Medsider Radio: Learn from Medtech and Healthcare Experts

Why Curiosity and Persistence are Crucial Characteristics for Medtech Entrepreneurs: Interview with the Legendary Dr. John Simpson, Executive Chairman of Avinger

December 05, 2016 Scott Nelson
Medsider Radio: Learn from Medtech and Healthcare Experts
Why Curiosity and Persistence are Crucial Characteristics for Medtech Entrepreneurs: Interview with the Legendary Dr. John Simpson, Executive Chairman of Avinger
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Medsider Radio: Learn from Medtech and Healthcare Experts
Why Curiosity and Persistence are Crucial Characteristics for Medtech Entrepreneurs: Interview with the Legendary Dr. John Simpson, Executive Chairman of Avinger
Dec 05, 2016
Scott Nelson

Dr. John Simpson.  Even if you’re a medical device newbie, you’ve probably heard of him.  He’s credited with inventing and commercializing the first over-the-wire balloon catheter used for percutaneous transluminal coronary angioplasty (PTCA).  This single idea created the field of interventional cardiology as we know it today. Over the course of his renowned medtech career...[read more]

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Show Notes Transcript

Dr. John Simpson.  Even if you’re a medical device newbie, you’ve probably heard of him.  He’s credited with inventing and commercializing the first over-the-wire balloon catheter used for percutaneous transluminal coronary angioplasty (PTCA).  This single idea created the field of interventional cardiology as we know it today. Over the course of his renowned medtech career...[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 meant 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, the one that I personally get a lot of value 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. 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Digital dot com Ford slash med cider again us. Reach fire digital dot com ford slash med Cider Grab that blueprint okay onto the upset Dr John Simpson, even if your medical device newbie you've probably heard of him. He's credited with inventing and commercializing the first over the wire balloon catheter used for perky Tania's trans liminal coronary angioplasty or PTC A. The single idea created the field of interventional cardiology as we know it today over the course of his renowned MedTech career. Dr Simpson has founded and successfully exited companies like a CS and Devi I, which were both acquired by Eli Lilly CVS, which was acquired by Boston Scientific Per Clothes, which sold the abbot Loom and which was acquired by Courtis and Fox Hollow, which was acquired by E V three and is now part of Medtronic. I mean, it's borderline exhausting, just thinking about all of these companies, let alone starting them plain and simple. Dr Simpson is alleged in the space, and he isn't done yet. He currently serves as the executive chairman of Adventure, where he and his team are developing a portfolio of unique cardiovascular products aimed at solving a challenging space of peripheral artery disease. In this interview with Dr Simpson and we learn about the key lessons he's learned throughout his historic MedTech career and while he still fired up about medical device innovation after all these years more specifically here, the things we're gonna dive into how Dr Simpson's infamous encounter with Jack Nicklaus yes, that Jack Nicklaus led to his firing as a bank teller, which eventually forced him down in New career path. The reasons why Dr Simpson decided to pursue Andre Screwed six balloon catheter Technologies and how it led to his own inventions as a med tech entrepreneur. Why knowing your strengths and limitations is key to making a difference in the lives of others. We're gonna learn more about Dr Simpson's approach to building a team and how surrounding himself, with people that have a broad group of skill sets, has enabled his success throughout the years, the key challenges Dr Simpson has faced with his new company, average ER and the important lessons he's learned, the advice Dr Simpson would give to his 30 year old self and how endurance through criticism is what ultimately leads to revolution within the medical field. So without further ado, let's get to the interview. Hello, Dr Simpson. Thanks for joining the Med Cider program. Really appreciate you taking some time out of your day to engage in a conversation.

Dr. John Simpson:   4:41
We'll take you. Thanks for this opportunity. A

Scott Nelson:   4:45
great school get started when looking at your know your vast and storied MedTech career most people would assume, and rightfully so that you've consistently he had these sort of top of the mountain experiences, you know, time and time again when looking at all of your successful MedTech exits as well. It's just, you know, all of the products interventional products that you've developed over the years, but it hasn't always been easy and even, you know, dating back to when you initially applied for medical school and didn't get in. So let's start there. Can you take us back to the late sixties and in your infamous encounter with Jack Nicklaus when you were working as, ah, bank teller in Columbus, Ohio?

Dr. John Simpson:   5:17
Yes. Oh, thank you for that opportunity. This predates my getting ready to go to medical school. Of course, I just graduated from Ohio State University and I was looking for a job that was recently married and had a baby on the way. And so I had no job. And so I applied for the a bank teller training job at the Upper Arlington National Bank for a house A are in Columbus, Ohio, and that was assigned to tell occasion before and where the necklace is. Secretary 1967 came to Taylor tell occasion before to deposit his winnings from the U. S. Open, and the winnings were $30,000. If you can imagine that you could look it up on the Internet. I looked it up. I can't believe

Scott Nelson:   5:54
it, but

Dr. John Simpson:   5:54
still $30,000 or more money than I could ever have imagined. And the new teller in training, I take the check all around. The Ohio National Bank showed it to everyone until it got to the branch manager. And he took a dim view of me doing that that I had to get back to the teller cage, which I did. I put the check in the wrong stack. No computers, and they couldn't find it for about a month. Teller

Scott Nelson:   6:14
cage.

Dr. John Simpson:   6:15
Every morning was out of balance, $30,000 which was a little bit more than was

Scott Nelson:   6:18
acceptable.

Dr. John Simpson:   6:20
Eventually the manager came to me and you said, You know, John, I had to be honest with you. I don't think you're cut out to be a banker. So perfectly got fired over leasing this check and then surely I went out shortly, and 30 years later I got a letter from Jack. Nicklaus said he had heard this story. It was unfortunate. He said that you know, my interaction with golf had had led to big

Scott Nelson:   6:39
change

Dr. John Simpson:   6:39
in my career path. But he hoped to work.

Scott Nelson:   6:41
Okay, such a great story on a number of different fronts, but that we'd start out with that. That sort of that funny anecdote because they think it tells a lot about about you and your your background. But let's use that to transition to kind of just your general interest in cardiology, because correct me if I'm wrong. Before going to medical school at Duke, you pursued a PhD in immunology and then went on to pursue medical school at Duke and then went to train at at Stanford and cardiology. So treating cardiovascular disease, especially peripheral vascular disease, is it seems like it's always been sort of consistent theme throughout. You know, all of the medical device companies you've started and really throughout your you know, your career in medicine and health care tell us a little bit more about this disease, and maybe why you've always been that interested in it,

Dr. John Simpson:   7:24
of course, is plague of our society, and it results in enormous amount of mortality and morbidity. And so I've always been interested in Trained at Stanford is a cardiologists in my early work was treating corny already disease, but over time correct. Faded a little bit more toward purple artery disease, basically just a valuation of new technologies. And we always evaluate the first of the perp investors place before we take them into the corner space. Then, through that really developed This is fascinating observation. I would say that you know, I can fix them by these heart vessels and, you know, they say, OK, great. I don't have just think when I express in a more doc Do you want to have a beer? You save somebody from amputation and it's totally different. It is like, you know, they expect to leave their leg and then they do not. And it creates almost like a more rewarding experience, that culturally more rewarding experience. I would say for the physician for the hospital, you know, and for the nursing staff, your stories all the time about the nurses that air like, emotionally overwhelmed, along with patients, you know, when they were able to avoid amputation. I think that's the thing that has created the allure of treating patients. P. D. But also a P D is grossly under diagnosed in this country, and I think look at us and opportunity to make. Something is profoundly impactful to the mouth distributions. Let's say a patient care accessibility in the United States. And if you're African American, then you show up in the virtual room with a narrow blood vessel in your like there's 2.5 times the chance that you'll have your leg amputated as if you're white. And there has to be. It's not all racism, but there has to be some racial components of that. There's some

Scott Nelson:   8:56
socioeconomic

Dr. John Simpson:   8:57
drivers to that as well. But it's just this is so, you know, disturbing away for you. Well, I just have always felt like it's a very, very exciting challenge in a really, really important area to work in it. I think it has not really received the attention that it should have. And mostly attention goes the corny urges. And they're very important, too, because you definitely you know that a lot more mortalities associated with the corner already close enough in a leg vessel. But that's kind of my overview of PhD and what I think it's so appealing.

Scott Nelson:   9:28
Sure not completely relate. I remember this is back during my days at at Comedian before med, Medtronic acquired comedian, but I do recall a presentation from an interventional cardiologists as the name. His name is escaping me right now, but he was, I think, at the University of Oklahoma. But he was comparing. He made that exact analogy that you just referenced, and he was comparing his treatment of peripheral arterial disease to coronary arterial disease. And he said, You know, oftentimes after he treats, you know, someone's left main and goes and sees them the next day, they don't you know they don't really necessarily feel any any different. You know, there's not really much of a response. But when he when he saves someone's limb, you know and treats them from from upriver vascular standpoint, you know what the oftentimes give him a hug, you know, the next day. So he he said, It's It's just not much more rewarding. So interesting that you mention that is a component of kind of why, why you've always been interested in vascular disease, especially peripheral vascular disease. So let's let's let's transition to your time at Stanford, and this sort of goes back to it, too, before you know, you initially started developing angioplasty balloons. But in doing the research and preparation for this interview, it looked like you were almost ready to head to Jackson, Mississippi, for additional training and cardiology until you sat in on a presentation from Andreas cruising. So can you kind of take us back in time and tell us a little bit more about that experience and how that sort of train change your career path at that point in time?

Dr. John Simpson:   10:41
Yes, I think maybe a better way to say it is that I was a cardiology fellow at Stanford at the time, and you're

Scott Nelson:   10:48
always just

Dr. John Simpson:   10:48
a fellow. You're always looking for a free meal, maybe a free sandwich, and I saw that there was a noon lecture and you get a free sandwich for this guy named Undressed. Grim said he was gonna talk about putting a balloon into patients, corny authorities blowing it up, and they were going to get better. And I thought right for a minute. But I'm need a free sandwich. So I did that. I went to to the noon offering address was there, and he gave this. Give the talk about your 1,000,000,000 shipped last in and to treat human Carney already disease. And I thought, Wow, I don't know that seems all that crazy And I told my wife that same day I said, You know, I don't know. He's either going to revolutionize the treatment of Ask your disease or he's gonna go to jail, and I sort of favorite jail. It's kind of the most likely

Scott Nelson:   11:32
in

Dr. John Simpson:   11:33
point for undress, but I had a complication. Stanford, Six months later, I didn't think too much more about undresses technology for probably another 45 months. Maybe they had a complication, and I thought, Gee, if I had that little balloon catheter that undressed was talking about, maybe I could have pushed this stuff that was in the already that I had dislodged that could push it back into the wall and and ultimately convinced the chairman of the department chief of cardiology at Stanford, Don Harrison, to give me some time off to go to Zurich than to see on dress, used some of his early blend catheters, and I just thought it was so magical. Came back, ordered the catheters. I couldn't get them. The balloons exactly so ended up starting to work with Ned Robert, another cardiology fellow at Stanford. And we work together who developed and then over the wire balloon angioplasty system. We evaluated animals first, and then eventually it was it was good. It was safe so that we could use the impatience. And that was only out of desperation. It wasn't like a headed in the expression development balloon catheters or, you know, even having a very good thoughts about how to do it. But I thought I could surround myself with people that didn't know how to do it. It would be working together, you know, we could figure it out and we could end up making something good.

Scott Nelson:   12:44
Got it? And I definitely want to get to that that last that last part of your your answer there in regards to surrounding yourself with people that sort of allowed you to experience. Ah, you know, many successes that you've had over the course of your career. But just as a follow up question of that experience with, you know, with sitting in on that presentation from Andrea Screwed zig, you know, as as I, you know, as I heard about that, I read about that story and kind of thought about it. I think it'd be easy for most people to look at your career and think, you know? Yes, Dr Simpson is that he's an entrepreneur. Of course, that makes sense. He saw a need and the marketplace and developed Ah, balloon catheter. But, you know, if if I try to try to attempt to put myself in your shoes of that time I mean, you're still a fellow. I got to think that this technology that Andreas Groups in Euros was presenting is, you know, you kind of mentioned it. A lot of people were pretty skeptical, allowed it, but you went ahead and sort of, like, Dove dove that much deeper when most people probably would have just sort of moved on and thought maybe it was interesting and pursued it. You know, they're more traditional career path, but you sort of went deep and begin to sort of toy around with technology. What do you attribute that to it? Just, you know, you consider yourself sort of a natural tinker or just naturally curious. And what college? You just sort of take those initial steps toe, you know, to go a little bit deeper with. From a technology standpoint,

Dr. John Simpson:   13:51
well, probably not. Brain is

Scott Nelson:   13:52
all

Dr. John Simpson:   13:52
messed up so

Scott Nelson:   13:53
that

Dr. John Simpson:   13:55
that's

Scott Nelson:   13:55
explanation

Dr. John Simpson:   13:56
for it. You know, I've had this question posed to me before. I really did not have a very good answer. Somehow, to me, it seems like if you're presented with the problem, I don't know. It just seems sort of natural to try to seek out a solution that's better than what we're currently doing. I don't know if that's come from, so my graduate school training, getting a PhD or if it it's part of my basic nature, I just really wish I could answer the question, and I'm Unfortunately, I think my interests are always

Scott Nelson:   14:21
a little

Dr. John Simpson:   14:22
bit weak. But there's something about my nature that is like a persevering type person personality, if you will.

Scott Nelson:   14:28
And

Dr. John Simpson:   14:29
if I do find a problem potentially if I couldn't see a way to what I think, maybe it's just my own ego. What I think

Scott Nelson:   14:36
could be a

Dr. John Simpson:   14:36
really, really good solution. And what if we could do this? Wouldn't that be helpful? Then I tend to kind of focus on that, and then what if we could do this? I usually work on just trying to find a way to do it, and that's really sort of the thing that probably separates me from some of them. Some of the other physician entrepreneurs I would say, I just keep just hanging in there until we figured out

Scott Nelson:   14:59
that I certainly wouldn't expect you to have sort of, ah, you know, the $1,000,000 answer to that question. But I do think it's interesting to hear kind of get your take on on that initial start, I guess in the kind of towards the your entrepreneurial side of your romantic career. But on that note, let's let's kind of transition to some of your business accomplishes accomplishments over the over the years, and I definitely want to get Thio average er, you know, the company that you found it in the kind of the middle eight to thousands and where you're at now. But before we go there, I sort of want to set the stage for the audience that's listening. That may that may be loosely familiar with your work, you know, and I would encourage anyone just to Google Kugel, Dr John Simpson. You'll find a laundry list of different, You know of accomplishments and successes along the way, but just to kind of quickly set the stage all kind of run through some of these companies. And then you can kind of, you know, correct me if I'm wrong, But I don't want to spend too much time on some of your earlier earlier MedTech exits. But I do think they're interesting to note. Nonetheless, you know, advanced cardio cardio vascular systems or a C S, is most people refer to it now. That was your first company that you started back in the late seventies, which you eventually sold to you, Eli Lilly in 1981 or early eighties. That's right. That's correct. Something like that. The numbers may run together a little bit, but then Devi I or devices for vascular intervention That was a company where you initially that sort of like started this this interest in after ectomy and you were developing after ectomy, devices or devices to remove your plaque out of someone's blood vessels again, you saw that company toe Eli Lilly in 90 and that that eventually formed sort of the Foundation for Guidance, which which Abbott eventually acquired and kind of the mid two thousands. But Devi, I was to Eli Lilly again in kind of the nineties, right? Right around 99 to your cell?

Dr. John Simpson:   16:37
I think so. Those right? Never. But the important thing to observe their that when

Scott Nelson:   16:41
we

Dr. John Simpson:   16:41
formed advanced code investor systems, we were able to put these little balloons in arteries, this all treated corn charity to see. And we didn't fight the blend, and sometimes it would almost be like a miracle occurs. And now, then the problem is fixed. But sometimes it would not be a rare called the problems actually made worse. And when the problem was made worse, sister part of stenting, it kept going through my mind instead of trying to just push it around with the blue. What if we could actually clean it out? And so it was a natural transition for me, mostly because, uh, the heretic outcomes when they did not work well on edge Spice did not work. Well, it was it really did not work well and so we definitely wanted it something to be better. And that's sort of the transition to go to something that cleans it out.

Scott Nelson:   17:23
I guess that kind of speaks to what you are. What you mentioned earlier is you saw you saw problem you saw need. You said I don't want to just simply inflate this balloon and squish the disease up against the best of all. I want to try to remove that. Why not try to get it out of there? And I think that kind of points to what you what you mentioned earlier and just try to try to solve a problem that you that you see? You know, that's very clear to you. And maybe that may not be as clear to everyone else on that note with Devi. I mean, you have obviously had a really good successful exit with Fox Hollow. And then now you're producing some really compelling devices with lavender related to a threat to me. Why don't you think after ectomy took off with Devi I back in the mid to late eighties?

Dr. John Simpson:   17:56
Well, it was very difficult to use. The devices were long and the housing the way they were configured. What? You've got to be in place. I mean, they worked beautifully. To get in the in place was very, very difficult and Also, it was competing with, you know, simpler and easier to use technology with a blend and then invested competed with stents. And I think just ease of use was kind of the biggest problem for Devi I and and I think that was the concept. Those and we still see a lot of patients. There's like 20 years out from being treated the DVD device and already looks really well, it read. I will go to

Scott Nelson:   18:30
a

Dr. John Simpson:   18:30
hospital now, just so I have a patient. You have a patient 20 years out from the diva and then already still looks spectacular. So when it worked well, it worked really well. A little bit like balloon angioplasty. There was also very difficulties.

Scott Nelson:   18:44
The concept was, was there it was just the device itself means a generation which we'll get to with Avenger and kind of what you're know what your portfolio that you're building out to treat peripheral vascular disease here in here in a minute, kind of going through the other. The other companies that you have to form cardiovascular imaging systems again, I think that that's unique because we'll get to it here in a second with your workout Avenger. That was with Dr Paul Jac. If I'm if I'm pronouncing his last name. I've never known how to pronounce his last name. I've seen it so many times, but probably never, never asked anyone that actually actually knew. But is that how you pronounce his last name?

Dr. John Simpson:   19:13
I

Scott Nelson:   19:14
got it. And then, let's see here, per clothes, which is Ah, ephemeral art era closure device. You sold that to Abbott and 98 then loom in, which was acquired by Courtis in the in the mid nineties and then in the late nineties, kind of leading up t worry right now. In the late nineties, you helped start Fox Hollow again focused on a threat to me as I mentioned before, and that was acquired by E V three in 2007. And then, as most people know, Covidien acquired E V three and then Medtronic acquired committee in a lot of lot of M and a activity over the years. But now, now in the bag of Big Blue at Medtronic and then and then, lastly, that that leaves this sort of sort of two today, which which adventure, which is the company right? now which you formed, I think in mid middle eight to thousands of my researchers right here, which I see is almost a culmination of all of these products over the years, you know, from crossing devices to a threat to me devices, thio imaging devices. It's almost like, you know, everything that you've learned along the way you've been able to make generations to are now developing an Avenger.

Dr. John Simpson:   20:07
Yeah, I think that's probably the advantage that I've had. This is one of the advantage to be a little bit older, unfortunately, that you have seen a lot of a lot of things happened, right? And some of you want you also, y'all must always want to make it better. But in the very early days of angioplasty, you know, we needed something playing the vessels out started DVD, and that's something that I think the vessels out. But you could not always aim it in the direction that you wanted to base system the X ray images. So we talked about adding imaging to this and Paul York, part of the motivation we had with Paul Yacht Inco domestic abuse. The system was at Intervest ultrasound to the imaging catheters, which we tried to do. But it just turned out that it was too hard to do at that time because the technology just did not exist along the way we were in that era. Also, we're putting in some early stents, and we ended up with bleeding problems in the growing cause. These patriotic regulated and so we started per closed toe close these holes for Archie Relaxes. So I

Scott Nelson:   21:03
said,

Dr. John Simpson:   21:03
that was really you know, it's a little bit of a deviation, Let's say from the theme that I've used mostly, which is to treat your dirties, but eventually that you should back up in the tree to narrate already track with Fox. So and really great device, but limited because once again, back

Scott Nelson:   21:17
to the

Dr. John Simpson:   21:17
diva uh, era, you could not really rely as much as you would like Thio on the X ray images to tell you where to cut. Polyak pointed this out to us really in the early days. He said he would like for these deposits to be really concentric and they're not, and by interesting culture sand, you can see they're not concentric. You can see which side to aim your devices out. And so Fox all had that limitation in that. Although the device worked well, sometimes you cut too deep lended already. Well, and when that happened, then you had the risk of some ex travel station locally of contrast. Or you would have her records rates and it led to back to the theme of, you know, if we could Steve, we know they removing the plaque is really, really fable. If you could prove just the right amount in the right spot that you wanted Thio, then that that could be the answer and that I think that's what Adventure has embarked on. Developed a lot of technology around image and using optical Harris tomography is the imaging system, which is a laser based system that allows us to look at the already while we're working on it. And it really creates a remarkable safety profile as well its efficacy profile, say physicians from excess radiation. So I think that is in a way, you say the combination of the efforts may be so but culmination just sounds like the end. So I don't know if I really

Scott Nelson:   22:30
like that. Yeah, yeah, yeah. No, I I couldn't. That's the word I came up with, I guess, but certainly don't want to. Don't want to depict that you're at You're at the end of, you know, putting a book and on this particular chapter anyway. But But in terms of devices themselves, it certainly seems like, no, your career's could have led up to this point where you're you're iterating. You've been able to operate on a number of different devices that you develop over the years and, you know, here we are with With With Avenger I wanna ask you a few more questions with respect to adventure, but just kind of going back to all of these companies that you've started the past. You've always been able to surround yourself with with a great team. And you even pointed it out earlier in the conversation. No. People like Ray Williams and Bob Griese at a C s. Alan, will a d. B i playing at per close. I'm just mentioning a few names that most people would probably familiar with. But, you know, the list certainly goes on and on. So for those for those people that are listening to this right now, that that would consider themselves med tech entrepreneurs, whether their physicians themselves or just entrepreneurial in nature. What's been your approach to the building of that team? Is it always coming after layers have been by intention that you've sort of sought after people that, you know, bring different skill sets to the table, talk to us a little bit about about that?

Dr. John Simpson:   23:34
Yeah, they did right there. Sort of a harsh reality is that, you know, all of the people that you've just had the artifact were introduced to me about someone

Scott Nelson:   23:42
else, and

Dr. John Simpson:   23:43
they said, You know, you ought to talk Thio and Ray Williams is the best

Scott Nelson:   23:46
example.

Dr. John Simpson:   23:47
No asset. That's not quite true. I met Ray Williams when he was a parking lot attendant for the circus Club. What's it called? Have the horse riding show at the circus lip? And he was parking cars and his wife was on the committee that ran the show, and he said to me that he had heard about what we're doing with Glenn angioplasty he was interested in, And what would I give him a call? And he said that he does a lot of venture capital work, and I had never heard of the term venture capital before, so I had no idea what that WAAS and so I never called it. Then finally, one day he called me that and you say, Gosh, you know, I thought maybe you would have called me back, you know? And you know, a lot of people looking for funding, but made it sound like you needed it. That's what we always needed. But I don't know. I don't know how to do it. And he

Scott Nelson:   24:30
did. He

Dr. John Simpson:   24:31
said, Well, I'll do it And he did. And then he was the one who hired Bob Griese A C s. I mean, he's just a fascinating litany of been wonderful people that I've been involved with, and I don't have any idea at all to cut it to place a lot of times just by being introduced to somebody who knows somebody. I don't think I've ever done it like a you know, like a real search and

Scott Nelson:   24:52
found

Dr. John Simpson:   24:53
somebody that I wanted for a position. That's usually I'll ask a friend, you know, anybody who could do this and they say, Oh, yeah, once, Yes, so and so That's been I think a better system for me, but a lot of your rely heavily on searches to find. I do that to my friends and now

Scott Nelson:   25:06
them

Dr. John Simpson:   25:07
my acquaintances. Now that I have enough friends, acquaintances, I can cheat a little bit.

Scott Nelson:   25:12
Certainly your networks brought enough in Europe. You've had enough enough accomplishments that along the way that I'm. I'm sure people would be more than willing to try toe be a part of your team, or at least help help someone they knew that you know, to be a part of your team. But let's go back to you know where you're at with Avenue. I know, I know. You mentioned a little bit about that. The broad prefer a vascular portfolio that you're building out now in the unique aspects of your products. But, you know, I think a lot of people would have looked at maybe, you know, after exiting having a nice exit with Fox Hollow TV three. You know, considering all of the previous accomplishments that you've had, they would have said, You know, Dr Simpson, it's easy for you to go ride off into the into the sunset. You know, most people would clap their hands and give the innovation and say Wow! What? What an amazing career. But you haven't stopped, you know, you went on to form, you know, average er and four sort of, Ah, trying to find a better word for culmination. It's sort of a next step. A lot. A lot of these different product. You know what? You know what? What's that you know? Is there something that kind of that causes you to keep going and starting these companies? You know, what's the what's the sort of is they're burning challenge that you're, you know you're trying to solve for you knave, injure that keeps you, keeps you going?

Dr. John Simpson:   26:18
Well, I think I do. You have the additional advantage of being able to see the patients and see the misery that these different diseases cause, Ah, a combination of an entrepreneur and a physician. And I don't think I've ever lost sight of that that have miserable these diseases are you know, if there's an opportunity to build out a system that would would reduce this misery and suffering, And I mean, when you've seen patients that are about to lose their leg or the patient and acute M. I said, In the coronary care unit, you just want to help him. It's very motivating. It's not like you read about and, you know, some kind of ah science book. I mean this Israel. And if you work hard at it, you know, then you can you can make a difference. That's always the way I approach it to make a difference. The patient I'm not. My strength is not business. Uh, definitely surround myself with people that are really good at it. But, you know, that's not my straight. My strength is more clinical, and that may be a tinker is the right term. I just do sort of like that. No, no, no,

Scott Nelson:   27:18
no, no. I think it it to me for my perspective, It makes it makes a lot of sense. I mean, you sort of know not only your interests, but it seems like you know, you know where your limitations are as well. And you know, when you asked that question of, like someone that can serve in this capacity, or you can help me meet, meet this certain eat. I think that's that. That's that's a good lesson learned for any med tech entrepreneur out there is, you know, kind of, you know, be cognizant and be acutely aware of, sort of were your wheelhouse is and where maybe your limitations are and, you know, asked, you know, don't be afraid to kind of gas for help where it makes sense,

Dr. John Simpson:   27:48
that is one of the things that I feel like that I am pretty good at is knowing. I know what I'm good at. And I know what I'm really bad at.

Scott Nelson:   27:55
First in the list of what I'm really

Dr. John Simpson:   27:56
bad at is pretty long. Lot of good. That's actually pretty short. But I've told a lot of people that if we keep let me get inside a blood vessel, then I've got you. You just

Scott Nelson:   28:05
got really

Dr. John Simpson:   28:06
hard for, you know, for you to beat me inside a blood vessel. You give me a P en el our balance sheet or something like that, and you have me. I will

Scott Nelson:   28:13
be clueless that so

Dr. John Simpson:   28:15
that's why I have to hire somebody else to do that.

Scott Nelson:   28:17
It's a really good listen. I think it's one that sounds simple when people describe it, but it's someone you know when you're in the trenches knee deep in the work. Sometimes it's hard to let go, you know, and not acutely aware of, like when to hand something off. So obviously, maybe it comes me a little bit more naturally for you, but maybe, maybe more challenging for other other folks. You know, the other thing that I thought was interesting thing that you point out there, too, is just in granted your physician, your cardiologist, but also just that natural bias towards the patient. And I think that's that's one of the unique benefits of advantages of being involved in med tack or health care. Is that unlike other tech companies there in Northern California? No Facebook, Apple, Google, et cetera. Not that those are great companies, but you know, there's always sort of the benefit to being involved in Med Tech is that you know you're working on devices that are being used in on a daily basis to treat patients, and so I think that's always. It's always kind of a nice aspect, especially when you when you appreciate it, and it sounds like obviously you have over the years,

Dr. John Simpson:   29:07
it's hard to avoid, and if you know that and I do know a lot of people, a lot of engineers that they can, you know, make these things better, and I rely on them to do that. I'm a little bit like the quarterback on the football team with the team is really great. But it's only because of the lineman on the

Scott Nelson:   29:22
receivers

Dr. John Simpson:   29:23
and running back stop because the quarterback and

Scott Nelson:   29:26
yet the

Dr. John Simpson:   29:26
quarterback gets way, way, way too much credit. I sort of feel like I'm in that situation. I get the credit for all they're worth. The engineers do the assemblers. I mean, the symbols

Scott Nelson:   29:34
were

Dr. John Simpson:   29:34
put together, stuff just like is miraculous. Yet I get the credit, which is totally wrong.

Scott Nelson:   29:40
E I think you're being humble, but I think most people would appreciate that comment. Tell for sure, and to your point, definitely. Without a doubt, it takes a strong team on a strong quarterback leader to kind of move, move the team forward, you know, kind of kind of going back to you know what? Your experiences over the past 89 years or so with Gavin Jer, you've certainly been able to take ah lot of experiences with you along along the way so thinking about Alvin Jer and what you've experienced over the past, you know, the past year three was three decades or so. Are there certain challenges that have come up Aven jer that have surprised you? And then maybe on a similar note or in a similar vein, as you've approached some of those challenges? Are there some key lessons that have sort of helped you key lessons from the past that that this sort of helped you during during some of those more challenging times? An adventure?

Dr. John Simpson:   30:25
But I will say that the challenges that have surprised me with adventure that will be different than some of the previous challenges is the difficulty this modern era of racing capital

Scott Nelson:   30:34
always

Dr. John Simpson:   30:35
raised capital seems like a bit more easily.

Scott Nelson:   30:36
Maybe you

Dr. John Simpson:   30:37
need to go back to Ray Williams and has him put aside to start that over for us again. But

Scott Nelson:   30:42
he was always

Dr. John Simpson:   30:42
really good at it. I feel like that in in the current era, and I don't think I'm speaking just for adventure. I think across the board, people are investing a lot less now in innovation at the early stage, there's a time when everybody wanted to invest in that. That's no longer the case there. Want to invest in a large revenue stream, would like to invest in profitable companies. I've ever had one of those on what that would be like, but I

Scott Nelson:   31:04
would say that it's

Dr. John Simpson:   31:05
just different, and some of this stuff would be to me, totally an anticipated. That being said, some of the physicians are under such enormous pressure from their hospitals the do cases to, you

Scott Nelson:   31:17
know,

Dr. John Simpson:   31:17
do patients have increased patient volume that there may not be so interested in learning a really new and innovative technology that probably can give better results. It's gonna take more time. It

Scott Nelson:   31:28
would be

Dr. John Simpson:   31:28
resistance to that. I see some of that. Right now. I find that love it shocking never occurred. You know, Maybe when I was a little younger and practicing medicine daily, I just I can't see that approach it is. It does exist. I think the overall lesson this still is about the same. I mean, regulatory affairs were still hard, but just persevere. I mean, you know, the F d A. You could eventually have yet just provide the right date. And once you do that eventually everything will be approved. Just perseverance is really important. Raising money because everybody talked to almost always will say no, keep working at it and that's what that's the way I would probably characterize it. I don't think I mean average er is trying to do something that's never been done before, and amateur is actually doing something that's never been done before. It's Manito, almost

Scott Nelson:   32:14
like a

Dr. John Simpson:   32:15
camera on a cutter, and you can see what you're cutting without an

Scott Nelson:   32:18
extra

Dr. John Simpson:   32:19
never been done before. That means that it's hard, and that also means that suspicious and people would say, Oh, you know, that's never gonna work. You know, Simpson's tried do that forever, and that's just not gonna happen. So I think you know, you have these prejudices and biases that are in the market, the physician community and investment community. You just have to overcome them. And, you know, we did a lot of that with the early days of blind angioplasty, when the surgical community this was a nup roar. I was a cardiology fellow. Stanford. You know the fact that Stanford would come by that the way they started that morning off every day to make him really happy. That combined laughed at what I was doing. So it was eventually. Sometimes that's motivating, right? You know what? I'm going to show them. So anyway, I'm digressing from the original question. But perseverance is the key, and raising capital is the current impediment in my

Scott Nelson:   33:09
mind. No, no, that's it. I really appreciate that answer. And I and I think sometimes it's very easy to under appreciate something like that. I like, I like how you put it, you know, just know that it's gonna be hard. It's gonna be difficult. I mean, like, as an example, you just like you mentioned, you know, with lavender. You you're trying to put a camera on a therapeutic device, you know, so that that allows physicians to see what they're treating and also treat at the same time. So I mean, something like that. That's yeah, definitely an engineering feat. But yet you're still able to do it in today's climate, you know, when so many people with lamb and in complaining about how hard it is to raise money. And I like your approach on, just know that it's gonna be difficult and know that there's gonna be times that you're gonna have to persevere through those challenges. It's a great anecdote and something that I think a lot of us need toe here again and again. I think that's

Dr. John Simpson:   33:51
okay, said it took about How Hardy are you willing to work and how committed are you? He argued to the project.

Scott Nelson:   33:57
Yeah, easy to understand, but yet yet hard to sort of implement and execute on for sure. But on that note, before we would kind of wrap up with the last three rapid fire questions, Anything else that you think that that would be good for the for the audience to know whether that's, you know, about med tech, entrepreneurship in general about cardiovascular disease or you know what you're doing it at average or anything else that you think is we're sharing.

Dr. John Simpson:   34:16
I think we've covered it in good detail. I would like to add that anything that anybody who's listening can do to increase the awareness about how serious performer diseases and how important you just get early diagnosis and treatment almost like cancer, if you will, because he went out there that can help do that, then that would be lovely, wonderful. It's a huge problem.

Scott Nelson:   34:35
Sure, definitely can appreciate that It No, it's It's one of those Most people fairly easily understand coronary arterial disease, you know, because you understand, you know, people think of stents or something like that. They think of, you know, Stenson stints in your heart. But people are are pretty unfamiliar with, you know, prefer arterial disease, cause it's not something necessarily that, you know you're gonna die from immediately. But at the same time, it's a severely under diagnosed as you mentioned before, so good. So let's let's let's quickly kind of transition to the last three Rapid fire questions. The rapid fire just in nature from a question standpoint. But don't feel don't feel like you have to be rapid fire answers. You can feel free to expand if you expound a little bit if you want, but the 1st 1 is what's your favorite business book?

Dr. John Simpson:   35:12
Well, I'm not. I'm not sure you, because I

Scott Nelson:   35:14
think

Dr. John Simpson:   35:14
it's a business book. So Malcolm

Scott Nelson:   35:16
Gladwell's

Dr. John Simpson:   35:16
out Liars talks a lot about it takes 10,000 hours to be good at anything. I think that's probably an understatement. Unfortunately for Malcolm, I think it takes more than two hours, but I think that's it's a really cool book, and to me, it just talks a lot about and I think probably it is a theme. There is perseverance, which maybe just fits my basic nature.

Scott Nelson:   35:37
Yeah, yeah, definitely. Let's see. The second question is, is there a business leader that you're You're either following right now? Or maybe one that's inspired you in the past that you sort of naturally gravitated towards?

Dr. John Simpson:   35:47
Well, for sure, I mean, you made a consumer business leader e to me. He is business later. He's also a really good surgeon. His name's Tom, Furby and Tom. Without Tom, I would have never been able to do anything because he was the surgeon that supported me. A secure hospital locally and just absolutely amazing guy. And they grew up a huge family, the Appalachian Mountains, and mended the motor scooter. Plus, he has the ultimate inventor, and I think I am not. I'm the kind of a worker bee that just keeps plugging away until we get it right. He has a different approach at any time. For Buddy, it's just a huge was a huge factor in my life and you know with that and we had to be willing to stand by and bail me out of trouble. And unfortunately, Tom was called him a lot to bail me out of trouble. So But I'd buy Tom because, you know, he's built.

Scott Nelson:   36:35
You're

Dr. John Simpson:   36:36
certainly more a lot of businesses. And justice starts really, really magical stuff. And I think he's just a huge, huge factor and and driving away vaster diseases, not not only treated but also diagnosed.

Scott Nelson:   36:49
Yeah, it's funny. I remember the first time I met Dr Fogarty, is that this is what I was at at committing again. And I think I was a medical meeting of some sort. I can't remember which medical meeting it was, but we were displaying the trellis devices. I'm not sure if you remember that that device for yeah, for DVT or yeah, exactly. But I remember I think it was at one of the year showcasing the device of the booth. And sure enough, he was there and he walked up and sort of introduced himself as the inventor of the device. And I think a lot of the people around, you know, thought he was joking, but I was like, No, no, you really You really did invent this device out. Just got a funny anecdote. Probably speaks to his personality, but very cool. Lastly, we'll kind of wrap it up here. But when thinking about your your med tech career, tons of accomplishments, obviously a lot of challenges the way. But you really pushed through and had a lot of a lot of really great accomplishments. Is there one piece of advice that you tell your 30 year old self if we had the opportunity to sort of rewind the clock

Dr. John Simpson:   37:38
30 year old? Yeah,

Scott Nelson:   37:39
yeah, uh,

Dr. John Simpson:   37:42
you know, I don't know that it's a few different things that we should have already stated. I mean, I think that you have to be willing to endure a lot, and then you have to be willing to persevere and be willing to endure is sometimes the most difficult part. Sometimes think about. The pathologist at Duke University is got a philosopher too road in some article that you know any time you develop something that is incrementally and improvement in medicine, there's a huge applause and everybody congratulate you, and that's really wonderful. If you do something that is really transformational in medicine, then you'll have a lot of criticism. Everybody

Scott Nelson:   38:18
would find

Dr. John Simpson:   38:19
fault with it. You know, if it's revolutionary, they would, you know it will be absolutely criticized. And so I think I focused more my attention on trying to do things that are that revolutionary that way. And so there's a lot of criticism that comes your way. But what you want somebody to conclude at the end of what you've done and they look at it and they say, You know what these air signs that you would associate with a revolution and that's been

Scott Nelson:   38:41
my

Dr. John Simpson:   38:42
goal. I was supposed

Scott Nelson:   38:43
Yeah, now that's that's that's creating a great way to sort of wrap up this conversation. So I'll have you hold on the line here, Dr. Simpson, I can't thank you enough for joining me in on this conversation, and, you know, for those I get all into it in the in the show notes online. But if you want to go check out Avenger, just goto a v i n, g e r dot com, Avenger dot com and otherwise, just use Google Average or or Dr John Simpson. You'll you'll be sure to find his current work? Thanks again for your willingness to have a discussion today, Dr. Simpson, I'll have you hold on the line, but just wanted the pleasure and express my thanks again. 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.