Foreword: The following is an abbreviated and 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 1 of the videocast, click here.
A husband, father, world-renowned physician, venture capitalist and prolific entrepreneur, John Simpson, MD, has helped revolutionize the field of cardiology via his innovations.
Credited with inventing and commercializing the first over-the-wire balloon catheter used for percutaneous transluminal coronary angioplasty (PTCA) and helping to create the field of interventional cardiology, John also founded and successfully exited numerous companies, including Advanced Cardiovascular Systems (ACS) and Devices for Vascular Intervention (DVI), which were both acquired by Eli Lily; CVIS, acquired by Boston Scientific; Perclose, sold to Abbott; LuMend, acquired by Cordis Corporation; and Fox Hollow, acquired by ev3, which is now part of Medtronic. Today, he continues to innovate in his work as a senior advisor to Cordis-X.
John has been recognized with numerous awards over his career, including the prestigious Russ Prize from the National Academy of Engineering. His name comes up frequently in Fogarty’s Medtech Trailblazer’s series because, in addition to the tremendous impact of his inventions on our field, he has also mentored and inspired hundreds of medical technology entrepreneurs.
Andrew Cleeland (AC) had the pleasure of chatting with John (JS) to learn more about his career as a serial entrepreneur as well as his insights on what it takes to drive innovation. The following is an excerpt of his interview.
AC. Tell us about where you grew up and your family life.
JS. I grew up in Lubbock, Texas. My family worked in agriculture, but my father was a builder. I initially wanted to become a vet because I spent a lot of time on my grandfather’s ranch where he had horses and cows. Although I didn’t get into vet school, I did stay focused on science. I eventually went to Texas Tech and later transferred to Ohio State where I met my wife, Lynn. She’s been an integral part of my life and a huge supporter as I went through undergraduate school, an additional four years of graduate school at University of Texas to earn a master’s degree in biomedical sciences and a Ph.D. in immunology, medical school at Duke University, and then internship, residency and fellowship in interventional cardiology at Stanford – all before ever getting a job. During these years we were blessed with four kids – three girls and one boy.
AC. What led you to medicine?
JS. I’ve always found science fascinating. In graduate school I had an emphasis on immunology, and later at Duke, I worked with Dr. Bernard Amos, who discovered the very first histocompatibility antigen that is the major cause of transplant rejection. He is also the one who helped me get into medical school. Reflecting on graduate school, it’s what best prepared me for my career. We were taught to always look for a better way to do things and to question the status quo. This was the opposite of medical school, where we weren’t supposed to question the way we were trained to do things.
My interest in science and medicine eventually led me to Stanford.
AC. As we look at the companies you founded, coronary and peripheral vascular disease are a common element. Why are these conditions important to you?
JS. There were several cardiology-related fields I could choose from during my fellowship at Stanford, and coronary disease was the most interesting to me. What sealed the deal was listening to a lecture by Andreas Gruentzig, MD, who came to Stanford to discuss the balloon angioplasty technology he had invented. While I was fascinated at its potential to revolutionize the treatment of coronary disease, I was also skeptical. However, a few months later, I ended up having a complication while doing an angiogram and thought that maybe if we had used Gruentzig’s balloon, we could have done better for the patient.
Eventually, as I became more involved in angioplasty, I discovered that 3% of the patients had to have emergency surgery after their procedure, which motivated me to improve Andreas’ technology. I give a lot of credit to my training at Duke and to like-minded colleagues, such as Dr. Fogarty, for the mindset of always looking for a better path.
AC. Tell us about the evolution of what subsequently became ACS.
JS. At Stanford, I worked with Ned Robert, who was another cardiology fellow. While Ned wasn’t convinced that angioplasty was going to be a game changer, he was very energetic and fun to work with, and we fed off each other as we developed the first over-the-wire balloon catheter. I ultimately wanted to pursue the development of this technology aggressively over the long term as I felt it could make a real difference in patient outcomes. These were patients who would otherwise need to have bypass surgery, and now we had the opportunity to treat them with a simple, small balloon.
AC. What were the pivotal moments at ACS for you?
JS. The first was meeting Ray Williams who had the capital, because without it, we couldn’t build a company. Ray provided a very supportive environment, – he got many of his friends to invest and they never tried to direct us or control us; they just wanted us to get things done and move forward. The funding allowed us to keep working on the technology, which led to the development of the movable guidewire that gave physicians more control over the procedure and eventually transformed the industry.
None of these things happen without an enormous number of people, ideas, thought and feedback. Because of the infrastructure here in the Bay Area, we were able to find the right people to help us develop, finance, and grow the company.
AC. I hear there’s a fascinating story about how you developed the knot-tying sequence for Perclose. Will you share it with us?
JS. I was fishing with an anesthesiologist from Stanford outside of Ketchum, Idaho. As we were tying knots to fly fish, I told him we were struggling with the knot that we were using to tie the sutures at Perclose. He asked me why we weren’t using the clinch knot that we use for fly fishing, which never slips. We ended up using a double clinch knot in the technology, and in retrospect, it was so obvious, as it’s a knot that works so well.
It’s this blend of disparate people and expertise that really helped drive forward many of our innovations. And, I would add, a desire to persevere. You have to have that in this industry, where you are often developing a solution you think is going to be perfect but ends up not working right away.
AC. What’s next for you?
JS. Well, I still believe in trying to make things better. There’s a movement in our industry towards using some combination of ultrasound, maybe OCT, in imaging and trying to reduce the reliance on fluoroscopy and radiation exposure. I want to keep working on other new technologies as well. I have found that if you do something special for the patient, you have a great chance of building a good business around it, and that philosophy still holds true. Lastly, I also want to improve my golf game, which sure could use it.