Dr. Bryan Hartley
Appearances
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
This week on the Backtable Podcast. You should be agnostic about the technology. You shouldn't care at all. And if you need to throw your entire technology out the window to come up with something better, that's completely fine because your success was never tied to your tech. It was always tied to solving the market need. So that gives you a lot of freedom.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And to me, just like stretching, it just clears out all the soreness. It clears out the restriction. It clears out the acid. You're right, ultimately. If you really knew your market, you knew your criteria, it was so constricting that the answer did just kind of come at that point. You didn't have to brainstorm too much.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
So we don't get to run the experiment again where you do biodesign without it. Yeah.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Yeah. But here's what I would say. Daniel's son was pissed at Miyagi for making him paint the fence, but he was learning a skill that he didn't know he was learning. And to me, that is what biodesign was doing with us with the brainstorming.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
I do think about the work that went into that program. I'll just say I'm incredibly grateful for it. One of the things that I struggled with, though, is that I left surgical residency and really feeling like you had climbed to the top of a relative hierarchy. And then you go into that program and you realize you are starting over, not even as an intern, as a medical student.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And that is a huge shock to the system. You have to completely start over at zero and climb a new sort of S curve of competency. And, you know, for most surgeons who would try this, you're in your mid to late 30s at this point, that's a big lift to do that again. And I would just let everybody know that that's what they're in for if they want to do it.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
I usually start by saying I'm St. Louisan, born and raised. Dot, dot, dot. Became a trauma surgeon. Married a California girl. You left out a lot there. Married a California girl. Moved the family out to California. did a very interesting innovation fellowship with you as a classmate, and then stumbled my way into becoming the CEO of Watershed Therapeutics, which is a drug delivery company.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Well, out of Biodesign, they encourage you, if you have a good idea, to try to pursue it a little bit on your own. And we had an idea that was around the unmet need of really bad thoracic pain after surgery. You know, pain control is famously very difficult for surgical patients. And if you have bad pain control, your intestines don't work. You don't breathe fully. You get pneumonia.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
There's lots of downstream complications. And so we had a clever solution for it. And the reason our solution, or the reason we had an unmet need was because the existing solution, which was long acting local anesthetic, Xperel, was priced really high. It was priced appropriately for its value, but it was priced very high.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
So anyway, we go into this development, we prove a couple of things in animals, and then we go do our IP diligence. And it turns out that Xperel's patents are going to expire in three years. That killed the company. And that was a really useful experience for us because the unmet need, the reason the market was there was because there were people that could not afford an existing solution.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
But once the IP expired, generics were going to flood the market, the price was going to come down, our unmet need was going to evaporate. So we would be just in time to have wasted all of our time. And so seeing that down the down the road, we just decided to fold it up and we actually gave back the money that we had been given to pursue the idea.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And I'm told that we are the first team to have ever done that. And we earned a lot of goodwill with those investors for doing that.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
I will say that super valuable thing to me after I left biodesign, biodesign is great on the inventor side of things. What I was missing in my education was what do investors think? I didn't have the reps.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
I wanted to sit on the other side of the investor table and see lots of companies come by so that I could pick up their rubric for how to immediately spot something that had promise versus something that didn't. I learned a ton during that experience, but one of the things that struck me amongst the best investors was that they didn't try to be right.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
They tried to weigh their risk and decide which risks they would pay for and which ones they were not willing to pay for. So if you have an idea and it starts with a really brilliant technical solution, I can look at that and I can say, well, I think the risk that you're technically going to be able to do the thing that you say you can is probably pretty low. You seem like a really smart guy.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Is that where I think the risk in the company is hiding, though? The risk might be hiding in the fact that you've never done this before, that it would take too much money to get to market, that the margins on a product that you delivered would be too small. that the value that delivered is too little, or that the competitive space is too crowded.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
I mean, there's like 13 different dimensions you can look at a thing. So I would run the list and I would ask people about it. And if they hadn't thought of it and I had, that was usually a red flag. But it could also be an opportunity. You know, what an easy way to make a company more valuable than to surface an unrealized risk and retire it.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And then you just look at you look at these risks and you just say to yourself, how much capital do I have to put in play before I can retire those risks? And if that is an exposure you can tolerate, go ahead. If it's not, you just say no. And I think it's important to do that as early as possible because. You know, we're all going to die one day. You probably have enough time.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
This is a Topherism, folks. This is how he speaks in the real world. Yeah, we're all going to die one day. You probably, if you're an entrepreneur, have enough time to work on, as an operator, three companies. If you start at my age, right, I'm 40.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
So if each one is going to take me 10 years and I might have to raise $100 million per each one, I cannot afford to waste your money or my time on a bad idea. So it's a service to the whole world to kill the bad ideas early and to avoid the risk that is not worthwhile. How do you kill an idea? That's so much easier with an example. I'll give you one. Someone reached out to me recently and said,
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
They were talking to a startup that was very interested in and had good proof of concept for head transplants. Head? Head transplants. Wow. And for me, knowing what I know about transplant medicine in general... I thought that that was quite a big lift.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And knowing that we have never figured out how to heal the central nervous system without glial scar blocking all communication, I thought that there was no way a head was going to get transplanted and control a body. And there were so many technological marvels that would have to be co-realized for that to work that that seemed like it just really wasn't in play.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And that's not even addressing what on earth would the market for that be? How many people are there that would be interested in that?
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Well, I would say that, you know, there's a couple of like magical phrases that people say to you. And if you can hold them in your head, I make fewer mistakes. One of them is when you are involved in a company, especially if you're an inventor, you tend to fall in love with the solution you came up with.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
In our company, and this comes from Stanford's biodesign program, you do not fall in love with the technology. You fall in love with the unmet market. You fall in love with the unmet need. You should be agnostic about the technology. You shouldn't care at all.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And if you need to throw your entire technology out the window to come up with something better, that's completely fine because your success was never tied to your tech. It was always tied to technology.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
solving the market need so that gives you a lot of freedom the other way that i snap people out of this sometimes is i remind them that you could be right about what you're right about but wrong about what you're wrong about so you could give me all of these great reasons why your tech does exactly what you say it's going to do and i'm not trying to have that conversation with you i'm having the conversation about even if you're right about your tech it might still not work
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Yeah, there's a pithy phrase that came out of the biodesign program that was assume invention. So it allows you to completely skip getting wrapped around the axle about how cool your widget is. Just as, yeah, assume all of it works exactly as you say it does.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Yeah.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
In our medical school, the dean at the time gave our class a really good piece of advice. He said, don't get intellectually wrapped into what you think you should do. Look at all of the residencies. Look at where your people are. And if you really like the people that happen to be in that field, that's probably what you should do. I followed that and that changed.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Yeah, well, one of the things that scares people about leaving medicine or going to Stanford's program or then leaving the program is, what am I going to do about my deal flow? It's also why people move out to Silicon Valley. It's this idea that I want to be exposed to lots of opportunities. So that area of the country is the best place for that.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
But within that ecosystem, how do you maximize your chances? And so I went to work with an investment group where I would regularly just help them for free research all of the companies that came through. So it was mutual benefit. I learned about investing, they got to learn about medicine and so forth.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
I was at a conference and there was a social event afterwards and I dropped my name tag on the ground and then a guy picked it up and said, is this yours? And he was a really smiley gentleman. And so I started talking to him and it turns out he had started a company to solve a problem I had identified as a surgeon, which was putting a breathing tube in the food tube.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
So someone's dying, they can't breathe for themselves. You try to artificially ventilate them and instead you inflate their stomach and they die. So it sounds like a mistake you shouldn't make. It gets made all the time. So I had a post-it note on my desk that I was going to solve this problem one day. And I meet this guy and he's already solved it. And he's really far ahead.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And so I knew that I liked him immediately. And he and I started talking and he learned that I had done some consulting in urology. I was a surgeon. I had this background. And he pitched me this other idea of his. And the way that idea came to him was that he was a paramedic. And he kept getting called to nursing homes to pick up women who were really ill.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
The other way that I snap people out of this sometimes is I remind them that you could be right about what you're right about, but wrong about what you're wrong about. So you could give me all of these great reasons why your tech does exactly what you say it's going to do. And I'm not trying to have that conversation with you.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
No one was sure why and bring them to the emergency department. And time and time again, it was because they had a UTI and that was causing them to have sepsis and their brain was altered. And he thought that was pretty interesting. But then he kept getting called to bring the same women from the nursing home to the ER month after month after month. And then he got pissed off.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And he talked to the doctors and said, why can't if you know who's going to have the problem, why can't you stop it? And they said, we can't. The best solution is they take antibiotics every day for the rest of their life. They don't want to do that. The side effects are terrible. And a lot of them can't remember to do it. So this is just their reality.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And so again, on a post-it note, he writes a problem that he's going to solve. And then one day he's sitting in a friend's jacuzzi and he sees this plastic ball floating in the water. And he says, what's that? They say, oh, you know, it's got a little chlorine in it. It releases it into the jacuzzi so that bacteria don't grow. You know, it's warm water. It's easier for them to grow.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And I guess he'd had a couple of beers at that point. He was fuzzy enough that he connected those two ideas together. And he said, what if I put a floating jacuzzi ball into the bladders of women to stop them from getting UTIs? And he went home and got a piece of graph paper and wrote the provisional patent. That ended up becoming the core IP to the company.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
So he brings this idea to me and immediately I try to kill it and he's got a good answer for the first objection. And so I attack it from another direction and he defends again and I attack from another direction and he surprises me, tells me things I've never heard.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
realized never heard before which is that there are companies that have put bladder drug delivery products into the bladder patients can have a very large object in their bladder and have it sit there comfortably and the problem's enormous and i didn't know any of those things and so after six weeks of trying to kill this guy's company i failed and you know my head kind of drops i go ah damn it all right he and i decided to start the company together and that became watershed
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
led me immediately to general surgery.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Oh, you know, Peter Thiel's got this book called Zero to One. And in it, he talks about how a company that is not formed with a solid base is doomed from the beginning. So, I mean, I took this process very seriously. I'd also come out of Stanford's program and they... famously have teams that form of four people. And in the beginning they say, you know, we're going to split it equally.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Each of us has a quarter of the company. And then if it goes anywhere, there's usually two people that do that actually work on the product and the other two stop and it creates a whole bunch of team problems. So I was very sensitive to this. Meanwhile, think of it, think about it from his standpoint. He's got this great idea.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
He knows a secret the rest of the world doesn't know, which is how big this market is, how desperately they want a solution and a really cool approach. And he's done me for six weeks. So how on earth do you trust a person you just met with any part of your company? So the negotiations were sensitive.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
We ended up coming pretty close to a, I think the smartest thing we did was we said, what are the roles in the company? You know, there's a clinical role, there's an R&D role, there's a technical development role, there's a fundraising role. What do we think each of these roles is worth from an equity standpoint? And what do we think each one of us can carry?
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And we signed up for the pieces we thought we could carry. And over time, if it turned out that our obligations made it so we couldn't carry that percentage, well, we had a gentleman's agreement written between us, which was that we were going to do the right thing.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And we were going to give that piece of equity to the other co-founder who was going to carry it, or we'd give it to another person who we'd have to hire in who would do that. And anyway, as the company evolved, his company started doing very well. It required a lot more of his attention and we needed to bring in a specialty technology expert.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And so when we hired our CTO, my co-founder gave up a significant piece of his equity to entice her to join the company. But I still think that was the smartest thing we could have done and the best way we could have structured a company, like when those sensitive things are being considered.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Oh, when you're doing your equity split at the founding of a company, 50-50 is a bad idea.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
80 20 seems a little bit lopsided ultimately to people seem to arrive at the split arbitrarily and if it's arbitrary it can't be revisited it can't be reasoned one of the things i'm proud of that we did was that we were very reasoned from the beginning as to not that equity was owed but that equity was earned by the roles in the company that you fulfilled
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
So if you were doing R&D and you were doing clinical and you were doing preclinical and you were doing fundraising, you know, you got the whole company. You don't even need a partner. But if you have to break off pieces of that, then, you know, somebody else gets 20%, somebody else gets 25%, etc. And so that's how we sort of split the pie.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
You really hope you've done a good job in your life of having people trust you. You know, one of the very interesting things was that my co-founder, Clay Nolan, he had done such a great job with his company, Colabs. He had a lot of trust built up. And so some of his existing investors, when they heard that he had another project that he had co-founded, immediately said, how can we support you?
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And they wrote a check. And that was an amazing experience. I reached out to my friends and family and tried to be very honest with them and said, you don't have to invest in my company. I'll find the money. But I want you to have the opportunity in case you think that's a good idea. Just know that the money is probably going to be set on fire and disappear forever.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And it works best when $15,000 disappears at a time. And I had a cousin of mine who told me from a young age that if I ever started a company and he didn't get to invest, he would kill me. So I reached out to him and he wrote a check to support us. And so we had maybe 50 grand to start and we did an experiment and the experiment worked. We did another experiment. That experiment worked.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Yeah, couldn't agree more. The other side of that story is that I met my wife because she was interested in becoming a surgeon. And once I shared that piece of advice with her, she decided that she did not want to be a general surgeon at all, but wanted to be an emergency medicine doc. And I don't know what that means for our marriage.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Yeah, go to a farmer and ask for a cow or a pig bladder before they hemisect the animal. So you have this intact organ. And then you... place what you think your product is going to look like into that bladder and then see if it stays and see if it behaves the way that you want it to. And then you do that a number of times, you quantify the result and that looks good.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Then you do a little bit of research on intellectual property and you file your first patent and you do a freedom to operate analysis and all that looks good. And then you get urologists and other people who are experts on the market to
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
write you letters that say this is a huge problem this is a pain point for us if you had a product like this we would use it and so you start to piece the sort of story together from start to finish de-risking the biggest thing as you go along and it's like the first domino falling i think our first check was for fifteen thousand dollars we quickly got to fifty
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
We did the experiments that we got to a quarter of a million. We did more experiments than we got to a million and then raised 2 million and then 4 million and so on. How much have you guys raised?
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Well, again, this is the advantage of thinking of assume invention and think backwards. We originally thought our product was going to be a device. And when we looked at existing codes for placement of a device into the bladder or installation of a product into the bladder, the codes existed, but they reimbursed very low.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
It would not be worth it to bring a product to market if that's all you could charge. And that was an inescapable, it felt like an inescapable problem. And so one of the first pivots we did was we decided we were going to be a drug company. Because if you go to a hospital with a device, you go through this thing called a value analysis committee. And they look at your product.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Let's say you're an orthopedic company. You have some new plate or new screw. Well, they look at that and then they say, well, this looks like something from Home Depot. I can buy it at Home Depot for five bucks and you're trying to charge me 400. We'll pay you 50, you know, and then and then the negotiation starts.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Whereas if you go to a value analysis committee with a drug, that's a witch's brew. Like, who knows how to make a drug? So you have a lot more pricing power and you don't have this thing that's anchoring it to it should be worth nothing. You can actually anchor it to the value you're delivering for the patients. So there were advantages to being a drug.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
The disadvantage was we had no idea what we were doing. We didn't learn how to develop drugs. We didn't learn how to do a drug company. I didn't know anything about that regulatory path. I ended up going on Amazon and trying to search for how do you run a drug company and buying those books and reading them, completely unhelpful.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And it was a useful experience because what you learn along the way is that you actually don't need to know. You just need to know what to do next. And so long as you keep doing the thing you need to do next, that goes slow enough that the future kind of fills in. You get the right people around you and you can figure it out. That's awesome.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Today, we have completed two clinical trials in healthy patients with a placebo version of our product, proving that we can deliver it and that it's retained and that it's safe. And in parallel to that, we've demonstrated in the lab in a bladder model that we can release the drug over the course of several weeks out to several months at a level that would be meaningful for bladder disease.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Well, the interesting thing is that we developed a technology to solve for chronic or recurrent urinary tract infection. Okay. We accidentally created a platform for drug delivery into the bladder that should work for any disease where you need to deliver drug into the bladder. So you can expand into overactive bladder or bladder cancer. Our reason we exist is for recurrent UTI.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And so that's our lead indication. But we've explored these other indications as well. All right, sweet.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Oh, we are. We've met with the FDA to understand our path forward and we have an opportunity to get an IND and then do phase two clinical trial. So we're raising a series A for that now.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
So not everybody has a year to take off from their life to go to Stanford to do their biodesign program. So there is a need for the ability to learn what you're going to learn quickly. That's what books are for. The other need was that biodesign program's really built for entrepreneurs who are going to kind of give up everything they're doing and pursue that path.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Yeah, I've always been interested in problems you can't buy your way out of. So when I was training as a surgeon, there's this beautiful operation called a carotid endarterectomy, super high stakes surgery. It's so elegant and changes people's lives. So lots of surgeons fall in love with it. And for a while, I thought I was going to be a vascular surgeon. The problem is that it's so high stakes.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
But that's a different problem set and that's a different type of person than somebody who wants to do this part-time or somebody who already has a full-time job, whether it's in corporate or whether it's in a hospital. In those cases, you need to have something that will work in pieces. And there are certain things you have to prioritize that are different than at Biodesign.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Chief among them is early and quick results. And specifically in an environment where you have different resources available, you know, you're not a startup. And so that was the impetus behind the book, which was that when we would go and try to teach The important lessons we had learned at Stanford inside of a corporate environment, you know, it's just a different rule set.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
So you had to you had to tweak the program quite a bit to make it successful. And we had to do it the same way every time. And so we thought, OK, this is a recurring problem. You should probably write it down and just make it easy for people. So that was the genesis of the book. And the philosophy behind it was, again, killing things quickly. So that's why we named the book Wombat.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
It stands for waste of money, brains and time. And the goal of it is to remind you when you're considering an idea. It might be great tech. It might be really clever, but it has to satisfy more things than just being clever or being useful.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
It has to be a good use of your money and your brains and your time, which means that even if people would love it, if there's another problem you could work on that's worth 10 times as much, it's a sin for you to work on the smaller problem. You need to solve the bigger one. So we thought that it was useful to give people that rubric for trying to figure out which opportunity they should pursue.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
How's it been received? Near as we can tell, great. One of the frustrating things about writing a book like that is that I don't get to talk to everybody who buys it. So I don't know what the people in Germany and Japan are doing with it, but I'd love to hear from you and tell me why you're buying so many copies.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
My children dictate that now. I used to start Halloween three months in advance for some huge ornamental set piece. And now it's what my kids want to do. So my son, one son is obsessed with ninjas. Another son is obsessed with Star Trek. I've got a daughter who wants to go as a horse every single year.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And then I have a daughter who likes to mix and match things that make no sense. So one year she wanted to be a cat princess. Oh, nice. And another year she wanted to be a ghost, but covered with flowers.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
I want them to see early on that you can make things. So it's always homemade.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Yeah, strokes. No attending surgeon really feels comfortable letting you do it as a resident. You know, because if you mess it up, the patient has a stroke. Brain's pretty important stuff.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
So what I wanted was I looked for a surgical trainer that would allow me to master all of the steps, both technical and planning wise, so that when I showed up in the operating room, it would be clear that I was there as a serious participant. And when I went online, I could not buy my way out of my problem. There were no surgical trainers that were anything close to what I wanted.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
The more controversial way I would say solve problems you can't buy your way out of would be if rich people don't have your problem, it's not a problem. Yes, that is controversial. And that's why I love you, Topher, because you do not shy away from controversy. Yeah, because if rich people have the problem, everybody's got the problem.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
If only people without money have the problem, then the solution is money.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Our audio team is led by Kieran Gannon, with support from Aaron Bowles, Josh McWhirter, and Josh Spencer. Design and digital marketing led by Brian Schmitz.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
You could buy something that had fake skin over a fake blood vessel. So you could go through the act of cutting skin and then open it up and then the vessels right there. But that surgery, just like every surgery,
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
is 99 what you don't do every structure you don't injure yeah yeah everything you have to protect i mean for god's sakes everybody's watched a surgeon who has beautiful exposures and one that doesn't it's the difference between can the intern do the case versus does it need to be a fellow with an assist and there were no surgical trainers made like that none so i had to build it myself so that i could train on it
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
I'm having the conversation about even if you're right about your tech, it might still not work.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Yeah. So I got really involved in elaborate Halloween costumes. Oh, right. Great segue. Yeah. Well, it turns out that a knowledge of anatomy is really helpful in making accurate Halloween costumes. So these things sort of played off each other back and forth. And so I used glue and plastic bottles and latex tubes and felt to
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
to reconstruct a human neck and, you know, made of all the same materials as my Halloween costumes, but it was good enough to practice on.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
The next thing that happened was I started training other residents on it and it was lifelike enough that people started to sweat. You know, you could you could drape it as if it was a surgery
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
and i didn't really take that much farther because i had solved my immediate problem but then during my trauma rotation i saw an ed thoracotomy which you know for your listeners if they're not entirely familiar with that the easy version of this is that there's some catastrophic injury to your your aorta you're bleeding faster than we can get you to the operating room so the solution is to cut your chest wide open
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Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
reach inside, grab the aorta, and clamp it above the injury. And this is in the ED, not even in the operating area. Yeah, in the emergency department. So now you start dying a different way, but it's slower. So now we can get you to the OR. And the survival rate of this is terrible. And it's really chaotic. It's actually dangerous for the people that do it. It doesn't make you feel very good.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Somebody invented a really clever solution around that. This company called Prytime Medical, they had a balloon on a catheter. You would poke someone in the groin, you would feed the catheter up above the hole and then inflate a balloon. So instead of clamping from the outside, you're clamping from the inside. Really elegant, really clever. I was in love with this thing. Is this the Reboa?
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
This is Reboa, R-E-B-O-A, for resuscitative endovascular balloon occlusion of aorta. And so I went to our trauma doctors and I said, I want to do Reboa. I think we should do that at our hospital. And they said, that sounds great. And what year were you or what were you? What level of training? Fourth year resident, I think. And they said, that sounds great. We're never doing that.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Hello, everyone, and welcome to Backtable, your source for all things urology. You can find all previous episodes on Apple, Spotify, YouTube, and on backtable.com.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And I was shocked. Why? I said, listen, I haven't been trained on it. And in an emergency, I'm not going to go to something I've never seen and I've never practiced. Like, okay. So I looked and said, how do I get this for my facility so I can do this procedure? And it turns out at the time, there was only one place you could train to get proficient. And that was at Maryland Shock Trauma.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
They had a course. It was once a month, maybe. And I think they had a carrying capacity of 20 people because they were doing it on cadavers. And, you know, I did some quick math for the number of trauma surgeons in the country and And the opportunity cost to take off work and fly over to Maryland Shock Trauma and do the course and everything. And this was never going to work.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
So I went to the website of the company and they had a contact form. And so I just filled out that little contact form and said, you guys have a huge problem. I want to use your product and I can't. You guys need a surgical trainer. And my phone rang within 10 minutes. It was the CEO of that company who I'm still friends with today. And he said, who the hell are you?
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And so we got to talking and he said, I believe you. I believe we need a surgical trainer. Can you make one? And in that moment, I told a very important lie. I said that I could. And he said, okay, email me back when you're done. Yeah, so I said I could do it. And so I canceled my plans for that. I was so excited. Canceled my plans for that weekend.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
went to Home Depot, bought a $5 Homer bucket and started to carve and used everything I had learned from making the surgical trainers before to make a human torso with a groin with tubing that you could cannulate and whose life you could save. And I was very proud of it. I sent him photographs of it. He said, Topher, this looks pretty amateurish. But I like where you're going.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
It's the vision, right? You generated a prototype, basically. Exactly. And it contained all the elements that you need as an operator, which is not, again, it goes back to the... It's not for sales, right? This is for just get it done. Exactly. And he said, can you do a better job of that? Can you make it look like it's commercial? And I said... yeah, I think I can.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And so I went back to the drawing board, decided I was going to get a credit card for this effort, went into a couple thousand dollars worth of debt making it, but came back with a really slick looking version of the product.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
No, he was in the catheter making business. He wasn't in the surgical trainer making business. And I think as a CEO, he saw me maybe as a free resource. Like he doesn't have to pay me anything. I'm doing this. I'm taking all of the financial risk, all the time risk myself. And so I made this and I brought it to Maryland Shock Trauma and they used it for training there.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
I brought it to the American College of Surgeons. They used it for training there. He helped me get Entree into all of these rooms. How many did you sell early on or total, I guess? I mean, oh, I went so foolishly, but I went $60,000 into the hole to do this, which sounds insane out loud. But at the moment, you know, you're just a frog boiling in water. It's fine. Yeah.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
Ended up breaking even within six months. Wow. That is so impressive. Yeah, it was pretty crazy. And I think that was because there was a real need for it. People really believed in this approach. They believed in the product. They just didn't feel comfortable. They needed to feel comfortable.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
My wife decided that. At the time, I thought I was going to become a vascular surgeon. And my wife, her father's also an entrepreneur. And so she grew up in a household with somebody like that. And whether that was why she married me or she just recognized it after the fact, she thought we had the same phenotype.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And so she just skipped to the end and she said, look, I've never seen you so fired up about anything as trying to solve this problem. What if instead of becoming a vascular surgeon and never seeing me or your kids, you went into business making medical products? And that's when I started looking at programs around the country that do bio design.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
So they tell you, don't come with any ideas for a company you want to start. And then everybody does that. Everybody has their idea for how they're going to become super rich. They're just using Stanford as a springboard and you get there and you learn two things that are so important that they changed my life.
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Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
And I think that they're going to change the lives of every patient downstream of everybody that goes there. The first is that if you have an unmet market, if there's a lot of people who have a problem, especially if they can't buy their way out of it, Those people aren't going anywhere. So if you really pay attention to what it is that they want and you solve it, you will be successful.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
You just have to really get religion around identifying who's hurting. The second thing, and it's paired with that, is inventing is the easy part. You know, everybody thinks that... These ideas get born out of some genius mind, fully formed, delivered into the world. It's completely incorrect and it's backwards.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
If you meet your unmet market and you really do your research and find out what they need, the constraints that they place on you are so tight that there's really only one or two things you could ever invent. And they told you what to do. It's like that saying, a well-asked question is half answered. It's the exact same thing.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
If you know the market perfectly, they're already telling you what to invent.
BackTable Urology
Ep. 196 Biodesign Insights: Embracing Risk and Innovation with Dr. Christopher Kinsella
The most useful thing that came out of the brainstorm is when someone would come up with an idea that you had not thought of. It didn't have to be useful. The information was that you hadn't thought of it. And so that told you where you had some limiting constraint or some assumption and gave you the idea to start questioning it. Why is my assumption there? Why didn't I think about that thing?