A Harvard Doctor’s Cancer Survivors Startup: Julie Sivler MD

Oncology Rehab Partners is looking to better cancer survivors quality of life.

Dr. Julie Silver is pretty damn busy these days. She's an assistant professor at Harvard Medical School and  the Chief Editor of Books at Harvard Health Publications, the consumer health branch of Harvard Medical School, and the director of the Harvard CME course  "Publishing Books, Memoirs and Other Creative Nonfiction", Julie has founded and runs a medical startup focused on accrediting hospitals through Oncology Rehab Partners.

She's also an author here on Freelance MD of course. Read all of Julie Silver's posts here.

From the Bloomburg article

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Break Your Ideas In Half

This video is right on target with it's message about cutting all of your ideas in half and structuring your business to excel at the basics.

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Physicians Starting A Company

How do you start a company as a physician?

Many physicians are looking to start new ventures. In this presentation, Dr Michael VanRooyen discusses his esperiences building for-profit companies as well as his ventures building humanitarian solutions.

Michael VanRooyen MD MPH FACEP

Dr. VanRooyen is the Director, Harvard Humanitarian Initiative as well as the Director of the Division of International Health and Humanitarian Programs, Department of Emergency Medicine, Brigham and Women's Hospital. He is also an Associate Professor in the Department of Global Health and Population, Harvard School of Public Health and an Associate Professor of Medicine, Harvard Medical School.

Dr. VanRooyen has worked extensively in humanitarian assistance in over thirty countries affected by war and disaster, including Somalia, Bosnia, Rwanda, Iraq, North Korea, Darfur-Chad and the Democratic Republic of Congo, both as a physician and a policy advisor with numerous relief organizations, including CARE, Save the Children, Physicians for Human Rights and Samaritans Purse International Relief. He has served as a special advisor for the World Health Organization and as a member of the UN Inter-Agency Standing Committee's Health Cluster. Domestically, Dr. VanRooyen has provided relief assistance at the site of the World Trade Center in New York on September 11th with the American Red Cross and also helped to coordinate the American Red Cross public health response to Hurricane Katrina, sending over twenty physicians from the Harvard system to hurricane-devastated regions.

Dr. VanRooyen teaches courses on humanitarian operations in war at the Harvard School of Public Health. His textbook, Emergency Field Medicine, is considered one of the key reference texts in this area, and he has authored over 50 publications related to international emergency medicine development and humanitarian assistance. Dr. VanRooyen has served on numerous advisory panels and boards, including International Rescue Committee, the National Academies/GAO evaluation of mortality studies in Darfur, and is chairman of the Humanitarian Action Summit. Dr. VanRooyen has also been awarded the Reader's Digest Health Heroes Award, the Raoul Wallenburg Foundation Humanitarian Award, the Hippocrates Society Humanitarian Award and the AMA Pride in the Profession Award. He was given the University of Illinois Alumni Humanitarian Award and was featured as one of two US physicians in the American Medical Association's publication entitled Caring Physicians of the World.

This video is from the Medical Fusion Conference in 2009.

Transcript

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Movin' On: The Path Not Taken

Last week I got an email from a former physician colleague. He still works at a health care organization that I left years ago. The re-connection got me thinking about what I would have missed in my life and career had I remained at that organization. Now that I'm about three months away from leaving ACPE after three and half years as CEO, I've been in a reflective mood.  

First, leaving the traditional health care organization, with its typical hospital-physician-insurer tugs of war over reimbursement, culture, and authority dynamics, was a breath of fresh air for me. Never comfortable with the status quo, I wanted to get out and find new approaches to improving health care. 

Freed from the constraints of orthodoxy, I signed on to join a small start up company focused on changing consumer behavior in the workplace to reduce health care costs, and create a healthier workforce. I learned how to find investors. I learned how to assemble office furniture from IKEA because frugality, functionality, and teamwork was required of everyone on the senior team. I liked the idea that our work and execution of strategy would determine whether the business concept would succeed. When a couple of senior professionals left, I understood that I would have to take over some of their responsibilities of consumer research. I enjoyed doing that. Even though the company eventually closed its doors (like most start ups), the experience was a good one.  

Next, I joined a couple of system safety engineers in their growing consulting group to learn about how aviation, nuclear power, manufacturing, and other industries had become highly reliable. It required learning new concepts and language, then translating that to health care. It was exciting to work with health systems, physicians, and nurses who were committed to being pioneers in adapting the safety science of engineering to health care. I soon discovered that several other physicians were intrigued by the same concepts. We could talk the same language, and see a path to improving performance and patient safety. The consulting work was part-time, which allowed me to travel, and get a major stonemasonry project moving along. Could life be any more interesting or satisfying?

When ACPE's founder and CEO announced his retirement in 2008, the opportunity came to build on everything in my background. I found the new challenge that made my life more interesting and satisfying. I'm convinced that having worked in the insurance, hospital, medical practice, consulting, and entrepreneurial sectors of health care was attractive to the ACPE Board. I viewed the College more as a nimble, creative start-up opportunity than a thirty-five year old professional association. The strategic thinking and business plan execution required of start-ups was far more important than having a background in association management.  

Learning how to listen to the staff, which includes journalists, artists, educators, and professionals in marketing, IT, and finance, was key to surviving the recession, and rebounding from it. I asked our creative artists and journalists how they would redesign our journal - pej - to give it a more contemporary look and feel.  Who would have thought that changing to small case, big blocky letters would have such an impact?  The quality of writing - both from physicians and free lance journalists - increased.  

From my private equity market experience, I paraphrased a quote from Malcomb Forbes with my Board about their role and my role:

"There are but two questions a board should ask at each meeting.  The first question is always the same: 'Should we fire the CEO today?'. If the answer to the first question is "yes", then the second question is, "Then who among us shall serve on the search committee?". If the answer to the first question is "No", then the second question is, 'Then how can we support the CEO and the staff to be successful?'

Some said that was "too harsh" a way to look at the governance-management issue. Not for me, nor for the great board chairs I had the privilege to work with. All are great friends - but we all understood the harsh reality and consequences of running a business.  

I was left thinking that if I'd stayed with my previous organization, I would have had a nice salary, important title, pension plan, and nice people as colleagues. But I most certainly would not have found my way to ACPE, learned how to lead and manage through the recession, or have the opportunity to work with talented people outside of health care, who have a lot to offer to those of us working in the health care industry. I'm looking at my next transition at the end of the year as adventursome, exciting, and fulfilling. One way or another, I'm "leaving the tribe" again - a topic I'll be speaking on in Las Vegas at the Medical Fusion Conference in November.

Working For A Small Or Startup Company: The Other Side Of The Coin

If you don't want to get in bed with Big Pharma or Big Device, think small.

Several of my co-authors on this site have described their experiences working for large biopharmaceutical or device companies. While I work with a few as a consultant, most of my experience has been in starting and developing my own companies or consulting to early stage companies. Here are some experiences and lessons learned working with small companies:

You are being hired to provide the 3 C's

Early stage companies hire you because you provide the 3 C's: credibility, content and domain expertise and connections. They want your credentials on their website to raise money and establish credibility with investors. They want you to connect them to other thought leaders, users or participants in future clinical trials. They are looking for bioangels and early stage investors and turn to you for connections. They don't want you just because you have MD after your name.

Startups expect you to work for equity

Early stage companies have little or no money. Their first priority is to save cash and survive to the next step of development and commericalization. If you don't have that kind of risk tolerance or are looking for a big salary supplement, you are barking up the wrong tree.

You will be a co-chief cook and bottle washer

This is the fun part. In the beginning. there will be an organizational chart that includes the CEO, Sales and Marketing, Finance and other functions. In the beginning, maybe two or three people fill the boxes. You will be expected to supplement them and play multiple positions on the team until it gets to the point where the company can afford to hire specialists, like a CFO to help with a private placement memorandum, or a Director of Sales and Marketing to handle the sales force.

You will fail more often than you succeed

Let's face it. Creating a successful biomedical company is a crap shoot. Don't put all of your eggs in one basket and try to work with a portfolio of companies to increase you liklihood of success. The more experience you get, the better you will get at spotting the losers up front.

If you want to work with industry, you don't have to be the Man in the Grey Flannel Suit. I think it's more fun to wear jeans and a black tee shirt.

What Do Seed Investors Look For In A Medical Startup?

Investors look for ideas that are big, doable and profitable.

When it comes to looking for money, keep in mind that different strokes attract different folks. Most investors, be they private equity groups, venture capitalists or angels, have different approaches, styles or sweet spots when it comes to parting with their money. At a minimum, they will look for :

• An investment that is comfortable for them and fits their risk and domain profile
• A project that satisfies a large, growing unmet need
• A solution that works
• Something that is different
• A good story
• Something that has the potential to make a lot of money in the shortest time
• Good management
• Other sources of cash

A related article on About.com

During my work with www.headwatersmb.com , I"ve identified some others characteristics of growing companies that are not as obvious.

The structure of the capitalization table.

The "cap table" describes how the company has been funded to date, who owns what and how much do they own or owe? For example, it is not uncommon for early stage company management to get money from many small investor family and friends. Multiple people owning relatively small amounts of the company in stock or other claims complicates the cap table and makes subsequent investments by large investors more complicated , though certainly not impossible. You are better attracting a few large investors than a lot of small ones.

Scalability of the business

Congratulations. You've made a workable prototype or sold and shipped an item on the internet. Now you have to make and sell a thousand a month. Does your plan describe how you intend to do that?

People are messy. The fewer the better.

If your business plan calls for hiring a lot of people that adds costs, re-think the model. Internet companies are easy to grow and scale with a few people. Just ask Jeff and Greg, the cofounders of this site and others like it. Craig's list has 8 employees.

Finding early stage investors is never easy, particularly in this economic environment. Put your business plan together so that it pushes the right buttons. If you do, the cash-meisters won't be able to resist.

The Physician Entrepreneurs Five Minute Business Plan

The executive summary is the Cliff’s Notes of your business

One of my favorite Saturday Night Live sketches was Father Guido Sarducci’s Five Minute University. The idea was that a 16 week college course could be reduced to one thought in five minutes, like economics is basically the law of supply and demand. To pass the test all you had to do was attend the right class for five minutes.

When you need money for your business, investors will initially want to see an executive summary of your business plan. Nothing elaborate or fancy, pruned of jargon and business buzz-speak, the executive summary is like a Cliff’s notes of your business, quickly identifying the highlights to help them determine whether, in five minutes, your idea is worth a further look.

Here’s an example of what is should look like in PDF form so it can be sent to your favorite smart money source.

OVERVIEW

Our Awesome Company (OAC) is a medical device company with a revolutionary patent pending technology to treat bad breadth.. Our goal is to be the market leader in providing minimally invasive treatments that address the root cause of bad breadth. In 2010, OAC successfully completed its initial human proof of concept study outside the US. OAC is seeking a $500,000 bridge fund right now and  $3 million in funding to perform a Pilot clinical study at a US site beginning in early 2011. An additional $10 million will be required for a Pivotal study in Q4 2011. FDA approval is expected in late 2012. The Company anticipates financial exit via acquisition.

BAD BREATH

Bad breath has multiple causes including gastroesophageal reflux disease, sinus infections and chronic infections of the tonsils and adenoids. The most common cause is gingivitis and bacterial impregnation at the base of the tongue. Treatments to date, including turning your head to the side, oral breath mints and putting your hand over your mouth have proved ineffective over the long term.

MARKET

The current market for bad breath/halitosis products is $6+ billion worldwide. Market growth rate is estimated at 20% per year due to demographic factors , growing awareness of the condition and increasing intolerance of members of the opposite sex. The current standard of treatment for patients are insults, denigraton and criticism.. The current treatment  consists of an air pump and mask that the patient wears while in contact with humans.. The compliance rate for this treatment is less than 50%. The National Institutes of Health has stated that bad breath is a major public health problem and is associated with other chronic diseases like excessive nerdiness, depression and withdrawal..

TECHNOLOGY

Our product, BetterBreath,  is an implanted device inserted into the tongue by a single needle injection under local anesthesia. Once implanted, the device emits a remotely controlled plume of breath freshener into the mouth.  The entire procedure takes 2 to 5 minutes and can be performed in a doctor’s office. The device can be easily adjusted or totally removed in 1 minute without the need for anesthesia. Extensive preclinical and initial human studies show efficacy with excellent safety and patient comfort.

INTELLECTUAL PROPERTY

OAC/BetterBreath’s initial patent application has been filed in the United States, the European Union, Japan, and other important markets. Two other patent applications are also pending.

FDA PATHWAY

Intraoral devices for treatment of halitosis are considered  predicate devices with a 510(k) regulatory approval process.

FINANCIALS

Management is seeking $500,000 in bridge financing to prepare for pilot clinical studies in the US;  $3 million to fund Pilot study clinical trials beginning in early 2010, and an additional $10 million is budgeted for Pivotal study trials leading to FDA approval in late 2012.

TEAM

Bob Dragonbreath is the Chief Executive Officer of OAC. He has 20+ years of product development experience focused in minimally invasive implantable medical devices at Johnson and Johnson, Cordis, and C.R. Bard. He has 10 issued patents and several more submitted. He has lead small and large teams in the areas of concept development, product design, clinically relevant testing, and product commercialization.

I.M. Lookingforanotherjob, M.D.DDS, is founder and currently Chief Medical Officer. Dr. Lookingforantoherjob is a leading authority on the anatomy of the human upper airway as well as a board certified Otolaryngologist and Dentist with 20 years experience in treating patients with really bad breath. He was a faculty member in the Departments of Otolaryngology at Harvard, Cambridge and Oxford for 17 years. During that time he was Principal Investigator on 5 NIH grants researching unique aspects of the human upper airway. He has published over 50 articles in medical journals and received 15 major research awards.

INVESTORS

Big Deal Ventures LLC, a New York-based venture fund, invested $3.5 million in early 2007 to fund product development and the first-in-man trial.

In the words of Father Sarducci, ''There were actually more than ten, but Moses was old and grumpy, and after he broke the tablets he could only remember the negative ones. "Don't do this. Don't do that." The truth is, most of them were more like advice. The Twelfth Commandment, for example, was "Whistle while you work." (People think its from Disney, but Disney stole it from God.)" Even Moses needed to keep it short.