Medsider: Learn from Medtech and Healthtech Founders and CEOs - How to Take Your Medtech Idea from Zero to One: Interview with Dr. Scott Wolf, Founder of Aerin Medical

Episode Date: April 7, 2021

In this episode of Medsider Radio, we’re chatting with Dr. Scott Wolf, a prolific medical device entrepreneur and investor who founded Aerin Medical to bring non-surgical therapies to patients with common nasal airway problems. Prior to founding Aerin Medical, Scott started Zeltiq Aesthetics, the maker of CoolSculpting. His other startups include Endogastric Solutions and Cardiac Dimensions, and he was a partner at Prospect Venture Partners as well as VP at Frazier Healthcare Ventures, both leading life science venture capital firms. Scott received his M.D. from George Washington University and his B.A. from the University of Pennsylvania.You won’t find many people with more hands-on medtech experience than Dr. Scott Wolf, and today he’s going to share his expertise with the Medsider community. In this interview, we’ll discuss Aerin’s technology, break down the advantages of cash-pay versus insurance reimbursement, and get Scott’s advice for would-be founders hoping to turn a great idea into a real prototype.Before we jump into the conversation, I wanted to mention a few things:If you’re into learning from proven medtech and healthtech leaders, and want to know when new content and interviews go live, head over to Medsider.com and sign up for our free newsletter. You’ll get access to gated articles, and lots of other interesting healthcare content. Second, if you want even more inside info from proven experts, think about a Medsider premium membership. We talk to experienced healthcare leaders about the nuts and bolts of running a business and bringing products to market. This is your place for valuable knowledge on specific topics like seed funding, prototyping, insurance reimbursement, and positioning a medtech startup for an exit.In addition to the entire back catalog of Medsider interviews over the past decade, Premium members get exclusive Ask Me Anything interviews and masterclasses with some of the world’s most successful medtech founders and executives. Since making the premium memberships available, I’ve been pleasantly surprised at how many people have signed up. If you’re interested, go to medsider.com/subscribe to learn more.Lastly, here's the link to the full interview with Dr. Scott Wolf if you'd rather read it instead.

Andrew Fraser is our VP of engineering now. He was with me from the start as VP of R&D, and he was able to get a prototype done for really very little money, rapid prototyping. We actually took that device. I mean, we kept rapid prototyping all the way through our first human study. So basically, he and I, as the only, you know, full-time employees, were able to get through our first human study for, or under a million dollars. Having nice industrial design comes way later. In these first, you know, just to prove safety and efficacy, you know, you want to basically spend as little money as you can in the early days.

Our first radio frequency generators were like something that looked like, you know, from Soviet era, you know, the engineering and we lugged it across the country, you know, had to get through TSA with this 150-pound generator. So now it weighs 15 pounds or less. Welcome to MedSider Radio, where you can learn from proven med tech and healthcare thought leaders through uncut and unedited interviews. Now, here's your host, Scott Nelson. Hey there, it's Scott with Medsider. And in this episode, we're chatting with Dr. Scott Wolfe, a prolific medical device entrepreneur, an investor who founded Aaron Mezzaner. to bring non-surgical therapies to patients with common nasal airway problems.

Prior to founding Aaron Medical, Scott started Zeltique Aesthetics, the maker of Cool Sculpting. His other startups include endogastric solutions and cardiac dimensions, and he was a partner at Prospect Venture Partners, as well as VP at Fraser Healthcare Ventures, both leading life science venture capital firms. Scott received his MD from George Washington University and his BA from the University of Pennsylvania. You won't find many people with more hands-on med tech experience than Dr. Scott Wolf, and today he's going to share his expertise with the Medsider community. In this interview, we'll discuss Aaron Medical's technology, break down the advantages of

cash pay versus insurance reimbursement, and get Scott's advice for would-be founders hoping to turn a great idea into a real prototype. Okay, so before we jump into the conversation, I want to mention a few things. First, if you spend any time in the med tech or health tech space, you probably understand how difficult it may be to hire the right physician partners, whether you need help with voice of customer research, advice around clinical study design, or something more straightforward like content review. Whatever the task, instead of spending weeks searching for physicians or paying thousands

just to meet one, I highly recommend you check out FlipMD. It's a physician hiring marketplace where you can seek the expertise of thousands of physicians in one simple platform. FlipMD features 2,000 plus physicians in every specialty and their marketplaces growing every day. When you post your project and set a rate, physicians then compete for the job with bids, and then you make the choice on who you want to hire. To get started, it's really simple. Just register your account, post your project, check out the bids that come in, and then hire a physician.

No finder's fees, no obligation, and no risk. It's super easy. Even better for the Medsider community, FlipMD is offering to waive their normal transaction fee for the first 60 days. So just head over to MedsiderRadio.com forward slash flipmd for all the details. Again, that's Medsiderradio.com forward slash flipmd. Okay, second, if you're into learning from proven MedTech leaders and want to know when the new content and interviews go live, head over to Medsider.com and sign up for our free newsletter. You'll get access to gated articles and lots of other interesting healthcare content. If you want even more inside info from MedTech experts, think about a MedSider premium membership.

We talked to experienced healthcare leaders about the nuts and bolts of running a business and bringing products to market. This is your place for valuable knowledge on specific topics like seed funding, prototyping, insurance reimbursement, and positioning a MedTech startup for an exit. In addition to the entire back catalog of MedSiter interviews over the past decade, premium members get exclusive Ask Me Anything interviews and masterclasses with some of the world's most successful MedTech founders and executives. since making the premium memberships available, I've been pleasantly surprised at how many people have signed up. So if you're interested, go to medsider.com to learn more. All right, without further ado, let's get to the interview. All right, Dr. Skalt Wolf.

Welcome to Medsada Radio. Appreciate you coming on. Well, thanks for having me. All right, and for the sake of this conversation, we'll keep it informal. I hope you don't mind. We'll go back and forth as fellow Scots, if that's okay. Perfect. Awesome.

I mentioned your more professional bias. kind of at the outset of this interview. But let's start here, because you've got an incredibly impressive background and as not only a startup founder, but also as an investor as well. So lots of stuff that we'll get into over the course of this discussion, I hope. But I'd love to hear it from you first. Can you tell us a little bit more kind of about your professional background kind of leading up to your work with Aaron Medical? Yeah, so I've spent really my whole career in life science startups.

So like you said, I've either started companies or I invested in them as a venture capitalist or an angel investor. I got into this whole area, I guess from the time I was a boy, I had plans of being a doctor. And I guess Mike Tyson said it best. He said everybody has a plan until they're hit in the face. And that happened, I guess, in medical school, I found out, boy, I like this. I like learning the science. I think the biology is amazing. Practicing medicine really wasn't for me, but I found the unmet problems in medicine really interesting. So that's where I've spent my career. And after my internship, I had an idea that I wanted to start companies and just

pushed myself into it. And so have founded, like you said, a number of companies over my career and was also a venture capitalist with two firms. And after founding Zaltique, I went off on my own and founded Aaron Medical. Got it. That's super helpful. And I think you mentioned Zeltique. I think most people are going to be maybe most familiar, right, with Zeltique and the commercialization of cool sculpting, right?

I'd be surprised if there was people listening to this interview that weren't familiar with cool sculpting. and hopefully maybe you can touch on that experience. Or we've maybe some of those experiences into this conversation. But knowing kind of at least a high level of your background now, let's kind of go back to that like 2010-ish timeframe, something like that, when at least kind of I think those were maybe the more the formative years for Aaron. And I think this was coming out of maybe your time at Prospect Venture Partners.

But tell us a little bit about like this idea for how the Aaron kind of platform, you know, came to be. And if it's helpful, maybe we start with kind of like what it is and why a patient may even benefit from this technology. Yeah, yeah, sure. So Aaron developed and is marketing now office-based solutions for nasal obstruction, rhinitis, chronic rhinitis, and really focused on all of the most common complaints that bring people into the E&T's office. And we do this with a with a proprietary temperature controlled radio frequency platform. So it's really the first platform where you can in the office accomplish things that really you could only do with surgery in the past. So we have two products now, Viver, that's a product for nasal obstruction,

and Rineer is for chronic rhinitis. Got it. And just to talk, I don't want to spend too much on like the disease state per se, but someone that's dealing with one of those issues, they're having trouble breathing, right? But maybe you could provide a little bit more detail just to kind of help level set people who are listening kind of what, you know, what this typical kind of patient treatment kind of, you know, a pathway looks like. Right. Yeah.

So for people with chronic nasal obstruction, you know, it's really just anybody who feels like they don't breathe well enough through their nose. So it could be that, you know, they feel. stuffed up on both or one side or they feel, you know, at night that it's hard to sleep or they're snoring, you know, it's really anybody who feels like, like they just don't breathe as well as they want to through their nose. That brings them into the E&T's office eventually, you know, and that's, that's probably the most common complaint that E&T's here. And so what typically happens is this patient will go through medical,

they'll try allergy therapy and all the medical therapy they can. And the E&T will finally get to the E&T and have an exam. And the E&T will probably find that they have a deviated septum or enlarged turbinates. Those are probably the two most common things that will lead. And eventually they'll go to surgery to have, say, a deviated septum repair. So that's kind of a common pathway. And what my original idea was is that this is a problem of how a patient feels, really. You know, the goal really is to get that patient feeling better,

to get that patient feeling like they're breathing like they want through their nose, like they're getting enough air through their nose and exercise. So it really maybe not focus on what their anatomic problem is, focus on how to get them breathing better. So it's kind of a subtle differentiation, but in my mind it was really, I guess, profound for me when I had that thought. So I started looking at what causes all the resistance in your nose. you know, and there's this area called the nasal valve. And it's the, I had never heard of it, and it's an atomic structure in your nose that's the narrowest part of your nasal airway. And so my thought was, okay, if we enlarge that area, no matter what, wouldn't a patient breathe better?

And you could, and it's basically the way breathe right strips work also. you know, they pull on this most narrow part of the airway and open it up. And really small changes make a big difference. Airflow varies through a tube to the fourth power of radius. So little changes make a big difference. So that's where I focused. And from my work in aesthetics, I had been, I founded a company called Primeva where using radio frequency energy,

to shrink tissue for wrinkles. So I knew something about how to, how to shape tissue without ablating it, you know, without really damaging tissue. Because in the skin, you obviously don't want to damage the epidermis, but you want to shrink the dermis.

It's kind of the same thing that I was going after here is kind of replicate what a breathydride strip does inside by just curving this little piece of tissue. So yeah, that that's really what I guess the main thing that's novel about about what we're doing for nasal obstruction got it got it that's helpful I want to kind of I want to I want to ask you a few more questions about how you know how you typically get to the first you know alpha or beta version of a product a product like like what you're like the tech that you're you're developing at Aaron

but just so I understand I mean I'm assuming this is a super minimally invasive procedure right that someone just gets done in an E&T's office, correct? Yeah, it's very minimally invasive. It's done under local anesthetic, and really it's quite quick. And, you know, it just, you can basically have the procedure done in about half an hour for both sides and go right back to your normal activity. So it's all office-based. The physician just does it with a speculum, so just without even an endoscope for the for our nasal obstruction product. For our rhinitis product, we use an endoscope, but it's the same,

similar technology and also quite quick. So yeah. Cool, cool. That's helpful. Let's transition a little bit to how you take kind of this idea, right? And I love the fact that you call that kind of subtle difference on how you kind of viewed the problem, you know, with how patients typically approach this challenge. But there's a lot of folks that are listening to these, you're listening to these medseter interviews that are, you know, physicians, engineers, you know,

et cetera that have like what appeared to them to be pretty cool ideas to maybe solve fairly large problems. But how do they, like, what's your advice for getting to that next step and actually kind of beginning to make this idea that's maybe on the back of a napkin into an actual product, right? Whether it's an alpha, you know,

version, a beta version. Like, what do you see, maybe, maybe some of the mistakes you've made in the past or what you often see startup folks make and how you, you know, what would be your advice for, you know, for those, for those folks that are in a similar position? No, I think this is the key question

for everybody who wants to start a company, you know, has an idea. And so what do you do? Because everyone has ideas, but not everybody, it turns them into reality. And, you know, So I guess for me, the main thing, one quote I've always loved was, whatever you can do or dream you can do, begin it. Boldness has genius, magic, and power in it. And I say that to myself all the time. And so it's really take that first step. And your first step could be almost anything.

It could be naming the company. And the first step will lead to the next step. And it's all about iteration. So your steps might not be, you know, the right steps. You could make mistakes. But it really doesn't matter as long as I think movement towards the goal is really the most important thing. So, yeah, so that would be my advice. I mean, the goal of taking an idea and turning it into reality, you have to ring out risk, you know, as you go along.

So for instance, for Aaron, you know, I had to show that we could, you know, that this would be a safe and effective thing to do before we raised any money on it. So we were really, how do you do that? And it was we were able to, for not a lot of capital, build a prototype, go into, get animal tissue from the butcher and look on the bench top that we could actually make. the changes that we want. And then, so kind of, you know, each step takes you a little bit closer and, you know, to the point where you can actually raise money to move into humans. Got it. Got it.

I love the fact. And I want to maybe go touch on this a little bit, but like, I love the fact that you just brought up getting even tissue from the butcher, right? So here we have like a very, very proven, successful like startup, MetTech, you know, founder like yourself. and you're still kind of going back to the butcher, right, for some of this early feasibility work, right? So can you talk to us a little bit more about that?

Maybe let's put ourselves in the shoes of a startup founder has what appears to be a great idea on paper, maybe even has like a cool looking deck, right? Raising seed stage money, especially in MedTech, is pretty tough, arguably maybe the toughest thing to do. How much budget do you think is expected to kind of throw out a product, right? So it's something that you can actually work. on and showcase, right? Maybe it's the very alpha version of a product, right, to be able to

like actually showcase in your situation that I can actually ablate the type of tissue that you want. What is like a range? Like what's your advice for folks kind of that are in that, in that very kind of like interesting spot getting something off the ground? Well, it depends. And for for something like Aaron, where, you know, there are that we were able to for, probably $100,000, let's say, you know, get through an initial bench top studies to prove. So get, you know, now with rapid prototyping and 3D printing, you know, you can do a lot with not a lot of money. So we were able to make devices that we could test on the bench top. So it really, I guess the goal is to do as much as you,

you can for the money that you have, that you can then use that to raise the first, you know, whatever it is to get to your next goal. But however you do it, like I said, the butcher, I mean, if you can go to Home Depot, you know, do things on CAD, however you do it to tell your story, you know, to be able to ring out risk and show investors that, you know, this is something that really has the potential to work. That's really the main thing. So it's going to, you know, basically the budget is going to be different for, you know, a radio frequency device than it would be for, you know, quantum computer in medicine.

Got it. No, that's super helpful. Even to like have some ballpark numbers, right? To hear you kind of throw out some ballpark numbers, right? Because I don't know, just in my network, you know, there's a lot of folks that would have, like they have this great idea and they immediately go to like a cool industrial design shop. And then they're in, all of a sudden, they're in whatever, 30, 40K just for, like, cool looking renders.

And it's like, you can actually get that done a lot cheaper. And you don't need to look, you don't need it to look like totally pretty at this point, right? Let's get to like an actual tangible thing to see whether or not this works. So I'm glad you even threw out like 100K just to like, that should be, you know, I mean, all things considered, there's going to be some variability, of course. But like, that could get you to some, you know, through some initial prototyping, even some bench top testing even. Oh, yeah.

we were able to get, so Andrew Frazier is our VP of engineering now. He was with me from the start as VP of R&D, and he was able to get a prototype done for really very little money, rapid prototyping. We actually took that device. I mean, we kept rapid prototyping all the way through our first human study. So basically he and I, as the only, you know, full-time employees were able to get through our first human study for under a million dollars. Having nice industrial design comes way later. In these first, you know, just to prove safety and efficacy, you know, you want to basically spend as little money as you can in the early days. Our first radio frequency generators were like something that looked like, you know, from Soviet era, you know,

engineering and we lugged it across the country, you know, had to get through TSA with this 150 pound generator. So now it weighs 15 pounds or less. Yeah, that's great. I love to hear that. Because I mean, I'm sure you could, you would probably agree. Like, it's easy to get like enamored with like something that looks pretty cool, like some really cool ID and just kind of lose sight of the fact that you need to, there's a lot, a lot more steps kind of along the way that are that are much more important, you know, when it comes to these med tech projects. But on that note, let's transition to, you know, you mentioned kind of, you know, getting to your first clinical studies.

Let's talk a little bit more about like Reagan clinical and maybe we start out with the former meeting, meaning the regulatory environment. I'm assuming that you're, the air in technology, it's 510K device. Yes. Yeah. Yeah. Generally speaking, like from your perspective, maybe as a, as a startup founder as well as like an investor, do you almost have a rule where you're just working on 510K devices,

or what would cause you to maybe even go down like a de novo or even a more like, you know, capital intensive PMA process? What's your general take kind of on the regulatory environment as it pertains to start up net tech startups? So I don't have any, you know, rule against de novo pathway or PMAs. So it's about how fast you can get to cash flow. positive, really, you know, and how much money it's going to take to get, you know, through your clinical studies. So, because for Aaron, you know, we, we eventually, we're doing even, you know,

right now we're in the middle of two randomized control studies, which, you know, for medical devices is, is a big deal for any company to do randomized studies in devices. So, you know, eventually we wind up doing the, you know, the even more, more studies than a PMA path would have required. So, but it's, it's expensive. And for a PMA, you have to spend that money, you know, in advance before you, you have approval. So that's, that's kind of the big difference, I think, is when the, when you're actually spending for those big clinical studies. So yeah, 510K is always going to be, you know, just in general easier to build a company around.

But PMA products have been, you know, if you're doing a neuro-inplant that you can eventually sell for $20,000 and are reimbursed, you know, I mean, that's worth going after a, you know, a large expensive PMA path. Sure. When it comes to like the regulatory pathways

that you've kind of encountered, right, throughout your experience. Is there anything else that you, maybe that you've went through that you learned a lot from or, you know, kind of walked away with a bit of a aha. Like, I'm not ever going to, ever going to make that mistake again. Is there anything that comes to mind? Well, yeah, you know, it, um, certain, so, so, uh, endpoints, you know, so timing of endpoints.

And I did, uh, I started one spinal implant company with, um, partners of mine, from Scout Medical back in the day. And that one required, you know, a two-year follow-up for the end point. And so, so yeah, I'll never do that again. Yeah, it's too long. So that things like that where, you know, for a specific device, you know, either you have to have very difficult and expensive endpoints. That's the main thing.

Got it. On that note, since we're kind of talking about, you know, clinical, really clinical study strategy per se, any best practices that you've kind of followed, right, as you begin to think about kind of the overarching clinical evidence plan, you know, for, you know, your whatever startup company you're kind of working on. Well, the worst thing that can happen to a company is to have a late stage failure, right, to have a failure in a clinical study. And that happens in pharmaceuticals, I think, you know, more often because, yeah, it's just harder, harder to get early data. So you never want that to happen in devices. So your strategy should be to wring out, you know, all of the risk before you get to the point where you're doing large human studies. So that's one thing. The other is to have really be very careful about the endpoints,

because those have to matter. You know, they have to be the thing that's not only going to get, you know, your FDA clearance or approval, but has to be the thing that patients and physicians care about. So it's really, yeah, just study design. And then on actual doing the studies themselves, enrollment times can really, you know, that's one of the most important things, you know, for the whole company is,

is how fast you can enroll these studies because, yeah, if you're spending your burn while you're doing these studies. So you have to, I guess, plan, have the best enrolling in physicians that you can and have plans in place if enrollment's not going well, maybe using what we're doing a lot now with that. Aaron is using social media advertising to recruit patients, and that's gone very well. So really thinking about, you know, and designing the study for rapid enrollment also. So everything has to be geared towards being able to rapidly enroll a successful study. I'm thinking about right now, I'm incorporating the word rapid into the title for the same.

Yeah. Rapid prototyping. We're talking about rapid, rapid enrollment. I like that. I've never actually heard. I mean, clearly the idea of focusing on, you know, enrollment is, you know, that's important. But I like, I like to kind of the way you describe that, right? Like, you know, having a plan for rapid enrollment is ideal.

I like that. I like the way you describe that. Let's talk a little bit about something that's probably on a very similar note, kind of as Ray, clinical, kind of the next big one, you know, reimbursement, insurance coverage and reimbursement. So with respect to, like, Aaron's technology, was there an existing, or is there an existing code in place? for your technology and then whether you know regardless of how you answer that i'm curious as to how your approach when you think about designing and developing you know med tech med tech devices that like could be really great but the path to you know a cpt code or insurance coverage reimbursement is just

going to be too big a hill to climb so curious to get your kind of your your opinion on on this topic of insurance coverage and reimbursement right yeah no exactly what you said is um it's it can be very expensive and time-consuming to get a new code, and it will be. And that's what we are doing at Aaron right now is we're going for new codes. And there are existing codes, and so it's kind of a dual strategy. But if you're going for a new code, you have to have a very good plan and really understand what you need to do that and really have the capital to be able to do that. So, yeah, it's always best to have an existing well-reimbursed code. I think that's obvious, but it's definitely doable to build a successful company while going for a new code.

Yeah, I've got two follow-up questions, but one is actually regarding cash pay, and I'm curious to kind of get your take, considering all of your experience at Zilteak with Cool Sculpting. But before we go there, when it comes to maybe the need to establish a new code, I recently had interviewed Mike Koojack with Francis Medical and then Sean Sain with with Companion Medical, which recently sold to Medtronic. But they both hinted at this idea of like when it comes to insurance coverage reimbursement, you got to start early and really start to establish relationships with payers.

So is that been kind of your experience as well? Is like, do you start that process and really try to engage with the payers pretty early? Yeah, exactly what they said, because you're going. It's really the biggest, unless it's pure self-pay like cool sculpting, you know, you're going to encounter both coding and payment issues, you know. And so working with the academies to plan for new codes and then working with the payers for their reimbursement decisions, you know, you definitely need to need a plan for that. and even, you know, have, you know, eventually we actually have someone in-house now who's,

who's, that's their sole job is to work on that. Got it. Okay. Cool. So what I'm hearing is like it, just, just, you're kind of echoing the sentiment from some those other other folks is like it needs to be, it needs to be a focus for sure. If it's not, it's, it's going to be a problem. Right, right.

Yeah, you know, it's a, it's a, you want, the physicians are. want the best for their patients. But it's a sad reality that, you know, patients in general don't pay out of pocket for anything other than aesthetics. And so, you know, it's just the way our system is, I guess, what people are used to and how it's designed. I don't know if that's going to change. It seems like, I mean, who knows how quickly that will change, but definitely seems like

there's a there's an under, sort of there's an undercurrent of people willing to pay cash to be a little bit more proactive about their health. But on that note, like, let's, let's talk, like, maybe a few minutes around your experiences with Celtic and cool sculpting. When you think about kind of like the cash pay environment of like the world, of the world of aesthetics, do you kind of think that if you could operate in that world all day, that would be so much easier or like, how do you, how do you balance kind of those two kind of potential pathways for, and I'm really kind of referring to to MedTech folks that are kind of maybe maybe thinking about like going all in on this cash pay route and they think they can maybe pull it off like what's your general general kind of like

advice for for those folks yeah I mean so it's definitely the case that cash pay is is a pleasure when you've been you know when you come from this world of coding and reimbursement and payment so it is great and there's in and in a field like aesthetics. The physicians are rapid adopters because they, I guess, you know, first of all, want to have the build a market their practices as having the best latest technology, and to bring patients in the door and give them an effective solution to their issues and then also have that patient to eventually, you know, as they age and need other. procedures, you know, have that patient in the practice. So there's a lot of reasons why

aesthetic physicians are going to be rapid adopters and willing to pay for new technology. And, yeah, and patients want, you know, will, are, have proven to pay for, for beauty. So that's, that's not a big surprise. I guess on the other side, it is quite, you know, very competitive. And, you know, there will be new technologies coming, you know, down the pike. And so I guess it's, it's, there's less, yeah, there's just always going to be the newest thing that, you know, you're competing against. So it's, you can grow to a certain point very quickly. And then I think it's difficult to, uh, to hang on to that, that lead position forever.

Sure. Yeah. That's a good, that's a good thought. Just know, knowing that. that, you know, there's kind of that sort of cuts both ways, right, in terms of clinicians, aesthetic clinicians rapidly adopting technology, but it also means they're willing to adopt other technology pretty rapidly as well. So, yeah, creating a lot of competition in the meantime.

And yeah, I mean, we could probably talk for, for, I have a whole other interview just on kind of this, this whole cash pay thing. I mean, I certainly, you know, over the past four or five years with Juve, you know, commercializing a cash pay kind of over-the-counter, you know, class two device, you know, have a lot of stories to tell about, you know, consumers' willingness to pay a lot of money, you know, for their health. So I definitely think there's a trend there for sure. We'll just see how quickly that unfolds over time. But I know we're a meeting into our time. So I want to kind of ask you a few other questions before we get to the rapid fire kind of portion of the interview.

So this next one I think you'll is probably maybe of particular interest from my perspective is kind of this concept of investing. And we touched a little bit, right, about around early stage investing. But considering you have Scott sat on both sides of the table, right, as a venture investor and then as a very successful like, you know, startup founder time and time again, what's your general advice for, you know, MedTech founders that are in those early stages? And I kind of want to focus more on the early stages versus the later stages. But in that kind of, you know, pre-seed, seed, maybe series A, and there's going to probably be some variability in terms of their approaches at each of those stages. But like what advice would you give to most people that are in those early formative years with their idea or their company?

So I guess I'll start off at going what you've said, which is that that is the difficult money to raise. So in MedTech, raising a seed round especially is very difficult. And so I've talked a lot about ringing out risk, but that's where you really have to, I guess it's most important. You need to be able to tell these seed investors, you need to be able to convince them in this early stage that this is an idea that brings out the risk in all the areas that they're looking for.

So it has a very large market. it has a straightforward regulatory and clinical plan, and that is going to be safe and work. You know, so however you can do it, that's what you need to do. So that's what I talk about going to the butcher, going to Home Depot, you know, I mean, just whatever you can do to bring out that risk. One mistake I see when first time founders go to raise their seed round is they're not confident enough. they, you know, what investors are looking for is investing with the world expert in this field. And so you really need to know your stuff and be confident that you know your stuff.

You know, and so you don't have to know the answer to every question that is being asked, but you have to know the question is coming and how to answer it. So that's, it's talking to a lot of people before, you know, before you're, you know, and whether it's just going, you know, to pitch your idea a million times or doing, you know, run-throughs and however you do it, but you talk to as many people as you can and understand the questions that investors are going to ask and either give them good answers or explain why you don't have the answer to it, but here's how you're going to find out. So I guess those are the two main things. Yeah, that's great advice. One other kind of quick follow-up,

question on this kind of the seat stage fundraising kind of topic, if you will. I recently had Renee Ryan on the show too with she's now running Cala Health, but is also sat on both sides at the table, right? Yeah, yeah. We've been on a board, at least one board together. Yeah, yeah. I mean, I don't know her obviously as well as you do, but she, she was, she provided some really, really fun answers to a lot of these same topics that we're talking about. But she made a really interesting comment around dilution. She said, like, I see this over and over again, like, so many founders just get cut up on how much they're being diluted. And she said, you just can't, like, you can't get, you can't get stuck on that. You need to be focused on who's backing you

and the value at that they bring to the table. And so on that note, I'm presuming you probably agree with all or most of that. But like, what should early stage founders expect in terms of dilution, right, at those, you know, whether seed or maybe, maybe we'll just start with seed round. So if I've got an idea that's maybe I even have a prototype of it, what is typical dilution, you know, from your perspective at that seed stage? It's just too hard to give any kind of general answer to that except to say it's going to be, you know, it's, there's going to be a lot of dilution over time. And it's not just the first round. It's overall that you really have to think about because, you know, you. You know, if you can get, if you get diluted in the first round, but that money takes you to higher valuations for future rounds, you might be in much better shape than if you, you know, if, let's say, things don't go well or you didn't meet the endpoints that you need to raise money at a higher valuation.

What really hurts, I guess, are down rounds. So the way that, you know, most documents are worded is if there's a down round, you know, the founders get extra deletion, basically. And that really hurts. So what really hurts is having to raise more money doing extra rounds, having to face a down round. So I agree, you know, what Renee said is. is right. If you can get the right investors that are going to help you meet your, you know, your goals for to raise money at higher valuation, that's going to be worth a lot to you.

That's great to hear your perspective on that. I want to transition to the rapid fire questions, but anything, any last things you want to say about, about Aaron Medical? Like, what, what are you most excited about? Like, you know, as you kind of see the, in terms of what's ahead for the, for the company over the next few years? Well, I think, um, The platform, this temperature-controlled radio frequency can do a lot in the nasal passage. It's basically the first non-ablative technology that can treat in the nasal passage. So there's more that we can do with the platform. But I'm excited.

When I see a physician who's used it a lot and sees their patient coming back with good outcomes, they start to look at it differently and look at it as, boy, I can really, you know, this is really a first-line therapy for nasal obstruction or for rhinitis. And it's not, you know, something to be used if you can't do surgery on a patient. It's something, you know, that's first line. And that's what we're seeing now. So I'm really excited about that. That's cool. That's great to hear.

And I'm assuming you probably have people that are interested in learning more about what you're doing. Just go to the website, Aaronmedical.com, which I'll link to in the show notes, but that's A-E-R-I-N-Midical.com. Yes. Hey, everyone. If you're looking for a contract manufacturer that specializes in minimally invasive interventional devices, you need to consider switchback medical. Here's why. First, their world-class engineering team has deep domain expertise in the endovascular space. Think of pretty much any interventional device and a switchback engineer was probably involved in its creation.

I can't think of another R&D partner with the sheer amount of knowledge and experience they have in the vascular arena. Switchback can be your single source solution for all your contract design and manufacturing needs. Second, Switchback recently launched Biosim Innovations, a full-on biosimulation lab that uses human and animal models, as well as cell, tissue, and organ cultures. It's the perfect lab for physician training, pre-clinical model development, and device testing. Switchback Biosim innovations provides a phenomenal sandbox environment for scientists, engineers, and physicians to innovate together. Demand is incredibly high for an experienced design and manufacturing partner like Switchback Medical, but for the Medsider community, Switchback is offering

to expedite your quote to the top of the stack. Just visit Medsiderradio.com forward slash switchback. There you'll find the best ways to get in touch with me, and I'll personally provide an intro. Again, that's medsiderradio.com forge slash switchback. Okay, let's get back to the rest of the conversation. Well, let's use these last few minutes, if you're okay, Scott, to just kind of run through some rapid fire questions. Feel free to respond with rapid fire answers,

keeping in mind with this rapid theme that we're having this conversation. Or if you want to expound, don't hesitate either. But let's start with the first one. What is the most important piece of advice you'd give to someone that is starting their entrepreneurial journey. And you can maybe, you know, tweak that to someone in MedTac or just, you know, like an entrepreneurial journey in general. Well, number one is to keep your personal burn rate low

so that you don't have to be up late at night worrying about where your next meal is coming from or how are you going to pay the rent. So keep that low until you've made it. That's great. Love it. It's so practical. What influential books, podcasts, or any other resources have been most helpful to you along your entrepreneurial journey?

The one I go back to a lot, Emerson's essay on self-reliance, when I first read, he talks about like how to listen to your inner voice, how to take your ideas seriously and drown out the doubts, the doubters that you're going to hear. I love that essay. I also like reading about people who've gone through difficult times and came out, you know, the other side. So like Abraham Lincoln is my favorite. There's a great book called Team of Rivals that I think is really inspiring. All right. I was just jotting that down, Team of Rifles. I have not heard of that.

And then Emerson's essay, how do you spell Emerson just for those kind of listening in and not, don't have time to check the show? I mean, Edmond, E-M-R-S-O-N. Ralph Waldo Emerson. Oh, okay. Okay. Yeah, I must, yeah, I have maybe my residual New York accent. Very good. I think most people are at least familiar with Emerson now that you put them in context here.

Okay, cool. If you had to, let's get to the second, the last question here is if you had to teach a class in one thing, what would that subject or topic be? If I could teach it on anything, I would probably teach something. the history of science, I really find that fascinating how Einstein came up with his ideas or, you know, just how the great discoveries were made. Ah, great. Love that. And then last one, starting over, maybe not in your mid-20s because, right, you were still in,

you were still probably mid-school at the time. Let's maybe start in your late 20s, maybe early 30s. Knowing everything you know now, would you do anything differently? Not really. First of all, if you watch enough Star Trek, you know you don't mess with temporal anomalies. So something's going to go wrong if you change things. But I'm pretty happy with the way things are now. I guess I would probably not stress so much over everything. You know, starting companies can be quite an up and down, you know, a thing to do. I think that's something that people have to learn over time is to write out those inevitable highs and lows that come with this, you know, job. So I would teach myself that and avoid, like I said, some sleepless nights. Got it.

That's great advice. And I guess I said the last question, but on that note, let me add one more. I know you've got, you know, it sounds like you've got some kids. I'm not sure how old they are. but what's next for you? Like after Aaron, I mean, it sounds like you guys are doing some really cool stuff. I mean, is there another startup kind of in the belt?

Or are you going to kind of maybe go back to investing? No, no, I want to, yeah, I want to do. I think I'll just keep doing startups until they don't let me anymore. Yeah, no, I have, yeah, I want to do another startup after, you know, I see Aaron off on its. next adventure. No, that's great. That's great.

I love it. Well, Scott, I can't thank you enough for spending an hour, you know, with the, with the medsider community here. Your background is obviously incredibly impressive, but I love, I love kind of you're just down-to-earth, genuine approach to, you know, a lot of questions that a lot of other startup folks have, you know, in the, in our audience. So I can't thank you enough for coming on the, on the show. Oh, it was a great pleasure.

Really nice speaking with you. Yeah, and I'll have you hold on the line real quick. But just to recap the show here, guys, thanks again for your listening to attention. If you want the show notes to this particular episode, just go to Medsider.com. While you're there, if you haven't already subscribed to our email newsletter, sign up, it's completely free. And that way you'll know when the next interview goes live. And we certainly don't, won't spam you at all. In fact, the only times you'll hear from us is when that next conversation goes live.

So thanks for your listening attention. And until the next episode of Medsider Radio, everyone, take care. You know,