A Medtech Pioneer Comes Full Circle As Co-Founder and Now Incoming Director of the Stanford Byers Center for Biodesign
Foreword: The following is an abbreviated and lightly edited transcript from the latest Medtech Trailblazers, the real stories behind the Innovators, Fogarty Innovation’s series of casual, in-depth conversations aimed at discovering the people who have forged our industry. To view part I of the videocast click here.
Anyone who’s spent time in the medtech field knows that the name Josh Makower is synonymous with innovation, as he has blazed numerous trails for new technologies and therapies alike. His academic credentials are impeccable, including a Bachelor of Science in Mechanical Engineering from MIT, an MD from NYU and an MBA from Columbia University.
Josh cut his teeth at Pfizer, then went on to become the quintessential entrepreneur, founding eight medtech companies in a variety of clinical specialties including minimally invasive vascular surgery; ear, nose and throat (ENT) issues; and women’s health.
He created an incubator, ExploraMed, to bring promising technologies to market and has been and still is a general partner at NEA, a global venture capital firm that funds innovation; and is the incoming director of the Stanford Byers Center for Biodesign. With this new position, Josh is coming full circle in his career, having co-founded the program 20 years ago and now taking the reins from the incomparable Paul Yock, MD, to lead it into the future.
Andrew Cleeland (AC) had the pleasure of chatting with Josh (JM) to discover the personality behind the genius and find out what drives his passion and made him who he is today. The following is an excerpt of his interview.
AC. Tell us a little bit about your childhood. Where’d you grow up? What was your family like?
JM. I’m the first of three kids, and we were fortunate to have very dedicated parents. Both of them were high school teachers who were passionate about science: my dad taught earth science and astronomy and was a part-time geologist, and my mom taught biology and physiology.
Growing up – this is before Google, of course – my parents were Google; they always knew the answer. My passion for education was obviously embedded deep and framed by them. And I have a real love and appreciation for science and how things work and why things are. In fact, even in my childhood, I liked getting involved in creative projects and started quasi-inventing early on.
Before I was 10, I was inspired by the popular 1970s TV drama, “The Six Million Dollar Man,” and its premise that technology could improve people’s lives. I think that was the initiation of my fascination and what ultimately became my career direction.
AC. Where did you grow up?
JM. I was born in Massachusetts where my parents were finishing their graduate degrees at University of Massachusetts. We moved around a lot because they were high school teachers, and there were a lot of budget cuts earlier in their careers, so they were constantly looking for jobs in different places. Overall, it was a good experience because I learned to make new friends in all these places. We eventually wound up in New York City, which is where my parents settled into long-term careers. We stayed there until I moved out to Silicon Valley as an entrepreneur.
AC. Who was the most influential person in your life?
JM. My mom; she taught me to believe in myself and how to stand up to criticism and bullies. She always believed in me, even when some teachers had doubts because I was a real daydreamer. She taught me to rise above criticism and not let it impact my self-esteem and self-worth.
AC. Your academic path is incredibly impressive — MIT, NYU, Columbia. Tell us a little bit about that.
JM. I’ve always just wanted to learn. I transferred to MIT because my girlfriend at the time was there, and that’s where I rediscovered how much I love engineering — knowing how things work and making things work. Then the question was what would I do next? And back to “The Six Million Dollar Man,” how am I going to learn how to make engineering work for humans? I decided to go to medical school because I felt learning from a doctor’s perspective would help me understand the real challenges physicians face. I went to medical school to learn how to be a doctor so that I could make things for doctors, which really put me in a different category than most other students. I loved physiology and anatomy, and I was fascinated by the human body – how intricate, complex and unique it is. I always wanted to know the “why.”
I decided to get my MBA after working for a few years at Pfizer. While there, I realized there was a piece missing, a “language” I didn’t understand and conversations I couldn’t participate in. I was categorized as a technical and clinical person, rather than a business person, and I felt I needed that background to be successful. I had a great experience at Pfizer and was very fortunate to have bosses who supported me and made it possible to keep working while going through the executive program at Columbia.
AC. Switching over to your work career…your time at Pfizer seems pretty foundational. Can you tell us about that?
JM. By the end of medical school I had decided I wanted to be involved in the business of creating technologies, so I was looking for a job. And here’s a piece of advice I would like to share with anyone who is looking to get a job at a particular place: don’t look at the job postings – reach out to the highest-level person whose email you can get at the organizations you want to work for.
At that time, we were communicating by letters, so I wrote to the CFO and CEO and said I wanted a job creating new technologies or working in business or technology development, and the CFO of Pfizer pulled my resume out of a stack. He was also the VP of strategic planning, and he invited me for an interview, and I got the job. Shortly into my tenure I was asked to research what makes startups so innovative when they are independent, only to stop innovating effectively once they are acquired.
That one moment changed my career forever. It led me to an investigation in identifying the best process for innovating new medical technologies. I interviewed all the founders and founding teams of the companies that created the businesses that had since become divisions of Pfizer and then interviewed the leadership of the current Pfizer teams. I discovered they initially develop a technology to solve a specific problem, but once they are inside a larger company, they’re just looking for new applications for that technology, which leads them down a very narrow path.
Remaining innovative meant focusing on needs first. From there, I created the Pfizer strategic innovation group, which was the origin of what is now the Stanford Biodesign process.
AC. What led you to start ExploraMed?
JM. While Pfizer positioned itself as an innovative company, at the time, it was difficult to pursue paths that truly hadn’t been traveled before. I felt compelled to leave so I could have the freedom to find ways to overcome the inevitable obstacles to move a technology forward. Entrepreneurship felt like the only way I could achieve my goals.
For that reason, I launched ExploraMed. I had proven that the innovation process works, but these projects that could have been companies inside of Pfizer weren’t thriving. My idea was to go to VCs with solution concepts to important unmet needs, get funding and develop a technology. I had a process and tracker I could show, but no ideas yet as everything I had invented was still at Pfizer, so I started from scratch.
I got a few nibbles from some really good-quality firms. But the key relationship was the one I had with Bobby Anderson, who was one of my mentors at Pfizer and founder of Valleylab. He connected me with John Nehra, a former general partner at NEA. So, with as little as $500,000 from NEA and $200,000 from Bobby, we formed ExploraMed and we wound up creating two companies out of that funding.
AC. What are your lessons learned from ExploraMed?
JM. People are everything, even more important than the idea. The idea has to be exciting enough to draw the best and brightest people, and then you give them the freedom and opportunity to actually create what the company will be. The company is the people, not the product. It’s a living thing.
The other piece is being honest with yourself about what something is and is not. I think entrepreneurs and founders have a tough time with this. I certainly did in my first go. As you try to solve problems and create innovative new solutions, you have to believe in yourself, but also face the facts. If things don’t go as planned, you have to be willing to look at the data and consensus feedback, and then adapt to fix the issue. While persistence is the key to success, you have to recognize when it’s time to change course.
AC. You’ve founded, led, incubated and funded companies. Which of those roles is your favorite?
JM. I do love the founding piece of it. One of the greatest thrills in life is to do something that’s never been done before that works and helps people. It’s about breaking new ground, creating jobs for people, improving outcomes for patients and finding success for our partners. And helping other people build their careers is part of that as well – there’s a lot of pride in the contribution of seeing them invent and create their own companies.
AC. Moving to consumer products, tell us a little about co-founding Coravin.
JM. One of the guys that I hired into Pfizer, Greg Lambrecht, became a good friend; I worked with him for a couple of years at the company, and I’ve helped him and he’s helped me with a couple of companies. We’ve stayed in touch all these years, and one night at dinner he pops a bottle of wine on the table that looked like it had never been opened but was completely empty. In reality, he had drunk the bottle over the course of a year. He pulled out a funny looking object and put it on the table. He was calling it the “wine mosquito,” which thankfully got a name change, but the concept is to take a glass of wine out of the bottle without ever exposing it to air. He invented the technology, and after one year of playing with it I suggested we found a company, so we launched Coravin, my first consumer company, and it’s been a lot of fun.
AC. Let’s move on to the next steps, director of Stanford Biodesign. You’ve been associated with Stanford for 20+ years. You’re one of the founders of Biodesign, which is celebrating its 20th anniversary. What’s the plan and the vision?
JM. What Paul (Yock) has done at Stanford Biodesign is incredible. He is one of the kindest, most generous human beings I’ve ever met in my life, and it’s been a pleasure to work with him. It’s a huge honor to have this opportunity to pick up from where Paul has brought the organization and move it forward. We created Biodesign to be a community, and I want to keep that spirit vibrant and make it about the community and for the community.
As I look ahead, I see opportunity to think more broadly about what we could be doing and perhaps bring a little more structure to some of it. Our mission continues to be to create a framework for educating the next generation of healthcare technology innovators. And so how can we do that even better and more effectively? I think there are some tools we can apply.
One of the other parts of supporting the innovation ecosystem is how Stanford Biodesign can play a pivotal role in policy. There’s a need for a voice in the debate that brings data and an unbiased view, but one that’s oriented towards helping patients get access to new technology and creating an environment where those technologies can thrive and help improve patients’ lives. This is something we have and will be working with you [Fogarty Innovation] to achieve. I also think we have to consider how to make the opportunity to benefit from new technologies more available to a broader group of people, a more diverse group with regard to race, gender, sexual orientation and economic status.
AC. Looking back over your career, what have you learned? What words of wisdom would you have for somebody starting off their career in healthcare?
JM. The most important thing is to always keep the patient or the person you’re trying to help at the full center of your focus. If you do that, you will be successful. And that means listening to data, building the right team and persevering – all while making sure you’re doing it for that need for that person.
Obviously rooted in that, of course, is the need. There has to be a well-founded need and a clear spec to shoot for that you can’t deviate from. Keep that patient, that person, that disease they have that you want to try to fix, right in the center. And when you think about that person being you or your loved one, that helps you make all the right decisions.
Click here to view Josh’s full bio.