Medsider: Learn from Medtech and Healthtech Founders and CEOs - Three Hurdles to Medical Device Adoption: Interview with Esperto Medical CEO Aditya Rajagopal

Episode Date: June 29, 2026

In this episode of Medsider Radio, we sat down with Aditya Rajagopal, co-founder and CEO of Esperto Medical.Esperto is a Caltech spin-out utilizing compressed sensing technology with ultrasound to continuously and non-invasively measure blood pressure.Before Esperto, Aditya co-founded ChromaCode, a molecular diagnostics company, and was a researcher at Google[x], where he worked on novel medical imaging methods. Aditya also serves as part-time faculty at Caltech and USC, and holds BS, MS, and PhD degrees in Electrical Engineering from Caltech. In this interview, Aditya discusses why great science doesn’t necessarily make great companies, what it takes to win as a fast-follower in medtech, and how to sequence a platform technology without spreading resources too thin.Before we dive into the discussion, I wanted to mention a few things:First, if you’re into learning from medical device founders and CEOs and want to know when new interviews are live, head over to Medsider.com and sign up for our free newsletter.And if you’re ready to level up your medtech game, you should check out Medsider Courses — 8-week masterclasses covering topics like fundraising, M&A and exit planning, design and development, clinical and regulatory strategy, and commercialization.These courses, featuring hard-earned lessons from elite medtech CEOs, can be purchased individually or come free with our All-Access Pass.If you'd rather read than listen, here's a link to the full interview with Aditya Rajagopal, which includes a link to ScottBot — an AI version of host Scott Nelson trained on every Medsider interview and playbook. Feel free to ask ScottBot any questions you'd like!KEY MOMENTS FROM THE INTERVIEW(02:44) - Aditya’s journey from Caltech and Google to tackling one of medicine's hardest engineering problems at Esperto (05:17) - How Esperto is trying to solve a 50-year-old problem: continuous blood pressure monitoring without an arterial catheter (07:17) - Why Esperto was okay with being a fast-follower in an established market instead of creating a new one (16:12) - "Great science doesn't necessarily make great companies" and other lessons Aditya learned at ChromaCode (24:02) - Three hurdles every medical device must clear before clinicians will actually adopt it (27:44) - How Aditya determines whether a technical problem actually has a "there there" (37:51) - Esperto’s pitch strategy and how it raised from a position of strength (43:18) - What first-time founders often misunderstand about how venture capital actually works

One is the clinical paradigm as it exists today, even if it's the best widget in the world, if it creates friction by eliminating jobs that are necessary, eliminating nurses. It's not going to get adopted. You're going against the grain. Even if it saves costs, there is a human capital cost to that new device, and it's going to result in a lot of friction. Welcome to Medsider, where you can learn from, 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, in this episode of Medsider, we sat down with Aditya Rajagopal, co-founder and CEO of Asperto Medical. Esperto is a Caltech spin-out

utilizing compressed sensing technology with ultrasound to continuously and non-invasively measure blood pressure pressure. Before Asperto, Aditya co-founded Chroma Code, a molecular diagnostics company, and was a researcher at Google X, where he worked on novel medical imaging methods. Aditya also serves as part-time faculty at Caltech in USC and holds BSMS and PhD degrees in electrical engineering from Caltech. Here are a few topics we explored in this conversation. First, what does it take to win as a fast follower in MedTech? Second, three reasons why even a clinically superior

technology can struggle to gain adoption. Third, how do you avoid spreading yourself too thin when building a platform technology. And last, what do first-time founders often misunderstand about how VCs make decisions? Before we dive into the full episode, if you're a MedTech founder or CEO preparing to raise capital, you should check out the MedSiter fundraising cohort. This four-week live workshop combines small group sessions with real-time feedback to help you sharpen your investor story, build a targeted investor pipeline, and run a focused fundraising sprint instead of a never-ending slog. Over the month, you'll walk away with an investor-ready narrative in deck, outreach scripts that actually get responses, a refreshed LinkedIn profile, a simple content

plan that keeps you on investors radar, and a repeatable system for running your raise. You can join the waitlist at medsider.com forward slash fundraising cohort. Again, that's medsider.com forward slash fundraising cohort. All right, let's get to the interview. Detail, welcome to Medsider Radio. Appreciate you coming on. Thank you for having me, Scott. Yeah, very much looking forward to this conversation, for sure. I think it'll be fun one. I recorded a very abbreviated bio at the outset of this episode. But let's start there. Give us kind of like the one to two minute, you know, pitch on your journey from undergrad and graduate work at Caltech to Google to start in Chroma Code and now Esperto. I grew up in Southern California. So staying close to

home for school was definitely in my parents' dream and wasn't mine. But somehow life happened and I stayed close. And it was the right home for me because it gave me a lot of confidence to build things with my hands when I was there. So as an engineer, it was kind of kind of a playground. And the class of problems I started to work on because of exposure to people like my advisor and other classmates was using engineering tools for biology. And the time I spent at Caltech was just at the cusp

of when people were starting to invest a lot of research dollars into understanding neurons and brain functions. I spent a lot of time building tools to understand the behaving brain. And as part of that work in biology, like a bunch of ideas around startups, kind of came to mind. Caltech is a very friendly place for starting companies when you're at school and even as a faculty member. So some of those ideas got turned into companies in the disease

diagnostics segment. And along the way, because of some of my mirror science work, I got introduced to a guy named Andy Conrad, who was the chief science officer of a company called Lab Corp. We got recruited into Google to work on life science projects. So Andy recruited me up to Google to work alongside him in a few of those projects, and I ended up working in the ultrasound segment. And that's kind of where my interest in ultrasound measurement started, and this idea of measuring blood pressure with ultrasound, was like, okay, is this even possible? Kind of germinated at that juncture.

After my stint at Google, I'd raised capital for one of my ideas out of Caltech, and then rest is history. I became more of a business person than an engineer, if you will. That's when I first really started running companies. We're going to spend most of the time talking about, But I think the company you're most focused on as right now, which is Esperto. So I'm on the website right now, esperto.com, is the URL. We'll link to it in the full write-up on MedSider.

But for those that have never heard of what you're doing at Spurto, give us, pretend I'm a middle school student, you know, frame this up in a way that would help me best understand it. If you hold your finger up to your wrist, you can tell your heart rate, just with your pulse, right, that your heart's beating faster, faster. You can feel that thumping right by putting your finger right on your artery. But heart rate and its very related metric, blood pressure, are great indications of how healthy we are and how sick we might become. But blood pressure, unlike heart rate, is extremely difficult to measure without being invasive, without puncturing the artery itself.

So blood pressure cuffs are a great example of a non-invasive tool, but they're not able to measure blood pressure continuously, just once in a while. You know, you squeeze the balloon until you stop your heart rate. And they say, okay, you record that number. And then you let the ear out of the bladder from the blood pressure cuff until that pulse starts again. You say, okay, okay, I'm going to record these two numbers. I'm going to call the first one, the systolic, the higher blood pressure number, the second one, the diastolic, the lower blood pressure number. But that's how they do it in the doctor's office.

When you're really ill, you need to know second by second, beat by beat, how your blood pressure is changing. And the only way you can currently measure that is with a, invasive tool. It's an arterial catheter. It's a little perverse. They basically stick like a straw into your artery, grow out a little bit of blood, and they put a sensor right against that blood that measures the pressure. People for about 50 years have tried to take that measurement that's kind of gruesome and make it much simpler, just like putting a finger on your pulse. The problem is that from a physical perspective, it's an incredibly challenging problem to measure blood pressure without contacting the blood. So it's spirit to medical. We spent about eight years at

Caltech developing the only method. We can prove this actually. We can proveable from physics. The only method you can use to measure blood pressure non-invasively and continuously. That scientific concept has a lot of clinical utility. My co-founder and wife and also fellow faculty member Elena is a physician by training as well. And so her initial insight was, hey, we can use this method to replace this invasive procedure for measuring blood pressure. And so as paramedical was built to take that technique and bring it into the hospital where continuous blood pressure is needed, and then to extend that forward, and take the platform to measure blood pressure and put it just into the strap of your favorite smart watch. So you can have continuous blood pressure

monitoring even on the go. Okay, got it. I was just going to ask you kind of what does this actually look like from a patient's perspective? Is it a wearable? Is it something like a whoop or a Fitbit, right? Is that, is that, that's how you envision, you know, this being utilized? The second product definitely will be, it'll be just the strap. Okay. Just the strap. And having it interface to a smart watch is helpful because you can, you can use the smart watches display to deliver the data to the patient. For the hospital device, it's going to be slightly larger, but it's going to be on, it's going to be a brachial cuff. So you get that familiar 120 over 80 blood pressure measurement. And it'll have a battery pack so you can have the patient,

walk around, use the restroom, something they can't do with existing invasive tools and other tools that other companies have brought to market. It'll be wearable in the sense that the patient can walk around with the Esperto device, even in the hospital. Got it. That's super helpful. And is your team pursuing kind of both sort of applications in parallel, right? The more medical application as well as the more consumer style?

Yes, yes, we are. So our view really is both of those opportunities represent different ways. ways to impact patient care. In the hospital, patients that need to be measured continuously with blood pressure sometimes don't have the right tools used because it takes so much time to set up these invasive catheters and there's danger to the patients, especially like pediatric patients, where there's a high probability that there's going to be a complication in putting in a device like that. So for those types of patients, it's necessary to have a tool that's non-invasive but accurate and continuous. And so we feel like we can hit all those three things with the platform we've built.

And the impact in the hospital itself is an extremely interesting company. Dan, kind of put it into perspective. The market opportunity is like 20 billion in recurring revenue a year. And if we wouldn't hit that, we would cleanly be the most valuable med tech company in history. It's like cleanly, right? It only works because the last 100 years, people have developed the clinical utility for measuring blood pressure. It's ubiquitous. Everyone who goes through surgery and they're critically ill patients, and I see if they all get this invasive measurement, so the only thing we're doing is making the invasive measurement non-invasive.

It's hard technically, but the market had already been built. So it's a very easy market to make an impact on commercially. The second one, putting the device into the wrist, technically challenging because you have to miniaturize a whole bunch of components, but that's something that myself and other teammates have done before. In fact, a lot of the work we had done about 15 years ago was in reading and writing of neurons and fruit flies. We were remote controlling them at that point in time.

And so a lot of the skill sets we learned in making electronics really small translate into building a blood pressure device that fits right into the wrist. Okay. The interesting thing about that device is it's actually the world's highest speed ultrasound camera. So our device takes pictures 3,000 times a second. And the amount of compute that's required to pull that off, let alone the ultrasound aspect of it is, it was an astoundingly hard engineering problem.

But now that we've kind of done that work already, putting it into the band of the smart watch, just the band of the smart watch, it's a pretty tractable problem. It takes time and money, but that's something that we're, I think, well equipped to address. And the interest in that second market is that, like Woup or ORA that are trying to provide metrics to, you and I,

humans outside of the hospital, we'll be able to provide that data directly to patients. We want to start with hypertensive patients that are on medications to manage their blood pressure. But more importantly, you can get hospital-grade accuracy on everybody's wrist. And on top of it, you'll have a wonderful camera that can look at other metrics that are just not possible that causes the devices. You'll get the blood flow itself. And why is that important? As you go through different stages of cardiac disease progression, things like calcification on your arteries,

really matters. And it matters on how you dose yourself with medication. It matters on the lifestyle choices you make. And having that information, high quality information, not just in the physician's hands, but in the patient's hands, I think that's going to be the biggest triage for making sure we live longer and live more importantly, more healthier. And there's this whole slew of new things to look at, you know, things that we as a spirit as a small company probably won't do. But what we can do is provide that microscope back to the people so they can look at their own data with those images. And things that we think are interesting as an example are, can we predict strokes before they happen? Probably with this camera system, you can't because you can look at blood flows.

As the, as clots begin to form, you can actually see that with our device and looking at other things like, you know, preeclampsia prediction or fall detection. All of those things are within the scope of possibility with this type of a device and longer term, that has us pretty excited. Not to get too sidetracked, right? But the wrist specifically, is that a function of, look, most people find it easier to wear something like a watch? Or is there something particular about the wrist that allows for, like, your technology,

the camera, right, to see certain things that you otherwise wouldn't if it was in a different anatomical area? That's a great question. So the technology itself works on any artery. In fact, it works on veins. You can measure venous pressure the same way. There's no machine learning or training or anything like that. It's a first principles method that works on non-humans too.

You can take it to your favorite animal and the same principle, same device will work. So there's nothing special about the risk, but patient compliance is really important. A friend of mine ran a company called Omran Healthcare for a long time. Great human, guy named Randy Kellogg. If you haven't met him, I should make the introduction. I love talking to this dude. He's just a great human being. So Omron has is probably the most prolific provider of at-home blood pressure monitoring devices.

They, amongst other companies. But they were the first to build a bespoke smartwatch that has a bladder on the wrist. And so their idea was, okay, it's easy for people to wear. It's got a watch on it. It's a lateral inflate and deflate. You can measure blood pressure. And they found that, you know, over time, people just stop wearing it one or two. They just stopped wearing the device.

So even though they put it into a form factor that was, they thought was convenient, the measurements just didn't get done. On the other hand, at this point in time, everyone wears smartwatch. mainly for the text messages, I think that the notifications are probably more important than any of the reader. So our view was, let's learn the lessons that Randy had to go through a decade ago and what can drive people to wear the device. And that led us to wanting to put the device just into the strap of the smartwatch itself, where there's no friction. And as a consequence, though, we can do some cool things. You know, the reimbursement for a company like a script of medical in providing these devices to people like you and I at home is sufficient. It's pre-established. We didn't do any of that work. So we could as an example provide a new smart watch to a patient every year.

So we can make whatever platform they prefer. And I happen to be a Google guy. The Google in me dies hard. So I love Google's electronics. But my wife loves apples. And so you can pick your favorite platform to incorporate this. type of device. That makes a ton of sense. It'll be fun to see to see, you know, where you go kind of with both arcs, right, of the Esperto story, right? The consumer arc as well as the pure play medical route. Before we kind of jump into the more sort of substantive part of the discussion, give us a sense for where the company's at right now. Are you still very much in the throes of development? Are you in, like studying this in patients yet? Where's Espirito as of, you know, call it mid-2020s here? We've collected a fair number of patient data sets at this point in time.

So what we'll gear up to do the rest of this year into early next is completing our pivotal study. So we'll do some industrial design work streams that will complete at the end of this year, leading into a pivotal study early next year. And the intent is with that pivotal study for regulatory clearance, we should be in a position to sell to hospitals at the end of next year. As we start to transition into commercial entity for the hospital market, we will divert our engineering resources into ramping up product development for the remote patient monitoring and consumer markets.

So we'll start to shift technical focus internally. That's how we're thinking through the company. Okay, got it. That's very helpful. So kind of maybe by the end of 27, that's the goal that you can potentially be, you know, be staring down some early commercial efforts. I think that's very helpful for anyone kind of listening to this after the fact. That's right.

Yeah, exactly. That's exactly right. Very good. Well, that's cool. It's very helpful overview. You've got such an interesting background kind of from technology heavy science now to running multiple companies. So excited to kind of dig into these a few topics in particular. But one of the ones I want to start with was kind of your experience in startups, right?

You've got quite a few years now kind of under your belt. And I know Chroma Code and Esperto both are largely related to kind of this area of biological signaling. And so let's start maybe there. Like when you think about kind of like some of the key lessons learned from Chrome code that you're now pulling into Esperto over the past, call it seven, eight years now. Are there a few that kind of stand out? Absolutely. Maybe hard lessons learned. Mistakes that people were fortunate enough to let me work through at the previous company. Chromacode was a technology seeking a problem when we started it. It was myself and another

Caltech colleague, a guy named Emil Karlo, a brilliant scientist, had developed a mathematical strategy for increasing the amount of information in biological signals. So it's like a biological signal. So as an example, like if you're looking at a fluorescent signature from like a PCR test, like from a COVID test as an example, instead of looking at just one thing, we developed a method where you can get 10 things out of that fluorescent signal. So it was actually fundamental mathematics. It was solved a problem that had been proposed about 100 years ago called the problem of Phoenix sums. I think it was an NRL. The Navy had proposed that problem because they were trying to increase information in ship-to-ship communications with antennas.

But the solution to that problem, when applied to biology is that you get this beautiful increase in the number of things you can measure or set another way, you can measure 10 things in the same effort it takes to measure one thing, you can make things 10 times as cheap as well. So that technology really predated the need for it. So we started that company in 2012, and we started to build products and get them into the market closer to 2020, just when the pandemic was hitting. And so it's interesting that the COVID pandemic really increased the market need for a solution like Chromocodes. But for the first eight years, it was a technology seeking a problem. And now Chromocode's doing well. It's historically has happened in direction about $100 million in cumulative revenue. And it's very laser focused on cancer diagnostics right now.

So if you've heard of some of these cancer companies like Garden Health is one that has a lot of blood, blood-based cancer tests or Grail, which happened, which is started by a friend of mine from Google's guy named Jeff Huber, who might be a great guest, actually. He's a great dude. But companies like that use next generation sequencing, often made by companies like Illumina, to look at a genomic record and translate that into either a prediction in the case of Grail. Like you might have cancer that's developing or a diagnostic in the case of garden health saying, hey, you have cancer, we think you're eligible for these types of drugs. And that type of testing is really useful, but it's expensive. And so the Chormacode strategy now lets you take that same result and get it at a much

cheaper price point. So it's beneficial to patients. It's beneficial to providers because they get the information much faster. And ultimately, it saves everyone a lot of money. That utility, though, wasn't present when we started the business. And this was kind of maybe, in essence, a very important lesson I learned is great science doesn't necessarily make for great companies. You have to have to time the markets well. And to give you a sense in developing the blood pressure technology for Espirito, as an engineer, I was woefully ignorant of the clinical applications. I'm just like, oh, it's going to be super cool. I'm going to do this blood pressure measurement non-invasively. It's all going to work out. But I was very, very fortunate that my co-founder

Elena was a physician and knew exactly what the market needs. was in the hospitals, and we were fortunate that in the hospitals, people had established the need for continuous blood pressure monitoring over 50 years. So companies like Edwards Life Sciences or GE or Phillips really built the clinical utility. And so everyone was using these types of devices already. All we had to do was kind of take it forward for this last mile of making it non-invasive. On the other hand, companies like Omron Healthcare, run by Randy, for many years, and companies like whoop and aura and now maybe Google what they're feeling there. They're starting to really build out the market need for measuring people at home

in a very convenient form factor. So we are kind of dividing the coattails of others in going into the market as a fast follower, but our trick is, hey, we're a best in class device. You won't be able to beat the underlying physics that gets you the right information for blood pressure. And so that for us is a pretty exciting journey. but that clinical need and the market need had been established. And so focusing on solving a problem that needed to be solved

rather than trying to bring the technology to market before the need, I think was one of the fundamental lessons learned in Esperator versus Chromacode, and it's directly translated into how efficient we can be with the capital that we need, capital requirements of the company and the capital we need. And also kind of the step function for the market that we're, we can achieve. Once we bring this to market, it's, you know, in essence, we're going to build a monopoly. And so the ability to do that really comes into play when the market is already established, when there's like a single thing, one small step, but critical step, if you solve that one,

then you can flip the market. A lot of these lining up these advantages only came about because of painful lessons learned on another company where I had to make mistakes and learn how to approach markets a different way. Yeah, but it's so so crucial because in the early days of like idea iteration, right, it's really hard to sometimes let go, right, of an idea that's really promising. You find yourself, you know, thinking about it, right? Maybe there's sleepless nights because you're thinking about this idea, but it simply may not line up, right, with a clear market need, a market opportunity. Timing oftentimes is the piece that sometimes, that often, that doesn't fit, you know, in the equation. So I'm glad you brought that up. And actually, that was one of the next

questions I had for you is because I, and it reminded me when we were drafting kind of notes for this particular interview, reminding me that the conversation I had with Anthony O'Dell, he runs a startup called Echo Point, somewhat loosely related feel, I guess, but he's got a fair amount of experience kind of taking IP out of the, out of academia and kind of like trying to figure out if it's, you know, these ideas could be viable. And he said, one of the things he often looks for is, has this academic at, whether it's Caltech or Stanford or name your academic institution, if they're working on something, have they, one of the things he looks for always is have they actually talk to a clinician? Have they talked to a clinician and actually figured out, like, does this even

work in like in a traditional workflow, right? Is there really, is there a need here? And so that's, that's kind of the thing he looks for like. So when you, when you think about, because you, I imagine you still to the state probably see a lot of ideas, probably have a lot of ideas yourself, right? When you think about whether or not to pursue or go all in on a, on a particular project, are there other things that kind of come to mind, you know, from your perspective? There are, and I can sort of give you my perspective on it. But I think the most important thing for me to keep in mind is my own perspective on anything is quite limited. It is a product of my experience and a product of my training.

So learning from people like you, we're experienced operators in the med tech space, or learning from people like Elena, their experience clinicians, that's requisite. And every time I haven't been humble about that, I've made mistakes. And so I think continuing to take a good perspective from others is necessary for orienting my companies for success and certainly necessary for my own growth. But with that said, I do think in the case of medical devices, there's a few perspectives for a new technology that should be taken into account. One is the clinical paradigm as it exists today, even if it's the best widget in the world. if it creates friction by eliminating jobs that are necessary, like eliminating nurses or doctors, it's not going to get adopted here going against the grain.

Even if it saves costs, there is a human capital cost to that new device, and it's going to result in a lot of friction. Hey, everyone, let's take a quick break to talk about Fastwave Medical, the company I co-founded and lead as CEO. We're developing next generation intravascular lithotripsy or IVL systems to tackle complex calcific disease. Over the last few years, we've closed a series of oversubscribed funding rounds bringing the total investment into FastWave to over $50 million. Corporate interest in the IVL space is growing to the $900 million acquisition of Bolt Medical by Boston Scientific in 2025,

and Johnson and Johnson's $13 billion acquisition of Shockwave Medical signal a lot of attention on emerging IVL startups like FastWave. And we're making serious progress. In addition to recently receiving our ninth patent, we've successfully completed peripheral and coronary feasibility studies and are gearing up. for pivotal trials. If you're interested in investing in the fast-growing IVL market, head over to fastwavemedical.com forward slash invest. Again, that's fastwavemedical.com forward slash invest. Now, let's get back to the conversation. The second is a real alignment of interest between doctors who are always wanting to do the best for their patients and payers that have to look at how to triage resources across their entire

network as every patient's lives matters, so you can't over-index some resourcing for a particular patient. I think payers sometimes get a bad, bad route, but without insurance, we individually wouldn't be able to afford these acute medical events that spike costs in a very major way for each of us individually. So aligning interests from a reimbursement perspective and from a regulatory perspective is really important. And on that latter element, I used to think that the FDA was a horrible entity that was a gatekeeper. It prevents people from getting things out to the market. But after now 15 years and you're working in the segment, I realize how important their perspective is in making sure that you do no harm when you bring new devices

into the marketplace. And that requires a great deal of rigor. And if we were building, let's say, like a video game, maybe there, even there, you need to have a lot of careful thought and is this going to create harm. But ultimately, the ramifications of doing something poorly are a lot less than when you're building things in the health care segment, whether they're therapeutics or medical devices, because cutting corners results in patient lives lost, and that's not unacceptable risk to take. So being mindful of all of these requirements to bring things to market, I think, is necessary. And it's certainly not a perspective I had the first time I spent something out of Caltech. Yeah, spoken from experience, I can tell for sure.

even the first point that you mentioned, not to diminish the kind of the latter point, but understanding kind of the stakeholders that are impacted right by your technology, because it's, again, it's so easy to get kind of laser focused on the direct end user, but understanding like how this may impact referral patterns or various economics inside a hospital versus maybe an outpatient care center of some type. I'm just kind of throwing out examples. But that's so, so important to understand some of those dynamics, you know, as early as possible because they're likely going to impact whether or not maybe you work on

the project, maybe certain design decisions early on, et cetera. So really, really good points. On that note, I want to talk to you a little bit about early stage development because obviously you're engineer by background. You've got a lot of experience taking very sophisticated technology and actually turning it into a viable product. And I think the early stage development, it's so hard because there's oftentimes very little capital that you have to work with, right? Maybe some non-dilutive, maybe some early angels, et cetera, that are willing to take a bet, but you just don't have a lot to work with. So you've got to make, you've got to like ruthlessly prioritize decisions. And so when you think about, and maybe frame this up for another

technologist and another physician that feels really bullish about this idea and they want to maybe take a swing, how do they, like what's most crucial to get right in those very early years of development? That's a good question. I was fortunate to have had two PhD advisors. One of them was an old school physicist named is Tom Tombrello. He used to always say, I don't think there's a there for certain things. It's a phrase that for me rings true here. For technical solutions and it's challenging to build the right intuition. Sometimes you can get incrementally close to the right answer but never have the capability of getting to the right answer. There's no there there. Blood pressure is one of those problems where I myself have tried many things that have

gotten incrementally close but never could have gotten to true blood pressure. So having a good pulse on is this actually a tractable problem is probably the most important insight to have. because that directly translates into how you spend money and the time scales at which that money needs to be spent. So in the case of blood pressure, as an example, every other technique out there that's not the invasive arterial catheter is looking at proxies for blood pressure, things like blood flow, as an example. There's a variety of ways to do it.

You can do them with capacitive sensors on your skin. You can do that with PPG sensors looking at blood oxygenation. But none of those methods actually get to blood pressure. They get close. Sometimes, you know, close in some cases where you're either using machine learning models to fit to data or you're using, you know, calibrating against a known blood pressure standard over time for that patient. But the ability to get to true blood pressure doesn't matter how much money throughout the problem, it's not going to be there. So having an insight that if you want to solve a problem properly, there needs to be there there is really, really important. And again, in the case of blood pressure, doing that in a safe environment like Caltech was an advantage.

because for others' academics, discovering a whole bunch of ways to not do something is just as valuable in terms of scientific productivity as discovering the solution to doing something. You know, the goal being a faculty member at a school is to help students launch their careers. That's like the primary objective. So the student will still be just fine. I might not get as, you know, nice grand dollars a job, but the student's going to be one. That's the primary objective will be achieved. So doing this in a safe environment at Caltech. The example of blood pressure is really important.

So we'd probably add that four or five technical strategies that we don't talk about that were actually incrementally close to blood pressure. We almost got there one time. We got to like change in blood pressure over time we could tell. Delta pressure. But we couldn't tell absolute pressure. And so we're like, oh, this is almost a company. And the reason we left it at Caltech and not didn't move forward is when we looked at

what it would take to bring an almost solution to market, it's just as expensive as the almost solutions that were already on the market. So it didn't make sense to start a business. So having that discipline to say, okay, this is a tractable problem. Now it's time and money. But now we need to capitalize the stages of that engineering project carefully and align expectations, which was really important to take that to the next phase. That was really a crucial insight.

Does that kind of give you a perspective? It does. And it allows maybe to segue into like clinical validation too, right? And maybe a little bit easier in your shoes, right? Because your wife is Elena. up at that's a, but when you think about a technology like, like you're developing at Espirito, it's obviously any, talk to any, any physician in the world and they're familiar with like how to take blood pressure, of course, but this is a fundamentally different sort of mechanism

in a way to do that. So when you were kind of navigating or putting together your clinical roadmap, obviously there's the regulatory requirements that are needed and then the clinical data that laders up to that. With there other kind of aspects that you thought about when putting together the kind of the clinical trial design that, that you felt were needed to convince physicians that, no, look, this is different, but it's the same. Like, they can, they can feel confident, right, to trust this new tool. So rigor around the, the data sets is really important. And in its essence, the best advantage I had is that my most rigorous critic was also my co-founder. So the evidence generation was part and parcel of the, for the development process, even at

Caltech, we measured like 300 patients and work we'd done there. So there was a lot of confidence we had that it would work and conveying that to physicians with the data enhancing, hey, here's all the proof points we have, was, I think, easier because of that ballast of evidence. But you do bring up a great point in medical device development in particular, having that evidence to not fool yourself that there's a, back to that there's a there there, I think is really, really essential. The other thing is to communicate it to clinical customers, would ultimately the practitioner is using the tool, I think, is essential. In the case of blood pressure on that latter aspect, we had a convenience that a lot of people had already tried to solve this problem

in a variety of ways. So many of the physicians that are our natural customers, folks like cardiologists or surgeons or anesthesiologists or ICU docs and ER docs, they already were aware of a number of the other methods and their pitfalls. So for us, there were a lot of, was less effort needed to convince them that there was a problem worth solving and a lot of effort needed and convincing them that we had solved. There's a couple of different topics I want to touch on before we get to the rapid fire portion in this interview. But one of one is fundraising, because I know you've, you have experience too in this arena, you know, generating or attracting capital, right, to fund these companies. But let's tackle kind of this, this topic of platform

technology, right? Because I imagine you probably went through this at ChromeCo, too, right, with this very novel underlying kind of technology, but where do you basically, the question becomes where do you start, right? How do you prevent yourself spreading too thin? And where do you focus kind of those early efforts? Not terribly dissimilar to probably Espirito, right? It sounds like you've got a pretty good idea of how to sequence this from the medical to the consumer side. Even like with a medical focus, you could focus on a lot of different areas of medicine, right? When you think about like all of your experiences kind of on this topic, whether it's Chromacode, whether it's at Espirito or any other startups for that matter. What's your advice for other folks that are working on kind of this

platform, this platform technology? How do they, how do they just focus? Maybe the advice for me, I hope I'll listen to this and remind us advice to myself. And then perhaps, perhaps for others, but I'm sure they've already figured this out is if you do one thing well, doing the next thing well is much easier to do. But trying to do two things well at the same time, you might succeed it neither. So laser focus on accomplishing the first task is needed. In the case of Esperto that was displacing tools that are continuous blood pressure monitors, so clinical utilities established, they're already used in the standard of care. Only thing we're doing is being non-invasive. So that was the initial goal is let's go replace the markets that have already

been built. And once that's done, there's other use cases. in the hospital that tools like the arterial catheter haven't been able to address. So measuring patients as they go from ward to ward or measuring patients in the emergency department where invasive tools because of workflow reasons are just infeasible. You don't have an hour of time to spend with each patient to put in a blood pressure monitor. You need to triage the patients and deliver care immediately because everyone's acutely ill when they're coming in. So those future markets are ones that work better when you've already established the business

in that pre-existing market, so that laser focus on doing the first thing well, I think we'll continue to pay dividends for us in the future. To learn from Chromacode, in its essence, back to being lucky, better to be lucky than good. And we definitely were very lucky. We had a global pandemic of unheard of proportions that took place that made Chromacode's product very valuable. And so it enabled $85 million in sales, like, super quickly with very low. effort. And that type of a market need was the reason why we were successful early, early days.

Outside of that, we would have had to triage our own resources very carefully into solving the problem. Couldn't have boiled the ocean and gone from measuring, you know, drug resistance for septic patients all the way into cancer. It would have probably taken us 10 years longer to get there. But there was this wonderful chance to establish ourselves. that was because of this pandemic that enabled all these other things downstream. So as Perra, I don't think has that type of a once-in-a-lifetime opportunity, but it can be smarter about how it addresses markets. And this is kind of the reason why we're focusing on hospital markets that are already there

and then focusing on expanding an RPM and consumer markets later days. I always like this topic because you said it's advice to yourself, right? You can go back and listen to this interview and make sure you feel. follow your own advice. Same thing for me, right? I always like to hear, it's good to kind of to continue to see here. Like, focus is so, so crucial because it's, I think all of us that are entrepreneurs are probably inherently optimistic, and we think we can maybe take on more than we truly can. And so if you opt to default into focusing, that's usually, usually the best approach. But with that said, let's, let's, let's end the discussion before the rapid fire

portion talking a little bit about fundraising. And I think, I don't show that you guys closed, As Specter closed, you're an oversubscribed Series A back in early 25. When you think about everything that led up to closing this series A, I'm sure there's so many things that you've learned over the past 10 plus years raising capital, were there a few things that really came to mind that allowed you to close this oversubscribe around that kind of key lessons learned based on a decade of building companies? I think so. It applies for bringing investors on board or applies for bringing co-founders, employees.

every time you add people to the team, you have to make sure everyone is aligned in rolling in the same direction. That discipline in making sure that people are aligned is necessary across the team, but ultimately it's the responsibility of the CEO to do that. So in the case of fundraising, it means that, you know,

we talk to a lot of groups to find the right participants in building out the team at this juncture. And we're phenomenal. We got some phenomenal investors for the, for the series eight was Catalyst Help Ventures and Bold Capital in particular. I'd love to shout out to Josh Phillips, who we started Catalyst and runs in is a phenomenal partner and friend in the process and a longtime friend from Caltech and mentor from Caltech, Helen McBride, who led the round from the Bold Cap side, along with her colleague,

Neil Bud Kamker. Those three individuals were exceptional at providing the resources and helping align everyone to this broader mission. And along the way, when we talked about 200 groups, we had three term sheets we processed and picked the one that mattered in probably the most challenging venture financing landscape in the last 25 years. Being in a position to choose only happened because we had like exceptional discipline and raising money at a time where we had a lot of runway to do so. and making sure that we were careful in accepting investment from the right groups,

which I think is one of the more important principal components in situating for success. There's two things that stand out in hearing you answer that question. One is you said you spoke to about 200 groups or roughly about 200 groups. A lot of times I'll talk to founders, CEOs that raise you capital. They're like, I just can't. Like I'm struggling, raising, et cetera. I think it's hard for everyone, even if you're quite proven. But, you know, when I asked my question, how many, how many, you know, roughly how many firms,

groups, et cetera, have you talked to. It's like 20 or 30. I'm like, oh, you need to like 10x that. I mean, like, is this like you need to talk to a lot more people, you know, but, but secondarily, that point around being disciplined about who you take capital from, right? I mean, we've, I think most people that are listening to this are probably familiar with like my story with Fastwave. And I, like, asked me that five years ago. And I would have said, how big of a deal is that really? I mean, it's, it's important, but like, is it that important? And it's like, wow. I mean, it's like you are getting married to a group of people in most cases, right? I mean, I hate to sound cliche, but it's very much like that.

And it's good to hear you say that, right? Because you've raised from a lot of different groups, right? And kind of understand that that's pretty critical, right? To only take money from the right partners. Yeah, it is ultra important. And a lot of things oriented for success to enable that. I had an exceptional set of angel investors of three executives from Google. Jeff Huber, who I mentioned, had started Grail at our earlier juncture,

and a guy named Michael Frumpkin, who wrote AdWords, kind of made Google's economic engine work, and third guy, Phil Nelson, who's been a senior exec there for a number of years. And having those three, or longtime friends and friends and mentors, as part of our Angel Syndicate was really important. They're very involved in making sure that we could say no to things. And along the way, there was really, a phenomenal guy named Mark Stevenson.

He was chief operating officer at Thermo Fisher Scientific for a number of years. And he's seen everything happen for startups and big companies, everything good, everything bad. And having him as a strong investor and support on the company put us in a position where we could be very highly selective. So leading into the right series A for the business really started with who we included in that initial company formation stage. And in addition to that, we had an advantage that there's two folks,

a guy named Vern Ruriel, who was this longtime life science attorney at Wilson. He said, he's a phenomenal guy. Again, maybe a great host. He had started a company called Affametrics, and he took that public. It was a $10 billion public company, kind of financially retired, and then built Wilson Sincini's IP practice over like 30 years. And so having him as a wise advisor and a seed investor, his partner on the on the corporate side at wilson guy named marty waters having their wisdom

and helping select the right groups i think made things highly effective and putting together that yeah yeah those early angels it sounds like they were pretty pretty crucial right to putting in the in the best position possible along with obviously execution and a lot of very cool technology with that with the big market um what another kind of follow-up question related to fundraising when you think about other other whether it's academics, physicians, technologists, right, that are raising capital for the first time, what do you think they underappreciate most, right, if they've never done it before? I don't think I understood how venture capital worked when I started.

And sometimes you get noes from groups and the reason is, okay, it's a no, the reason is X. But really, the reason doesn't X, looking at the fund dynamics, that particular partners interest, the other types of investments sector, specific investments, they've, made their LP base, where they are and raising their next fund, how this current fund they're investing into has returned. All of those dynamics lead into a decision on whether or not they're going to make a financial bet. But it's like a hidden Markov model. You have none of that information as an operator saying, okay, I pitched this venture capital company and they said, yes, great, I must have done everything. If they said no, then it's probably not my fault. They just didn't

get it. Or it's their fault. But you don't know why things work or don't. And you don't know why things work or don't. And spending a little time in understanding the perspective and incentive structure for the folks investing into the company, I think may help others overcome this hurdle that I had when I started raising capital for businesses earlier on. But at this point in time, keeping that framework in mind, I think, makes me much more effective in raising the money we need for the company. Yeah, it's a totally underappreciated aspect, right? I think even if you've, you've been around fundraising for a while, right? It's oftentimes easy to, easy to forget how important those fun dynamics are. And just doing a little bit of research at advance and making sure that

that's one of the first things like you and the folks on the other side of the table understand together because it's like the worst thing is is you get two or three meetings in. And it's like this is, this is never a fit anyway, right? Yes. Yeah. You know, so with that said, I know we only have a few minutes left. I want to get to the rapid fire portion of this interview. But again, for everyone listening, espertoealth.com is the website. We'll need to it in the full write-up, but ESP-E-R-T-O, Esperto, just as it sounds. Dot Health is the website. Really interesting technology and huge markets that the company is going after,

both on the medical and consumer side. So it would be fun to watch what you and your team accomplished over the next couple of years. But first question on the list, when you think about the next 12 months, take us out to kind of mid-20207. What's the most exciting milestone for Esperto? I think if things track, we'll have submitted everything we need to the FDA, so we'll be sitting tight and waiting, and then we'll be doing more of the fun stuff,

which is to start onto the RFBM side of the project where we get to miniaturize everything into a single piece of silicon. So it's going to be an exciting time of growth for the company, and hopefully we'll have lots of published data publications that will have in the public domain for people to look at in the interim. Very good stuff. All right. What's the one key lesson that every MedTech entrepreneur should really understand?

It's been less than you have. That's, I think, the most important. important thing. Very pragmatic, yes, but so, so important. You're right. All right. Last question. One piece of professional advice that you'd give the younger version of yourself. Have confidence that you can learn from other people become a better version of yourself. Good stuff. Adida, I can't thank you enough for covering out some time to do this. Thank you, Scott. A fun discussion. You've built a lot of cool technology over the years. So definitely appreciate you,

lending your wisdom right to the folks listening to this podcast. Thank you so much for having me, Scott. It's been a pleasure. I'll have you hold on the line here. But for everyone listening, appreciate your attention as always until the next episode of MedSider Goes Live. Everyone, take care. Hey, it's Scott again. One quick thing before you go. You see, I love bringing you insightful conversations with the best founders and CEOs of medical device and health technology startups.

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