From Idea to Market: Ep 12 - From Here, It's Yours

In the finale of From Idea to Market, the surgeons, engineers, founders, attorneys, and investors who lived every stage of medical device innovation look back and answer one question: what do they wish they had known from the start?

Across this series, one pattern kept surfacing: innovation doesn't begin with a business plan. It begins with a clinical problem someone can't let go — a resident watching a procedure that felt inadequate and carrying that feeling for twenty-five years, or a physician-turned-founder who couldn't stop thinking about a patient who lacked what she needed.

In this closing episode, Robert Cohen reflects on four decades in med tech and the permission to say "I don't know." Alexander Sah describes the emotional rollercoaster of introducing new technology — and knowing when to abandon an idea. Charlie DeCook and Simon Mifsud explain why the idea itself is never the advantage. Charles Lawrie distills the whole journey into a playbook: start with a problem you live, build with people who know what you don't, think big but execute small. Leo Whiteside talks about protecting intellectual property, standing alone on panels, and why the work is "a very joyful thing to do." Emily Ast and Marie-Isabelle Batthyány close with the tests that matter: the right team, the family at the dinner table, and a real need — not an imagined one.

If there's a problem in your practice that keeps coming back to you, this episode is the series' parting argument for taking it seriously. From here, it's yours.

⏱️ Chapters:
00:00 Introduction: what the series taught us about innovators
02:54 The problem you can't let go: where innovation begins
07:13 What innovation demands: vulnerability and listening
09:42 The emotional rollercoaster of device development
11:29 Why the idea is not the advantage: iteration and teams
13:55 Charles Lawrie's playbook: start with a problem you live
16:52 Leo Whiteside on opposition, IP, and the joy of the work
19:04 Legal, financial, and family support for innovators
20:33 Real needs, not imagined ones: the test of every device
22:03 From here, it's yours: a challenge to the next innovator

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This podcast is intended for educational and informational purposes only.

The content discussed does not constitute medical advice and should not be used as a substitute for professional judgment. Clinicians should rely on their own training, experience, and clinical decision-making when applying information from this discussion.

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Transcript

Joseph M. Schwab 0:21

Hello and welcome to the AHF podcast. I'm your host, Joe Schwab. This is the final episode of "From Idea to Market," and when we started this series, we thought we were making something about medical devices, about the process, about the pathway from an idea to a product, and we did. But somewhere along the way, something shifted. The process stopped being the story. The people became the story. What they chose, what they carried, what they refused to put down even when putting it down would have been the rational thing to do. We sat with surgeons who had watched the same inadequate outcome repeat for years until they couldn't justify accepting it anymore. We sat with engineers who built things that didn't exist because the things that did were falling short. We sat with entrepreneurs, lawyers, investors, and clinicians who gave years of their lives to problems that the rest of the world had learned to live with. And making this series changed how we see this work. We came in thinking innovation was about invention. We came out understanding that it's about something much more difficult. It's about deciding again and again that a problem the system has normalized isn't something you're willing to normalize. So this final episode belongs to the people who dared to innovate, who stayed committed through the hardest stages and kept going even when looking away would have been the easier choice. The surgeons, the engineers, the entrepreneurs, the lawyers, the investors in their own words. Looking back, they tell us what this journey actually asks of a person and what it gives back. This is episode 12. From here, it's yours Every innovation in this series has pretty much started the same way. Not with a business plan or a market analysis, but with a moment, a specific, often unremarkable moment in a clinical environment when someone saw something that didn't sit right, and instead of moving on, they stayed with it. Jared Foran was a resident when he had this. He was watching a case, watching his attending surgeon work through a procedure that everyone in the room accepted as standard, and something in him just couldn't accept it. He thought there had to be a better way to deliver antibiotics into a joint. He didn't have a plan or a company or a prototype. He just had a feeling that what he was watching wasn't the best version of what was possible, and that feeling stayed with him for nearly twenty-five years. And that, more than anything else we discovered making this series, is what separates the people who actually change things from the people who notice things and move on. It's not intelligence necessarily. It's not resources. It's the inability to let a problem go once you've truly seen it. Peter Noymer has two hip replacements. He knows what it feels like to go from significant pain and limited activity back to a life that is fully his again. He describes that transformation in a way that makes the stakes of this work impossible to abstract. And now he's building a better treatment for the patients who don't get that outcome, the ones who have a joint replacement and then develop an infection, the ones who, instead of getting their lives back, spend months or years in revision surgeries and prolonged antibiotic courses, facing complications that compound on each other

Peter Noymer 4:55

there's the altruistic part, like for me personally, you know, kind of getting up, waking up every morning and going to work on something that I know is gonna make people's lives better. That's huge.

Joseph M. Schwab 5:06

That is the foundation of everything in this series. Not the regulatory strategy, not the funding structure, not the manufacturing process. The patient who needs something that doesn't yet exist, and the person who decided they were gonna be the one to build it. The stages between that decision and the outcome are long and demanding in ways that are very hard to fully anticipate at the start. There's a version of this story where the hero has the idea, navigates the obstacles, and arrives at the destination. But that version isn't what we found. What we found is messier and more honest than that. We found people who pivoted multiple times, who ran out of money, had to find more, who stood in rooms full of skeptics and made the case again and again, who built something they believed in and then had to rebuild it when the real world told them the first version wasn't practical. And what we found underneath all of that in every conversation was something that never changed: the patient at the other end of the work, the specific human being whose life would be different if the work succeeded. That connection, held through every setback and every revision and every year of slow progress, is what the work actually is. The process this series covers, the shaping and the testing, the funding and the regulation, the manufacturing and the scale, all of that is how you honor that connection. It's how you take the feeling of a resident standing in an operating room twenty-five years ago and turn it into something that reaches patients at scale. That is the story we set out to tell, and these are the people who lived it One of the questions we kept asking our guests was some version of this: What did the journey ask of you that you didn't expect? The answers surprised us because they were almost never about the process. They were about the person, about what you have to be willing to become in order to carry something like this all the way through. Robert Cohen has spent four decades inside med tech. He's built companies and sold them and evaluated hundreds of other people's ideas from inside of one of the largest organizations in this field. And when we asked him what the work had taught him, he didn't answer the way we expected

Robert Cohen 8:00

and what I realized I was taking it too personally and I realized it's okay to show vulnerability and it's okay to say I don't know, or it's okay to say I'm not perfect.

Joseph M. Schwab 8:11

There is something profound in that. Someone who has been through the full arc of this journey multiple times, and the thing he wants most to pass on is permission. Permission to not have all the answers, permission to be honest about what you don't know. Because the innovators who struggle most in this field are often not the ones who lack talent or resources. They're the ones who spend so much energy maintaining a posture of certainty that they lose the ability to hear the information that might actually help them. The setback that looks like a threat is often the data point that changes everything if you're willing to receive it

Robert Cohen 8:59

Be a good listener and stick to your competency and sticking to my competency are words to live by

Joseph M. Schwab 9:04

Knowing what you are genuinely good at and trusting others with the rest, that isn't a limitation. In a field this complex with this many disciplines intersecting, it's the only viable strategy. The journey also demands something that has no formal name, but we kept seeing across every conversation a specific kind of emotional stamina, the ability to hold the long view when the short view is pretty discouraging, to stay connected to the reason the work matters when the process is grinding. Alex Sah has introduced multiple technologies into orthopedic practice and has felt the full arc of that emotional experience, the early excitement, the long, difficult middle, the moments of genuine doubt, and he's honest about what it takes

Alexander Sah 10:00

it's gonna be a rollercoaster. some portions will go very well and some will be incredibly frustrating or time consuming or costly. So just knowing and being prepared that it's gonna be physically and emotionally a roller coaster.

Joseph M. Schwab 10:13

People who told us this said it not to be discouraging. They said it because going in knowing the true shape of the journey changes how you carry it. The difficult stages that break someone who expected a straight line are navigable for someone who expected the curve. And the balance that the long version of this journey ultimately requires is a difficult one to hold. You have to be persistent enough to survive the stages when progress is invisible, and you have to be honest enough to know when persistence has become something else

Alexander Sah 10:50

have patience, be persistent, um, know, know who your good partners are, and at the same time know when to abandon an idea. So it's just having that balance of what's realistic.

Joseph M. Schwab 11:01

Holding that balance, knowing when to push and when to release, is something no course teaches and no book fully captures. It develops through experience, through feedback from people who care more about the outcome than about your comfort, and through a relationship with the evidence that is more loyal than your relationship with your original assumptions. Charlie DeCook describes something we heard in many forms across this series. "The idea," he says, "is not the advantage. What you build around the idea is the advantage."

Charlie DeCook 11:42

you have a good idea now you have to take the next level, and I don't think surgeons realize how much time and effort is required to refining your idea. Um, and to continue to pivot. Continue to iterate on that idea, Make sure your product is right. Make sure you have a financial model and surround yourself with the right team. I think if you do that, then you can take it to market.

Joseph M. Schwab 12:07

That last line is where so many promising ideas fail to arrive, not because the science was wrong, because the team was incomplete or the financial model wasn't built or the product wasn't refined past the point of the original concept. The journey demands all of those things, and it demands something underneath all of them: the willingness to keep asking whether what you're building is actually serving the person it was built for. Simon Mifsud is building a novel hip implant in a market where he competes against organizations with decades of surgical adoption behind them. The odds on paper are daunting, and what he says about how he approaches that challenge says everything about where his attention actually lives

Simon Mifsud 12:59

For me, I think the ability to offer something that has truly transformative, properties not only to patients, but to surgeons and healthcare providers alike. By reducing perhaps the number of revision surgeries, the number of dislocations, and giving people the ability to get back to their lives, get back to being active, get back to being productive. You know, that has a massive thing.

Joseph M. Schwab 13:25

Getting back to their lives, getting back to being active, getting back to being productive, that is what the journey is in service of. And when that connection stays clear, when the work remains anchored to the patient who needs it, the difficult stages of the journey become something more than obstacles. They become the price of something worth paying for. Well, there's a specific kind of generosity that comes from people who have worked a long time on hard things. Not the generosity of resources, the generosity of honesty, of being willing to tell the next person the true version of what the journey was and what it cost and what got them through it and what they wish someone had told them at the start. Every person in this series offered that, and this final chapter belongs to them. Charles Lawrie has built a company while continuing to practice as a surgeon, He's raised money and built a team and navigated the commercial realities of a healthcare system that isn't designed to make adoption easy. And when he steps back and describes what he's learned, he does it with the clarity of someone who has earned it

Charles Lawrie 14:49

start with a problem. You live every day, not an abstract one. You know, the best ideas come from. Front lines, once you've identified the problem, resist the urge to build an isolation. surround yourself with people who know what you don't. build simple, define these series of checkpoints where you say, I have my, here's what I want my minimum viable product to look like. This is the point where I'm gonna take it to market you know, and finally I would say don't be afraid to think big, um, but execute small, Pilot, iterate, you know, fall flat on your face, fail a few times measure the impact really be a scientist about it.

Joseph M. Schwab 15:27

Start with a problem you live. Build with people who know what you don't. Stay simple. Measure the impact. Be willing to fail. That is the whole series distilled into one quote, and it came not from a textbook, but from someone who is still in the middle of doing it. What we also heard from nearly everyone is something that the process-focused parts of this series can obscure: the importance of the community around the work

Doug Fairbanks 16:00

it's nice when we see surgeons and organizations like Anterior Hip Foundation saying, we're gonna dedicate time to innovation and to embracing and learning about what's new because it may help us do this thing better.

Joseph M. Schwab 16:13

Innovation needs a community. It needs surgeons willing to evaluate something new before the evidence is complete, institutions that create structured spaces for that evaluation, organizations that bring clinicians and innovators into the same room and let something happen between them. The willingness to be part of that as a mentor, as an evaluator, as someone who shows up and shares what they've learned is one of the most meaningful things an experienced person in this field can contribute to the next generation of people who are standing at the starting line. Leo Whiteside has spent decades generating the clinical evidence that gave others a foundation to build on. He has published and presented and been challenged and held his ground and seen ideas that were opposed eventually become standard practice. What he passes on carries the full weight of that experience

Leo Whiteside 17:13

the first thing is make sure you're totally behind it because most people don't realize it. It could be a lifetime of work to get it where you want it to be. And then, uh, the other is early into protection of intellectual property. get a lawyer early and then, assemble a good team. and then, uh, it, it's a, it's a very, uh, joyful thing to do. most people are not willing to, to, to face the opposition. Opposition will come from all sides sometimes. It's amazing. you better be ready to be by yourself on panels over, over again with everybody disagreeing. if you believe what 95% of the people believe about any topic, you're wrong. It's the 5% That's right. And, and you hang on to that.

Joseph M. Schwab 18:15

It's a very joyful thing to do. That line sits in the middle of a passage about lifetime commitments and standing alone in a room where everyone disagrees, and it's the most important thing Leo says. Because the people who sustain this work over the long term aren't the ones who endure the difficulty. They're the ones who love the problem, who find something alive in the questions they're chasing, who would rather be working on this hard thing than on something easier that matters less. That joy, earned through commitment and tested through opposition, is what keeps people going the morning after the rejection and the morning after that. Emily Ast works at the intersection of innovation and protection. She's been in the room when the idea is brand new and the decisions being made will define the future for years, and what she passes on goes further than legal strategy

Emily Ast 19:21

From Idea to market to me means get your team in place. If you're lawyers, your accountants, your advisors, your family, get everyone on board so that you can have the support and guidance along the way, and I think that will lead to great success.

Joseph M. Schwab 19:37

Family. This journey doesn't stay in the office. It comes home. It sits at the dinner table during the years when the funding hasn't come through and the timeline has slipped again. It's present in the conversations that happen late at night when the person building something wonders whether they made the right decision. The ones who do this sustainably are honest about that early. They don't treat the people closest to them as a safety net to fall back on when things get hard. They bring them into the vision before things get hard because they know what's coming. And we end where we should end, with Marie-Isabelle Batthyány, a physician who became an entrepreneur not because she had a business plan or the right background or a clear path forward. She started because a patient was in front of her who didn't have what she needed, and she could not stop thinking about it. She didn't wait for the right moment. She started because the need was real

Marie-Isabelle Batthyány 20:49

from idea to market means, leading with clarity and actually purpose, it makes you stick to things and turning a real need, not an imagined need, but a real need into a validated from the beginning, clinically validated solutions, building with users not. Not for them and driving it forward until it creates really an impact in the real world.

Joseph M. Schwab 21:22

A real need, not an imagined one. That is the test that runs through this entire series, whether the patient in front of you genuinely needs something that does not yet exist, whether the gap you see is real, not constructed, whether you can stay honest about that through the years of building, even when the commercial pressures are tempting you toward a different answer. If the need is real, everything else in this series is just an instruction manual Over 12 episodes, we heard from people at every stage of this journey: the surgeon who was a resident 25 years ago watching a procedure that felt inadequate, thinking there had to be a better way; the engineer who found a way to see anatomy in real time; The physician who built a VR experience so that patients could walk into surgery truly prepared. The entrepreneur who designed an implant that lets a patient get into deep squat and named the company after a yoga pose. The people who funded the work, protected the work, navigated the regulation, and built the systems that made the work repeatable. All of them, across different technologies and different decades and different roles, were working toward the same thing: a patient who is better. Not a better market position, not a stronger portfolio, not a higher valuation. A patient who went home better, who got back to work, who picked up their grandchild, who did the thing they hadn't been able to do for years. That is what we kept coming back to in every episode, at every stage of this journey. No matter how deep the regulatory strategy or the manufacturing process or the acquisition mechanics the conversation went, it always came back to that, and it is what we wanna leave you with. If you're listening to this and there is a problem in your practice that keeps coming back to you, a case that you can't let go, an outcome that bothered you in a way you haven't been able to put down, pay attention to that. That feeling isn't the noise; it's the signal. The people in this series didn't start with companies or prototypes or patents. They started with that feeling, and they made a decision in their own time and on their own terms to take it seriously. You don't need all the answers to start. You need a real problem and the commitment to sit with it long enough to understand what it actually requires. You don't need to see the whole path. You need to take the next step and trust that the work itself will show you what follows. The problems worth solving in medicine aren't waiting to be discovered. They're already visible. They're being worked around right now in operating rooms and patient rooms by clinicians who have accepted them as the cost of doing business. Someone will eventually decide they're not willing to accept that. That someone could be you. From here, it's yours. Thank you for listening to 'From Idea to Market.'