Entrepreneurship and Innovation in Medicine

Course Description

Lectures

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   Lecture 1 - The Accidental Entrepreneur

   Paul Yock, Co-Chair of Stanford's Department of Bioengineering and Director of the Stanford Program in Biodesign, describes himself as an accidental tourist in entrepreneurship. He talks about his love for technology innovation.

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   Lecture 2 - Biotech Bay: The Other Silicon Valley

   Yock talks about the Biotech bay - the other Silicon Valley, and how the products offered are based on the science of genetics. Medtech focuses on instruments, equipments, and is not a trivial market sector, he says. The Bay has titans like J&J, Guidant, and Boston scientific, for example. There is significant start up funding into the Medtech sector. Half to two thirds of venture funding for Medtech goes into Northern California, he adds.

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   Lecture 3 - Biotech: Interface Between Industry and University

   Yock talks about the interface between the universities and the industry. He talks about the rich MedTech environment at Stanford and other universities.

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   Lecture 4 - Cardiovascular Disease vs. Bioterrorism

   Yock focuses on cardio vascular disease, which is a very profound disease - it is the # 1 killer in the western world. About half of all Medtech companies have to deal with cardio vascular diseases, he says.

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   Lecture 5 - Beginning of Less Invasive Cardiac Techniques: Charles Dotter

   Yock tells the story of how less invasive cardiac techniques got started. He shares a video clip from Charles Dotter, better known as crazy Charlie

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   Lecture 6 - History of Balloon Angioplasty Catheter: Thomas Fogarty

   Yock continues the story about a non-invasive cardiac technique and how it quickly had a Stanford connection. Thomas Fogarty, a surgeon at Stanford, worked with Charles Dotter and soon developed another technology - the Balloon Angioplasty Catheter.

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   Lecture 7 - Coronary Angioplasty: Andreas Geruntzig

   Yock talks about the fundamental problem of applying the balloon technology to dilating the heart narrowing. The balloon was too compliant. He talks about the development of a balloon that actually worked.

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   Lecture 8 - Guidewire Catheter: John Simpson

   John Simpson, a Stanford trainee in cardiology, thought the catheter system didn't work so he worked in his kitchen in Menlo Park to develop a catheter that is easier to use. He used a guidewire to travel down into the coronary artery . With money from Fogarty and Ray Williams, an angel investor, he started a company called ACS, which grew into Guidant.

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   Lecture 9 - Mentoring Changed My Life

   When Yock started getting involved in training, he worked with John Simpson and the mentoring changed his life. One thing that was starting to become clear in mid 80's was that there was a problem with angioplasty - arteries were narrowing at an alarming rate. Hence surgical procedure had a 40% recurrence rate. Yock started to focus on the need to visualize during a surgery and hence the need to get inside the blood vessel. With Simpson, Williams and Fogarty, Paul started a company with technology that went inside the artery and saw in high resolution. He talks further about this technology.

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    Lecture 10 - Testing Medical Devices and Overcoming FDA Hurdles

    Yock talks about his company and his experience with the FDA and a Norwegian government official who approved their technology very quickly.

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    Lecture 11 - Restentosis and Stents: Just in Time Design

    Yock talks about how over the years the technology improved and the problem of re-narrowing of blood vessels could be addressed. He shares the reasons of this re-narrowing - the blood vessels shrink. He further discusses the solution that he and other doctors have employed.

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    Lecture 12 - Using Stents as Drug Delivery System

    Yock talks about further developments moving from radiations to using drugs with the stents as a carrying mechanism. This is a blockbuster idea which has dropped the recurrence rate from 20% to essentially 0.

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    Lecture 13 - Opportunity: How to Cover Economic Loss from Stent Use?

    Yock mentions a problem - there is a tremendous diseconomy because loss per stent has gone up. There will be serious economic trouble with this new technology, he says.

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    Lecture 14 - Medtech: What's Going on in Region and at Stanford

    Yock comments about what is going on in the region and at Stanford in the Medtech sector. Things that make up regional advantage in this sector are very similar with what is being studied in different industries, he says. A network of expertise has now been setup in this area.

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    Lecture 15 - Interdisciplinary Biomed Education and Clark Center at Stanford

    Yock talks about next generation of Medtech and biotech innovation at Stanford. The idea behind the Clark Center is to put something physically at the interface between school of engineering, school of medicine and H&S and draw people in to start interdisciplinary collaboration between the sciences. The new department of Bio-engineering, under both school of engineering and medicine, will be housed here. Yock also talks about the BioX program at Stanford.

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    Lecture 16 - Identify the Need: Invention and Being Contrary

    Yock declares that the key is to identify needs correctly. He suggests that one finds an area of strong consensus among thought leaders--and then do something different.

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    Lecture 17 - MedTech: Keep it Simple

    Yock states that the most important thing he learned in his in whole career was that in medtech, you have to keep it simple. The reason is that people in MedTech seem to have less skill, and even less patience than a typical kid in an 8th grade shop class.

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    Lecture 18 - Patents Dominate MedTech

    Yock explains why MedTech is dominated by the importance of patents. People who don't patent their early ideas lose out.

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    Lecture 19 - FDA and Medicare

    Yock emphasizes that in MedTech, there are two forces that can make your life miserable-- the FDA and Medicare. He emphasizes the importance of understanding how medicare will handle new technology. Same with the FDA; there are different pathways through the FDA and sometimes it takes longer than a year and that can be a problem in getting a technology through.

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    Lecture 20 - Think Big and Pay Close Attention to Market Assessment

    Yock suggests that entrepreneurs pick a big idea. He gives an example of the smart needle. Pay attention to market assessment; time is a valuable resource, he adds.

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    Lecture 21 - Envisioning the Future in Medtech: Go Where the Puck Will Be

    Yock's final suggestion comes from Wayne Gretzky. How is he so successful? Gretzky knows how to go where the puck will be, he says.

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    Lecture 22 - Who Does Non-surgical Procedures?

    Yock talks about a group of people called interventionists who train in catheter techniques. This requires a different set of skills. One of the trends recently is for surgeons to cross train, he says.

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    Lecture 23 - Medical Inventions: Physicians and Entrepreneurs in Partnership

    According to Yock, physicians characterize needs. Half of the medical inventions depend upon characterizing needs well, he says.

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    Lecture 24 - How are Financials for Cardiac Surgery?

    Yock talks about how the hospitals make money on cardiac surgery, but they are concerned that the stents will take away the nice margins they have in cardiac surgery. This would mean loss of revenue for the hospital, he says.

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    Lecture 25 - Cost vs. Price for Medical Stents?

    Yock talks about the costs versus the charges of medical stents. A cynical approach is that the actual metal stents themselves cost 80-90 cents to make and their charge is about $1200. However, there is an enormous amount of R&D effort to get it approved, he says. For example, a clinical trial can cost as much as 10 millon dollars.

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    Lecture 26 - Future of Robotics in Minimally Invasive Surgery?

    Yock discusses the future of minimally invasive robotic surgery. He says it is very exciting and Stanford actually has a lot of expertise in this area.

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    Lecture 27 - Attributes of a Successful Entrepreneur in MedTech

    Yock talks about the attributes of a successful entrepreneur. The key is being able to find needs and to frame them well, he says.

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    Lecture 28 - What's the Future of Medical Diagnostics?

    Yock explains that the biotech sector is starting to get a glimmer of hope that they will be able to change the genetic make-up of cells and have a huge impact on patients. Having said that, he notes that the press reminds this sector that it is not an easy road to travel.

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    Lecture 29 - Who is Leading the Stent Market Today?

    Yock emphasizes how dynamic the stent market is because the numbers are just so big.

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    Lecture 30 - Startups: How to Avoid Being Squashed by Big Companies?

    Yock states that the best pathway has been the start-up. The best platform-shifting comes from these companies. Get some angels and venture companies to back you and then you're good to go, he says.

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    Lecture 31 - Convergence and Drug Delivery

    Yock addresses the question: Where else is convergence happening between biology and devices? He believes that outside of the cardiovascular area, convergence is happening in local drug deliveries for many uses. The combination of sensing some condition and delivering and optimizing drugs is something that will be seen in the future, he says.

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    Lecture 32 - Medical Devices and Nanotechnology

    Yock sees tremendous theoretical progress for nanotechnology. However, he does not see the first hand hold at least in the cardio vascular area.

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    Lecture 33 - Scaling Technologies to the Developing World

    In areas of the world that can't afford new technologies, there is progress in making them available, he says. Yock gives an example of how this is being done. Money is being invested in appropriate technologies as cardio vascular disease is spreading to other developed nations.