Medsider: Learn from MedTech and HealthTech Experts

Why Keeping The End in Mind is Critical for Every Medtech Entrepreneur: Interview with Erica Rogers, CEO of Silk Road Medical

January 17, 2020 Scott Nelson
Medsider: Learn from MedTech and HealthTech Experts
Why Keeping The End in Mind is Critical for Every Medtech Entrepreneur: Interview with Erica Rogers, CEO of Silk Road Medical
Medsider: Learn from MedTech and HealthTech Experts
Why Keeping The End in Mind is Critical for Every Medtech Entrepreneur: Interview with Erica Rogers, CEO of Silk Road Medical
Jan 17, 2020
Scott Nelson

In this two-part interview, I was lucky enough to sit down with Erica Rogers, CEO of Silk Road Medical. We first spoke a few years ago and then again much more recently to catch up on what had changed at Silk Road since our first conversation.

During our catch up, we discussed how Erica led her team at Silk Road through PMA approval, successful insurance coverage and reimbursement strategy, which led to a very rewarding public offering for Silk Road, opening at $20 a share. This resulted in the opportunity to continue the company’s goal, which is to change the standard of care in carotid artery disease with their TCAR procedure.

Much of our first conversation was about Erica’s career trajectory and how she was able to successfully, and gracefully, exit multiple medtech companies. Her lengthy career and insight as a medtech thought leader is just as interesting today as it was when we recorded our conversation.

Before leading Silk Road, Erica was the COO of Medicines360, a nonprofit pharmaceutical company developing drugs and devices for women. Erica was the founder and CEO of Allux Medical as well as the cofounder of Visiogen, which was acquired by Abbott Medical Optics in 2009.

Prior to that, Erica spent over 12 years at Boston Scientific in a variety of sales and marketing positions. She began her career in pharmaceutical sales after receiving a B.S. in Zoology from San Diego State University. Erica holds five issued and 15 pending US patents for medical devices in nanotechnology.

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Show Notes Transcript

In this two-part interview, I was lucky enough to sit down with Erica Rogers, CEO of Silk Road Medical. We first spoke a few years ago and then again much more recently to catch up on what had changed at Silk Road since our first conversation.

During our catch up, we discussed how Erica led her team at Silk Road through PMA approval, successful insurance coverage and reimbursement strategy, which led to a very rewarding public offering for Silk Road, opening at $20 a share. This resulted in the opportunity to continue the company’s goal, which is to change the standard of care in carotid artery disease with their TCAR procedure.

Much of our first conversation was about Erica’s career trajectory and how she was able to successfully, and gracefully, exit multiple medtech companies. Her lengthy career and insight as a medtech thought leader is just as interesting today as it was when we recorded our conversation.

Before leading Silk Road, Erica was the COO of Medicines360, a nonprofit pharmaceutical company developing drugs and devices for women. Erica was the founder and CEO of Allux Medical as well as the cofounder of Visiogen, which was acquired by Abbott Medical Optics in 2009.

Prior to that, Erica spent over 12 years at Boston Scientific in a variety of sales and marketing positions. She began her career in pharmaceutical sales after receiving a B.S. in Zoology from San Diego State University. Erica holds five issued and 15 pending US patents for medical devices in nanotechnology.

See more...

Scott Nelson:   0:06
Yeah. Now you know, there's a real lesson there, Scott, and that lesson is you know how you exit Cos in terms it is great that window's kinds of acquisitions happen, that you're invited to staying. In fact, that's what happened. And many people in the original target organizations were let go in that merger because there was no duplicity and I was preserved and in fact elevated in my role in the organization in neuro and was able to stay in California and move up the ranks that target their peers inside. Welcome to med cider radio, where you can learn from proven med tech and healthcare thought leaders through uncut interviews. Now here's your host, Scott Nelson and this two part interview. I was lucky enough to sit down with Erika Rogers, CEO of Silk Road Medical. We first spoke a few years ago and then again much more recently, to catch up on what it changed. A Silk road since our first conversation during the catch up with you here in part to unfortunately, the audio quality isn't as good as I would have liked. But we did discuss how Erica led her team. It still grow through the PM a process successful insurance coverage and reimbursement strategy, which led to a very rewarding public offering for Silk Road, which opened up at an incredible $20 a share. This resulted in the opportunity to continue the company's goal, which is to change the standard of care and corroded artery disease through their seek our procedure. Much of our first conversation, which you're here shortly, was about Erica's career trajectory and how she was able to successfully and gracefully exit multiple mental cos her lengthy career inside is a med tech thought leaders. Justus, interesting today is it wasn't recorded our conversation back then. Before leading Silk Road by way of background, Erica was the CEO of medicines 360 and nonprofit pharmaceutical company, developing drugs and Devices for Women. Eric was also the founder and CEO of a Lux Medical, as well as the co founder of Is Eugen, which was acquired by Abbott Medical Optics back in 2009. Prior that Eric has spent over 12 years at Boston Scientific in a variety of sales and marketing positions, and she first regain her career in pharmaceutical sales after receiving a B S and zoology from San Diego State University. Eric also holds a five issued and 15 pending U. S patents for a wide variety of medical devices in nano technology. A CZ you can imagine. There's a lot of things that we cover in both parts of the interview with Erica. But here are a few things that I'd liketo highlight how she went or how she felt when Abbott purchased busy Oh Jen in 2009 the company that she initially cofounded. Why keeping the end in mind is absolutely critical for every med tech entrepreneur. The key lessons Erica learned at Deluxe Medical when they were forced to shut the company down. Why every medical device entrepreneur absolutely needs to start with a problem first, so you don't end up with a solution looking for a problem and specific to reimbursement. Why it's imperative to put yourself in the shoes of CMS and or societal stakeholders. Why Silk Road end up going public and what led to their overwhelming success and, lastly, Erica's favorite business book, the CEO she most admires and what she tell her 30 year old self. Of course, there's a lot more we cover in this wide ranging discussion with Erica. But just before we get started, I wanted to highlight a few things first. Admittedly, it's been quite some time since I recorded the last Met cider interview, probably close to two years, to be more specific. But there's a good reason for that. I've been knee deep in my own startup, that juvie. That's J O V V. That's where we manufacture light therapy devices, which is technically referred to his photo by a modulation in the world of academia. It's a really interesting space because our products are technically class to medical devices, but we're following a very classic direct to consumer commercialization model. It's been a fun ride over the last 3 to 4 years and have definitely learned a ton. And if you follow these meds, sidle interviews, I'll be sharing quite a bit about my experiences. So keep on listening and again. If you want to check out Jude, go to juve dot com. That's J. O v v dot com for a second message. If you're new to mess that a radio and wanna be updated when the next interview goes live, head on over to med cider dot com. and enter your email address. That's med cider M e d s i d e r dot com Rest assured, you won't be spammed at all. In fact, the only time you'll likely hear from us is when a new conversation goes live and get it super simple. Just visit med cider dot com and right there on the home page us through the opportunity to enter your email address. And lastly, as a small reminder, if you continue to enjoy these interviews, please give us a rating on your podcast app. It's super simple. Just open their reviews tab and click on the old five stars. Thanks again, that really helped us out. All right, so without further ado, let's get to the two part interview with Erika Rogers. Erica, welcome to the program. I appreciate coming on. All right, let's say let's go start with Vizier Jen. You co founded that company back in 2000. I believe the 2000 timeframe. If my notes are correct here on my end, and then you you left in 2004 to start Alex Medical. So let's go back. You know, I want to kind of set the stage here for when Abbott finally purchased Visio Jen back in 2009. So I think that was about five years after you initially left. So with that in mind, you know, any thoughts as to you know, where you were in time and what you're sort of mindset was when when Abbott pulled the trigger on video jet after, kind of, you know, building the building, that company back in the early two thousands.

Erica Rogers:   5:24
Yeah, well, I was absolutely overjoyed for a number of reasons. First of all, you know, obviously, as the founder or co founder of the company, that coronary vested interest in seeing that technology come to flourish in and kind of get to the market. We were taking on a massively huge challenge. They're busy agenda which must create a true, accommodating, intra ocular lend, one that would provide more accommodation power than any any lens prior to that time. And the structure of that lens is very, very complicated. It was a huge validation of the best that I had placed in my career. T do video again in the first place. Which kind of began with starting at three. Are partners as an entrepreneur of residents and video was half out of that. So it validated the whole decision making process around the unmet need, their around the technology and all of that. Also the founder I still had a reasonable position in the company. So economically it was good for me as well and in terms of, you know, wasn't bitter. Sweet. Yes, of course, you'd love to be there at the end of the exit end. It's never the end the technology lives on and and all of that. But yeah, it would have been great to be there for that kind of victory lap. And also what I learned in hindsight kind of many years later. Is that because it wasn't there when the company actually exited? I didn't really get credit for the exit, even though I was one of the first. And so that was a little bit of a bittersweet pill. Sure, but the reasons for leaving in the first place, we're kind of twofold. One waas The company was heading into what was going to be a very long, protracted process with FDA. And I was, by the time I left, I was at that time running marketing because the cofounder originally I was doing a bunch of things wearing a lot of half, you know, clinical, regulatory and marketing, and some often RG thrown in and, you know, office management side and then narrowed the role, obviously, over the years to marketing. And so where it was both a personal decision around geography, just needing to be back in the Bay Area and then, secondly, wanting to place another bet because it is going to be long and drawn out. And I thought, Well, you know, I want to go do another startup and place another bet and not have all of my kind of equity eggs in one basket, if you know what I mean.

Scott Nelson:   7:53
Sure, yeah, that's a good anecdote. I want to ask you a few more questions here later on in the conversation about Alex Medical in your decision, that kind of place. Another bet after founding busy. Oh, Jen. But let's go and test set the stage for for the audience. I I provided, you know, an intro and in your bio, sort of at the beginning of this discussion, but you joined Silk Road Medical as president CEO in 2012. We're recording this conversation in early 2017 about five years ago or so 45 years ago. So can you provide us an overview of of the device you're commercializing now? It's Silk Road and really, how it's different than crowded stenting or crowded in our direct Amis and then give us a little bit of a take. And I want a little bit of a long winning question. But give us a little bit of a take on where you're at in terms of commercialization, both here in the U. S. And abroad.

Erica Rogers:   8:36
Sure feel free to interrupt. I'm going long on. Either of those really got it All stars in this story, really all starts with stroke and stroke is, as you know, is a devastating and fatal, often fatal disease and corroded artery disease is responsible for about first of all strokes in the United States. So, unfortunately, one of the downsides of performing a procedure to fix that karate lesion and prevent the future stroke that it could cause in the process of fixing it, you can cause a stroke during or in the Perry Procedural period. And so today, Kurata artery disease is typically treated with an invasive surgery called corroded endarterectomy, or C A and TA is super good, protecting the brain, preventing future strokes and strokes during the procedure. But it's pretty invasive. It's a long incision down the next particular surgical section. Collateral damage, cranial nerve injury and heart attacks and room complications. And things like that go along with invasion surgery. And so, to your point over the last call it 15 plus years industry has attempted to solve for that morbidity around. This invasive procedure, called TA Way did that with a minimally invasive, catheter based approach called Has corroded artery standing. And that is from the trans ephemeral route. And the problem is, as it turned out, has actually increased the procedure related stroke risk relative to see a due to inherent design and technology flaws and in particular, starting from the groin. And so surgeons and pears weren't willing to make that trade off of excess throat rip in and around the procedure just to get the minimally invasive benefits. And so so Road has been able to go to school on 15 years of trial and error around corroded, scenting and really honing in on where shortcoming lie. And it's really all about delivering the stent stately and so T car, which is transcribed ID arterial revascularization, which is the procedure we do dark in the next. It's a direct access to the common Karada artery. We set up a flow reversal. Sean Penn outside the body returns blood into the temporal vein, and we played a stent under that flow reversal so that any debris that rendered is captured and never, ever had a chance to hit the brain. So we published our first results from a big U. S trial in the Journal of after Surgery in 2015 and showed a 1.4% throw great in all patients, which was the lowest published stroke rate of any modality, whether it be surgery or creditors sending up until then. And so that's what really put so road on the map got everybody's attention, and last year we got a very favorable Carver's decision, which we can talk about later if you want. Thio and we commercialized the device last year really in earnest in April and had a phenomenal first year with each of our territory annual izing it over a $1,000,000. So we're

Scott Nelson:   11:54
really cool success story for sure, especially for, you know, washing early stage. You know, med tech company actually commercialize the technology here in the US without, you know, without having to be acquired by a larger strategic, for sure. So it's It's cool to see what you've done. You and your team of Don it up to the state so far. So we're gonna circle back around and talk about some of those more specifics. But let's take this opportunity now to kind of go back in time and learn a little bit more about your career and some of the the challenges that you faced over the time as well. Some of the lessons learned that have brought you and help, you know, force the path where you're at now with Silk Road. So let's go back to your days at Boston Scientific. I know you were there from, like, the mid nineties toe, I think, around the 2000 timeframe. So what? First you brought you into the med tech space and what were you? What were your role is like a Boston Scientific over that over the span of those five years.

Erica Rogers:   12:36
So I'm gonna tell you true answer, which I had spent the early part of my career in the pharmaceutical industry. And so I was out in hospitals and things like that. And every time I pull up to the hospital in my no Ford Taurus and I would park next to somebody who would get out of there BMW

Scott Nelson:   12:59

Erica Rogers:   13:00
I would ask that person, What did they dio? And they would say, Well, you know, I sell medical devices back in the day was pacemakers, right? And so it became really clear to me early on,

Scott Nelson:   13:12

Erica Rogers:   13:13
cool jobs were over in the text. That's the honest answer to the question that why did I start paying attention to that area of medicine in the first place? And so I started Boston Scientific as a sales rep, literally hearing the bag of super drawn to that role in that company. It was a company called Medi Tec at the time. It was before it was even called Boston Scientific and before the I P. O. Now you should understand I was a child prodigy. I was really only 12 years old doing the math on how old I am. So I was around Boston scientifically in public, and I have one of the very first chair still framed in my office. So what truly there was obviously interventional medicine was just getting started, and it was obvious this is gonna change the world The whole vascular bed was poised for from the big open surgical procedures thio these minimally invasive things. And it started with a really simple angioplasties of iliac arteries. And obviously, history speaks for itself. That's what really drew me into Boston Scientific beginning of something really, really big.

Scott Nelson:   14:29
Glad that you mentioned that. That's the point about being in the in the pharmaceutical space and seeing your, you know, your your colleagues in the device base, just leading a much better quality of life in terms of thinking. I'm sure a lot of those people, including myself, that are listening this interview cancan. Absolutely, absolutely appreciate that perspective the roles that you had at Boston Scientific leading up to two when you left in 2000. So you eventually I presume he eventually went, went in house.

Erica Rogers:   14:56
That's a complicated story, so I did work up through the ranks in the sales organization and sales training in particular, and ended up in leadership roles there. But there was a need for me to move physically to Boston, and I was unable to do that for personal reasons. And so I kind of maxed out in what I could. D'oh! At bottom. Which is why I ended up in Target Therapeutics and I cross over into target. Did market development at the very, very early days of aneurysm coiling. Literally, I started at Target Therapeutics, like within days of the five K clearance on the first aneurysm coils and my role. There was market development. It was figuring out how to go from, you know, the five doctors in the world who recoil an aneurysm to, you know, taking over all of intracranial and yours and therapy. And what were all the things that we were gonna need todo to solve that puzzle. And it was everything. Everything from reimbursement Thio, additional data thio randomized trials against aneurysm clipping. And it's just a giant puzzle that had to be solved on the market development front as target therapeutics. So when I think about my Boston Scientific years, I love them all together because I left Boston Scientific and we could target Therapeutics. And within about 90 days of me going, their target was acquired

Scott Nelson:   16:18
by Boston Scientific. And so I was a boomerang. Yeah. Boomerang effect.

Erica Rogers:   16:23
Yeah. Now you know, there's a really lessen their Scott. And that lesson is you know, how do you cos and s terms with great such that when those kinds of acquisitions happen that you're invited to stay, And in fact, that's what happened. And many people in the original target organizations were let go in that merger because there was no duplicity and I was preserved and in fact, elevated in my role in the organization in neuro and was able to stay in California and move up the ranks that target their fears inside.

Scott Nelson:   16:55
Got it. Okay, wait. Did you just take me back to that time for Because I have, like, when, you know, when you first found it. Visage in in the early two thousands, but was when you went to Target and then Target was acquired by Boston Scientific. Do you recall the dates back inside? Yeah. Yeah, I was just trying to get a better feel for, you know, for sort of the timeframe to help people track along.

Erica Rogers:   17:17
It was like four years, you know, four years ago, in neuro inside Boston's, like, around 90.

Scott Nelson:   17:24
I got it. Okay, Okay, that makes sense. L c You were in inside. You know, you went to Target was obviously a very early stage States company, Boston choirs target. And then you make the decision to sort of you go to three R's partners, so walk me through that. And how did you end up as a entrepreneur in residence at three Arch, leading up to the eventual formation of busy agenda?

Erica Rogers:   17:43
Well, that's one of my favorite parts of the story. You know, when we take these right turns and we decide to kind of pursue the road less traveled, very happy, it's part of their way. We're just not going to cover off the ball there and making enormous strides in intracranial aneurysm therapy and getting into scheming stroke. And it was super hot, super exciting. And I was working for great people and I had a great team under me, and then I got introduced to three are partners, and they were looking for an honest error and residents who has a background in the stroke arena, which is how I sort of came across down. I was really corn as what to do because, you know, I had never gotten been inside the venture community. I've never done a startup. I didn't know what a nonsense residents, even Waas and what? How would my success be measured in all of those things that I was coming out? This giant organization and one of the partners at three are sat me down and he said, Look, every single aneurysm in the world were coiled instead of clips. What would happen to the value of your Boston Scientific stock? I said, Well, this is, you know, 2000. We're talking about 1999. Well, not a whole lot,

Scott Nelson:   19:02

Erica Rogers:   19:02
at that time it was all about coronary and stocks rose and fell on the basis of corner market share and coronary market entrance and stents and all of that stuff that was happening in the cardio Cath lab. And so what he was trying to tell me was that I had reached a point in mind this in there where I could no longer have an enormous impact on the feet of Boston Scientific. And he said, If you come here and you do this very early stage thing, you will have an enormous impact because you will go and found something if we do this right. And I said, You're right, I have to go do that. And so that was what was behind the decision, Scott. But then there was also this other small voice in my head that said, They're probably not gonna ask me twice. Probably go do this. Leading been for travel firm in Silicon Valley,

Scott Nelson:   19:59
right? What do you think was it that attracted the partners of three arts to sort of pursue you and want you to come on board as any I r.

Erica Rogers:   20:07
I have asked myself that question. I

Scott Nelson:   20:09
don't have to be

Erica Rogers:   20:09
definite, sir, but I think one is I had a real core confidence. See, in all things intracranial aneurysm and stroke. That was a hot area of investment at a time. Three art obviously had some deal flow in that area. I would be helpful there as an entrepreneur in residence in principle. In that capacity, it was one of the areas that they wanted me to incubate around. I knew all of the citizens globally, so that was helpful to them. But I also think that you can have an entrepreneurial spirit inside these large companies, and I think they picked up on my entrepreneurial spirit and wanted to tap into that. What separates some entrepreneurs is everywhere entrepreneur that has that spirit and that gut. And you also know what it's supposed to look like a fiend. When it's a big company, you can connect the dots from early early all the way up to what it means to be your Boston Scientific. And so I think they became convinced that I could do that. I start something very, very early in a way you look and act like a big company

Scott Nelson:   21:22
notes that I'm Johnny nine years, you know, seeing ability to see the end in mind for a med tech startup. That's a powerful thing, you know, when in retrospect, you know, sort of looking at it under the guise of, you know, having division of 2020 vision, but less fast for your time now at Visage in and then at Alex Medical. And I think there's probably some interesting, interesting things to pull through it at Alex Medical. But your three arch and then you decide to place a bet. ATV is Eo Jin and kind of like slide back into the operator position. So what? What led up Thio founding busy Jen back in in the early two thousands.

Erica Rogers:   21:51
Well, it really started with looking at a bunch of unmet needs and various disease and therapeutic categories and one of the categories that my then, you know, kind of partner as re art of phenomenal gentleman by the name of Dad. No. And I we're kind of joined him there at three arts to figure this out. One of the DVD in areas that we're looking at her therapeutic areas was with presbyopia. You know, the loss of near vision as we age the law. You know, the change in vision as we age and so way were two people from vascular backgrounds and invented the inter ocular lens. And we pinched it. I don't know, three or four times inside three arts to say this is the thing we want to go do because we're absolutely convinced that we're on to something and this is gonna be big and gonna be transformational in ophthalmology. And, you know, we got the typical response. What the heck do you guys know? You're two people from vascular having anything about inventing a lens in the eye. Right? And what do you know about ophthalmology and running a business ophthalmology, etcetera. We were turned down multiple times me out. And so we had to really home the arguments and hone our own skill set. And finally we got it right, and they allowed us to spin it out. And then they dedicated the first financing and we were off and running a video again. So really, we were trying to solve presbyopia, and we were doing it with a kind of cataract replacement lens which would give people at the time of cataracts dream back there full range of vision. And it was an extraordinary complex problems. And the learning curve was very I did not know a whole lot about objects going into that. But I came out knowing a lot about objects in the eye and all of that Did you also get into kind of like what led my departure?

Scott Nelson:   23:48
Yeah, Yeah. I was gonna ask you one. Follow up question before we go there. But I'm interested in getting your saying the name of the other. Your partner of up helped co found visage in what was his name again. So you're both had vascular experience. But yet, you know, to the point of you know, some of the other three arch partners who evaluated that that deal and said, You know, what you guys doing with vascular experience Trying attack? No. The ophthalmology space. You can't get inside your head because I think for most people, they probably gravitate towards something. You know, if a company they were gonna found their domain expertise is in the interventional vascular meaning, they're probably gonna gravitate more is towards that space. But you both didn't considering your experience. So, you know, was it Was it the disease state? Or was it just the new challenge? What was what was going on in your head and why? Why'd you attack? You know, wanted to decide to do a new therapeutic arena with with disease

Erica Rogers:   24:31
way looking at kind of becoming smarter around several different areas. And at that time, obesity was really hot. Ophthalmology was really hot and stroke, right? And there were a couple of other way would go to the major medical meetings in those categories. Way major U ophthalmology conference is and you know, they're relatively dull, boring overall lost around, you know, the various breakout session and didactic sessions. We realized the ones where they were standing room only, and the rooms were packed and you couldn't get in. We're the ones that we're talking about presbyopia. And so just through observation, reasonable isn't anything people really care about this presbyopia. It's obviously a hot topic. So we just dove in and one of the things that that one of my boss has said to me back in the Boston signs of the gate. Hey, you know what I like about you, Erica, is that you're so brave and you'll just dive into anything because you actually have no idea that you can do something. And so it never occurred to read or me that we couldn't invent an inter ocular one's

Scott Nelson:   25:46

Erica Rogers:   25:46
Simply figured we have the skill set to tell you the problem. If you study the problem carefully enough and talk to enough people do enough of the back of the envelope math and things like that probably solve that problem. And we did.

Scott Nelson:   26:00
Is that something that you believe is It's sort of innate to your your character. Is there something that you serve learned over time?

Erica Rogers:   26:06
I think it's in aid.

Scott Nelson:   26:07

Erica Rogers:   26:08
You know, I I would love to be able to say you can learn it over time, but it's been kind of a tenant in my entire career, which is, you know, just taking these, Johnny. It leaks into the unknown with absolutely not a thought that I wouldn't be successful. I'm gonna go do that and I'm gonna go do that. And I'm gonna be successful in doing that cocky way, but sort of life. And certainly I don't want to miss lead you very aware of my own shortcomings in doing so. So the he success in the lease of courage knowing what you don't know, being hyper aware of knowing what you don't know and surrounding yourself with people who know what you don't know allowed.

Scott Nelson:   26:56
That's a really good good point, cause it's not like you're just, uh this jumping off off off a cliff per se. You've got your sort of intentionally surrounding yourself with people that are going to have the expertise that you know that you don't bring to the table or some some value that you're not you don't have and making sure that you're around those people that can sort of, you know, bridge the gap in the in those situations. It's interesting you bring up this point. I remember listening to an interview of a kind of a serial entrepreneur in the text space, and I think he made some comment a lot along lines of Look. He was speaking to a pretty broad audience and you mentioned that, you know, look, I get to the plate and swing more often than most people. So of course, my batting average is gonna be higher because I just swing more. You know what I mean? Self. He gets probably appropriate toe your you know, maybe as someone of a similar analogy to your common about willing to like, you know, willing to swing. You know where most people maybe wouldn't. So that's good stuff. Let's let's that for the sake of time, let's kind of move forward. But I do want to circle back to you know your decision t join Silk Road back in 2012. But I'd like to ask you a question in regards to visage in and then Alex. So if we kind of, you know, move forward in the timeline of your career, You said earlier that you wanted to sort of you're out at a point with physiology and that, you know, there was gonna be a pretty extensive regulatory hurdles, you know, that you were gonna be running into in the future. So you wanted to take another bet with with Alex Medical. So I think if my dates are correct, he joined Alex Medical in 2000 for So what did you see it, Alex? And why? Why make the leap and then talk to us a little bit about, you know, when that shut down, I think maybe around the 2008 timeframe what you learned from that experience,

Erica Rogers:   28:24
that's a long, long tale. But let me start

Scott Nelson:   28:26
with. So

Erica Rogers:   28:28
interestingly, when I made the kind of personal decision, it was time for me to exit Vizier Jen against both for Girardi, Three reasons and also wind to place another bet. I went back to the investors that were around the table a video and they said, Well, let's just incubate you to go do something else and we'll do it up in the Bay Area where you need to be. So it started with an incubator I another partner at that time, a position and we were funded by three arts, Venrock and Prospect to a bunch of so ideas. And again it was kind of back to where are the big unmet me and looking at the clinical problems first, which I'm a huge fan of Let's first look at the problem and then solutions to the problem and what we see a lot in our faces people who have solutions trying to find a problem. Uh, that is not what I d'oh d'oh! I start the problem and then go try to find a solution. And one of the things that we were incubating at the time was allergic rhinitis and the whole continuum of air wages orders, which is allergic rhinitis needle. Paul opposes excuse sinusitis, chronic sinusitis, a functional endoscopic Sinus surgery. You know, that whole continuum. And here we are again, like I'm taking this massive leap into, you know, and I didn't even know it when I was incubating this idea

Scott Nelson:   29:53

Erica Rogers:   29:53
So we found some technology over in Europe that had not only received the market had already published papers on the use of ultraviolet light in the interior error wei and down regulating immune system for the treatment of allergic rhinitis. Paul opposes and sinusitis. And that's what we did. So we myself, in this partner in these three investors we sat around. This is enormous, right? I mean, rhinitis, allergic allergies is just enormous market, right? Not to mention chronic sciences. So we went after it knowing that there was a published paper and data to rely on the licensee intellectual property from this team in Europe. And we started down the path to get into the United States. And the good news was, the technology have been kind of mostly developed. We had to tweak it a little bit. And we were very, very quickly into a clinical trial in the United States. And we conducted a 350 patient trial in an allergy during an acute allergy season, applying this ultraviolet light inside the nose, and we massively failed to hit the endpoint. So much so that way had, you know, look ourselves in the eyes and say, How could this possibly have happened? There's a published paper already on the results of this technology, and the thing that I learned I completely underestimated failed to appreciate how difficult it is to run a trial in patients, reported some objective outcomes. The outcome measure for allergic rhinitis and all those disease was things like, how much you're changing, how much you blowing your nose, how much you coughing, you know, stuff like that. And patients have to report this in the diary every single day and after turn the diaries and at the end of everything. And it turned out there is a tremendous noise in that subject iveness and in the patient reported, although validated but patient reported scales, Which is why the drug companies that did you know Claritin and all the rest of those drugs literally have to enroll thousands locations to three pluck 1000 patients. Thio. And that was completely lost on us. That was probably the closest example Thio a really in your face. You don't know what you don't know and not having a deep seated experience in that hold these days really took me by surprise, surrounded ourselves with experts working with really well known allergies. We hired some people who were experts in an allergy and immunology, But it was all lost on us. And so all of this was kind of crashing and burning right at the time of the economic crisis in 2008. And we had a story of raising a bunch more money and trying to figure out what we're gonna do next. We're shutting the company down and cutting our losses, which at that time were very small. We hadn't raised that much money. Three investors. You here to write it off honestly in 2000 and it was for them to continue to figure it out. And so that is what happened.

Scott Nelson:   33:02
Well, and so the fact that you were able to surround yourself with with experts in the space and you would you would think that something like that, someone would have noticed that along the way, like, hey, this clinical trial, it's it's heavy on patient reported outcomes that are very subjective, you know, in hindsight, obviously that you know you it seems like someone could have solved for that like along the way. But do you ever look back and think? Wow, you know, we could have done that differently. Or how did we miss that? Oh, absolutely, for

Erica Rogers:   33:29
sure. I mean, you know, I think we relied too heavily on the on the previously published work, which has been a very small study, smaller than what we did. And yet they showed a signal. And so, you know, always be skeptical about other people's data, even though they're

Scott Nelson:   33:42

Erica Rogers:   33:43
very few journals. That one note of caution. I think the other thing is way part of the data out and ended up discovering that the sickest of the patients. So, you know, I think the lesson there, Woz, if you're gonna dio a patient reported outcome kind of study and that place a lot of things like headaches and pain, you know, those two really tough spaces that are patient reported, you know, although validated oil scales, right? And so I think it had We have to begin with, in other words, the criteria that we would have had a very sick patient. We would hit the employees

Scott Nelson:   34:26
say, without a doubt, a good lesson for other med tech entrepreneurs that are listening for sure, even your common about always be skeptical of others. Others, you know, data And where where you're a clinical trial could potentially go wrong, I guess is such a such valuable feedback. So I want to be sensitive time in the fact that I'd like to, you know, get to Silk Road Medical. But one of the question about your background before we kind of come up to the current time. But you spent some time at Nanosys and then joined medicines 360 a c 00 before joining Silk Road. So your position at medicines 360 s CEO. That strikes me as a little bit of a little bit of a surprise, considering. Kind of like you're you know, you're you're strengthen in commercialization and building companies. But is there Is there a rationale that others could learn from in regards to your move toe to medicines 360 before we jump to Silk Road?

Erica Rogers:   35:12
Yeah, well, let me take them holistically. Nanosys and medicines 60. Both of those were driven by a desire to check a box for me. One does in nanotechnology. I really felt like Nana was gonna play an important role in medical devices, and I wanted to get smart about it. And so I went and did bad, and that was super helpful. Medicines 60. I had always wanted to be able to run a pharmaceutical company, and although I had strong operational background and devices, I've never won, you know, a device company. I mean, I'm sorry, a pharma company which has all of its unique and different regulatory constraints and all of that. And so what was cool about medicine? 360 is a drug device combination, and Alan knew that they were facing were on the device. Side is a very successful intra uterine device for contraception, and they were having issues around the device piece of it. And so it gave me this brilliant opportunity to come in and be operational, solve all the device related problems and also get really, really smart about what it means to run the drug companies. It was just

Scott Nelson:   36:20
that's good stuff. I don't think I would have expected that response, but just the ability to like move outside your comfort zone and pick up on skill sets that maybe you wouldn't have other otherwise acquired along the year so that makes it that makes a ton of sand so fast. Forward 2012. You get to call to join Silk Road Medical, But obviously you have a lot of interventional vascular experience, especially as relates to the crowded space. So, Laurie, initial thoughts when you get by calling your Are you thinking you know what? Why would I ever want to join the chronic company knowing the crime stenting sort of didn't pan out despite the hype.

Erica Rogers:   36:46
I'm laughing. No. And hell, no. I

Scott Nelson:   36:49

Erica Rogers:   36:53
it was no hell, no, like three times

Scott Nelson:   36:55

Erica Rogers:   36:55
the phone with the lead investors who were trying todo least take a look at this deal. So finally, they were persistent enough. I said, Okay, okay, well, at least it down and listen to the story. And I was very happy at medicine 360 as well. You know, it's hard to extract someone to go to something crazy when they're really happy. So anyway, the investors sat down and told me about the approach which was very novelas described earlier trans corroded approach. And not only was the approach novel, but their target customer made sense. They were targeting the vascular surgeon and a vascular surgeon has always and will always own the karate domain on the problem with not only all the technical issues that transfer Meral cans had in doubling the risk of stroke compared procedurally But all those technologies were also aimed at the interventional cardiologists predominantly. And the pattern didn't go that direction. It was going to be incredibly disruptive to a lucrative and procedure that fastest really liked. And so they were gonna hold on vehemently to that. And they on, you know, did everything they could to squash corroded arteries stunting on very successfully. So So this road was gonna go straight after the vascular surgeon way. Wanted karate in your domain. We want you to evolve you the vascular surgeon who has evolved everywhere else in the body So they had, you know, in the in the late nineties in early 2000 learned all the endovascular skills, obviously dominating the triple A space doing after acne drug code. Napoleon instance everything else in the periphery. So they were starting to convert their own and no vascular open surgeries, endo vascular procedures and show me it was the right technology at the right customer and Still, there was the cloud of, Well, what about coverage? Particularly And so. But I thought, Well, if we generate the right data and we do, it's right for patients that will solve itself. In the end, I took up again.

Scott Nelson:   39:08
Leave me. Yeah, no kidding. And I think that that leak may have been even harder considering your domain expertise. It's just a hunch. But sometimes those leaps could be given could be the most challenging when you feel like you really have an understanding and deep expertise in the, you know, in a therapeutic arena toe to make a jump like that. But I want to ask you, Ah, before you. I do want to touch quickly on the topic of coverage because you, as you mentioned earlier, you had a big win. And when it comes to CMS coverage last fall. But you have a unique relationship with Cortes right now, where from a procedural standpoint, you're leveraging, you know, they're they're stent technology. So why you walk us through that decision not to not to develop your own stent technology, but instead partner with a large strategic in courts and cardinal on utilize their platform instead

Erica Rogers:   39:53
Yeah, Well, first of all, I can't take credit for the genius idea. It happened before I got Thio Road. The idea was to leverage the years and years and years of clinical data around and existing karate extent because what we didn't know about Protestant is that they were durable once you've got them in safely, they were durable and provided the same protection against stroke in the long run as corroded. And our direct me so the only had be sold with how to get them there safely. And so we were able to leverage on existing P m E approved karate stent and exactly shortened the PM A pathway, really, what it bought us. We license that whole technology from courted and do the supply agreement. They acted kind of alien supplier for us.

Scott Nelson:   40:36
Got it. I guess we don't have a lot of time to dig into that. But that's a very interesting point. The fact that if you were to develop your own technology, you're going tohave to most likely at the very least 5 10 K, but most likely a p made to your point. And that's going to be so expensive. So, uh, it's gonna take so long, why not partner with with someone else instead? So I'd love to learn more about, like, you know how that came about. But we certainly have time, but But nonetheless, it's a good learning lesson for other other folks out there that are potentially, you know, at that point time where they could develop their own technology. But instead, maybe it makes sense to partner with partner with someone else if it makes sense. So before we get to the last three rapid fire questions, let's touch on coverage. Obviously, Silk Road had a big win last fall. When it comes to CMS coverage. I got to think that there's probably a lot of complexities there, a lot of conversations, considering, you know, the fact that crowded stenting was really never widely covered, I think unless patients were involved in the clinical trial, but help us understand sort of how you went about that. And maybe is there a good lesson there for other other med tech entrepreneurs to learn from in your approach to getting CMS coverage?

Erica Rogers:   41:35
Yeah, sure are things that happened road, and it's something we're super excited about it, you know, in all my years in doing this in early stage companies, this is the first time I've ever seen on early stage company less than one year into its commercial life, achieve that trifecta, really of reimbursement, which is code already in place, appropriate and good healthy payment levels in place. And now a favorable coverage decision. Really, what is a brand new therapy really apart from, you know, kind of anybody else in the early stage arena? So the way we do well, it starts with. We solved several people's issues. So we looked hard at what? What was the goal at CMS? And the goal of CMS was to kind of solve for the morbidity associated with crowded endarterectomy without trading offense, through Chris and in particular in their high surgical risk patient population and see elderly females, which happen to be the vast majority of the Medicare constituents. And so they did have a real desire to solve this. It's just transfer moral cows wasn't the answer in their minds. Start with that and existing under the national coverage determination, which covers all of angioplasty inventing all over the body and that is buried in that is the rules around Corrado and so there was a real desire on their part to kind of figure out How could we work within the existing infrastructure without starting all over and having Thio, you know, med, cack and all of those complicated things. And so the first thing we did was really understand where CMS good, what was in it for them of what it meant to their constituents, what was important to the people and CMS and how much work was going to create for them and very constrained environment. That was number one number two waas. Working with society of vascular surgery and understanding what was important to them. We knew that corroded artery disease was one of their top priorities, and research and karate was one of their top priorities. We also knew that they were trying to advance a program called the Vascular Quality Initiative, which is they're putting these, you know, database modules in every hospital in America to collect data on all vascular surgery procedures. Thio do Hospital Hospital benchmarking in comparison to do regional comparisons to leverage that to look atyou, no position to position comparisons, and it was all about improving quality of vascular surgery care across America across all of the procedures, and they wanted to create more and more reasons for hospitals to participate in this quality initiative. They also had a desire to do something with CMS. They were trying to figure out Could could the vascular quality initiatives be tied into seeing us in some way? And so what? We did it Silk Road was simply solve other people's problems come to them with an idea, which was, Let's make coverage dependent on to kind of stipulations. One. That coverage for T car should require FDA approved car devices trance corroded devices. Turns out, so is the only company that has those currently on that second stipulation. Would that be? Every one of the T car procedures will be logged into the Society of Vascular Surgeries registered there. VT. Why they're vascular quality initiative and that would drive hospitals and physicians to participate in the Y. And it would provide coverage for this really promising new procedure that seeing us is very interested and was off course a leading research priorities for the society. And it happened on the heels of our very, very promising early data from our original clinical trials.

Scott Nelson:   45:30
Yeah, so certainly all the pieces were there for things to come. Toe come to fruition quickly, but there's so much that I I wish we had time to unpack there because it's your point that that trifecta at you mentioned earlier I mean, it is very, very unique from attack. And I wish I wish we had more time to kind of kind of unpack that you know that answer. But you know what stood out for me, honestly, was your approach to CMS and the society vascular surgery and really putting yourself in their shoes, asking yourselves what they want. How hard is it gonna be for them to get this, Don et cetera Those such a good lesson there. But I know we're running short on time. I want to get to the last three rapid fire questions. So let's go and get to those and we'll try to squeeze these into the last minute here. Eric, if you don't mind. But first, what? You're you have a favorite business book that comes to mind.

Erica Rogers:   46:10
I have a book I don't know. Every single person needs three daring greatly fiber in a Brown. My favorite book is my Bible is how I want to run my company is how I want to run my life

Scott Nelson:   46:24
daring greatly. I have actually not heard of that one, but definitely definitely is Getting down is getting jotted down in the notes. That's good. Second question. Is there a CEO or a business leader that you're either following right now or one that's really inspiring in the past?

Erica Rogers:   46:37
Yeah, you're the one that inspires me. Is my husband Theo, Like my like my behind the scenes board member, He is absolutely amazing. But the one that I am following is Omar is rock and electronica is giving away a big way, and he is looking at, you know, the whole broad category of episodic care. And what does that mean for coverage for device development, for providers, for hospitals prepares, and he is approaching its very holistically, not just from you know, what are the witches, Medtronic cells, but canny the entire continuum of the episode of Care? And I'm super impressed by what he's doing there. So I am. I'm following everything thing that he writes and

Scott Nelson:   47:28
couldn't hear a Seymour last question and admittedly It's a little bit, Harding answered in rapid fire fashion. But if you had the chance to rewind the clock, what would you tell your 30 year old self? Down, Settle down, passing patients. That's good advice officially coming from a serial Met Tech entrepreneur. So thank you, Eric. I'll have you hold on line real quick. But thanks again for your willingness to do this interview and to those listening, as always, Thanks for your your attention until the next episode of Med Cider. Everyone take care. Welcome back, T O Med Cider Radio. Your second appearance really looking forward to this sort of this recap conversation on the latest and greatest in the world of Silk Road. Well,

Erica Rogers:   48:14
thank you. Scott is great to be here as always,

Scott Nelson:   48:17
just level set things. We had a really interesting conversation that was that was very wide ranging about two years ago. By the time we're recording this really all about your entrepreneurial journey in the world of med tech, that sort of led up thio some of the more formative years of Silk Road Medical. And since then you guys have had a ton off of successes, namely the type O, which some consider maybe one of the best med tech I pose in history, or at least recent history. So maybe it maybe let's start there and talk a little bit more about maybe why maybe about that I've, you know, and why it was such a success in your opinion. And then and then what kind of cover? Some of the other of lessons learned and latest made us things that you've sort of uncovered in the journey was still crowed over the past few years.

Erica Rogers:   49:05
Sure, we could start with the I P. O. And I think you know, it's interesting to frame up success, right, and we've heard this before. Silk Road was a very successful I P o. And I think it really comes down to How are we measuring success and what does that really mean to people? And why are people saying that? You know, and if you think about what the goal of the Ai Po is typically and it's no different in our case, it's an opportunity to raise additional capital to continue the mission, to continue to do what we set out to do, which was changed the standard of care in the treatment of corroded artery disease with our procedure called T car. And so if you look at it from through that lens, certainly one would say was successful. We more than met our goal in terms of the amount of capital that we were seeking to raise at the time of the Ai Po and that that simply means that we can continue on our commercialization share trajectory and we can continue to explore pipeline opportunities and growth outside the United States and other things like that. I think the other reason people feel it was so successful was kind of the changes in evaluation, and I could talk about those because it's in the public domain, you know, we

Scott Nelson:   50:22
filed a nest, one with a certain price

Erica Rogers:   50:24
on the cover. We ended up brief rice saying, right before the AIPO itself and then of course, there was a nice lift in the star price on the day of and subsequently they're after. And so what is really behind that well, it really starts with the quality of the story and for us it's always been the same story at Silk Road, which is we really are seeking to overcome the very last vascular domain that has yet to go Endo

Scott Nelson:   50:59
fully if

Erica Rogers:   51:01
you look at arteries across the body and even vain, certainly now. But if we just look att arterial beds across the body from head to toe personally, every single one of them has undergone this transformation from open surgical repair to some endo vascular procedures. Obviously, you guys know I spent a lot of time in intracranial aneurysm repair. That's just one example of a procedure that used to be this big, open, invasive surgery and is now done with endovascular, coiling and the like. So every arterial bed had gone that way over the last 2025 years, with one exception. And that exception is the corroded artery. And there were some attempts back in the 90 to introduce interventional tool, namely in the form of transferable carajo are re stenting or cat and has really never met the challenge, Uh, which was to provide a safe alternative to corroded endarterectomy. The stroke rates were just too high, with chasm multiple randomized trial

Scott Nelson:   52:01

Erica Rogers:   52:02
fast forward to get to the answer to your question, which is

Scott Nelson:   52:05

Erica Rogers:   52:05
we are with finally a solution that measures up and finally an opportunity to convert this very last market. That is really a $1,000,000,000 opportunity just in the United States alone, just the conversion of the existing treated patients converting it into our procedure t car. And so I think that really resonated with investors. They've seen and made money on this open to Endo conversion over the last 20 to 25 years, and this is literally the last chance, the last artery. So I think that lead Thio a fair amount of interest in the company and what we were doing and had a nice lift evaluation as a result.

Scott Nelson:   52:49
That's a really interesting way to sort of contextualized that I hadn't really thought about it previously. To be honest, Erica, that this is to your point. This is really the last vascular bed that hasn't been sort of disrupted by endovascular techniques. And that's it. That that idea of just converting open to Endo and the market opportunity that that exists around that is phenomenal. So I thought about that Norma, that probably rings true with you, you know, after after carrying the crowded bag back a way back in the day right with Courtis.

Erica Rogers:   53:23
Well, the technology that Silk Road encompasses is just so amazing. I mean, you know, as you're talking, Erica, I can't help but think ones preventing all doctors from jumping on board. You know, you talk about it's a $1,000,000,000 opportunity. I mean, you should have all of that $1,000,000,000 money because the technology in which you guys use is amazing. You know, what is your biggest hurdle with these With the docks. And I mean, is it just kind of status quo changing the mentality or what? What are you seeing? Yeah, I think the best way to answer that question is to look closely at the current standard of care, which is corroded endarterectomy. This is a procedure that has been around for 65 years. And if you are a vascular surgeon in your, you know, mid forties on up, you were trained on this procedure. It is the dominant way in which you've treated this disease, stayed over the course of your career. And maybe you've even done hundreds of these procedures in your career. And therefore, in your own hands of a surgeon, you completely understand the strengths and weaknesses of that particular procedure and whether or not it's perfect is, is not necessarily the question for some surgeons. It's really this. This is the surgery that I know and that I trust. And so that is what we are up against and obviously the tailwind to that. Our clinical data and we have been very much a clinical, data focused company. We believe clinical evidence is the way to really move the needle in this market. And so we've continued to amass very large amounts of clinical data. Um, and I think, as that build, uh, surgeons will be ableto have different conversations with referring physicians and patients about the proof

Scott Nelson:   55:18

Erica Rogers:   55:19
T car a CZ. We continue to grow the evidence based.

Scott Nelson:   55:25
That's actually a nice A nice Segway into into what's next for Silk Road. Maybe you can speak to that over the next maybe 1 to 2 years. And then you know if if you feel if you feel the freedom to speak to, even, maybe the next three toe three or five years after that, yeah,

Erica Rogers:   55:45
obviously, you know, I have to be a little bit cautious about what I see here. Just uh, now that we are a public company. But but certainly the thing, the thing to really stare hard at is the opportunity that immediately right in front of us, which is this conversion of the already treated patient population in the United States. And if you think about where we are today, you know this. This is in the public domain. We've we've stated this publicly that were, you know, call it. We ended the year last year. Less than 5% penetrated in that market. So there's just a ton of room to grow over multiple years just in this US conversion opportunity. But one way to think about it is that, you know, stroke and corroded order do. These aren't unique to the United States, so certainly, looking to deploy these technologies and other geography is around the world is certainly in our sights and as well, we have ah, fairly robust intellectual property portfolio. And within that intellectual property portfolio are other disease states that can be uniquely treated from this trance corroded approach. And so we'll look to expand our exploration of those patented opportunities along the way as well.

Scott Nelson:   57:10
Very good. And I mentioned this sort of FT. FT. Outset if of this kind of part two of our conversation in part one. We talked a lot about your your entrepreneurial leading up to kind of wear Silk Road was was at the time, And I believe this was, um that's kind of early 2017 timeframe something, something like that. And we talked about, you know, the kind of these concepts of exiting gracefully from from previous startups. Um, we talked about, you know, not to sound cliche, but kind of pursuing roads, less traveled on and the ability to kind of sort of keep the end in mind. And so, Erica, when you think about really the past, maybe few years and, um, some of them or maybe you know, challenges or big wins that stand out from your perspective, Can you name a few of those or maybe speak to a few of those? Yeah.

Erica Rogers:   58:01
I mean, look, when I started as a CEO of Silk Road in 2012 we were just on the eve of enrolling the first patients in the Roadster. One trial. Uh, so we had yet to get through an I d. E. We had get to get through 5 10 k clearance and p m A approval. We had yet to tackle reimbursement. Um, and we had get to really formulate a commercial strategy. So there was a lot of wood to chop between 2012 and where we said today. So all of those are considered winds along the way, and certainly I cannot take a singular credit for any of those. This has been a team effort all along. I am incredibly blessed. Toe have really the world's best management team. I know everybody says that, but mine is truly the world tennis receive. And together we've taken down each one of these major milestones along the way. Whether it was completing the clinical trial, obtaining FDA approval and clearance, building a commercial team, getting through those first early commercial years, tackling reimbursement. All of that is kind of in the rear view mirror.

Scott Nelson:   59:21
Major major milestones. Thio, to say the least, means a massive one session should be underappreciated. And I know you know in our feet are kind of our apartment conversation, one of those sort of rapid fire questions, I asked, What would you you tell your 30 30 year old self if you had the opportunity to sort of go back in time. But maybe I'll change that question of a little bit and say, You know, Erica, what if you had to go back to 2 to 3 years ago? Would there be anything that you tell your you know, your your CEO self at that point in time?

Erica Rogers:   59:53
Yeah, I think it's It's similar to what I would say to my 30 year old self, which is Be patient, you know, if you are seeking to change the world, which is what we're seeking to dio here. We aim to become the standard of care in our current disease date, which is corroded artery disease, and that takes real time and the accumulation of riel clinical evidence, which takes time. And so this transition doesn't happen overnight. The transition Thio team kind of commercial mo mentum doesn't happen overnight, and so I think I think good advice to myself back then would have been be patient. This is a long, long haul on back in 2012 if someone had told me in 2019 you will be the CEO taking this company public on the NASDAQ. I probably wouldn't have believed it at that time.

Scott Nelson:   1:0:54
The this the sage advice solar folds True's Keep your head down and be patient. You know, that actually reminds me about an interview I recently listened to with Reid Hoffman and and and, uh, gosh, is that well, sicky, I believe, is how you pronounce your last name. She's Yeah, she's not sure if you if you run in her circles at all. No, no, her, you know, the the founder and CEO of 23 me and most people, I think listening have at least heard of 20 turning me in. I think that, you know, that kind of the overarching narrative of that conversation, uh, her conversation with Reed, the founder of Linden for everyone was saying it isn't respectable. And listening to this nose knows Lincoln was really around. You know what to do with with gatekeepers? And to go kind of a little deeper is like, What what am that kind of spoke to you is that, um, like most people that are ambitious Pretoria like yourself, have a tendency to kind of drive hard, right and and mention that like it was, I think, you know, a sort of a mentor and her and her life that basically encouraged her to say, Look, what do you want to do with 23? Me If if you mean to sort of change the world as you just referenced Erica. Advice given to Anna was, like, you know, keep your head down and be patient. You know, this is a long haul. This is a long journey that the v patient and work with a work with the right people. And I think that really, That kind of reminds me of kind of your what? Just really spoke Thio.

Erica Rogers:   1:2:22
Yeah, it's a really interesting story. I know the story 23 me and, uh, you know, they obviously went a little bit crosswise with FDA in the

Scott Nelson:   1:2:35

Erica Rogers:   1:2:35
days. They were they wanted to provide individuals and families with their disease history, genetic information, and FDA had an issue with that. Right? And so and very admirably, you know, dealt with that gatekeeper, meaning the f d a, um, in a patient and careful way, which

Scott Nelson:   1:3:02
was to

Erica Rogers:   1:3:02
say, Okay, we're gonna follow the rules, and we're going to one by one by one on these genetic tests obtained the proper FDA approval, and she's been very successful in launching these one by one. I was fortunate enough to have done 23 of me before all of that, so I kind of got grandfathered in and saw a lot

Scott Nelson:   1:3:23
of my state

Erica Rogers:   1:3:25
genetic history. But but I think the theme really resonates with us here at Silk Road and that we have been extraordinarily mindful of all of the constituents all along the way. The most primary constituent, of course, is the patient with corroded artery disease. But really it encompasses vascular surgeons and, in particular, the Society of Vascular Surgery. It encompasses CMS as the primary payer of people over the age of 65 who suffer from corroded artery disease. Most of them are older, so CMS is an important constituent FDA, obviously a very important constituent and, of course, investors and all of the rest of the constituents around the table. So I think it's important for entrepreneurs to understand all of those constituents so called gatekeepers on the front end and really dig deep into what matters to those constituents. And are we solving problems for those constituents or making their life worse. Which some technologies and start up. D'oh! Um so it's important to really understand all of those constituents and bring them along all along the way

Scott Nelson:   1:4:44

Erica Rogers:   1:4:45
continuous communication, continuous understanding of what matters to them. Because this is a community health care is the community on did not just all about Silk Road and our technology. It's about making sure that we have solved a real problem and that we've done that in a way that matters to the rest of the constituents,

Scott Nelson:   1:5:06
such such great stuff. And it sounds like hearing you kind of describe or provide that advises the better way to put it. It sounds it sounds something so simple and straightforward, but the reality of it it's so true. It's so true And thanks for often we get stuck in this like art. Might my product or my service does X, Y and Z or solves this need, and we forget to like realize all of those giggle gatekeepers they're using Air Coast year for the listeners or stakeholders that have invested interest in helping you move things along, too. So understanding that you're that you're trying to address their needs along the way is, is extremely, extremely useful. And so such good advice

Erica Rogers:   1:5:48
that's staying patient is that easy, either. Because you have to be looking at this growing obesity epidemic in our country, and you talk about the patient age being 65. I can't help but imagine that age is coming down every five years. It probably is coming down another couple of years. Um, your your your pool of potential people, patients that you can help has to be growing exponentially. Yeah, well, exponentially. Maybe not, but it certainly is growing. Norbert. It's a good observation in that cardiovascular disease in general is on the rise. And I think there was a period in time where we all thought that smoking cessation and the you know, the real success that the country had in in reducing the number of people who smoke that that would have a real meaningful impact, coupled with the advances in Staten therapy. If you think about you know, satins and aspirin and smoking cessation is kind of the three biggest drivers to reducing cardiovascular disease. But along came uh, obesity, the sugar epidemic and as well, sedentary lifestyle and those two things are kind of counter balancing these other things that might have reduced cardiovascular disease, the prevalence. And so yes, um, it's on the rise. Certainly, the population is aging. That's another dynamic in the United States leading to increased cardiovascular disease. And in fact, we did see ah, single digit lift in the number of diagnoses of corroded artery disease from 2017 to 2018. So you're right about that. Interesting.

Scott Nelson:   1:7:36
Eric, I know we're kind of we're getting close to kind of are a lot of time. I want to be sensitive to your schedule, considering it's it's Ah, I imagine it's pretty. It's free, chock full. So maybe maybe I'll end it if it's okay with you. It's kind of one last question around advice. And considering that, um, in a lot of scenarios, we you know, we speak to, you know, met Zach entrepreneurs here on med side of radio and, um, knowing that most of our listeners have heard about your early journey leading up to Silk Road and then have learned a little bit more about we're stuck Road is that now and this the successes and challenges you've been able to overcome. What's that? Maybe 11 piece of advice, maybe other than other than patients that you would tell another another sort of med tech entrepreneurial Or, you know, someone to some of those ambitious in attack and, you know, wants to Dio wants to dio uh, the next big thing.

Erica Rogers:   1:8:30
Sure. Well, I get asked that question a lot, and I think you know what has positioned me for success. And certainly what was the thesis behind me? Taking this role at Silk Road was ultimately to become the commercial CEO Silk Road, even though it was really early in the trajectory of the company. And obviously I've been a founder of over 15 patents, you know, et cetera. So I certainly have done the entrepreneurial side of things. But really, the key to success now, um, and even arguably at the beginning of these early stage companies is that I know what it's supposed to look like when you get there. And the only reason I know what it's supposed to look like is that I spent riel time in my career in large MedTech. Obviously, most of that was at Boston Scientific, as you know, from the prior interview. And so my advice toe entrepreneurs. If you want to be an entrepreneur and you want to survive through through to the day on the NASDAQ, spend some time in your career in a large company in a you know, significant role in a large company and really understand what it's like when it gets very, very big.

Scott Nelson:   1:9:49
That's good stuff, not the answer that I expected you to provide, but, uh, but so really selling theater.

Erica Rogers:   1:9:56
You expect

Scott Nelson:   1:9:56
it? I don't know. Maybe maybe something along the lines of you start up and bias or something like that. But it's Ah, it's good. I mean, I can I can I can speak to my my personal career And I'm still grateful for the time that I was able to spend his activity in and Medtronic two massive, you know, organizations and just having a you know. Now I'm obviously running a different startup. Liketo have that experience of, like what? You know what, what it can look like at what things can look like. Its scale. And you know what? What had overcome certain challenges in a good way, how to overcome? You know that a kind of more of a painful slog to, so yeah, no, that's That's such such good stuff. I mean, it certainly resonates resonates with me for sure. Great. Well, that said, Erica, I can't think, you know, for taking the time out of your your schedule is sort of like a do. Ah, Bree sort of part part to to the to the original interview catching, catching us up on on some of the, uh ah, the winds, the successes. And you've got a lot of them over the past few years. We're still pro better post. Congratulations on on every on all of those. Those aspects, Major, congrats to you and and your team. That's really, really cool to see. Especially when you know some some med tech companies, you know, struggle, struggle t get to the point that you, uh you take in Sapporo too. So, Major, Congrats. Thanks again for doing this norm or anything else. Toe.

Erica Rogers:   1:11:22
No, I also would like to thank her, and it'll be fun to watch the trajectory and success of the company. And, you know, maybe do ah! Ah, follow up to the follow up again a couple of years

Scott Nelson:   1:11:33

Erica Rogers:   1:11:33
and you've introduced possibly Europe or new products to the market or new, uh, new areas of disease that you're going after.

Scott Nelson:   1:11:42

Erica Rogers:   1:11:43
right. Well, Scott, Norbert, thanks so much. I'm honored to have been asked to do this today. I really

Scott Nelson:   1:11:47
appreciate your time. Excellent. Thanks again, Erica. Really appreciate it. All right, take care.