Investor Spotlight: Dr. Jack Lewin Explains the Power of Clarity

Dr. Jack Lewin has what he calls an overly-simplistic maxim when it comes to reaching his goals. As an investor, the Principal and Founder of the healthcare consulting group Lewin and Associates, and Chairman of the National Coalition on Health Care, Dr. Lewin has no shortage of responsibilities. That is perhaps why “clarity is power” is his general truth of conduct. As he says, “being clear about what you want to do is the first step toward getting it done.”

Dr. Lewin is presently serving as the Syndicate Leader for the investment round in HealthPals. We recently had a chance to catch up with him to talk about his investment philosophies, how he got started investing, and what excites him about the future.

What Got You Started Investing?

I like to promote ideas that I think represent the future of healthcare. I look for innovations that are needed to make healthcare more effective for coming generations. I look carefully at what’s happening in the environment and try to associate myself with, and put my energy into, new companies that are going to create positive change.

What Gets You Excited About an Investment?

The principles of the company are really exciting. A lot of it is the team, but beyond that I also look for people who already understand the value and  potential of a company. I like when I see my friend Bob Harrington has decided that he wants to be part of something. He is the Chief of Medicine at Stanford, and the former head of Duke’s Cardiology Research Institute. When he’s there you know something really amazing is happening.

What Attributes Do You Look for in a Founder?

I like to see founders who really want to make a difference. You can feel that passion. It’s more than saying “I want to get rich.” I also want to see the passion that they’ve generated in the people around them about the potential for their product.

That’s part of what is fascinating about HealthPals. We’re living in this era where it has become cliche to talk about providing better outcomes and decreased cost. This company really contributes to those things, and not as a cliche.

What Have You Learned that You Wish You Knew Earlier?

Follow your own passions. Work on what you want to see happen in healthcare, and even beyond healthcare in areas like health information technology. Put your money and energy into something that you believe could produce better health, better healthcare, or lower costs. That not only feels good, but it does good. It’s contributing to the improvement in the health of the population.

What Three Things Get You Excited?

The long-anticipated idea of interoperability. It looms as one of the biggest areas of potential contribution. The potential exists, but there are all kinds of human barriers — proprietary data, privacy breach fears, a certain sense that there is no way to create pure interoperability in the same way that we have made it work in banking and finance. It can work. Privacy can be protected. Proprietary concerns are barriers to thinking about and building a more successful economy in healthcare.

I’m also excited about advanced analytics, or artificial intelligence as it’s called. I like seeing companies that apply AI to things other than search engines or financial tools. Applying it to healthcare is going to really transform the future of our industry. HealthPals is on the cutting edge of that transformation.

Finally, I get excited about new therapeutic options which seem like long shots or like science fiction. Occasionally I come across something that is relevant to the future. Thinking of my experience at the American College of Cardiology, when my tenure was beginning, we weren’t thinking that we would be able to replace heart valves using catheter-based therapy. A procedure where we wouldn’t have to crack the chest, and don’t have to use general anesthesia. In some case we can even send the patient home the same day. Creating a heart valve that comes out of a catheter, opens itself up, and can embed itself and just function? That sounds like science fiction. Ideas like that are worth exploring, and we’re starting to see a lot more of them.

That’s part of why I’m so interested in HealthPals. It fits all of my exciting areas. It’s really a leap in terms of how that information gets used. It employs a relationship with the National Cardiovascular Data Registry. I had the privilege of helping to found, promote, and turn the NCDR into a national resource during my time at the ACC. The NCDR has an impact on improving outcomes in the inpatient setting. The retrospective analysis of data can be turned into a means of advising and helping patients right at the point of care.

To a certain extent, HealthPals represents virtual research in action. Looking back at the NCDR and hundreds of millions of patient records, a clinician can advise a patient about what happens to the thousands of people who present with the same constellation of clinical and demographic factors that they have. It’s almost a means for the doctor and the patient to decide together what course of action to take based on real data and experiences.

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Dr. Jeffrey Hausfeld – Doing Good and Doing Well

While attending Health:Further in Nashville earlier in the month, we had the opportunity to meet and talk with a number of AngelMD members. Dr. Jeffrey Hausfeld is a startup owner, investor, former practicing physician, and long-time healthcare facility owner. This wide variety of activities gives him a unique aspect to the world of healthcare entrepreneurship that we wanted to share with the AngelMD network.

AMD: You bridge this gap really well between physician, and entrepreneur, and investor, and jack of all trades on the innovation side of the house. Can you tell me a little bit about the Society of Physician Entrepreneurs? What’s the history there, and what’s the goal?

DJH: Doctors in general are smart people, have great ideas, wanna help people, but are not very good in terms of understanding the business. The meshing of those two cultures is an enigma to most of us. Because we’re not wired that way.

Even though we’re not wired that way, that doesn’t mean that we can’t be trained, and taught the perspective of the business. We have to understand and respect that, just as there’s a science to medicine, there’s a science to business. So, myself and two other ENT physicians said, “Why don’t we try to teach some of our young residents about how to commercialize an idea?”

We started having these breakfast meetings at American Academy of Otolaryngology about nine years ago, now. All of a sudden, we had 150 people come out for a 7:00 AM breakfast. I said, “Gee. I guess people really do want to learn this stuff.” We took it out to the general public, and, over the last eight years, now we have probably 28,000 LinkedIn members, and 30 chapters that I have the pleasure of managing throughout the world. I get to meet people that have fantastic ideas, and great insight into unmet needs. That’s really where we fill an essential gap in the whole commercialization process.

You can have people that are really smart technicians, you can have people that are terrific marketers, but, if you’re building something without understanding that there is an unmet need in the marketplace, then you better think of something else. Because if it’s not faster, cheaper, safer, and better than what’s out there today, it’s never gonna fly. And that’s where healthcare providers can really make a big difference. Because we know what’s in our tool kit. We know what patients need, and we know what we would use. Without that essential ingredient, it really thwarts a lot of innovation, because you’re building something that’s no one gonna use.

Based on that, we decided to bring the Society of Physician Entrepreneurs to the general public, and it’s been terrific. We have these local chapters that build these small ecosystems, and they have four to six meetings a year, and we invite everyone to come to our meetings. We don’t restrict our membership to physicians. Matter of fact, probably 30 to 40% of our people are physicians, and 60% are others. Others meaning lawyers and software engineers, hardware engineers, regulatory people, and people in marketing, as well as finance, and investors. They all come to our meetings, and that’s great because it takes a community to really push innovation forward.

Society of Physician Entrepreneurs

AMD: Is it fair to say that most physicians have a bit of an entrepreneurial side to them?

DJH: Absolutely. Every physician that is in private practice thinks of themselves as an entrepreneur. Because running a small private practice, or even being part of a large private practice, you really do have to be an entrepreneur. You have to understand that you’re taking some risks. You’re not just an employee of a larger organization, and, at the end of the day, you can either pat yourself on the back or kick yourself in the butt, but the buck ends at you. That’s the mantra of a good entrepreneur.

AMD: You’re also running your own company. Can you tell me a bit about what you’re doing there?

DJH: Beside these memory care facilities, I got introduced to a biotech company in Frederick, Maryland, by the name of BioFactura.
At a pitch event, this CEO, Darryl Sampey, he gets up and starts talking about biosimilars. This is about four years ago. I said, “Biosimilars? What the heck is a biosimilar? Never heard of it.” He explains that it’s a generic version of a biologic drug when the biologic drug comes off patent. And, I said, “Gee. That makes sense.”

I was part of the great number of physicians that had to switch patients from branded drugs to generic drugs in the 1980s. My drug reps were very good and smart, in that they came in, they made sure that I was detailed in the fact that “those generic drugs, they’re made with formaldehyde, Doc, don’t you give them to your patients or you’ll kill ’em.” Back then, we believed them. So, we would write down “DAW”, which means Dispense As Written, so that the pharmacist could not substitute a generic version of the drug for the branded drug.

Now, looking back, I recognize that I really did the patients, and society, a disservice by doing that. Because I didn’t lower healthcare costs, I didn’t increase access. I also missed a very good opportunity to make some money on the switch to generic medication.

I said, I’m not gonna do that again. Because this is the next big wave of the potential to really reduce healthcare costs, and bring products to patients that will be even better than their branded drug. The manufacturing progress that we’ve made in the last 20 years has increased access tremendously. This has been exemplified in the European models where they’ve had a 400% increase in the use of these biologics and all the while the price came down.

AMD: That’s an incredible opportunity, and now you’re in on it.

DJH: I’m in on it, I’m the chairman of their board, I’m their chief medical officer, and I’m the largest investor of BioFactura.

BioFactura

AMD: In that regard, you’re not just an advisor, you’re also practicing entrepreneurship. But this is far from the first foray that you’ve had. You talked about the memory care facilities, and you’ve done some other entrepreneurial activities as well.

DJH: Oh, yeah. I serve on several boards of other companies, and I’m an angel investor in a healthcare startup.

AMD: What do you wish that more physicians knew when it comes to entrepreneurship?

DJH: I guess what they have to understand is that physicians fail in their attempts to create a new venture, or a new device, because of a few different things.

Most of the time, it’s arrogance. I hate to say that about my colleagues, but sometimes they’re just not smart in terms of accepting advice from others. Understanding that, at this moment, they’re not the smartest person in the room.

There is a low emotional intelligence quotient. They have to understand that if you’re going to build a company that is producing a product or a service, other than your own medical office, you have to make the environment right for bees to make honey. That means you have to empower your employees, and you have to nurture them, and exemplify their strengths. That’s the way you get productivity and accountability, in terms of manufacturing and innovation, in your own business.

When you’re bootstrapping a business, and when you’re dealing with other people’s money, especially angel money, you have to have that fiduciary responsibility that it’s other people’s money, I need to make sure that I’m spending it wisely.

Just the understanding that there’s a science to business, and respecting that, and learning that, is probably the biggest hurdle. That’s what SoPE tries to do.

AMD: I think it’s interesting that when I asked you about other entrepreneurial activities, that you discuss being an advisor, and being on these boards. I think that that’s something a lot of physicians miss is that being an entrepreneur is not always necessarily about “let’s go start this new company.”

DJH: That’s exactly right. But, most times, they don’t want to be in the CEO position. They want to be, but they don’t want to be. They have an idea, they’ve even gotten to the point of getting a patent on that idea, and they want to be the sole owner and steward of that idea as it goes through the process of regulatory and finance.

The problem with that is…just that. They have a day job as a physician, and in their free time, they’re going to try to raise money from angels to work on their project. What I tell them is that I never invest in a company where I don’t have a full-time, totally devoted employee to make sure that this project goes forward.

Because, at the end of the day, patients come first; and their loyalty will be their patients. It should be to their patients, and, if it’s not to their patients, they’re not the kind of person I want to invest in anyway.

AMD: What’s surprising you in the world of entrepreneurship today?

DJH: I see more and more young physicians finish medical school, maybe do a year of training, and then leave. That is a trend that is much more popular today than it was when I was in practice. As surprised as I was, I’m not surprised anymore. Because these young people are making a good deal of money in being advisors to companies, and being analysts for research firms, and for investment banks, and they’re making their contribution in their own way.

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It’s not seen as — you’re a pariah, you’re leaving the force — you’re just doing things in a different way, to help society and to further your own career. It’s just a matter of young people looking at potential opportunities. Often times, they look at medicine, and they look at the changes in the patient/provider relationship that over the last 20 years. They said, you know what? This is not what I want to do. I don’t want to be in an employed physician, which is what most physicians that come out of medical school now are. They don’t want to be looking at an EHR on a laptop instead taking care of patients, and be on the timer that they have to look at every 10 minutes to see somebody else. So they say, what’s an alternative?

AMD: Final question for you. Why are we seeing a shift toward entrepreneurship today?

DJH: For those that have been in practice for so many years, and they see that their incomes are steadily declining, and they’re expenses are steadily increasing, they’re looking for alternative revenue stream. They can leverage their years of practice and experience. Innovation and commercialization of products become another aspect of what they could do, we just have to teach them how to do it.

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TheraDep Makes Targeted Delivery of Pure Medication a Reality

To really get an understanding of TheraDep, it helps to have an understanding of the problems that the company is solving. We know that introducing medications to medical devices can aid in healing and prevent infections. Unfortunately there have not been effective ways to bond these medications to the devices, or to apply them to wounds without using invasive methods. The two arms of TheraDep — TherGen and BioDep — address these concerns directly.

TherGen – Treating the Tissue

In the United States, hospital-acquired conditions are a significant problem. These conditions, which are readily preventable, are now causing the worst offenders to have their Medicare payments reduced. As a former floor nurse with an interest in wound care, I know first-hand how hard it can be to treat infected tissue, and to prevent infection in tissue that is likely to be compromised during a hospital stay. That’s why TheraGen spoke to me.

TherGen is TheraDep’s method of aerosolizing a medication (such as an antibiotic), and then applying it to the wound in a non-contact, pain-free manner. For patients with burns or early-stage pressure ulcers, this means an enhanced quality of life. For providers, it means preventing even worse infections, and promoting healing in the existing wound without invasive procedures.

What’s perhaps even more impressive is that the process used is antiseptic, although not sterilizing. It does kill off bacteria, biofilms, spores, and viruses, leading to a dramatic reduction in bacterial load which aids in cell proliferation. So not only can TheraDep help to keep infections at bay, its treatments can actually help patients heal faster as well.

BioDep – Treating the Device

The other side of the TheraDep forumula comes in treating the devices that physicians use. For example, antibiotic coatings that are bonded to hip implants can help to prevent the infections that lead to ineffective healing. This is especially important in patients who are undergoing revision surgery, where post-operative infection is an even more significant concern.

I asked TheraDep CEO Patrick Burt about the longevity of these antibiotics, and his take is favorable for the company’s appraoch. The FDA mandates rapid elution for antibiotics. Though the antibiotic itself does absorb rapidly, TheraDep can combine the deposit with other biologics to slow the rate if needed.

The FDA already has guidance in place for medicinal coatings, so TheraDep works under the existing rules instead of having to wait for a new guidance. The company is presently in phase two of a study through Clemson University for the Department of Defense. As part of an $858,000 grant, TheraDep has been implanting their antibiotic-coated plates and screws with a zero percent infection rate, as compared to a 43-percent infection rated for untreated implants.

For patients going through lower organ surgery, TheraDep will be able to assist by bonding clotting agents to the surgical tools. These procedures, where bleeding is a significant risk, are made safer for the patient when clotting agents can be introduced during the procedure from the very tools being used to perform it.

The Past and Future of TheraDep

Burt tells me that the company has already been producing microplates for researchers, working with labs and pharmaceutical companies. The technology, however, is more broad than they first realized.

The company is keeping a close eye on plasma medicine, which already has a strong presence in Europe. Argon plasma is used for electrosurgery, cauterizing, and cutting. At a lower power, and by using helium instead of argon, it becomes therapeutic. TheraDep already owns the intellectual property for having plasma as a delivery system for medications, and looks forward to the opportunities that the technology will provide.

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AngelMD Adds Dr. Ronnie Mimran as Regional Medical Director

Dr. Ronnie Mimran describes himself first and foremost as a neurosurgeon, but then he’s quick to point out that he is also a passionate educator with extensive experience as a medical device consultant. We are pleased to welcome Dr. Mimran to the AngelMD team, where he will serve as the Regional Medical Director for the San Francisco Bay area. I recently had a few minutes to talk with Dr. Mimran about the joining the team, and I took the opportunity to pick his brain about what excites him in today’s world of neurosurgery.

Let’s start with your background

I’m a neurosurgeon by training, and I work in the San Francisco Bay area. I’ve been in private practice for thirteen years in a small group of neurosurgeons. I’m fellowship trained in spine surgery, so that’s the bulk of my elective practice. But I’m also the team neurosurgeon for the Oakland Raiders football organization, so I specialize a bit in athletic injuries to the neurological system. It’s a pretty small part of my practice, escalating a bit in the fall as you can imagine, but for most of the year it doesn’t occupy a tremendous amount of my time.

How did you get involved with neuro startups?

I’ve always been a huge fan of the startup world, and I think ultimately that’s the main reason I joined AngelMD. I’ve been fascinated by medical devices, and given my location in the Bay area, the startup world is pervasive here. I’ve found that world to be infectious. The motivation and ambition of many of these startups is exciting.

I’ve worked for a few different startup companies in various capacities — as a consultant or as a medical director — and I enjoyed my time doing that. As a result I went back to school and graduated with an MBA because I was interested in helping these companies gain traction while making the lives of patients better. As I was finishing the MBA and deciding on what I wanted to do next, it occurred to me that working for one startup was a narrow scope. I started to think more about how I could broaden my exposure and work with many different companies in order to better understand the startup world from that perspective. That’s when I knew that working with accelerators and incubators really made a lot of sense to me. As an offshoot of that, I found AngelMD, and it was the perfect fit.

What do you see as the role of the Regional Medical Director?

I feel like it’s an ambassadorship. I think it’s a role that is designed to bring together different entities. On the side of the doctors, I think they are lacking a vehicle to put their financial and intelligence weight behind. AngelMD, to me, provides that vehicle for them.

I would love to be seen as the face of AngelMD in the Bay area. As these companies begin to get traction, and they’re looking for help, I hope that AngelMD will be able to act as a resource for them to move forward on a sometimes-difficult journey. For AngelMD, I hope to be able to bring these entities of companies and doctors together to provide better outcome success for everyone involved.

How do you filter the signal from the noise in the Bay area?

That’s something that I hope to get better at as I work in the position of Regional Medical Director. I think it’s an experience thing. AngelMD has a unique position in that they’re using a scientific approach to vetting these companies and improving the signal to noise ratio. It’s unique in that it’s this crowd intelligence concept that nobody is really using in the angel investing space. That puts us in the position to have hundreds if not thousands of intelligent contacts, who are experts in these fields, to help us make sound decisions.

What do you want to see in a promising company?

Ambition, enthusiasm, and goal-driven nature. I like to see a good company culture that fosters new ideas and intelligent progression. Obviously a brilliant device with a huge hole in the marketplace is important. I want to see an initial traction of some type. Those early wins are important for de-risking a company’s profile.

It’s really a learning process. If I had all of those answers today then I’d be in a much different position. I’m encouraged by what I’ve seen, and I’m excited to learn more about these companies.

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Investor Spotlight – Dr. Navin Subramanian on “Evidence-Based Investing”

Around the halls of AngelMD we often talk about investing in what you know. This is the thesis upon which we’ve built the company, and so it’s an exciting moment for us when members of the network echo how important that sentiment is to them. We recently had the chance to speak with Dr. Navin Subramanian, a Houston-based orthopedic spine surgeon, whose own experiences are a testament to the power of the AngelMD network.

Dr. Subramanian is an interesting case for an Investor Profile. Normally we focus on investors who have been Syndicate leaders, or those who have the time to serve on AngelMD’s Scientific Advisory Board (SAB). Dr. Subramanian has not yet worked in either of these capacities, but he is a significant investor in the AngelMD Catalyst Fund (the money with which AngelMD, as an entity, invests directly into startups) and has joined a number of syndicates as well. As such, he’s a good example of the typical investor in the AngelMD network, so his experiences should speak to many of you who read this.

Beyond the money, what is your motivation for investing?

One thing that we’re driven to in healthcare is the idea that everything revolves around the doctor-patient relationship. That’s true to an extent, but that relationship is evolving. We’re just so focused on our training and experiences, and on the personal interaction, that we forget all the other things that surround healthcare. There is so much innovation, technology, and an evolution to a digital era that the future holds. For me, investing gives me the opportunity to see new technology and ideas that otherwise I might not have thought of or heard of. Those ideas and technology can lead to so many other possibilities.

You’ve been an active Angel Investor for a few years now. Looking back, what would you have done differently?

I wish that I’d known how to truly evaluate a product. There are analytical ways available, but I was using more esoteric and anecdotal ways. Today you can use data analysis to get a really good indication of the viability of a company or product.  The AngelMD platform allowed me to do that, and it’s sort of like Moneyball for investing.

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There is still value to what we call “the eye test”. What are the impressions that we’re getting? But that’s just one aspect of whether a company will become successful. I want to know how they’ll be different than other companies that have tried to do the same thing, so it’s important to take those impressions and combine that with evidence-based investing.

What gets you excited about the potential in a deal?

First and foremost, what clinical applications it has. Is it piercing a market that is otherwise untouched, or only has limited penetration? Particularly with spine, I want to know if it’s actually new or just a regurgitation of something we’ve seen in the past. I also like seeing things that are a novel approach to a previous treatment. Is there IP that can be protected, and have they done so?

On the other side of that equation, I want to see things that will save a physician time. It goes back to the idea of the doctor-patient relationship, and anything that can help to improve that.

How much of a role does healthcare play in your portfolio?

I get deals all the time to invest in areas that I don’t know — like ride-sharing startups and such — but I think you have to invest in what you know when it comes to high risk. For my Angel investing, healthcare makes up over 50 percent of my portfolio. I also don’t use my life savings for high-risk investment. I use money that’s otherwise earmarked for other areas.

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What attributes do you want to see in an entrepreneur? 

I want to know their passion. Do they have emotional investment in what they’re doing? I also want to see some personal financial and time investment from them. The technology is really just one piece of the puzzle. I also need to see how they do with marketing, and the general points of running a business.

Is there any advice that you could offer physicians who are looking to invest?

I think the most important thing to me is that I understand my limitations, the primary one being time. But I believe that AngelMD does the work of the due diligence for me, and that’s especially true with the Catalyst Fund. I also know my limitations when it comes to measuring financial viability, and using hard data to find the answers.

What are three things that you’re really excited about right now?

I feel like there’s a revolution coming in spine, and it’s centered around regenerative and digital medicine. When you look back, medicine tends to go through 10-15 year stretches of innovation, starting with the advent of penicillin. This allowed us to finally treat and cure infections. Looking at surgery, anesthesia was a huge revolution. We could finally cure these diseases because we could keep the patient asleep and comfortable long enough to perform the procedures.

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More recently we’ve seen a revolution in diagnostic imagery. X-ray became nuclear medicine, CT, and MRI in the 1980s. Then in the 1990s we saw a pharmacological revolution with new medications being invented, allowing us to treat all of these conditions that you previously couldn’t do much for. There was another surgical revolution in the late 90s with the surge of minimally-invasive, laparoscopic, and arthroscopic surgeries. Now we’re poised for another revolution in digital health and regenerative medicine as far as ortho is concerned.

What’s the last book that you recommended to someone?

I love American history, especially related to the American Revolution. The last great book that I read was Founding Brothers: The Revolutionary Generation by Joseph J. Ellis.

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