E85 Dr. Ed Harvey on Innovation

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Chad Ball  00:12

Welcome to the Cold Steel surgical podcast with your hosts Ameer Farooq and Chad Ball. We’ve had the absolute privilege of chatting with some amazing Canadian as well as international guests over the past year. While the topics have been broad in range, whether clinical, social or political, our aims for the podcast continue to remain the same. We hope to inspire discussion, creativity, scholarly research, and career development in all Canadian surgeons. We hope you enjoy our second season as we continue to highlight some incredible guests, deliver detailed masterclass sessions on a myriad of clinical topics and introduce some fresh new features such as debate and companion formats. We hope you relish the podcast as much as we do.

Ameer Farooq  01:13

In this episode, repeat guest and Co-editor in Chief of CJS, Dr. Ed Harvey joins us to discuss innovation. Innovation is one of those buzzwords that everyone loves to use. But rarely do we actually think about what it means to do innovative work, and how we might be more innovative. Dr. Harvey is an orthopedic surgeon at McGill University in Montreal and is involved in several startups developing new devices. We’d love to hear your thoughts, what makes someone innovative? What can we do to create environments that encourage innovation? Send us an email at podcast.cjs@gmail.com or @CanJSurg.

Chad Ball  01:53

When I look up innovation in the classic dictionary, there’s essentially two definitions. One is a new idea, method or device. And the other is an introduction of something new. So, we’re curious, how you define innovation in general, and in particular, how this is integrated into surgical care in the surgical setting as a whole?

Edward Harvey  02:15

Yeah, it’s kind of an interesting question, because depending on who you talk to, innovation means different things. And it’s become quite a buzzword. So over the last two years, I think innovation is being used differently, and probably wrongly, by many of the people that are using it. A lot of the universities have innovation programs in every single one of their departments, including sociology. And probably the way innovations generally was started to be defined, what that: it’s a disruptive technology, which brings about change. I think is the best way to look at it. And to drill down, like disruptive is defined differently as well. But it’s something that absolutely changes what we were doing before. And it was really driven by technology in science, right? So something comes along, whether it’s a new way of communicating wirelessly, or it’s a new way to sense things, or it’s a new way to study things. And it changes drastically what we were doing before. That’s your goal with innovation. Now, innovation isn’t always that. Innovation is sometimes just incremental invention. And that’s not a bad thing. Invention, though, is just a small part of innovation. You know, you can come up with something that’s new and wonderful. And it’s not necessarily innovative, but it’s still patentable. And still commercialized. You can still commercialize it. But it might not be strictly seen as being innovative and supplying a disruptive process. So for me, that’s what innovation is. Now, I don’t think that’s either definition you just read to me. So maybe my definition is yet to be proven. But if you think of it that way, then you get a lot more excited about innovation.

Ameer Farooq  03:58

I think it is actually important to talk about the word innovation, because I feel like sometimes the word actually prevents people from thinking creatively. Like, you know, if you ever tell someone to think out of the box, and suddenly like, there are no more ideas, and you really actually can’t even think of anything new to do. So I wonder if having that the term innovation as a moniker for a lot of the stuff that you do actually holds you back? Like, can you comment on just the word innovation? And if that ever actually kind of holds you back? Do you feel like being labeled as an innovative person actually sometimes makes it stressful to do new things?

Edward Harvey 04:40

Yeah, I don’t really like to be called an innovator. But, you know, I hold multiple patents and I’ve got multiple startups. I don’t know what kind of disclosure we need to discuss for the podcast, but I’ll get a disclosure out of the way if I decide to talk about anything I’m involved in. I’m currently involved, or Co-founder of three startups. NXTSENS, which is a micro-electronics company and MY01, which is developing biomedical devices. We have a new device for acute compartment syndrome, which is on market right now. And Stithera, which is a timing company. As well as another couple coming in. I have a ton of funding, which I don’t want to be seen as pushing something, like a hidden mission. So I have a ton of funding. Most of it is from peer review grants. I do have funding from the Department of Defense, CIHR, NSerc, NRF, Investment Quebec, etc. But nothing corporate, except for the stuff I’m founding. So I just want to get that out of the way in case I accidentally am seen as pushing something. So innovation. People smarter than me have thought about innovation and depending on whether you’re a loop, lumper, or splitter, innovation is sort of in four processes. There’s a financial and internal process improvement, an offering improvement, which is what we usually do in medicine. And delivery. And that might seem like kind of, oh what are those? How is there innovation in those? So like, on the financial side, you can change the business model. So like Dell changed the business model for computer sales to being online, and no one had done that before. In process, GE changed the way or innovated the way that your core economics are done in companies, right? So they’re basically a holding company where they get rid of people that don’t perform well. And that was an innovative process in order to increase their value. On the offering side, we do that in surgery all the time. New knife, new plate, whatever. That’s kind of what you do . You have new product or new product performance improvement. And then delivery. So how do you deliver things? I mean, Apple delivered music, not first, but best over the internet, right? So things like that. And how you brand. You know, Virgin branded their planes, music, records, all in one big package that make it seem more desirable. So those are the four main ways that innovations grouped. And if you think of it that way, you can actually quantify it, right? It’s not just a kind of nebulous word, innovation. I think for most people in the audience, innovation is really what I said: it’s a product performance, or a product system improvement. Like you have a robot for doing surgery, or you invent the Gamma Knife, or you have new implants that you can use. And that’s a thing we get our heads around, things we see every day that we’d like to innovate. Unfortunately, it’s also the easiest innovation step to copy. Because if you thought of it and can do it, then the barrier to entry is not really high. So even in a really lucrative market, it’s sort of a race to parity. You come up with a blue plate, someone else comes out with a pink plate, someone else has a purple plate, and you’re all racing to sell it to people that are colorblind. Right? So innovation is way bigger than we’ve seen in medicine. But the things we see the most are those really kind of easier steps to market. Does that answer your question?

Ameer Farooq  08:23

Yeah. And I think one of the things you highlighted there was just the idea that innovation isn’t necessarily like a new tool or a new toy, which is I think is what a lot of surgeons kind of think of. Can you give an example of some innovation that is present in the surgical world that wasn’t necessarily a technical innovation, but either an educational or clinical innovation? Or like a process innovation, like you talked about?

Edward Harvey  08:52

Sure. So on the front end of process innovation, the Mayo Clinic took a different bend on their approach to breast surgery. So usually people were doing… and I’m not a breast surgeon, obviously, but Chad might have more oversight over this than I do…but they decided that they were going to own a bigger market share in breast surgery. So they decided that instead of just doing a lumpectomy and having the patient go home, and then, you know, deciding whether the margins were adequate, and what kind of markers were on it, they were just going to hold the patients in the operating room. And it didn’t make sense to most people. Because that’s not really efficient use of operating room time, if you just have the person on the table for an extra 30 minutes. Instead of doing 25 cases a day on lumpectomies, you’re only going to do eight. And so people said we’re not going to do that. But Mayo Clinic decided to do that. And they were able to not only diagnose completely margins, do further surgery and have one stage procedures, but then before the patient even lot less, but Mayo Clinic, they needed markers and they knew what adjuvant chemotherapy they were going to get. And therefore, for the patient, that was an innovative process. They went in, they were treated completely, then coming out, they knew what therapy they were getting, as opposed to have to make three visits. And then part of that was predicated by the fact that Mayo Clinic is in Rochester, Minnesota, out in the middle of nowhere. But I think that’s a good example of surgical innovation that isn’t what we normally see.

Chad Ball  10:31

Yeah, I think that’s a great example. I totally agree. And, I don’t know if it’s accurate or not, you may agree or disagree. But from the outside, it seems like by nature, by culture, orthopedic surgery, and vascular surgery, at least in my travelings, are the two quote unquote, most innovative groups, or certainly the groups that seem to be have more of a bend on the innovation side, as you’ve defined it. Do you think that’s accurate? And if so, why is that?

Edward Harvey  11:04

Yeah, it’s a good question. I never really thought of it that way. Because, but maybe both of those specialties are extremely procedure and technique driven. And every day, you’re thinking, oh, I could do this better, I could do this better. And then you have to come up with a way to do it better, you can’t just talk about it. I know that in orthopedics, perhaps the arthroplasty group is not as innovation friendly. They don’t have to be. I mean, I think in 1986 we found that 36% bone and growth into a prosthesis was good enough. And even though other techniques have come out for bone and growth in prosthesis, we don’t really need it. But if you look at the trauma world where I am, when I was a resident, there was three plates. Now we have several 1000 different implants to put in. And that’s all been from surgeon driven innovation, by and large. So I think you see other people improving your specialty, and it’s sort of a self-fulfilling prophecy that you’re going to try to do it too. And I think that’s happened in the vascular world, with the endovascular procedures coming into vogue. And the vascular surgeons have been very good at adapting to both an open and minimally invasive surgery. So I think it’s sort of fitting.

Chad Ball  12:26

That’s it. I mean, it’s interesting, the culture and the seed of innovation. And you’re exactly right. I think if you look at some of the developments, I mean, the endograft would be, I guess, the classic example. And, you know, the individual, the Argentinian gent who came up with that, and how he came up with that, and how he pushed through that. Again, you know, it’s interesting, when you sit back and listen and watch these folks talk about these big, disruptive leaps forward. Cardiac transplantation would be another example. They tend to be more often than not, it seems like they’re in locations whereas you pointed out about Mayo, could sort of only happened in that space, in that place at that time. That seems to be a perfect sort of cauldron of factors that allow that to occur.

Edward Harvey  13:18

Yeah, I agree. But I think more and more people see that they can do it themselves. And I think some of that goes back to innovation. I mean, most of what we see come out of the OR is incremental improvement. And not to be surprised, but it’s hard to get a patent for a lot of these things. Where you come to the patent agency, and they go, well, it’s just clever engineering. It’s really not invention, and it’s really not innovative. And you have to argue why it’s innovative, and no one else could see it. But incremental innovation, incremental invention is still a good thing. You know, like, it’s driven the car industry for last 200 years. I mean, you know? Before you had a handbrake, then you had foot brakes, and then you had disc brakes, then you had some, you know, headlights, then you had lane departure technology. And now they steer you back in your lane if you’re out of your lane. And you know, the obvious incremental improvement comes towards self-driving cars. But when we get there, then that’s actually disruptive. And this goes back to the definition of a disruptive innovative. Like when I look at it, maybe I’m the only one that sees it this way. But it’ll become disruptive when you don’t have a steering wheel. And you can actually do your work on the way to work, like do your paperwork on the way to work. And you can live two and a half hours away, because you have, you know, five hours of paperwork every day and you only need to be at that meeting for one hour. And so that becomes disruptive in that it’s going to change the way cities are made. The way roads are made, the way people get to and from work. The way people communicate. But just having a self-driving car where you have to sit behind the wheel and still steer it, sometimes that’s not really disruptive but it is innovative.

Ameer Farooq  14:58

I’ll just circle back to something Dr. Ball is alluding to, in that this whole idea that certain innovations perhaps couldn’t have happened, unless they were in a certain place or with a certain kind of group of people. Malcolm Gladwell has written about this most famously, in his books like Outliers, where he talks about the Beatles playing in this very unique situation in Hamburg where they were playing every night. And it’s almost like to this point where now everybody knows about it, it’s in the Zeitgeist. And it’s almost passe to talk about innovation like that. But I’m curious from your perspective, as someone who’s actively involved in thinking about this, how important do you think culture and location and space are to the process of being creative and being innovative?

Edward Harvey  15:45

It’s a great question. I think it’s really important. I’ll use an example from my own experience. You know, 20 years ago, I really didn’t like the way that we treated trauma with the key compartment syndrome being a muscle condition that got you know, you have swelling and facial compartment and when the muscle dies, don’t recognize it fast enough. And finally, I got up my nerve to actually go to lower campus. So I was in the perfect environment, where I walked down to lower campus and I said, I need a sensor that will tell me when muscles are dying. And at that time, micro electrical machine system technology just came on the academic radar. And there was one person doing it at McGill. And he had a sensor that he didn’t know what to do with. And I said, well I can use that. And we should work together. And through that kind of, meshing, which would never have happened, if I was working in a community hospital, if I was working somewhere besides one of the big three hospitals, or big three universities in Canada, or maybe 12 in North America at that time, I would never have a sensor that was, you know, this miniature silicone chip non-hysteresis, perfectly accurate to within point, 0.1 millimeters of mercury sensor that was driven by a very low amount of power and could communicate wirelessly. It just wouldn’t have happened. And the fact that we were in med school and a lower campus, next to each other, and happened to talk. It happened. And so now we have this company that’s selling devices across the world, basically, you know? We’re working on contracts in Europe and the States and Canada as we speak. And that never would have happened. That innovation never would have happened if I wasn’t in the perfect spot. If he was on vacation that week, I never would have met him. You know what I mean? So there is some happenstance. But I think that gaps closing a little bit as people realize that there is technology out there that you can use. And so people are more apt to communicate with other people. Not like I did, like walking down and going office to office and asking what they’re doing. But I think it’s a lot more evident to engineering schools and other schools that they have to communicate with people outside in order to get translation of their inventions.

Chad Ball  18:08

I think that’s so well said, and it’s so interesting to think about your example, you know? We have one of our general surgical trauma surgeons here that’s crossed over from engineering. He was a robotic engineer before medical school. And that’s a great example of leverage and support. I guess the next question I’d like to ask here or would like to talk about is, how do you better or best support innovation? And I mean, specifically, the varying intent and the varying goals between sort of the formal academic world, the traditional academic world and the private world? Because, you know, certainly, we can think about lots of examples, and I’m sure you have many more than I do. But it seems like on the academic side, there’s more and more and more hurdles all the time through some of the major universities. The financial relationship, as I’m sure you know, better than me between a given University and a spin off is also extremely variable across this country and an interesting factor as well. How do you see supporting innovation in the best way possible?

Edward Harvey  19:21

Yeah, no, it’s a great question. It’s the million-dollar question, literally. So getting your ideas out there. I think we’ve been taught in the past that there’s like two valleys of death. There’s the valley of death where you have to have an idea, and then a valley of death where you need money to get this thing patented. There’s actually nine valleys of death that you have to pass through before you get any idea to market and I think unless we are, you know, really adamant about identifying what the problems are, we won’t get through them. And one of them is getting through a university. I didn’t even put that in the valley of death. But everybody’s got an Office of Technology transfer. It’s called different things in every university. I’ll just get that out of the way. So that can be a really hard relationship in some universities. And truthfully, it shouldn’t be. There are only 13 schools in all of North America that actually make money from their patents. You’d think, oh, everyone’s making some money. They’re not. You know? Like they all fall in, behind the top ones like Stanford, Harvard, MIT, Berkeley, Penn, Chicago, and a few others. There’s only 13 of them that make money. There’s one in Canada. I think Toronto is the only one that’s making money. So everyone else isn’t making money. So that relationship that the inventors have with the university isn’t working. And the universities haven’t realized that yet. Now, we’re very fortunate at McGill to negotiate a great deal on all our patents. And it just was a little bit more happenstance too because their model is that like most schools, they own 30 to 40% of your invention, no matter what. Whether they fund the patents or not fund the patents. And you’re stuck with that. You’re going into your corporate giving up 30 to 40% of your equity right away. And you can renegotiate that, because the schools are starting to realize that they’re in trouble with this model. I mean, they’re paying for all these patents, and not getting anything from it, and the best way to negotiate that deal is just say, okay, we’re going to pay for the patents, we’ll give you, x y, percent, 3% 5%, whatever. And they’ll usually take that. And there’s other models that are being broached now by McGill for design and patenting. And, you know, equity value. So I think that’s a negotiable thing. But it’s a valley of death that nobody talks about. But it’s a real problem. The first 15 years, I gave up all the money and all the patents right, and nothing happened with them. But you know, if the university is open to negotiation it helps. But I think if you want to talk about the other valleys of death, besides having an idea and actually getting funding to do it, I think the biggest thing that people don’t recognize is that this is a team sport. And if your team isn’t pulling in the right direction, then you’re not going anywhere. And as a physician, you can’t be a sole founder of a corporation, unless you’re doing an app. It’s very rare for a position to be a sole founder, sole equity holder, and, you know, eventually end up licensing out their product or taking it the market. And you’ve got to realize that the CEO’s job in any device, if you’re going to do a device particularly, is getting money full time. And even a doctor can’t do that. It takes on the average 17 years to get an idea to commercialization. That’s why you see most physicians have an idea and they sell it to Johnson and Johnson or Biomed, or whoever’s willing to take it. And you get rid of it, and you lose almost all your money, but you get a little bit out of it. I think the first idea, that’s fine. But if you really want to be an entrepreneur and take something to market, you got to be in it for the long run. For a type two FDA device, which is what most people are looking at, it’s a type two or type three device, it takes about $3 million to get a prototype to commercialization stage to be implanted in humans. And it takes about $30 million to get it through regulatory. So when I say that your full time job is raising money. Like the CEOs job is raising money full time, or the CFO’s job, or whoever it is in your company. So you need a bigger company. You need a team. And it’s really the major valley of death. And people don’t recognize that it’s a big team, have to be on the same page, and pulling in the same direction. I’ve been extremely fortunate that you know, at Mile one, we have little over 40 employees now. Everybody seems to be on the same page. The C suite is great, like brilliant people all working to get this to market. And we’ve had a good run at it. But not everyone’s so lucky. Because all the doctors are a little bit OCD. They want to hang onto everything and oversee everything. You’ve just got to realize that can’t happen as a physician. It’s a different game. It’s not the same game you’ve been doing since undergrad where you had to get the highest mark in your class and be the best in your class and do this the best and that the best. It’s a team game. And I think that if people recognize that, then it’s a lot easier to do innovation.

Ameer Farooq  24:53

Yeah I mean, it’s such a different mindset and mentality to kind of go from the traditional academic pursuits that we’re all used to, to this very different, agile, entrepreneurial kind of mindset. And in some ways, I’m sure it must be kind of refreshing for you. I just wanted to piggyback off some of what you were saying about trying to find the right partners and finding, for example, funding, you know? Traditionally, what a business would do is go out and raise money or venture capital. Does that look different if you’re a surgeon? Particularly with all the concerns about conflict of interest? Like how do you navigate that whole interaction with traditional industry partners when you’re trying to bring something new to market?

Edward Harvey  25:39

Sure. That’s a good question. Industry doesn’t care. They actually like that you’re a surgeon; that you’re in, that you can’t get out. That you have an opinion that matters. But I think what surgeons that other people have don’t have is an access to non-diluted funding. So grants, you know, whether it’s a CIHR grant, or NSERQ, DND or DOD. And I hold grants from all those people. I mean, that’s money that you bring into the company that doesn’t dilute your equity. The other thing is that government support has never been better for innovation. I mean, it got hurt a little bit by COVID, things got slowed down. But almost every province in Canada has an innovation minister, and there’s money to be had, and leveraged. I mean, there’s other grants that if you get some money from industry, you can get money from the government or from funding agencies, that will double your money. And all that’s different than venture capital money. Venture capital money, in my mind, if you can push it off as long as you can, it’s better. Because the less risk there is for them, the more they’re willing to evaluate your company. If they come in at the napkin stage, like a very San Jose, California kind of Silicon Valley kind of picture where “I drew this idea on a napkin, I sold it for a billion dollars,” – that’s not going to work in medical parlance. Because there’s way more risk. So venture capitalists will give you more money the farther down the pathway you are. You’ve done your due diligence if you’ve done all your clinical testing, preclinical testing, and then you come to decide whether you’re going to take it to the market with a real-world company, or you’re going to sell or license it and whether you need money from venture capital at that point or not. And the other option that a lot of physicians have access to is friends and family. So like it or not, you have contacts, usually, with people who are willing to invest money in you, who believe in you. And that’s another way to get fairly good dilution value. You can use other modalities like convertible notes or other ways not to dilute your equity too much. And so if the more equity you have, when it comes to the VC stage, the more leverage you have in keeping this idea going. So I think it’s not a weakness for physician driven companies and that companies like you to be positioned, and you get access to non-diluted funding a little easier than other people.

Chad Ball  28:25

You know, I’m curious, do you have formal training in any of this? Or is this just you being a smart, hardworking guy navigating your way through this path?

Edward Harvey  28:36

I have absolutely no training in this. But I was smart enough to be associated with some co-founders, which are really smart. But truthfully, none of them in business. So we have three co-founders for all these companies. All the same group. We all work together in the lab, on lower campus engineering lab. The two other gentlemen are engineers. But we’re all self-educated in business. But what we did early on, was bring on an expert board. Our board of directors, so we have one former President of J&J, a president of one of the big biomedical companies, and our finance intellect is from a gentleman who sits on the board at Mitsubishi bank. So we have a board of directors that are very knowledgeable in how to get things to market and how to get money and how to build value in your company. So we recognized early on, we didn’t have it, and we went and got it. And that’s part of that team thing: assembling a team to attack the problem. You have to have the right team. You can’t do it on your own.

Chad Ball  29:51

It’s fascinating. It makes so much sense. You know, when you frame it that way. You’ve given our listeners and Ameer and I sort of an indirect look in and some tangential comments about so much. But if you were to boil it down, is there a series of principles or a concept or a mindset that surgeons in general can use or should engage if they want to become more quote unquote, innovative or disruptive? How do they get going? What’s that trick to flip the switch, so to speak?

Edward Harvey  30:26

I think if everyone just read this book by Moore called Crossing the Chasm, or Chasm, depending what continent you’re on. This is a book that’s been around for 20 years, but it makes the point that if you’re going to bring an idea to light and you’re going to start a company, then you don’t go after a market that’s full of people already. There’s only two ways to make money in a company: that’s either sell it for cheaper or have something that no one else owns, right? And so it’s much easier when you’re starting, when you don’t know anything about financial processes and production processes to have something that no one else has. Because then if it ends up costing three times what you think you’re going to market it for, there’s no one else competing with you. And you say, well that’s impossible. There’s no market like that. Well, there is. I mean, you mentioned one before: endovascular procedures didn’t exist 20 years ago. And there’s tons of ideas left in medicine that are available that are disruptive, that can be innovated, you know? There’s telemedicine, telehealth, retail health clinics, personalized medicine. Tons of ideas that there’s no one in the niche, right? Because they don’t recognize that there’s a technology there waiting to get in. And so this gentleman, Geoffrey Moore, who wrote this book, Crossing the Chasm, basically compared it to going to war, and that you’d rather land on a beach, where there’s nobody on the beach, right? And then you know, you take your army onto the beaches, you don’t want it to be like D-day and having everyone firing at you. You want to go in on an empty beach and just walk inland and sell your product. And I think that is one of the big concepts. You know, early on. Our trauma device for muscle monitoring is basically an empty market because the device that was previously available was 30 years old. The sensor in it was 30 years old. It was basically very inaccurate. It’s been written up as being inaccurate, and the company that was marketing it – she sold it off, because it was a medical legal risk. So all of a sudden, while we’re bringing this to market, there’s nobody in the market. And so we’re lucky in some ways, but we had to recognize that we were going to go into this market that was poorly represented – that we’re gonna have something no one else had. So, it’s very difficult for someone, a novice, like me or my partners to come into a market and sell it for cheaper. Because we get knocked out of the park by someone from China, or India or US. If we’re competing. And, you know, coming into a market where there’s no one else in it allowed us to expand and learn. And then, you know, we’ve discussed this before, Chad. I mean, we’re going to expand to Domino compartment syndrome, or muscle compartment, head trauma, etc. And that’s typical. You’re going to establish your beachhead, and then expand as you have reputation. And that’s the way that people should approach what they’re doing. Otherwise, if you say, oh, I want to make a new plate. Then you partner with one of the established plate manufacturers. And you say, I want to do this kind of tweak. And I’m willing to do the preclinical testing. And we’ll do some clinical testing. And what will you give me. Because you can’t really negotiate with them and tell them what you want. But they’ll give you like a cut on every plate or a percentage, or they’ll give you a consulting fee, but you won’t own the plate and you won’t own the company. Those are two different mindsets in how to get in. But if you’re going to start, a good way to start is partnering with an established company. Somebody who’s looking to expand and you might be able to expand their niche that they’re in currently. They might want to expand out of it, and you might have some idea that can help them. And that’s a good way to start I think. I don’t think you jump in with both feet like we did, necessarily, unless you’re pretty sure it’s going to work.

Ameer Farooq  34:31

One of the things that’s a foible of mine is to listen to these entrepreneurship podcasts. And there’s one in particular that I really liked, which is called “The Pitch” where some new founder comes every day and pitches their idea to a group of investors. It’s sort of like Shark Tank but podcast format. One of the things that I’ve always been impressed with is how people kind of see these opportunities where I sort of just rolled over and assumed that’s how it should always be. Even if I noticed the same pain point, I never really, you know, thought that was something that could actually be changed or that there was an opportunity there. How do you think your innovation work and all the work that you do touches you on a day-to-day basis throughout your day in the operating room or in clinic and throughout your week – do you think that you bring that mindset to everything that you do? Or how does it sort of affect the rest of your life?

Edward Harvey  35:28

Yeah, that’s a good question. I think that can actually be taught. Recognizing, you know, that niche market that is right underneath your nose. And we started at McGill actually. Not me, it’s a gentleman called Jake Berelet who had the original vision. I think it came from a Stanford model. But three universities got together to make a program, which was unheard of. Like no university combines to do a program. But we had a business school, Concordia University, the engineering school at Ecole de technologie superieure and the medical school at McGill. And they got together to run a program on innovation. And part of this is that these teams of students made up from these three different schools come in to see what you’re doing in the operating room, they talk to the nurses, and they ask where the dams are in treatment and what can be improved, and at the end of it, there’s a week where they come and they identify these 100 things that are wrong. And then you know, the 10 teams will come up with the 10 best ideas, and then they’ll go into these pitch competitions where they develop that over a period of a few months. Right. So I think it can be taught how to do that. I don’t think our schooling – Chad and my schooling – definitely did not teach us how to do that. I mean, they were busy teaching us how to recognize that patients are well or not well, and how to put a nail in or how to staple a gut, right? So it’s just a different mindset. And it can be taught. I think it’s just that we’re not aware of it and we weren’t taught that way.

Chad Ball  37:08

Maybe in closing Ed, I was wondering if you could help us define, for sort of intellectually ignorant business folks like myself, what some of these terms actually mean, and how they integrate into all the things you’ve talked about. So in particular, the concept of intellectual content forming, you know, quote, unquote, a spin off company, trademarking something, patenting something, how do those terms, you know, parlay to the real world?

Edward Harvey  37:40

Sure. So we touched on it a little bit. I mean, intellectual content, or intellectual property is one of the things that you need protected, in some ways. I mean, not necessarily, but you need protected in order to drive a commercial entity, in that when you go to get money, one of the first things that venture capitalists ask is, do you have a patent on that? And that’s how you protect your idea, right? Or it’s just a race to equity, in that everyone’s got it. You’re not special. So you want to make these barriers to entry for any of your competitors coming behind you. Because truthfully, it’s just like publishing. If someone recognizes that you’re making a big profit margin on something, there’ll be a competitor there next week, right? So trademarking and patenting are two of the ways to do it. Trademarking or copywriting is really used for code. It’s really hard to patent code. You can patent ideas that are innovative. You can’t get a patent on every idea you have. You have to argue with the patent office sometimes. You have to argue with Xerox technology transfer, you know, there’s this argument, oh, well, it’s already been revealed, or it’s not self-evident, or it is self-evident, or it’s not self-evident. Or it’s just clever engineering, you just put two things together, that someone would have put together with a glue eventually, anyway. This can’t be patented. So that first step in causing a barrier to entry is intellectual property or trademarking. And then, when you come down the pathway, everything you do just makes another barrier to entry in that the regulatory steps you go through is something that is really hard to do so people can get there. I think the thing overall to realize is that there’s really no cookie cutter answer. And I can quote this guy. There’s a book by Ben Horowitz that’s called “The Hard Thing About Hard Things”. And basically, the book just really brings up the point of a bunch of examples that there’s no cookie cutter answer to all this. There’s no recipe for building a company. There’s no recipe for, like he said, making a series of hit songs or being an NFL quarterback, or being President. It’s just that that’s the hard thing about hard things. There’s no real recipe, and you have to deal with things. And what I really like about dealing with this with a bunch of engineers and rather than other people is that, you know, we’ve had multiple problems, which threatened to shut down the entire process along the way. But the engineers are just like, okay, let’s solve this problem. And all the engineers get together in a group and they go, yeah, let’s solve this problem. We just solve it. And that’s what I really liked about business is you can solve things, and enact things that you can’t do in my other job, and Chad’s other job, which is dealing with a government driven healthcare system where you come along, and you say, hey, I’ve got a great idea to solve this problem. They go, oh, that’s gonna cost money, or that’s going to make people not work here or there. We’re not doing that. Even though it’d be better for patients. That is just not the way it works. But if you’re driving the company, you can solve problems. And I love solving problems. That’s why I’m a trauma surgeon. People come in with the classic jigsaw of fractures and soft tissue injuries, and we put everything back together and we solve the problem, right? And that’s just what business is like and it’s a good thing to be involved with.

Ameer Farooq  41:25

Particularly I felt like this is a trainee. You look at people like yourselves, and you’d see their work and you think, man, like, how could I ever do something like that? Or how do I ever aspire to do something like that? If you could go back in time, this is sort of a spinoff of our usual question that we ask our guests at the end of our episodes. If you could go back and give yourself advice as a trainee, now having the experience doing the kind of innovative work that you’ve done, what would that advice be?

Edward Harvey  41:59

Yes, this is a good question. I guess I’m getting old. People are asking me this question now. I gave this talk to all the orthopedic residents in Canada a couple years ago. I gave this talk in Seattle and a few other places, where it’s sort of like, you know, what are your words of wisdom? And how have you got where you got and what can we do? And so I think, and the way I’ve always approached it and I think I would have just driven the timetable faster if I went back and talked to my younger self is that your career is arranged in five year blocks. It has been forever. You did undergrad, you did a four- or five-year degree in undergrad, you did a four or five year medical school degree, you did a four or five or six or eight year (like me) residency and fellowship group. And then you come out and practice. Your first five years are actually learning how to operate. Like you think you learned how to do it in residency? No. You spend your first five years with your head down, just learning how to operate, make sure you don’t make any mistakes. Then the next five years is really, you could involve a little bit more administration. But you’re still really perfecting your clinical acumen. And then after that, then you’re in your 30s, right? Then you’re gonna start, what do you do else? You know, because things get a little easier clinically, then you start trying to improve the processes around you, you know? You join administrative committees, you have input into things, because you’ve seen things before. So people ask your opinion. But then you get to this point where I was five years ago, where it’s like, yeah, well I’ve done that. And what now? I had like a life changing epiphany, I guess. But I mean, to me, I was always just going to take care of my kids. But then I said, well, I’m gonna do something else, intellectually. And I’d always done researching. But I said, okay, I’m tired of this. All these ideas going nowhere. You get more and more patents that are just sitting on a shelf somewhere. One of these patents I’m going to take, and we’re going to make a company out of it. And that was it, you know? And I think I would have done that a little earlier if I had someone to go back. But I think the thing to tell the people younger in the career is just: you can break this out in five-year blocks, and you know where you’re going, and just decide where that next five years comes. It’s not like I’m doing my board exams, and then I’m retiring. You need to plan for what happens in the middle or you’ll become really disillusioned with the whole system, and you’ll want to be out of it. And you see people quit medicine for what’s called “burnout”. It’s really just lack of planning. You know, either you planned your career wrong. I mean, there’s 248 medical specialties. You might choose the wrong one. There’s still time to change it. Or you just become bored with what you’re doing. But you need to kind of reinvent your life every five years. I think that’s the best advice I can give to anyone.

Ameer Farooq  44:58

You you’ve been listening to Cold Steel, the official podcast of the Canadian Journal of Surgery. If you’ve liked what you’ve been listening to, please leave us a review on iTunes. We’d love to hear your comments and feedback. So, feel free to email us at podcast.cjs@gmail.com, or connect with us on Twitter @CanJSurg. Thanks again.