Medsider: Learn from Medtech and Healthtech Founders and CEOs - How Data is Transforming Medtech: Interview with Avenda Health CEO Shyam Natarajan

Episode Date: October 18, 2023

In this episode of Medsider Radio, we sat down with Shyam Natarajan, founder and CEO of Avenda Health, which utilizes artificial intelligence and cutting-edge imaging to improve the diagnosis and treatment of prostate cancer.After getting his PhD in Biomedical Engineering from UCLA, Shyam worked as a postdoctoral scholar in UCLA's Department of Surgery, focusing on minimally invasive surgical interventions. He also managed the UCLA Business of Science Center, spearheading initiatives to guide students toward non-academic career paths. With experiences like founding UCLA Innovation Week and the Inventathon, he is committed to pushing the boundaries of medical technology. At Avenda Health, Shyam is now leading the charge in revolutionizing prostate cancer care. In this interview, we talk about what it really takes to understand the market need for your product or service, how prototypes can be incredibly helpful in convincing relevant parties, how Shyam approaches fundraising, and what to expect from medtech in the future given current technological advancements in growing fields like AI. Before we dive into the discussion, I wanted to mention a few things:First, if you’re into learning from medical device and health technology founders and CEOs, and want to know when new interviews are live, head over to Medsider.com and sign up for our free newsletter.Second, if you want to peek behind the curtain of the world's most successful startups, you should consider a Medsider premium membership. You’ll learn the strategies and tactics that founders and CEOs use to build and grow companies like Silk Road Medical, AliveCor, Shockwave Medical, and hundreds more!We recently introduced some fantastic additions exclusively for Medsider premium members, including playbooks, which are curated collections of our top Medsider interviews on key topics like capital fundraising and risk mitigation, and a curated investor database to help you discover your next medical device or health technology investor!In addition to the entire back catalog of Medsider interviews over the past decade, premium members also get a copy of every volume of Medsider Mentors at no additional cost, including the recently launched Medsider Mentors Volume IV. If you’re interested, go to medsider.com/subscribe to learn more.Lastly, if you'd rather read than listen, here's a link to the full interview with Shyam Natarajan.

Having a device that does a single function based on a single point of time in the past, I don't think is really workable for the future. I think now we understand that if we want to get the best clinical outcomes, these devices have to learn, adapt, modify, improve over time. Welcome to MedSider, where you can learn from the brightest founders and CEOs in medical devices and health technology. Join tens of thousands of ambitious doers as we unpacked. the insights, tactics, and secrets behind the most successful life science startups in the world.

Now, here's your host, Scott Nelson. Hey, everyone, it's Scott, in this episode of Medsider, I sat down with Avenda Health CEO, Shiam Nanaranjan. After getting his PhD in biomedical engineering from UCLA, Shiam worked as a postdoctoral scholar in the university's department of surgery, focusing on minimally invasive surgical interventions. He also managed the UCLA Business of Science Center, spearheading initiatives to guide students towards non-academic career paths. His current company at Vinda Health, where Shiam is founder and CEO, utilizes artificial intelligence and cutting-edge imaging to improve the diagnosis

and treatment of prostate cancer. Here for you the key things that we discussed in this interview. First, go deep, not just broad. Identifying a market need is only the beginning of an exhaustive investigative process. You must dive deeper to comprehend the root causes of the issue. Proceed to build a prototype only after you comprehensively understand the problem and seek mentorship proactively every step of the way. Second, don't overcrowd your board. Fundraising and MedTech requires a mix of politics, strategy, and clinical understanding. Be prepared to turn down offers that dilute your mission. And remember, it's a numbers game, meaning expect to do hundreds of pitches before you secure the capital you need. Third, cross-disciplinary functions to adapt adjacent

technologies. Look for ways to synthesize advancements in other fields, such as information technology, into your product. Putting the patient at the center of your mission allows you to identify how tools from adjacent disciplines can improve your product. Before we jump into this episode, I wanted to let you know that the latest edition of Medsider mentors is now live. Volume 4 summarizes the key learnings from the most popular Medsider interviews over the last several months with folks like Rob Ball, CEO of Shoulder Innovations, Kate Rummel, CEO of Abolative Solutions, Dr. Christian Ramdo, CEO of Tempe Health, and other leaders of some

of the hottest startups in the space. Look, it's tough to listen or read every Medsider interview that comes out, even the best But there are so many valuable lessons you can glean from the founders and CEOs that join our program. So that's why we decided to create Medsider mentors. It's the easiest way for you to learn from the world's best medical device and health technology entrepreneurs in one central place. If you're interested in learning more, head over to MedsiderRadio.com forward slash mentors. Premium members get free access to all past and future volumes.

And if you're not a premium member yet, you should definitely consider signing up. In addition to every volume of Medsider mentors, you'll get full access to the entire life. library of interviews dating back to 2010. You'll also be able to see all of our playbooks, which are handpicked collections of the most insightful interviews with the brightest founders and CEOs. Whether you're looking to master capital fundraising, navigate early stage development, tackle regulatory challenges, understand reimbursement, or position your venture for a meaningful exit, MedSider Playbooks have you covered. And last, considering that fundraising can be one of the most daunting tasks for any startup, we created a meticulous database of investors right at your

fingertips. Explore a wealth of VC funds, private equity firms, angel groups, and more, all eager to invest in medical device and health technology startups. Access to this database is a premium member exclusive, so don't miss out. Learn more about MedSider Mentors and our premium memberships by visiting MedSiderRadio.com forward slash mentors. Again, that's Medsiderradio.com forward slash mentors. All right, without further ado, let's jump right into the interview. All right, Sean, welcome to Medsider Radio. Appreciate it coming on. Thank you for having me.

Yeah, really looking forward to learning about your journey, you know, in the world of, in the world of kind of the med tech startup ecosystem as well as what you're building at Avenda Health. So with that said, I reported a brief bio at the outset of this interview, but would love to kind of hear your elevator pitch, right, for your kind of journey leading up to co-founding the company. Great. Well, thank you for having me on. So Eventa Health, quite simply, is all about building the next generation in personalized cancer care. I actually started out as an academic, as a researcher working in prostate cancer primarily.

So when I was at the university, it was really problematic for when patients went for biopsy or diagnosis to figure out, you know, what should they do next? or, you know, when they get the biopsy results, if they're facing a cancer decision, they really didn't know, you know, having all of this information in front of them, they didn't really know the right option. And typically the physician would send the patient home with a booklet with 20 different treatment options and talk to the patient, talk to the patient's family, and then try to figure out like a best course of action forward. Around the same time, we got interested in a,

new type of imaging technology to map prostate cancer with image guidance. So going from a sort of a needle poke randomly in the body to something that is a little bit more image guided and a little bit more precise, that totally changed our world in terms of how much information we're able to extract through images and through diagnostics. And so what we were able to do when I was at the university is take a patient's MRI, merge it with their real-time ultrasound, and give the physician a better way to diagnose prostate cancer. And for the first time, we're able to give the patient a better determination of, oh, here is where your cancer is, you know, in this particular location. So now they can make a more informed decision about what to do next.

Got it. That's super helpful. And the university you're referencing is UCLA. So right, this technology, you uncovered it at UCLA? That's correct. Got it, got it. Okay, cool, cool. Yeah, that's super helpful. So if I understand it right, if I'm in the unfortunate scenario

that I have sort of a cancer diagnosis related to prostate health, I'm not sure if you're kind of targeting, you know, other cancers at this point. But normally that process, I'm trying to figure out like how, you know, where the cancer's at, et cetera,

basically to get a better picture of that, it's pretty difficult. But this technology that you sort of uncovered at UCLA that's now part of Avenda Health, allows the physician to combine MRI with ultrasound and get just a much, much more precise picture of kind of the state of the cancer. Is that kind of a layman's description? Yeah. So that was actually the precursor technology to what we're building at Avenda Health. I wanted to start with, you know, what I did at the university because that project and, you know, for other sort of academics

and med tech entrepreneurs listening to this podcast, it was so fortunate for me to be. part of a project that went from the clinical translational stage to being actively used, you know, in patient care, to now standard of care in clinical care guidelines. And so that ability to map and target prostate cancer in a very precise manner has unlocked this new potential of actually knowing what's going on, you know, in the prostate, you know, throughout the patient's journey. And so what we've done at Avenda Health is actually taken that kind of information, as well as other sort of clinical markers from the patient. Their imaging, their, you know, clinical information, their demographics,

put it together using AI and map prostate cancer prospectively for the first time. So we can actually take a patient's existing diagnosis, give them a totally new type of image that actually shows exactly where it extends. Got it. This is not a domain that I'm like, you know, have a lot of expertise in. So when you say prospectively map it, like how far out are you looking? Is it like if I, if I am diagnosed with prostate cancer, you can give me kind of a better idea of kind of what that's going to look like in three months,

in six months? And is it rooted in kind of what I can, what happens if I, if I intervene in the meantime, like help me, help me better understand kind of that from a patient's perspective. Yeah. So from a patient's perspective, if you're facing this diagnosis, which is, you know, one in every eight men have a lifetime risk of getting this disease. So it's a really, really impactful disease. And half of men who get treated, end up losing their quality of life. So the wrong decision has a huge burden on the patient, you know, not only the healthcare system. So the challenge here is that imaging and other types of diagnosis, while they're really good at finding and identifying where cancer is, they don't

really do a good job uncovering all of the cancer or the extent of the cancer. You can imagine, like, if you've got a, you know, a jigsaw puzzle and you could only have, you know, 10 pieces in a hundred piece puzzle. You know like what the color is on those pieces, you know where, you know, maybe the texture or the pattern. You can maybe say that, oh, this is a shape that is indicative of this object. But you don't know where those pieces come from. And you don't know what the whole picture looks like, you know,

if you weren't given the box. So what we're doing at Evenda Health is exactly that. We're taking those, you know, small sample of pieces and then reconstructing the whole picture. Got it. Okay. That's super helpful. I like that. like that analogy. And so we're recording this in, you know, Q3 of 2023. I'm looking at your

LinkedIn profile. It looks like you kind of started Avenda sort of mid-2017. So, you know, we're roughly about six years and sounds like about six years into the journey here. Give us a sense kind of where you're at right now with Avenda in terms of, you know, R&D, Ray Klin commercialization, kind of the life cycle. Yeah. So it's definitely been a long journey, but in the last, I would say five years because the first year, we were still moonlighting at my other job. But five years in, we've got two FDA clearances. We've got breakthrough device designation. We've completed four clinical studies, and now we're in commercialization. Oh, wow. Okay. So you're actively commercialized technology now? Yeah. Okay, cool. Cool.

Well, if you're listening to this and don't make it over to the full write-up on MedSider, I definitely encourage you to check out Avenda Health. That's A-V-E-N-D-A-A-V-A-Helf.com. And you can learn a little bit more about the technology and follow the company. Sean, that's a super helpful overview. And I think it kind of helps paint the picture kind of for the next sort of maybe portion of this conversation,

which is really intended to kind of go back in time and talk about some of the key functions that every MetTech startup typically goes to. I love the fact that you mentioned, you know, the first year or so of Avenda, you're still moonlighting, right, at UCLA in the world of academia, which I think is super important. That's that's very real, right, for any any entrepreneur. It's like oftentimes you're trying to get this thing, you know, going, you know, out of the starting

blocks while still, you know, maintaining some type of full-time job. So with that said, let's go back to let's call it the 2017, 18, 19 timeframe. It was very early years. I'm sure the Venda platform now that you're actively commercializing looks a lot different than, you know, what it did back then. And so, and I think this question is especially pertinent based on your experiences at UCLA too and you've been around, you know, a lot of entrepreneurs for a while. When you think about kind of those earliest phases, those are often the most challenging for any startup because you're trying to be as efficient as possible with very limited resources to try to get, you know, some sort of alpha product that you can, you know, talk to other people about

eventually maybe raising, so you see money, et cetera. What do you think is most important, right, for MedTech entrepreneurs in terms of being really capital efficient, you know, in those, in those early days of development? Yeah, no, it's sort of two dimensions. One is like really understanding the market that you're targeting and understanding what is the true unmet clinical need. The term unmet clinical need is almost like a cliche at this point, but it's really true that just because you've observed a problem, you don't necessarily know at first blush if it's a widespread problem, if it's a problem that associated with the technology or with the clinical workflow or is it like a reimbursement

problem. So, you know, unfortunately in the medical device world, we are blessed with a lot of different dimensions and domains that a lot of interesting problems that we get to solve every day. And so I would say that for that early phase, talk to as many people as you can, constant feedback. I think I might have like interviewed, I want to say like 20 people a week for, you know, six weeks or eight weeks, even though I had already done like my PhD on prostate cancer, just like talking to other people and getting different perspective, really opened up my mind from like my narrow world. And then the second thing that I would say is getting to a prototype is really, really important.

You know, med tech, the timelines are long. regulatory takes a long time. Clinical trials take a long time and a lot of capital. But it's really cheap and really easy to come up with like a representative prototype that maybe you can't use on a patient. Maybe you can use only on a bench top model or, you know, in vitro or in vivo potentially. But it's all about proving out the concept, like proof of principle and then getting to the next stage. Because at the end of the day, it's all about getting the best clinical outcomes. And you want to have, as much of a signal as you can in those earliest phases to know if a project is worth pursuing further.

Yeah, yeah, there's no doubt. You mentioned a couple things. And I love the fact that you called out sort of the cliche around, you know, unmet need, right? Because it is cliche, but it's crucial because any met tech startup is likely going to be at least a five-year type of journey, right? I mean, it's so rare that there's, you know, it's anything less than that. And it's, you know, it's like pushing a bolder uphill for a long period of time.

And if you're not working on clear, true patient need, right, with a big market, it's just you're going to run into a lot of hurdles, right, along the way. And so, I mean, you know, making sure that you really, you know, you really have truly identified a very clear, not a want to have, but a need to have. I think that's really important. And it seems like over the, you know, I don't know, maybe the last five to 10, you know, founders, CEOs that I've had on the program have really called out this need to get to a prototype, like you just said, Sean.

And I think that's so important because having something tangible, right, that you can actually showcase and talk about, not just with investors, but also, you know, get feedback on from, you know, physicians and other folks in your particular domain. So crucial because, you know, they're oftentimes busy and looking at a gazillion other things. It's so, it's, and it's hard to translate something that may be on a PowerPoint slide, right? Or, you know, even if you have maybe a nice animation, it's hard to translate that into something like tangible. And so getting to that first kind of, you know, prototype really, really crucial, you know, in terms of, you know, getting broader feedback and hopefully getting people to lean in kind of what you're what you're doing versus, you know, leaning, leaning back, so to speak. But that's super helpful.

Anything else that you can think of with respect to kind of the early earliest days and what's been maybe successful for you or any other, you know, kind of lessons learned? Yeah. I would say it's especially because I was kind of a, you know, first time entrepreneur. I had started something else before that, but, you know, this was the first real. project, I would say, is finding good mentors because there's a lot to learn in this space. And the one good, really good thing about the med device industry or the med tech industry is that it's a small group of people that are all really willing to share because we know what the challenges

are. It's a really difficult process. We didn't. Hopefully it ends up being also very financially rewarding as well. But we got into this primarily for the, you know, making a difference in the world, making difference in patient care. So I think I would say that reaching out and talking to other people in the space is really important. And I was surprised when I started this process that how many people that I had sort of no business talking to like CEOs of very large companies of, you know,

large strategics, were willing to give their time in, you know, coaching, mentoring, et cetera. Yeah, that's such a good point. And you and me both, right? I mean, it's one of the things that that I find kind of really rewarding about the space is that although it's extremely challenging. I was like to kind of use the analogy, just sort of like playing the game on the startup game on on hard mode, you know, versus easy mode. But it's not only rewarding because you're like, you're building products that like have a very real kind of like health impact in a,

in someone's life. But in terms of the ecosystem, yeah, tons of people that are more than happy to share advice, you know. And I think back over the past, what, 10, 15 years of doing doing this podcast. And it's, it's really, really cool. the people that are that are, you know, have done a lot in their careers, are incredibly accomplished, have multiple exits under their belt, have raised a lot of money and have built some really cool companies. They're still happy to like, you know, download and share kind of, you know,

tips and tricks. They don't, they don't view themselves above others, you know, thinking of people like Bruce Shook and Mike DeVoreau and Derek Herrera and, you know, like the list goes on and on. So really, really, really cool to be around some of these people. So with that said, Shum, you mentioned some of the kind of the Ray Clinton accomplishments that you sort of have under your belt, right, at Avenda, breakthrough device designation for clinical studies. That's a lot. And this whole topic, right,

the Red Klin kind of pathway for any startup, even if it's straightforward, typically, you know, pretty daunting, right? It's arguably one of the biggest hurdles that you need to cross. And so when you think about just really this function and how you've kind of approached it at Avenda, any tips or tricks or kind of words of wisdom, you know, for other device entrepreneurs that are kind of building out their,

their strategy and about to kind of, you know, execute against their Red Klan roadmap. Yeah. This is a great question because there's a lot and there's a lot of context switching in this process. But, you know, I have my co-founders and I have always approached this from the perspective of, you know, before we bring on, you know, a quote unquote expert or consultant or someone else, just try to do it on our own, like try to go from zero to one on our own.

on our own to really understand like the new challenge and the new problem because even though they're very different spaces with regulatory reimbursement, clinical, et cetera, they're all tied together and they all have to make sense together in one cohesive strategy. And the best way to learn is to try it yourself. And you know, you may not be successful. Like for example, the breakthrough device designation, we submitted it once and it got rejected the first time that we submitted it. But we learned a lot. We got more clinical data. Then we went back to it and we're successful the second time around. And now I feel very comfortable and savvy in talking to like a, let's say a third party of exactly what we're looking for or what we want to accomplish because

we have a deep understanding of the process now. That's a really good point. I'm a huge believer in taking swings, right? And that framework, right, of being able to maybe you're not, maybe you're not a domain expertise when it comes to, you know, the regulatory function, but you've actually sort of taken some swings, right, and sort of done that. You're going to be, you know, you're going to be that much better apt, you know,

the next time around, right? Whether it's doing it yourself or, you know, in trying to find the right regulatory, regulatory partner for sure. But the four clinical studies you mentioned, that's a lot. I mean, were those all needed for your regulatory submission or some of the studies that you,

you sponsored were those conducted, I guess, for a different sort of initiative. Yeah, so I would say that some of the studies were related to software product, which go a lot faster. Okay. And some of them related to like, you know, cancer treatment, which take a lot of time and have a long-term outcome. Some of them were needed, I would say that not all of them were needed for regulatory approval,

but all of them were necessary in order to accomplish what we needed to accomplish, which was demonstrate that this product works, the way intended in a variety of populations and not just how well, like, for example, our AI platform to map prostate cancer care, not just like the performance of the AI platform and, you know, understanding how well does it work in independent patient populations, but how well do clinicians perform using the product? So it's sort of multidimensional, if you can imagine. Have you done all of those clinical studies internally, or are you working with a CRO? we've done them all internally or with a university partner.

Hey there, it's Scott, and thanks for listening in so far. The rest of this conversation is only available via our private podcast for MedSider Premium members. If you're not a premium member yet, you should definitely consider signing up. You'll get full access to the entire library of interviews dating back to 2010. This includes conversations with experts like Renee Ryan, CEO of Cala Health, Nadine Miarid, CEO of CVRX, and so much. many others. As a premium member, you'll get to join live interviews with these incredible

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