Speaker 1: Pushkin. Hey, it's Jacob. Just a quick note before we
Speaker 1: start the show. Today, I'm hosting a new podcast in
Speaker 1: addition to this one. The new show is called Business History,
Speaker 1: and it's about the history of business and I think
Speaker 1: you'll like it. If you like What's Your Problem, I
Speaker 1: think you'll like Business History. The first episode is out today.
Speaker 1: It's about Southwest Airlines, which is an amazing story. And
Speaker 1: then starting next week we're going to have a series
Speaker 1: on Thomas Edison, who is really a very What's Your
Speaker 1: Problem kind of guy, made an incredible amount of technological progress,
Speaker 1: had a really interesting life, lived at an incredible time.
Speaker 1: So the show is called Business History. You can listen
Speaker 1: to it wherever you are listening to this podcast, Please
Speaker 1: check it out. I hope you like it. In twenty seventeen,
Speaker 1: Mike Blue was a vice president of sales at Johnson
Speaker 1: and Johnson and he went to see a product demonstration
Speaker 1: at this little healthcare startup that he was interested in.
Speaker 1: It was a small medical device company that was hoping
Speaker 1: to use ultrasound in new and dramatic ways, but the
Speaker 1: company didn't have any products on the market at the time.
Speaker 2: It was in a garage in Ann arbor. Literally the
Speaker 2: office was a dozen or so engineers and they did
Speaker 2: a product demonstration for me on the old system that
Speaker 2: they delivered this sound energy into a tank of water.
Speaker 2: And you see what looks like a hologram. It's the
Speaker 2: bubble cloud and it's just suspended in the middle of
Speaker 2: the tank and it's just millions of bubbles that are
Speaker 2: colliding and collapsing, and it's just suspended there. And they
Speaker 2: can move it faster than the eye can detect. They
Speaker 2: can stop it, they can start it, like unparalleled control
Speaker 2: of it. They can do anything with it. And depending
Speaker 2: on who you are, what your lens or perspective is,
Speaker 2: I think your mind starts to race as to what
Speaker 2: that could mean. I thought, this is gonna be the
Speaker 2: best damn sales demonstration in the history of the world.
Speaker 2: And I thought, let's just assume it's gonna work. It's effective,
Speaker 2: and it's safe no matter where we use it. Oh
Speaker 2: my goodness, we're going to sell a ton of these things.
Speaker 1: I'm Jacob Goldstein, and this is what's your problem. My
Speaker 1: guest today is Mike Blue. He's the CEO of a
Speaker 1: company called Histosonics. The company is developing a technology called histotripsy.
Speaker 2: So many medical terms are in Greek, and so histo
Speaker 2: is tissue and tripsy is crushing, the crushing of so
Speaker 2: it's the crushing of tissues.
Speaker 1: So histo tripsy, if you speak Greek, it makes perfect sense.
Speaker 2: It's a mouthful for everybody else in English.
Speaker 1: Here's what the company has done. They've taken this histo
Speaker 1: tripsy technology that was developed at the University of Michigan
Speaker 1: and built a device that shoots multiple ultrasound waves into
Speaker 1: the body. At the spot where the waves converge, they
Speaker 1: create this cloud of tiny bubbles like the one Mic'
Speaker 1: saw in that demo. Those tiny bubbles destroy cells, they
Speaker 1: crush tissue. So, for example, you can aim the device
Speaker 1: at a tumor inside the body, and if everything goes well,
Speaker 1: you can use the bubble cloud to destroy the tumor.
Speaker 1: This could be incredibly helpful, especially for tumors that don't
Speaker 1: respond well to radiation or chemotherapy or surgery. And in fact,
Speaker 1: in twenty twenty three, the FDA cleared the use of
Speaker 1: the Histosonics device to treat tumors in the liver. Mike
Speaker 1: and I talked a lot about the use of the
Speaker 1: device to treat cancer and how Histosonics got there. But
Speaker 1: we started by talking about what was happening at the
Speaker 1: company when Mike joined in twenty seventeen. This was before
Speaker 1: they were focused on cancer treatment, and at the time
Speaker 1: they'd run a clinical trial comparing their device with surgery
Speaker 1: to treat men with enlarged prostates. But the study found
Speaker 1: that surgery worked better to achieve key outcomes. So you
Speaker 1: get to the company that the prostate treatment has failed.
Speaker 1: Is it already clear that failed? It failed to meet
Speaker 1: its primary endpoint. That's the great thing about a trial.
Speaker 2: It is.
Speaker 1: Well, but also it's acceedes or it fails. I'm sticking
Speaker 1: with fails.
Speaker 2: When I started and was just getting my teeth kicked
Speaker 2: in trying to raise money, I mean, we were a
Speaker 2: company running out of money. I mean I was a
Speaker 2: bit crazy to take this job. I'll use your term.
Speaker 2: We had a failed clinical trial. And you've got a
Speaker 2: technology that, or at least a therapy that is almost
Speaker 2: too good to be true and unbelievable. And yes, it's
Speaker 2: worked in animals, but enough with that animal. Yes, you've
Speaker 2: got to become You've got to become a a You've
Speaker 2: got to grow up and be a real business.
Speaker 1: And my sly and primates exaggerate, right, that's the and.
Speaker 2: Yes, well said, I was overly confident thought with my
Speaker 2: sales background and with an amazing therapy, I would come
Speaker 2: in and just raise money. I got my teeth kicked
Speaker 2: in for you know, almost two years. And the story
Speaker 2: of histotripsy it's to go back to how we open it.
Speaker 2: It's hard to say, like, it's not memorable, people can't
Speaker 2: remember it, and it's too good to be true, and
Speaker 2: you've got this failed clinicaltrure.
Speaker 1: I mean, it's just it was.
Speaker 2: It was hard and so I so we we flipped
Speaker 2: the script. We totally changed. We challenged ourselves to find
Speaker 2: a story that would resonate, and so we were building
Speaker 2: an almost autonomous robotic surgical platform. And if you look
Speaker 2: at the evolution of surgery, it's gone from open surgery
Speaker 2: to laparoscopic to robotic to our story became we are
Speaker 2: developing the future of completely non invasive surgery, which we are,
Speaker 2: and robotic non invasive surgery. And the appetite for robotic
Speaker 2: investments is incredible.
Speaker 1: So you changed the story, not so much on the
Speaker 1: medical side, but on the investor side. It's not saying
Speaker 1: so early in the conversation, you don't need to say hist.
Speaker 2: To tripsy, just know that we are going to complete
Speaker 2: the evolution of surgical robotics. And so that story led
Speaker 2: to an investment from doctor Fred Moule, who's the godfather
Speaker 2: of robotic surgery. He was a co founder of Intuitive
Speaker 2: Surgical and.
Speaker 1: Sort of the model company for your company.
Speaker 2: It's the poster child for robotic surgery, and he understood. Fortunately,
Speaker 2: doctor Mole understood both the robotics of what we were
Speaker 2: doing and the therapy.
Speaker 1: Was it already clear that cancer was going to be
Speaker 1: the next sort of thing. You tried to make it work.
Speaker 2: So we're blessed to have this ongoing relationship with the
Speaker 2: University of Michigan. So there's just incredible professors and researchers
Speaker 2: and students who every day get up and work on
Speaker 2: the next thing with histotripsy. So at that time, back
Speaker 2: now almost ten years ago, there was work being done
Speaker 2: specifically on cancers and tumors and small animals, and what
Speaker 2: we were learning was that histotripsy is incredibly effective at
Speaker 2: destroying cancer cells. And so now I join in January
Speaker 2: of twenty seventeen and it's you know, Mike, what do
Speaker 2: you think? And so we decided that abdominal tumors is
Speaker 2: where we would start. They're the most commonly treated with
Speaker 2: other quote unquote interventional devices today, liver, kidney, lung.
Speaker 1: There these are bad cancers to have. I mean, it's
Speaker 1: bad to have cancer, but it's really bad to have
Speaker 1: the worst.
Speaker 2: I mean liver, liver, lung, and pancreatic, pancreatic being the
Speaker 2: worst in terms of five year survival. So we had
Speaker 2: made that decision, and then you've got to have discussions
Speaker 2: with the FDDA, so we you know, to understand exactly
Speaker 2: you've got to align with them on certain things. And
Speaker 2: so what we knew we were going to do is
Speaker 2: build a robotic platform. We're going to automate the procedure,
Speaker 2: democratize the procedure so that you don't have to go
Speaker 2: to the absolute best in the world, and because it
Speaker 2: can be used anywhere in the body, We're going to
Speaker 2: build a platform that can rapidly go from each indication
Speaker 2: or application to the next, regardless.
Speaker 1: Of spect You're not going to build a machine to
Speaker 1: treat one kind of tumor as well one thing.
Speaker 2: We're building a thing we're building a platform that can
Speaker 2: treat a hundred things. You just need to do the
Speaker 2: clinical trials. And so we began to work with the
Speaker 2: FDA on a broader approach for soft tissue, which is
Speaker 2: very common both in interventional devices or for surgical platforms
Speaker 2: and robotic systems. A soft tissue indication that allows the
Speaker 2: physician to treat any soft tissue or solid tumor that
Speaker 2: they deem medically necessary. That's a appropriate Well, there was
Speaker 2: keen awareness of histotripsy and how novel it is, how
Speaker 2: different it is your liquefying tissue. There's nothing else in
Speaker 2: medical device or health care that does.
Speaker 3: This could go not as expected, and there's a different
Speaker 3: way that each organ removes that liquification from the bodies
Speaker 3: liquified are so in fairness, there's a different risk to
Speaker 3: each potential organ, and they asked us to at least
Speaker 3: start in a single organ or for a single application.
Speaker 2: So we chose liver based on it. You said, it's
Speaker 2: it's still although there's lots of different modalities that are
Speaker 2: used in the liver. For liver cancer, five year survival
Speaker 2: rates are still less than twenty percent. They really haven't changed,
Speaker 2: so you're throwing all this new stuff at it, but
Speaker 2: you're still unfortunately, the majority of patients, great majority of
Speaker 2: patients are not living over five years. And then, in
Speaker 2: addition to that, we want to do in dress because
Speaker 2: of all the different ways that you can apply a
Speaker 2: non invasive, non toxic therapy, the opportunity is to use
Speaker 2: histotripsy in new and novel ways to benefit patients that
Speaker 2: just aren't being done today. And that includes the great
Speaker 2: majority of patients who not just have primary liver cancer,
Speaker 2: but have tumors in their liver that were caused by
Speaker 2: their primary cancer.
Speaker 1: So you, for this initial test trial that the FDA
Speaker 1: wants you to do, you're gonna treat tumors that are
Speaker 1: in the liver, whether they start in the liver or
Speaker 1: start somewhere else. You get breast cancer and then it
Speaker 1: spreads to your liver for example.
Speaker 2: That's it, yep, And we're gonna we're gonna treat those
Speaker 2: tumors and we're going to demonstrate that we can do
Speaker 2: it safely and we can effectively destroy any tumor from
Speaker 2: any origin that is in the liver. And that was
Speaker 2: the primary objective or aim of the hope for Liver study,
Speaker 2: which was our pivotal clinical study for the FDA.
Speaker 1: Right, so let's talk about that study, the Hope for
Speaker 1: Liver study, Like, who was it, what was the endpoint,
Speaker 1: what were the patients?
Speaker 2: So, when you're working with the FDA on designing these studies,
Speaker 2: it is very collaborative. There are things that you want
Speaker 2: as a company and propose and work through, and then
Speaker 2: there are things that the agency ultimately requires a few
Speaker 2: And because this is a new novel therapy never been
Speaker 2: done before, especially in a cancerous tumor, they required that
Speaker 2: we treat patients who were had either failed all other
Speaker 2: treatment options or intolerable, meaning they just they just they
Speaker 2: hadn't failed surgery or radiation, they just can't they can't
Speaker 2: tolerate it be based on their overall condition.
Speaker 1: Basically people who don't have any other options, who are
Speaker 1: typically quite so.
Speaker 2: So yeah, and when we set the inclusion exclusion criteria,
Speaker 2: we had not envisioned that that would be.
Speaker 1: Well, that's how they do drugs, right. If you have
Speaker 1: a new drug, then the FDA says, well, make sure
Speaker 1: that patients have already tried the drugs that we already
Speaker 1: know work. Right, It seems quite analogous.
Speaker 2: Very analogous and in some respects fair and so yeah,
Speaker 2: so we were required to treat advanced, very advanced stage patients.
Speaker 2: The challenge with that is that when we set our
Speaker 2: safety goal and our efficacy goal, we set that based
Speaker 2: on the data that's available and on and the data
Speaker 2: that's available is on much healthier patients, usually earlier stage
Speaker 2: patients with curative intent. And we didn't change the the
Speaker 2: end points were, what the performance criteria was that we
Speaker 2: had established. We could only change who these patients were
Speaker 2: that we were treating. Why not, Well, that's not you
Speaker 2: don't necessarily get to site all the rules when you're
Speaker 2: negotiating with the agency, and so it's just a requirement
Speaker 2: that we ended up having to live by.
Speaker 1: So just the basics of the trial, like how many patients,
Speaker 1: what's the outcome? You know, what's the basics there.
Speaker 2: So we negotiated a study that would enroll I think
Speaker 2: it was up to fifty patients. We ended up I
Speaker 2: think we enrolled forty four and with pretty acute outcomes
Speaker 2: both in terms of safety and efficacy.
Speaker 1: And what was the result, What were the results?
Speaker 2: So they were incredibly positive. In fact, now we've published
Speaker 2: our one year data, and honestly, I didn't know that
Speaker 2: a year out or two years out the data would
Speaker 2: be very interesting at all. These were super sick patients
Speaker 2: and again we're measuring it the performance criterias against healthier patients,
Speaker 2: and so if you could get anywhere close at one year,
Speaker 2: you know, I thought we'd be doing pretty good, but
Speaker 2: I doubted that. But that's where we ended up. We
Speaker 2: just published our one year follow up data on the
Speaker 2: patients who have local tumor control, meaning meaning it's still
Speaker 2: dead ninety percent of the time in those patients, which
Speaker 2: rivals any other therapy that's being delivered in delivered today.
Speaker 1: And just to be clear, when you say it's still dead,
Speaker 1: do you mean the whole tumor is gone. I mean
Speaker 1: it doesn't mean they don't have cancer anymore. Right, This
Speaker 1: doesn't like these are super sick patients. You didn't just
Speaker 1: cure their cancer.
Speaker 2: Just to be clear, the aim of the study was
Speaker 2: to show that we can safely target and destroy a
Speaker 2: tumor and that that tumor does not come back. The
Speaker 2: aim of the study was not to show that we're
Speaker 2: extending their life, we're improving their overall survival, which is
Speaker 2: obviously a really important metric in cancer care, and ultimately
Speaker 2: we will do that.
Speaker 1: It's ultimately the one we care. I mean, I suppose
Speaker 1: there's quality of life as well, but neither of these
Speaker 1: is a clinical measure, right.
Speaker 2: And I would argue today now that we're a year
Speaker 2: and a half into our true clinical experience, what I
Speaker 2: call the real world rout the wild being used in
Speaker 2: an unbelievable number of different ways and use cases. Improving
Speaker 2: quality of life is probably the number one thing that
Speaker 2: I think we're just so excited about. It's just it's unbelievable.
Speaker 1: I want to talk about that. I want to talk
Speaker 1: about a lot of stuff besides the study, but just
Speaker 1: to finish on the study, Yeah, just the dumb question
Speaker 1: you're saying, you killed the tumor, why does the person
Speaker 1: still have cancer?
Speaker 2: Because for most of the patients we treated, again based
Speaker 2: on the requirement that the FDA established, they had lots
Speaker 2: of tumors. They had what they call multifocal disease. So
Speaker 2: not just two or three, we're talking half a dozen dozen.
Speaker 2: Many of the patients had dozens of tumors and the
Speaker 2: protocol allowed for the treatment of up to three. So
Speaker 2: we know most of those patients, the great majority had
Speaker 2: tumors beyond what we were treating.
Speaker 1: The one other endpoint you were monitoring was serious adverse
Speaker 1: events related to the right. What was the outcome for that?
Speaker 2: Yep, I think there were three grade three or higher ctcas,
Speaker 2: which is how one of the models they used to
Speaker 2: score serious adverse events. So there were three of them
Speaker 2: out of the forty four patients, which far exceeded our
Speaker 2: primary endpoint. And again the primary end point was measured
Speaker 2: against much healthier patients, so you had far fewer serious
Speaker 2: adverse events than you would expect and are measured against
Speaker 2: healthier patients. So incredibly excited about how safe this procedure
Speaker 2: is in a sicker patient patient.
Speaker 1: I thought it was six.
Speaker 2: There were three that were grade three higher.
Speaker 1: I don't know the grade three. I just thought there
Speaker 1: were six serious adverse device.
Speaker 2: The six in total.
Speaker 1: Thank you for going into the weeds with me. Now
Speaker 1: we can come back out.
Speaker 2: Not what I expected. I love it.
Speaker 1: After a break, we'll come back out of the weeds.
Speaker 1: So where are your devices in the world now? Like,
Speaker 1: are they out there? Are people buying them? Are doctors
Speaker 1: using them in the real world? Now?
Speaker 2: I mean this has been a long, long journey. A
Speaker 2: glorious Friday, October sixth of twenty twenty three that we
Speaker 2: finally had the email come across that awarded us at
Speaker 2: Denovo grant or a clearance to begin commercializing the Edison
Speaker 2: system and the use of histotripsy and the liver.
Speaker 1: This is the email from the FDA, an email from
Speaker 1: the FDA.
Speaker 2: So we've got a gong in the building that is
Speaker 2: called the getting Shit done gong, and we hit the
Speaker 2: hell out of that gong and an awesome party immense
Speaker 2: upon receiving that letter. I mean, it's just you know,
Speaker 2: it is the pinnacle milestone for any healthcare company, and
Speaker 2: so a first in my career. Within one hour after
Speaker 2: that announcement, we had our first purchase order for an
Speaker 2: Edison system.
Speaker 1: The one hour was it just waiting? Was it?
Speaker 2: Was?
Speaker 1: It just like you had the contract.
Speaker 2: They were waiting. We had. We had a very small
Speaker 2: skeleton crew of sales professionals who are out socialized in
Speaker 2: the contrast concept of histotripsy and and what it could
Speaker 2: mean to physicians, patients and hospitals and so uh, the
Speaker 2: Cleveland Clinic was locked and loaded and ready to claim
Speaker 2: that they were the first in the world to begin
Speaker 2: using histo tripsy for their their livertub er patients.
Speaker 1: And so how does the University of Michigan feel about
Speaker 1: getting scooped on its own technology.
Speaker 2: Yeah, yeah, it didn't go over so well.
Speaker 1: Were they were they number two? Do they have one?
Speaker 4: Now?
Speaker 2: They were not number two? They were they were within
Speaker 2: the top and now they have multiple within within.
Speaker 1: How many of them are out in the world now?
Speaker 1: How many of yes?
Speaker 2: You know. A year and a half into commercializing, the
Speaker 2: thought was it was almost exclusively be in the US.
Speaker 2: We're now in the process of a scheduling delivery of
Speaker 2: our one hundred system.
Speaker 1: One hundred okay, so a lot a non trivial number.
Speaker 2: You know, if you compare it to other historic commercial
Speaker 2: launches of a robotic medical device or platform, we're far
Speaker 2: exceeding expectations. And the patient demand for this is is
Speaker 2: like nothing I've ever been a part of and what
Speaker 2: we had hoped for. It's sad and that there's so
Speaker 2: many patients who are told their terminal because now they
Speaker 2: have tumors in their liver that can't be treated. They're
Speaker 2: adjacent to a bile duct, they're just too large there's
Speaker 2: just too many of them. There's no drugs that work
Speaker 2: for these tumors once they're in their liver, and we
Speaker 2: can treat these patients and we can do it without toxicity,
Speaker 2: without side effects.
Speaker 1: I mean, there is some pain right like related with
Speaker 1: the treatment.
Speaker 2: So they'll there will be discomfort because a lot of
Speaker 2: times you're treating over the rib cage that they explain
Speaker 2: it usually as they've done too many sit ups the
Speaker 2: day before, like that, that sort of pain. Some of
Speaker 2: them have flu like symptoms, which is symptomatic of potentially
Speaker 2: the immune system being revved up. But beyond that nothing
Speaker 2: like an invasive procedure or radiation therapy, you can't even
Speaker 2: compare them.
Speaker 1: So if I if I walk into a room where
Speaker 1: your device is, like, what's it look like?
Speaker 4: Like?
Speaker 1: Let's just talk about how it works. What do I
Speaker 1: see when I walk down the room?
Speaker 2: Yep, you see what looks like a medical device system
Speaker 2: with a It's pretty noticeable. It's got a pretty large
Speaker 2: robotic arm that is used to guide the therapy. It's
Speaker 2: got a very obvious forty two inch high fidelity touchscreen display.
Speaker 2: So you see a cart that's I guess similar to
Speaker 2: what you'd think of like an ultrasound cart. That's where
Speaker 2: all the work is done, and then you've got a
Speaker 2: robotic arm that comes off that that steers the histotripsy.
Speaker 2: Because it's non invasive, it doesn't require a sterile environment,
Speaker 2: so you definitely don't need to be in an operating room.
Speaker 2: It doesn't even require a clean room. You can virtually
Speaker 2: do procedures in any room. And ultimately the vision is
Speaker 2: it'll be used by an incredible number of specialists or specialties.
Speaker 2: So that's what it looks like.
Speaker 1: So let's say, so there's a procedure, what happens, there's
Speaker 1: a doctor, there's a patient, like, where are they?
Speaker 2: What happened? Like every robotic procedure being done in the
Speaker 2: hospital setting today, the patient usually not always anymore, but
Speaker 2: usually under general anesthesia. The reason for that is not pain.
Speaker 2: It's about limiting motion. So, because we're delivering this beam therapy,
Speaker 2: we don't want the patient moving, we don't want the
Speaker 2: organ moving, we don't want the tumor.
Speaker 1: Moving like you're targeting like a centimeter, right, I.
Speaker 2: Mean it's the yeah, the point on a pencil tip.
Speaker 1: Breathing, So does breathing mess you up?
Speaker 2: Right? And so where we are today treating in the liver,
Speaker 2: finishing our study on kidney tumors, beginning our studies on
Speaker 2: pancreatic tumors. These organs and therefore tumors move because of
Speaker 2: the diaph the movement of the diaphragm.
Speaker 1: What do you do about that? Like? That isn't I mean?
Speaker 1: Do you account for it? Do you predict where it's
Speaker 1: going to be based on the breath?
Speaker 4: Like?
Speaker 1: How do you deal with that?
Speaker 2: That's why you use general anthesus because the anithesiologists then
Speaker 2: can absolutely control motion.
Speaker 1: Oh so you say to the anesthesiologists, halt the breathing
Speaker 1: for one second. I'm going to shoot the beam.
Speaker 2: It doesn't have to be completely still. Almost all of
Speaker 2: them there's some motion, and we just, huh what they
Speaker 2: call envelope around that. So we just create you know,
Speaker 2: if you've got a one centimeter tumor, you create a
Speaker 2: two centimeter target so that the motion of the your
Speaker 2: targeted area still encompasses the tumor, even if even if
Speaker 2: it's moving.
Speaker 1: So okay, so the patient's under general anesthesis, so they
Speaker 1: don't move too much.
Speaker 2: Go on, Yeah, so there's still there's still and then
Speaker 2: you watch the physician operate on that again super high
Speaker 2: fidelity touchscreen display. There is a step to the planning
Speaker 2: process where we send in planning pulses to seven discrete
Speaker 2: points within the targeted area, both within the tumor and
Speaker 2: just outside. And the reason for that is depending on
Speaker 2: how much blockage there is, if it's under a rib,
Speaker 2: if it's under a bow, or if it's completely unobstructed,
Speaker 2: there's a different level of energy that is needed to
Speaker 2: destroy different areas within even sometimes the same tumor, but
Speaker 2: definitely if you're treating multiple tumors, one could be directly
Speaker 2: under a rib totally obstructed, one could be totally unobstructed.
Speaker 2: The variability then between how much energy the system needs
Speaker 2: the delivers it can be pretty significant. And then once
Speaker 2: they begin or initiate therapy, the robot has the ability
Speaker 2: to dynamically change the energy requirements throughout the treated volume
Speaker 2: based on that treatment map. So you watch that, you're
Speaker 2: literally watching the physician work at the console do their
Speaker 2: work there, and then there's a button that says enable treatment,
Speaker 2: and once everyone agrees they've they've set the plan. The
Speaker 2: system knows how much energy it needs to deliver and augment,
Speaker 2: they enable therapy and then it's all visualization. It's it's
Speaker 2: just monitoring.
Speaker 1: So once they enable therapy, like what happens with the
Speaker 1: robot arm, what does it do? And like where's the
Speaker 1: ultrasound coming out of?
Speaker 2: It goes to work. So it's the workhorse. It begins.
Speaker 2: It's got these amazing it's it's so elegant to watch.
Speaker 2: They've got incredibly fine smooth motions that are moving that.
Speaker 2: So think of the histo tripsy cloud the size of
Speaker 2: a grain of rice. It's super small and it's got
Speaker 2: to go through a large volume. So it does all
Speaker 2: the work moving that bubble cloud until it's completely destroyed.
Speaker 1: And just to be clear, it's destroying the tumor at
Speaker 1: a cellular level, right, the reason you're not spreading the
Speaker 1: cancer around the body.
Speaker 2: It's actually subcellular destruction. It's if you were to show
Speaker 2: it to a pathologist, we show or when a pathologist
Speaker 2: reads that liquefied tissue coming from an app they'll tell
Speaker 2: you it's unrecognizable. There's no cellular debris. They couldn't tell
Speaker 2: you forget about is it benign, or they can't tell
Speaker 2: you if it's liver, kidney anchoras brain. It's just a
Speaker 2: liquefied acellular debris that is unrecoible go. It's literally a goo,
Speaker 2: even more soluble than a goo, A.
Speaker 1: Thin, very thin that is. And then it's done. And
Speaker 1: then the procedure is done.
Speaker 2: Yeah, they awake from their anesthesia, hopefully they feel like
Speaker 2: nothing has happened, and they go home.
Speaker 1: So you have this indication for any liver tumor. What
Speaker 1: else are you working on beyond liver tumors?
Speaker 2: We are now realizing the vision of the researchers who
Speaker 2: invented histor tripsy and when the company was founded, moving
Speaker 2: as fast as we can into other clinical applications. And
Speaker 2: so we've finished in rolling patients in our kidney tumor trial.
Speaker 2: We will have the data back from that here shortly
Speaker 2: and be submitting for histor tripsy of kidney cancer in
Speaker 2: Q one of twenty twenty six. We've begun in rolling
Speaker 2: patients in a pancreatic tumor trial that's being done in Barcelona, Spain.
Speaker 2: We are working with the agency as we speak to
Speaker 2: arrive on a call for the US study treating pancreatic
Speaker 2: tumors with hista tripsy. I really do believe it's gonna
Speaker 2: be groundbreaking.
Speaker 1: What are you trying to figure out now? Like, what
Speaker 1: is a use case where you haven't kind of quite
Speaker 1: solved all the things you need to solve to make
Speaker 1: it work.
Speaker 2: There's very little clinically and technically. It's the challenges that
Speaker 2: come with such a high growth company and adding so
Speaker 2: many people. And I think if you I'll invite you
Speaker 2: to visit us, I think we'll give you a demo
Speaker 2: so we can make all this real.
Speaker 1: I want the demo. After you describe the demo.
Speaker 2: You have to have the demo. I think, you know,
Speaker 2: I'm very proud that whomever is visiting here, they immediately
Speaker 2: notice the people, the culture of the vibe, the tech
Speaker 2: permeates throughout. Super innovative company with great people, smart people
Speaker 2: but are having fun. Literally you know, change the world.
Speaker 2: And so it's it's preserving that as we grow at
Speaker 2: a unusually fast pace and at a significant number of
Speaker 2: people moving forward, is there such an unmet clinical need
Speaker 2: that we can address. And as I as I say
Speaker 2: to our team we've got a town hall tomorrow, I'll
Speaker 2: you know, I always remind them that I know we
Speaker 2: said unusually aggressive objectives, and I will not apologize. There
Speaker 2: is a patient who is suffering in every one of
Speaker 2: the diseases that we can impact, and we have to
Speaker 2: go faster. It's it's literally it's the first company I've
Speaker 2: ever been with, right, I feel like we actually have
Speaker 2: a I use this word a lot, or we have
Speaker 2: a responsibility the faster we can move and kidney pancreas,
Speaker 2: prostate brain diary, breast bladder. There's patients who need us
Speaker 2: today and we won't be there in time unfortunately for
Speaker 2: all of them. So it's our responsibility to go faster.
Speaker 2: So that's kind of stuff that keeps me up at night.
Speaker 1: We'll be back in a minute with the lightning round.
Speaker 1: We're going to do a sales focus lightning round because
Speaker 1: I know that you spent your career in sales and
Speaker 1: that was all we could figure out about you. Is
Speaker 1: there anything that you had to sort of unlearn from
Speaker 1: your life in sales to be a good CEO? Any
Speaker 1: like habits of the sales mind that don't serve you
Speaker 1: well as a CEO.
Speaker 2: So at one point in my career, before I joined
Speaker 2: his Tosonics, obviously I really doubted I wanted to be
Speaker 2: a CEO. I didn't know if I could get the
Speaker 2: same gratification statis satisfication. That's not our word gratification.
Speaker 1: I like satisfication. That's when gratification meets satisfaction too. Actually,
Speaker 1: the ginormous of satisfaction.
Speaker 2: I just didn't know if I could get that same gratification,
Speaker 2: like the rush of I love to win. I love
Speaker 2: closing a deal. I love to win. I hate losing
Speaker 2: even more. And that's what you get in sales. You're
Speaker 2: out every day competing against your peers, other companies. So
Speaker 2: I thought coming into this I would have to temper
Speaker 2: my excitement for the thrill of the win and the
Speaker 2: hatred for the loss. But I think what's helped the
Speaker 2: company is I haven't done that. Like, you can apply
Speaker 2: the same winning and losing philosophies across every function within
Speaker 2: the organization. I want to win with the FDA, I
Speaker 2: hate losing. I hate needing to renegotiate, I hate the delay.
Speaker 2: And you can literally apply that that logic across or
Speaker 2: dispe It works everywhere.
Speaker 1: It works.
Speaker 2: Everywhere. Okay, fair enough, Look you if you bring that
Speaker 2: to work every day, like you know, like I tell
Speaker 2: my kids, if you find something you genuinely love a
Speaker 2: company that you genuinely believe in, and you go out
Speaker 2: and work your ass off every day and you compete,
Speaker 2: Like at what I just said. And then third, and
Speaker 2: I hope if you were to walk through this building,
Speaker 2: what you would see is amazing human beings. Like that's recipe, Like, Yeah,
Speaker 2: find something you love and you're passionate for a company
Speaker 2: you believe in what they're doing, work your ass off,
Speaker 2: compete to win, hate to lose, and you're a genuinely
Speaker 2: good human being. And that's how you treat everybody. There's
Speaker 2: really nothing else. There's nothing more to success in industry
Speaker 2: than that.
Speaker 1: What's the hardest thing you ever had to sell?
Speaker 2: Well, I think I'm good at selling everything.
Speaker 1: I didn't say, what were you bad at selling?
Speaker 2: Like?
Speaker 1: I just said what was hard?
Speaker 2: I will so I will say this, I would make
Speaker 2: a horrible venture capitalist, like horrible.
Speaker 1: Interesting. Well, in a way, they're on the buying side, right,
Speaker 1: I mean, I'm sure they're selling themselves to the hot
Speaker 1: founder or whatever, but.
Speaker 2: They're evaluating all these opportunities in which ones they're going
Speaker 2: to invest in, and they choose one out of one
Speaker 2: hundred to invest in. My problem is I always look
Speaker 2: at them with the perspective or with the lens of
Speaker 2: could I sell this? And I'm an overly confident person
Speaker 2: that I look about just everything and say, oh, I
Speaker 2: could sell that. And so I'd be a horrible venture
Speaker 2: capitalist the heart.
Speaker 1: Because you'd invest in everybody because you'd be like, yeah,
Speaker 1: sure I could sell that whatever, I'll flip it for
Speaker 1: ten X.
Speaker 2: Yeah we could do we could do that. The problem
Speaker 2: is if you're not the one doing that, then you're
Speaker 2: relying on someone else. You don't have the control of
Speaker 2: what they're doing day to day.
Speaker 1: You know.
Speaker 2: I Selling medical technology is hard. It's just it is.
Speaker 2: It's just really hard. Especially in today's healthcare environment. Just
Speaker 2: getting access into hospitals has become so complex. So it
Speaker 2: doesn't matter whether you're selling a single use widget or
Speaker 2: a two million dollar robotic platform. It's changing the world.
Speaker 1: It's by the way, is it two million dollars? I
Speaker 1: didn't ask you how much does it cost? Is the answer?
Speaker 1: Two million dollars.
Speaker 2: It's not. It's not two million dollars. But what we
Speaker 2: generally say is it compares very favorably to the other
Speaker 2: high end surgical robotic platforms.
Speaker 1: Fine, I just wanted some ballpark.
Speaker 2: Call it a million, million, million and a half dollars.
Speaker 2: That's fun.
Speaker 1: Okay, great, last one.
Speaker 2: Uh.
Speaker 1: I'm curious as a as a person who knows sales
Speaker 1: so well, when you're on the other end of sales,
Speaker 1: when you're a buyer, say, when you go buy a car,
Speaker 1: what is it like for you?
Speaker 2: It's bullshit.
Speaker 4: It's like there's nothing worse, And it's everywhere in this world,
Speaker 4: like literally, just as I view my job as the
Speaker 4: ultimate sales professional, and every literally almost everyone I touch.
Speaker 2: Oh, it's gross, it's gross.
Speaker 1: Mike Blue is the CEO of Histosonics. Today's show was
Speaker 1: produced by Trinamnino and Gabriel Hunter Chang. It was edited
Speaker 1: by Alexander Garretson and engineered by Sarah Bruguer. I'm Jacob Goldstein,
Speaker 1: and we'll be back next week with another episode of
Speaker 1: What's Your Problem.