Medsider: Learn from Medtech and Healthtech Founders and CEOs - Identifying and Mitigating Key Risk Factors in Medtech Startups: Interview with Adona Medical CEO Brian Fahey

Episode Date: September 11, 2024

In this episode of Medsider Radio, we had an insightful chat with Brian Fahey, CEO of Adona Medical, which is a Shifamed-portfolio company. The Adona Interatrial Shunt is a smart implant designed to enable individualized management of heart failure. Before Adona, Brian founded a critical care company, Niveus Medical. He also spent time at J&J Innovation, specializing in drug-device products for oncology, and contributed to the leadership team at Arrinex, a neuromodulation company in the ENT space. An alumnus of the Stanford Biodesign Innovation Program, Brian holds a Ph.D. from Duke University.In this interview, Brian talks about the importance of identifying and mitigating medtech’s three major risk factors, how to assess ideas strategically, and how to approach investors and potential M&A transactions. 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 latest Medsider Mentors Volume VI. 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 Brian Fahey.

But my thoughts are when you're trying to tackle risk in a startup, you want to tackle risks that unlock your panel forward. And what I mean by that is understand where your blockers are. And oftentimes the blockers are money and getting investment and they're willing to, like an ability to go forward to carry, right, especially in this environment. So if that is the pace for your particular startup, understand your investor sensitivities. You know, what are they concerned about? and make sure that early development is geared towards mitigating those types of risks to optimize

their chances to go forward. 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 unpack 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 Brian Fahey, CEO of Adana Medical, a chief of med portfolio company he co-founded. Before Adana, Brian co-founded another company in the critical

care space, Nevious Medical. He also spent time at J&J Innovation, specializing in drug device products for oncology and contributed to the leadership team at Aernex, a neuromodulation startup in the ENT space. An alumnus of the Stanford Biode Design Innovation Program, Brian holds a PhD from Duke University. Here are few the key things that we discussed in this conversation. First, there are three major risk factors in MedTech, product market fit, technical feasibility, and clinical validation. When assessing an idea, the first thing to do is to try to talk yourself out of it. Once you reach a point where you can't argue any further, you may have something solid on your hands. From there, your goal should be to identify the areas with the highest risk factors and those that are quickest to mitigate.

Second, pioneering innovations can be substantially rewarding, but the trade-off is they often demand longer, more complex clinical trials. Mitigate clinical risk by studying the pathways of predicate technologies to refine endpoints, patient populations, and more. True disruption requires a product that's not just better, but significantly transformational. Third, be selective in fundraising. Consider your sector, stage, and the size of your round, you're after in order to focus your energy on your best prospects. Transparency and consistent communication, build trust and enhance your brand in both fundraising and M&A processes. Before we jump into this episode, I wanted to let you know that the latest edition of MedSider Mentors is now live. We just published Volume 6, which summarizes the key

learnings from the most popular interviews over the last several months with incredible entrepreneurs like Dan Rose, former CEO of Limflow, Dr. Stephen Michelson, founder of Ferrapulse, and current CEO of field medical, 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 ones. But there are so many valuable lessons you can pick up from the founders and CEOs that join a 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. To check out the latest volume, 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 library of interviews dating back to 2010. You'll also be able to see all of our playbooks, which are thematically handpicked collections of the most insightful interviews covering topics like capital fundraising, early stage development, regulatory challenges, reimbursement, M&A, and much more. And last, considering that fundraising can be one of the most daunting tasks for any startup, we curated a database of over 700 DC 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. All right. Without further ado, let's jump right into the interview. All right, Brian, welcome to MedSider Radio. appreciate you going on. Yeah, thanks. Really happy to be. Yeah, I enjoy reading your LinkedIn posts every

now and then. So it's fun to finally have a conversation. It's loosely following Adana's story for a couple years now. So looking forward to this conversation. I hope the audience finds it, finds it valuable as well. So with that said, I recorded a very brief bio at the outset of this interview. But to start there, if you can give us sort of an elevator pitch and maybe a couple minutes around your professional background leading up to starting the company, let's start there. Yeah, sure. It's always a funny journey, right? Because it never. takes that linear path that we all think that we're going to have when we're younger and high-eyed in our early 20s or whatever. But I was an engineer by training, went to school for engineering,

ended up getting a PhD in Elkestone stuff down to Duke. I thought I wanted to be a professor for a long time. And about halfway through getting a PhD had that crisis where I just became very disillusioned with academia as an institution, not that it's a bad path. It just wasn't for me. I mean, had to find whatever that new path was going to be. By just chance, I happened to see I think it was like an email advertisement for the fellowship of Stanford at Biodesign. I applied there, took a whim on it, and came out to interview. We're lucky enough to get to that stage. And I remember this is so clearly, like in the first 10 minutes of the Stanford

Biodesign introduction from Paul Yogg, I just knew exactly this is what I want to do. And then I had another panic attack because I wasn't prepared enough for the interview process. But long start short, I was lucky enough to be accepted into that fellowship, spent a year, about Mentech innovation, bench to bedside technologies, all the things that I think really resonated with me about how to make a patient impact maybe five to seven years, not 15 to 20 years, which is more the norm for basic science that you see in academics.

So complete that fellowship, spent most of the next decade after that running a startup that founded. Critical Care Space, we took that from basically ideas in a white board all the way through early commercialization I had about 20 hospital paid customers throughout the U.S. Ended up that technology tied out with being strategic, which was great. I spent a few years after that doing a few other things with some other startups

that we'd really interesting, saw some other emanating processes that get to be part of peripherally. Did some work at JJ Innovation, VARC innovation through the lens of a big company, strategy, business development, etc. And then ultimately ended up collaborating with someone I had known about 10 years earlier. Amr-Aar Salahier, who is the CEO of a group called Chief Met. I came in as an executive residence trying to figure out, hey, what should the next Shefmet portfolio company be? That was my mandate, and we ended up coming out with the ideas that became Madonna,

Flash Forge now and stick it around running the company. So that's the whirlwind journey. The cliff notes as fast as I can version, but that's my background. No, that's a great. That's a great overview. And the attempt is set the state for the rest of the discussion with the goal of not learning about insights that you've picked up along the way, but also what you're building at Adana. So we're recording this in mid-2020. I think you started, it looks like, based on our research, you started Adana, kind of Q4-ish time frame of 19.

So almost five years, about a half a decade in the making now, give us a sense for kind of what you're building and then maybe touch on where the company's at from a stage perspective. Yeah, so at Adana, we're building essentially hard failure platforms. And as I mentioned, I was there at the very beginning. I was employee zero. I was working on Adonna even before we knew what Adana was. And that's by design. In that early stage, we had all sorts of ideas. We had some good ideas.

We had some good ideas. We had some good ideas that I thought were great, and the physicians hated. It was very humbly. But it's a whole, it's a process. You change your mind a lot. But what actually helped me gravitate towards Adon is I thought we had an opportunity to be disruptive in actually two separate third. classes for art filler, right? And then I also thought beyond that, to get a step further,

you could possibly integrate these two technologies and ways that had never been done before. And by doing that, you know, it's the type of thing where the whole is greater than the sum of the parts, right? You have that synergistic relationship between these two types of technologies. One that's more diagnostic and one that's more therapeutic and how they might augment each other's functionality and unlock things that you could never do before in theory. That was the idea. And so early on, so the two classes of products were inter-HO shanti, which we didn't invent, we didn't come up with that basic idea. We just thought that we had some ideas that possibly could make it more advanced and more

patient-specific individualized. And then remote pressure monitor, hemodemic monitoring, which, again, we didn't invent that. That's a pretty robust, proven technology at least at this point. Five years ago, I think there were a lot more to be. But now we just got a second FDA approval from a second company to do this. It was just announced for the big acquisition. There was announced last week. And there's a lot going on there in that space, too.

And we thought that we could make a best in class version of that and then combining those two technologies. So early on, we asked about 2019, what was that? It was like there was a lot of technical risks of there wasn't a lot of product market fit risk. There was minimal clinical risk, but nothing's pretty. And so if you're leaving that all the table, you're shifting those risks to a big technical lift. But that was something we're really comfortable with because I was an engineer by training. I collaborated with a lot of former engineers that are now business type folks. And we felt

we got our hands on it. We understood what the risk profile was. And we thought that we could recruit a team of very elite innovators and gifted engineers. And our mission was like, hey, we think we could do something that's really impactful for patients. All we have to do is figure out two or three things that no one in the world has ever figured out before. And it sounds really big. And it was ambitious, but early on, it was, can we do this? Can we even build these things? Can we find a way to make it work? And if so, could we make it practical or cost effective or reasonable, whatever? All the checklists that you have to go through once you have a solution, is it a valuable solution? And then over time, we were able to prove those things that we're working. We were able to

validate that, hey, we can design it, we can build these sorts of things. We can do some of the testing, all that seems like it's panning out. And now we're able to, we're able to validate that. And now, we're at the precipice of our initial human use, which is coming up in the next period of time, several months, a quarter or two. Every startup, the timeline has some error bars on it. But it's in our, it's in our vision. We can see this. And that's the exciting time for us, because we work really hard. A lot of people have made a lot of really important contributions to this sort of thing. And now we're at the point where people are actually going to start to benefit from it. And there's nothing more exciting in MedTech than to put your innovations in the hands of physicians

and actually help people. That's why we're all doing this. Yep, no doubt. I'm glad I'd be touched on those three things, which I think we'll probably dig into a little bit more in more detail throughout the rest of the conversation. But those three risks that you call that, clinical risk, technical risk, and product market risk.

There's other risks associated with building a startup and MetTech, as we all know, but those are three of the largest. And so I think that's just a healthy framework for those listening that are maybe thinking of taking a swing on an idea. This is the name of the game of startups is how to minimize risk, right? Especially as you're raising capital. And I think that that framework is really solid, simple, straightforward. You're staring down three kind of risk pillars, if you will,

one of which was the biggest one, which is technical. With that said, you mentioned the stage. Again, we're recording this mid-20204. Hopefully, it sounds like maybe you're close to being in patients, maybe before the end of the year, maybe early next year. As you mentioned, all startups have just inflex in those schedules for sure. And if you're interested in learning a little bit more about the technology, it's at dawn-med.com.

It's ad-o-o-n-med.com. on Medsider, but it's A-D-O-N-A-M-D-D-com. A-D-O-N-A-M-D-com. And one of the quick question before we step into the time machine and go back and then a little bit more about things you picked up along your journey. When heart failure specifically, I'm sure you were evaluating other sort of therapeutic arenas, if you will.

Why heart failure? Was this something that resonates with you personally? Was it, did you have a fair amount of experience in this space? Why did you decide to build in this category? Yeah, it's a great question. The heart failure is very personal to me. My grandfather had heart failure. He suffered for a long time.

And ultimately is what led to his passing. But that wasn't really the only reason. That was just a nice to have motivator behind it. I think what attracted me to heart failure specifically is a couple of things. One is this certainly falls within the umbrella of cardiology. In cardiology, I think is an interesting space in METAC to be. And again, I've worked in credit care. I've worked in E&T.

I've worked in radiology, orthopedics. I've done some work in oncology and drug device combination products. And then this is my first time in cardiology. But one thing that's really interesting about cardiology is that there are a very large number of global strategic players that are still competing against one another for any new type of therapy. And you don't see that, for example, like an E&T or gastroenterology or other sectors where it's more consolidated. And so cardiology is interesting because if you have something really disruptive and compelling, you have a greater likelihood that you can create a competitive bidding

process or an auction at the tail end. That can help push exits to be a little bit more lucrative, but also give you flexibility, I think, to work with the right partners that align with your vision and not just work with the partners that are out there. So cardiology in general is attractive means it obviously is attractive to lots of people, right? But that's one of the reasons. But heart failure as a subsector, I think it's more of that nascent sector that this has typically been a medical management pharmaceutical domain, and it still largely is. But if you look at these patients, there's great therapies early on in heart failure when the patients really aren't than symptomatic. We have what we call end stage or destination therapies like that and transplant that will save their patient's life at the very end. And in the middle, there's like the whole bunch of nothing, right?

And these patients continue to get worse. They continue to deteriorate. Yeah, pharmaceuticals are getting slightly better, but patients don't like to take drugs. And compliance is terrible. And some of these patients are on something called hyper-phaliparmacy, that they're taking like a dozen drugs or something like that every day or more or whatever. And even those drugs, so many patients become refractory to them.

They're not even working so well anymore. And so you're beyond the steps where, like, see around-and-type devices are helping patients, and then just waiting until you get sick enough to get back. And it's not like an existence that anybody would want for their loved ones. And I thought that there's possibly a lot of opportunities there. And again, I'm not this savant that just saw this opportunity that no one has stayed. There's a lot of investment, both in the Mentec space as well as the pharmaceutical space, to try to put more stones or stepping stones in that gap, right,

and whatever our metaphor is. But to me, it was a big opportunity. And there's so many patients that these markets are just, you shift gears away from the patient perspective into, is this a good business? these market sizes are just enormous, even by METTEC standards. If you got something that was really great at serving 10% of the market, these are still just huge opportunities. And of course, I saw a path that we could get more than 10% of the market and everything else.

And so to me, it's just all of the stars aligned around it. Yes, it had personal meaningfulness to me as a individual, as a family member. I thought it could make a big impact on society, which is something that I think all of us aspire to do with our, careers. The business aspects, the market lined up, and then the exit potential for partners was also there. And you start looking at all these various aspects and you're like, this seems like a good space. Now let's see where to reclaim that space. And that's always the hard part, right? It's like where do you have an opportunity? Yeah. That's a great. That's a great to kind of

summary. And these journeys are so long in startups and you're building in med tech anyway. They're often really, they can be really rewarding, right? Not just from an economic standpoint, but from a technology and patient perspective, too. But if the ideal scenario is, what you're working on, checks a lot of those boxes that you mentioned, right? Because these are, this is not, these are quick flips usually, right? These are five, seven, 10 year journeys, it's a long time. So with that said, let's go. Let's step in the old med site or time machine is like to call it and cover some cross-functional topics. One of which I think is super pertinent considering your engineering background is early stage development, right? This is

some of the hardest stuff to do with typically pretty limited capital, right, in those early phases. Don is a chief of med company, so you around a lot of like other early stage companies as well. So when you think about that phase of a MedTech startup, where do you think most founders, CEOs go wrong and try to manage that early stage iteration with pretty limited resources? Yeah, a mistake I see frequently is that people try, I think, to tackle the wrong types of risks. And obviously, it's subjective. You could ask my assessment or something, and ask 10 other people and get VAT or whatever. But my thoughts are, When you're trying to tackle risk in a startup, you want to tackle risks that unlock your panel forward.

And what I mean by that is understand where your blockers are. And oftentimes the blockers are money and getting investing and they're willing to, like an ability to go forward to carry them, especially in this environment. And so if that is the case for your particular startup, understand your investor sensitivities. What are they concerned about? And make sure that early development is geared towards mitigating those types of risks to optimize their chances to go forward. And because of that, startups are often non-linear. So if you're a very linear thinker, you've got to throw that content into trash and be ready to adapt. And so a very specific risk I see oftentimes is people jump straight to a prototype.

And great, that's helpful. and you will reduce technical risk out the gate. I'm a technical founder. I like to think, let's all do technical. But investors often don't worry about that sort of thing, right? They're worried about market risk. They're worried about pricing or reimbursement or what is the huge hurdle ahead of you. Very few investors, if you check the rest of the boxes, are going to say, oh, I don't think you can build it.

We put a man on the moon with the power or competing power of our cell phone, right? Like, humanity with the right, have the ability to feel. figure things out. And so I'd always urge people to try to understand what box you're checking. You build a prototype and you spent $100,000 on that of critical money. Okay, that's important. But to who? To you or to them? And listen, it's important. You as a founder. If you're not sure you can build it, that's a great box to check also because you need to convince yourself that you're in it for that five, seven, 10-year journey that you would just describe. Whatever the risks are, I'd suggest working to

turn it over those risks. The highest risks and the quickest risk to mitigate are where I would spend most of my time. And sometimes that is product development. Sometimes that is, let me build the crappiest prototype I can think about and show up to physicians and understand yeah, I would use this or whatever.

So it really, it's a hard question to answer concretely. But I do think that oftentimes people aren't mitigating the right risks, right? And that's how I always try to press on people, be like, is this the biggest value, even though it's the next logical step? It might make more sense to jump-free steps and they work backwards. That risk you highlighted around, I think the way you describe it as the need to be able to move on, right, to get further, to advance the football down the field, if you will.

That's such an important point, right? Because it speaks to the necessity of engaging with investors as early as possible. Maybe not in a traditional kind of pitch format per se, but the more you engage early on, the more you'll learn about what they perceive as sensitivities and being able to fund a company like this. And that's so crucial because almost every single person that's listening to this or is working on a met tech startup is working on an idea that's likely going to need external funding. The chances that will are pretty low. So understanding those areas of concern right from outside investors is really crucial. So I'm glad you touch on that. And let's use that as a segue to financing in general, right? You've, I think, raised four rounds maybe of financing. If our notes,

my notes are correct here for Adana. And then you obviously had your previous experience raising for, is it Nievous? You might pronounce that, right? Nibius. Yeah, Nibis, but yes. We joked around about how the best pronunciation for Adana, kind of the outside of this conversation, hit the record button. So your experience at Nivius, then spent a couple years at J&JDC, you're a gate consultant with other startups along the way, et cetera. So you have, I'm sure, some pretty good thoughts around fundraising. So when you think about what you know now, maybe versus five, ten years ago when you used to pitch at Pittsburgh investors. Are there a couple key insights, key learnings that you picked up along the way that really inform how your approach

today? Sure. And again, there's no hard science to, I think, any of this, right? And there are different perspectives. And there's more than one way to get to your final endpoint. One thing that I think is really important that, again, I see others, some of the other. sometimes get this wrong, or at least in my opinion, get it wrong, is the shocking approach where we're just going to go talk to everybody. And that's, I think, it can be a waste of people's time. And I think, more importantly, it's not just time, because time is a founder. You can say, oh, life time is infinite. But really it's about focusing your time to be best prepared for your best shot in. Right. And so you should be able to understand, right, what

sector am I getting? What stage am I doing? What size round am I trying to get? what types of participants usually participate in a syndicate of that size or that stage or that sector. And narrow down your list to the people that you think are most likely to invest, right? And I think that's where you're going to get the best correction. That's where you're going to get the best bang for your buck, right? And if you're raising a series A and you're going to a late stage investor that possibly is investing or will invest in a header, All you're going to do is tell them all your great thoughts that who knows where they're going to end up. They're not suggesting that it's always people share the information, but we also know that at some level, this can happen.

And so talk to the people that you think are good things would be my first thing. And then to, again, understand their sensitivities, right? Don't be afraid to ask questions back. I don't think it's a sign of weakness or a sign of vulnerability to prevent that you don't have all the answers, right? If someone asks you a question, and it's a risk for the company, Oftentimes I see people try to say, oh, it's on a risk because of X, Y, and Z. And maybe, I don't know. I think oftentimes, like, you just say, yeah, that's a risk.

And if you're investing in this company, you're going to have to get comfortable with that risk and our strategy to mitigate it together as partners. And I think that can go a long way that when you're suggesting to your investors that even if you got a board seat, you have a voice. And we're going to work together as a team to sort these things out because your earliest investors, those are your partners for, again, 10 years or something, right? You need to make sure that you can go through adversity together. They can have a hard conversation together where you might show up and you disagree

about an idea, but we're talking about ideas, not people. It's not a person, right? And how do we sort through that? And I also think, especially for young entrepreneurs, it also shows that you're coachable, which I know is so important from the investor's standpoint. But you don't think you get it all figured out, right? that you're going in and you're receptive to ideas. And even if you don't agree with those ideas, you'll entertain them and hear people out.

And maybe you don't completely pivot what you do, but you'll take that 15% and start to align these journeys. Because oftentimes the investors have seen way more than us. They're seeing third companies at once succeed and fail and flounder and thrive and everything in between. And raising money, it's about targeting. It's about showing that you're going to be a good partner. I think it's about being honest. Being able to say, I don't know, I think is okay. And establishing that credibility.

One thing that I like to do oftentimes when it's really early on before it's something you get brought up is go talk to investors that are never going to write to a check because they don't match those boxes before. But just say, this is under base, but I want you to look at this like you're writing a check, right? You can't just ask for advice because no one wants to say anything negative to anybody, right? it's a great idea until you ask them to open their checkbook and they don't want to do it, right? And tell them what are your criticisms, giving all the harsh feedback and try to hear all the hard

feedback there in a setting where it doesn't matter so that you can be better prepared to hear it in a setting that it doesn't matter in the future. And I think that can be really important to just invite people to trash your idea. And once you've gotten to the point where you feel like you've got a great defense or a strategy for anything that someone's going to grow at you, that's when you know you're right. Yeah, that's good. That's a nice little practical tip is practice, practice that presentation in a low-risk environment where we can get really smart feedback, but it's not, does it come with a significant cost? But hearing you describe some of your thoughts on fundraising. It just, it always reminds me of this is a relationship game. And especially maybe more so in the life sciences or my tech specifically, your first pitch oftentimes is not going to result in a check, right? It's going to be this evolution of getting to know various investors over the time and how you run that process. speaks to probably how you may, how that relationship could look, what could look like if that potential party does in fact write a check and support your startup financially. It sounds like

that's been your experience over time too is like the building and the building of those relationships over time has been pretty crucial and getting the type of capital support that's needed. Yeah, absolutely. Listen, I think, and again, what I'm going to say is obvious to people that are seasoned in our industry, but it's, I work with a lot of the fellows from bio design each year. I'm still pretty close to the program. So I have a constant stream of people that are just starting up. And again, I don't pretend to be this wise sage that knows everything, but I've seen a figure too. And what is lost that a lot of young Viovators are first-time CEOs, is that your only goal of the first meeting is to give second meeting. Right? You're not getting

a chat to that first day. So you don't have to say everything, right? You don't have to give them 30 slides. Just show that you're credible. Show that your personal. relatable, show that you have a compelling insight into a problem that is real and then some upside potential. And then you can get into the details another time. If you bore everybody with fine details in the first meeting and excruciating people detail, you're just wasting time spitting your backs. Yeah. No doubt. And just to touch on that, like even with Fastway, which is the company that I run, we received a term sheet that was, I think, maybe 18 months in the making right from initial kind of initial discussions. And so that just for everyone listening,

that gives you an idea of how long sometimes these processes take to really get to know people to support a company at a certain stage. So it takes a long time. And it's never, rarely, rarely do you ever win someone on that first pitch? It's about the kind of the process that you're on. And it's super important and even more so on the M&A side. When you get these companies acquired, listen to a big global company will spend, in real months and months. And they're going to send dozens of people to your site to look at every piece of paperwork, everything that you've done. And that proper due diligence process is lengthy, even for deals that aren't a billion dollars or whenever. It's a lengthy process. And still, at the end of that, they're never going to

find to everything. And they know that and we know that. And so that's why that trust component is so important, right? You have to build that credibility and trust because otherwise you'll never get a deal on because they know they can't find everything. There's always some still. in some closet somewhere lurking that they have to trust us to prospectively flag it for them and then talk about why it's not a problem versus just bury it and they find it in six months and it's a disaster. It's a really good point. 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

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