Our Fogarty educational community recently enjoyed a special treat at “The Flavors of Innovation,” a Lunch & Learn featuring Bill Starling and Nancy Messonnier, MD, moderated by Fogarty chief alliance officer Allie Gregorian. The two visionaries shared stories of driving life-changing innovations forward in very different environments: Silicon Valley’s entrepreneurial ecosystem and the world of public health.
Both experts are Tar Heels with deep connections to the University of North Carolina at Chapel Hill: Messonnier is the dean and Bryson Distinguished Professor in Public Health at the UNC Gillings School of Public Health; Starling is an alumnus and, along with his wife, Dana, a major philanthropic donor to the University.
A pioneering entrepreneur, investor, and company builder who has been at the heart of medtech innovation for more than 40 years, Bill Starling is well known to many at Fogarty Innovation. Before leading the Gillings School, Nancy Messonnier spent 25 years at the CDC, where she tackled public health challenges including leadership during the CDC’s response to the COVID-19 pandemic, one of the highest-pressure health challenges in modern history.
“What is a Fogarty?”
Starling spoke first, recounting his early days selling heart valves and pulmonary artery catheters for Edwards Lifesciences. Promoted to manage the Fogarty catheter and instrument portfolio, he admitted, “I didn’t know what the hell a Fogarty was, so I started studying up on acute arterial embolization.” A month of library research at UC Irvine left him with a deep appreciation for how Tom Fogarty’s balloon embolectomy catheter had revolutionized treatment of blood clots in the legs.
“Before Fogarty, 50% of patients treated in the then-standard open procedure ended up losing their leg or their life,” he said. “ Today, if you go to the ER with that problem, they will still use a Fogarty catheter—not one iota of improvement has happened since that time.”
As part of his work, Starling started meeting with Fogarty in person, with the goal of having him develop a balloon dilatation system for cardiologists. Over time, the two became business associates and friends. As he described their interactions, Starling treated the audience to photos and stories from their numerous adventures, including a rafting trip down the Colorado River that was much improved by the keg of Fogarty Winery zinfandel that Fogarty arranged to bring along.
Doing Well by Doing Good
In part through his association with Fogarty, Starling met other medtech thought leaders who helped shape his career path. These included Andreas Gruentzig, MD, who invented the world’s first coronary angioplasty system, and John Simpson, MD, the “father of interventional cardiology,” who improved that system by inventing an approach that enabled more precise navigation through complex coronary vessels.
Simpson founded Advanced Cardiovascular Systems (ACS) to bring his “over-the-wire” platform forward, and Starling joined the founding management team. The approach significantly improved the success rate and safety of percutaneous transluminal coronary angioplasty (PTCA) procedures and quickly became the standard of care. The strong clinical demand catapulted ACS to a leadership role in the global coronary angioplasty market, leading to its acquisition by Eli Lilly.
ACS became a model for startup success. With only $9 million in seed, angel, and venture funding, the team achieved an exit valued at $237 million—more than $2 billion in today’s dollars. “It was a win on all fronts,” Starling said. “Patients everywhere avoided open-heart bypasses, the financial success elevated medtech innovation in the Valley, and ACS alumni launched hundreds of other startups.”
Starling went on to co-found Ventritex (now Abbott CRM), which developed the first microprocessor-controlled implantable cardiac defibrillator. The technology saved thousands from sudden cardiac death, and the company became another of Silicon Valley’s biggest success stories. He also co-founded and led Cardiac Pathways, a pioneer in treating ventricular and atrial arrhythmias that was acquired by Boston Scientific, and co-founded Synecor LLC to accelerate cardiovascular research and devices.
Diagnosing Arrythmia
Starling also got involved on the investment side, co-founding Synergy Life Science Partners, and championing the firm’s first diagnostic product, iRhythm’s ZIO Patch for ambulatory arrhythmia detection.
“The Holter monitor had been standard of care for decades, but it was cumbersome, and patients could only wear it for one or two days before returning it to the hospital,” he described. “The ZIO Patch, invented out of the Stanford Biodesign Innovation Fellowship, was an easy-to-use, disposable patch that could be used at the point of care to not only improve diagnostic accuracy, but also increase detection in an underdiagnosed population.”
Synergy invested $14.8M. After iRhythm went public in 2016, the fund distributed shares worth $86M. Today, iRhythm’s market cap stands at $5.2B.
A Systems Approach
Messonnier offered a public health lens, highlighting that while innovation in both public health and the private sector begins with unmet need, the challenges differ. “In public health, we start with the big picture,” she said. “What is the need, and what population are we trying to serve?” Implementation hurdles like logistics and trust are often decisive. “A vaccine sitting on a shelf is 0% effective,” she said.
To address these issues, public health uses systems science to model and map all of the factors associated with a given problem and figure out where to intervene in the way that would be most effective.
Tackling Meningitis
For example, Messonnier described working to address recurring epidemics of meningitis in a strip of poor countries in Africa called the “Meningitis Belt.” Meningitis is a bacterial infection of the spinal cord with high morbidity and mortality. The region had outbreaks every year, and periodically, major epidemics. In 1996, more than 350,000 people were infected and 35,000 died.
“The CDC had been working on this problem for years, trying to solve it by fixing broken systems of surveillance and response and lab detection,” she said. “But unless you could fix the underlying system, you couldn’t really fix the problem.”
It became clear that the way out was a vaccine. “At that time, the technology to make a vaccine existed, but the major pharmaceutical companies developing vaccines were targeting the strains of meningitis present in industrialized countries, as well as price point of $120 per dose,” she recalled.
Messonnier and colleagues from other global health organizations went to the Gates Foundation, which at the time, was focused primarily on TB, HIV, and malaria, to try to convince them to help. They successfully secured $70M to fund development of an affordable, region-specific vaccine.
“It took more than ten years, but by 2014, 200 million people were vaccinated across 15 countries, and there were no more epidemics,” Messonnier said. Uptake was high — families had seen the devastation firsthand. “No one made money, except maybe the Serum Institute of India, which manufactured the vaccine for 40 cents per dose,“ she said. “But I can only hope that everyone in this room gets the opportunity to feel the way we did when we celebrated that accomplishment.”
Responding to COVID-19
As the former director of the CDC’s National Center for Immunization and Respiratory Disease, Messonnier was also at the front lines of the COVID-19 pandemic.
In February of 2020, she tried to make sure the American public knew the pandemic was coming, warning in a White House press briefing that COVID in the U.S. was not a matter of “if,” but rather “when and how bad.” Later that year, she worked with colleagues to build nationwide vaccine distribution systems—an effort that normally takes years—in just a few months.
Messonnier described the complexity of the task, noting that they had to build—from scratch—a system that could not only handle safety and effectiveness monitoring, but also cold chain storage and transport.
Acknowledging the negativity in the news today about vaccines, she commented, “When I think about the vaccines, I don’t think about the fact that they saved millions of lives or caused very limited adverse events — both of which are true. I think about how these vaccines got us out of the house and back to normal life and got people feeling safe enough to interact. I believe in the long term, this is going to be seen for the huge success that it was.”
A Research Powerhouse
After leaving the CDC, Messonnier became dean of the Gillings School, the nation’s top-ranked public school of public health. With more than 2,000 students and 240 faculty, the School pursues projects around the globe while educating the next generation of public health innovators. Programs include an Innovation for the Public Good certificate, a focus on experiential learning, mentorship for student entrepreneurs, and a pitch competition.
Between 2012 and 2024, 57 companies were launched out of the Gillings School, including LiRA — a next-generation voice-restoration technology— and a low-cost, AI-powered ultrasound that aims to help pregnant women in remote villages in Africa know their due dates so they can plan to deliver at a birthing center.
Messonnier noted that despite its profound impact, public health often remains invisible. “Public health saved your life today, and you didn’t even know it,” she said. “If you buckled your seatbelt, drank clean water, or crossed safely at a pedestrian sign, that was public health at work.”