor when we broaden our footprint in the Series B in 2015 that's when we first brought in strategic CE and we brought in that crossovers and the like. We had, in fact, strategic offers for the entire round and the non non deluded fashion. We're in a business that is very, very strategically significant. So we had we had an offer on the table for that 11th hour. Those terms got inserted into that that we're not attracted to us. We walked away from it. What we tried to do from the very beginning is lay the groundwork for a long term play in the company we believe we've got a company that has staying power. We believe we have an opportunity to be a very successful standalone organization along the way. With that, of course, not only you need financing, but you need strategic advice, if you will, would love to learn from strategic relationships and if those leads is something they do. But that's not the primary goal. While we did wanna have strategic involved, what we did not want to do is have just one. That's really the reason why we ultimately ended up with two different strategic. But you had asked also about crossovers. We have traditional financial investors. The reason why you bring in crossovers if you have opportunity to, of course, is to set up for future rounds of financing, not the least of which is a public offering. Inner Siri's be. We brought in quite a number of crossover funds. As it turns out, our Siri see there was a great interest to complete the round from inside investors, and the only new investor we brought in was T. Rowe Price, again for the exact same reason is setting ourselves up properly for a future public office. So that's one of the goals, if you will. In structuring, I'm a believer that the round you're raising is actually setting you up for the next round. You're going to raise. So in some respects you're raising two rounds every time you are raising one.

Scott Nelson:   34:37
So he's trying to keep

Daniel Hawkins:   34:38
that in mind. Going forward.

Scott Nelson:   34:39
That's good Inside there. I think there's there's gonna be live how you derive from just that relatively short answer for a lot of those med tech entrepreneurs that are looking to raise their next round, you know, and I'd love the non with strategy, but just need the insight that went into that strategy for your two most recent rounds. Gives you plenty of options moving forward. It sounds like so very good lesson to learn. I know we've only got a few minutes left, so I want to ask you one more question with respect to shock wave, and then we'll get in the last three rapid fire questions. So I know and you just mentioned this fact. But a lot of you know, a lot of your investors have also been publicly quoted as saying they believe Shockwave can become a company that is that is able to sustain itself, you know, versus, you know, traditional med tech start ups that are that are gobbled up even earlier in their life cycle anymore. So with that said, give us ah, maybe a brief answer in regards to what's next for shock wife.

Daniel Hawkins:   35:23
So really, our future is going to be defined by how we perform clinically and, of course, how we performed commercially in the very near term. We're gonna start what turns out to be history's first randomized controlled study in peripheral vascular calcified Lisa. So, really, our specialty is calcium in the legs. There's lots of it. Half of patients have it. Surprisingly, there's never been a randomized controlled trial of one technology against another one to treat those patients. I didn't realize that we were going to be the 1st 1 until some reporter told us that, frankly, we think it's the right thing to do. We're doing the right clinical work going forward. That will be 330 patients kicking off very shortly. With that, we intend to demonstrate the capabilities and use abilities of the little plastic system versus angioplasty and recognize those differences across a very broad patient set. What's in the future for us. Additionally, near term this commercialization in Europe and in the United States for a peripheral vascular system. And in the second half of 2017 we would anticipate entering the corner a vascular system commercialization in Europe in more than medium and longer term. A logical next step for us would be an additional public offering. The markets will determine the timing of that and whether or not we do that in the near term, or if the market cycles aren't there, then we'll raise additional funds privately. But really, our goal here is to play for the end game, if you will, and to build this into a standard of care, level of technology and a long term sustainable French as a round little plastic technology.

Scott Nelson:   37:06
Mary could be exciting to watch what you do with Shockwave, not only in the near future but also the sort of along those that medium to long term timeframe as well. So because we're short on time, I'll ask you, The last three will conclude here with the last three rapid fire questions here. If you don't mind Daniel, so we'll start with number one. What is your favorite business book?

Daniel Hawkins:   37:22
The 22 of Beautiful Laws of Marketing.

Scott Nelson:   37:25
There's great clarity in

Daniel Hawkins:   37:26
there. It's really outstanding in one of my favorite parts of that is, if you're not number one in the category created category in which you could be number one,

Scott Nelson:   37:35
that allows

Daniel Hawkins:   37:35
you to shift markets and changed the dialogue at Intuitive, we turn that into one of the other laws I'm forgetting. Which one says that? A single word in the minds of customers No two companies can, on the same word, to combine the two of those and look back into the history of intuitive. We created the end of risk that became coined directly along robotic surgery and therefore were able to create the beginnings of a departure from existing technologies and ultimately ended up winning over that entire industry from the capability as well as the position. So that would certainly be the number one.

Scott Nelson:   38:10
Yeah, such a great book. Glad you answer with that in that fashion number two. Is there a CEO that you're following or one that you really admire?

Daniel Hawkins:   38:17
So there's a couple of different ones. Briefly, I'd say Fred Mall terrific visionary. He's the inventor of the safety TRO car continues to identify the painkillers and remove barriers. As I had mentioned a little bit earlier, you know, I'd have to say within my space, Omar Estrich from Medtronic. I've been extremely impressed with the culture that he's been able to create the quality of people in that organization and the consistency of the messaging and the capabilities within the organization. I think he's got an incredible vision for the value oriented future of health care. I'd say Mike Mahoney over at Boston Scientific for what he's been able to do in terms of the turnaround he's done for Boston Scientific and launch them into the number one position in stents and and push the entire franchise the entire business forward. I'd be remiss if I did not mention like Musallam again. Within my space, we do have the aortic valve concentration as well, but I've had some exposure to MIC, and I'd have to say that his vision for what became Taber and according SAPIEN early and then the management of that has been nothing short of spectacular has created an incredible amount of value for shareholders in incredible therapy categories for patient,

Scott Nelson:   39:29
great for CEOs that are definitely worth their salt, for sure. So last question before we end the conversation. If you had a chance to rewind the clock, Daniel, is there any advice that you give to your 30 year old self?

Daniel Hawkins:   39:41
Number 12345 is trust your gut. Your gut is never truly wrong. When you trust your gut properly at the high intensity moments, it won't fail you. It won't kill you.

Scott Nelson:   39:54
Great piece of advice to in the discussion. So I'll have you hold on the line, Danny, if you don't mind for a minute, but we'll go and conclude there. And for those listening to the interview, thanks for your attention. And until the next episode of Med Side or everyone take care. Thanks again, ladies and gents, for listening. This episode has been brought to you from the W. C. G studios here in Minneapolis. And don't forget to grab your pan optic stacking blueprint by visiting reach. Fire digital dot com for slash met cider Again that's reached fire digital dot com forward slash met cider. Okay, bye. For now,