Playing on Hard Mode with Scott Nelson, Co-Founder, FastWave Medical

Scott Nelson has spent a good portion of his career in the medtech space. As a serial entrepreneur, he has helped start a number of different medtech companies. His latest venture, FastWave Medical, is developing intravascular lithotripsy (IVL) systems for treatment of arterial calcification.

On this week's Medical Alley Podcast, Scott joins more to share about what makes FastWave Medical unique in the IVL space, discusses some insights he's gained throughout his career as a startup founder, talks about his longevity in the podcast space with his media company Medsider, and much more.

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Transcript

Frank Jaskulke  01:25

Good morning, good afternoon, and good evening to everyone out there in Medical Alley. This is Frank Jaskulke, your host on the Medical Alley Podcast, and I want to thank you for joining us on another episode. Today, we're going to have a fun conversation with a serial entrepreneur who is working on a pretty cool venture. I think you'll find that interesting in its own right. But also is part of a broader ecosystem here in Medical Alley. And it's just a really great representation of this amazing community that you are all part of. So I want to say thank you to Scott Nelson, the CEO and co-founder of FastWave Medical for joining us today. Scott, thanks for being on the podcast. 

 Scott Nelson  02:05

Frank, thanks so much for having me on. Yeah, I love what you guys are doing at Medical Alley. So a pleasure to have the opportunity to to record a podcast with you. 

 Frank Jaskulke  02:16

We really appreciate it. Well maybe the simplest place to start, could you give our audience a little bit of a background on introduce yourself, and then tell us a little bit about FastWave and what the company is up to?

 Scott Nelson  02:28

Yeah, so in terms of my background, I'll try to be brief, right, because I want to leave enough time to kind of get to the get to the good stuff. But first, I've really at a high level spent most of my career in traditional medtech, primarily the cardiovascular space. First half of my career was with large strategics like C.R. Bard, which is now Becton Dickinson, a little bit of time at Boston Scientific, then actually came into Covidien through their acquisition of Bacchus Vascular, kind of way back in the day, and then stayed on board through Medtronic's eventual acquisition of Covidien. So yeah, first, probably, you know, 10 to 12 years or so of my career was with large strategics. And then really over the past eight to nine years, I spent most of my time with early stage startups. Some of those include a company called Touch Surgery, which is a London based digital health startup that's now part of Medtronic. I started a couple other companies along the way, including including FastWave.

 Frank Jaskulke  03:19

Oh, that's very cool. And we're gonna have to talk about touch maybe for a second because the digital part of that's pretty darn interesting. But start with, tell us, what is FastWave Medical doing?

 Scott Nelson  03:28

Yeah, so we're designing and developing intravascular lithotripsy systems, or the acronym that's often used is IVL. And I'll explain it, you know, for maybe at a high level for those that aren't as familiar with the cardiovascular space. But when it comes to cardiovascular disease, it's best to think about plumbing right in your house. When you've got a clogged pipe, you want to get that cleared up so you can reestablish flow, right? In the sense of plumbing, it's water flow. In the sense of our kind of our bodies, it's blood flow. However, when it comes to those blockages, if they're heavily burdened by calcium, which is tough to treat with traditional modalities, that's where intravascular lithotripsy system really comes into play. And so what this technology is, it's a balloon angioplasty catheter, it looks kind of kind of like just any other balloon balloon catheter. However, the difference, the major differences is you're you're delivering energy inside the balloon to provide shockwaves and the shockwaves are then sent to the, you know, into the calcium to create fissures or cracks in the calcium in order to kind of modify it so you can deploy a stent, use another maybe a different sort of angioplasty, catheter, etc. But at the end goal, you're trying to open up the blood vessel.

 Frank Jaskulke  04:47

And what like, if we weren't using IVL? What's the, like, the modality we'd be using to go in and pull that stuff out? I've gotta ask then, what's the genesis of the company? Or like, how did this get going? 

 Scott Nelson  04:53

Yeah. It kind of depends on whether you're using this type of technology for peripheral vascular applications or for coronary applications, but generally speaking other treatment options include, you know, traditional balloon angioplasty, right? So what kind of a POBA or plain old balloon angioplasty. Stenting, right, with either a bare metal or a drug eluting stent, or tools that are referred to as atherectomy, which in essence, kind of sand down plaque or try to cut it out. And so most physicians will use all of those kind of as part of the treatment algorithm to kind of depending on the patient, the burden of disease, but IVL is a relatively new type of technology that fits into that into the tool bag, so to speak. Yeah, so we started actually working on the company towards the back half of 2020, largely rooted in in two things. One is that we were watching the only incumbent in this space, which is a company called Shockwave Medical. They were doing fairly well, and we expected that the utilization of IVL would only continue in the coming years. And this was before Shockwave's coronary approval. So the company really hadn't taken off like it has. And so we sort of had this underlying belief that IVL, the popularity of IVL and the utilization of the technology would only increase. And then two, we were keeping track of a company called CSI, Cardiovascular Systems, which is in the Twin Cities, recently exited to Abbott. We were watching the progress they were making with respect to IPR related initiatives to sort of, for lack of a better description, kind of invalidate some of Shockwave's IP. And so anyway, without getting too far into the weeds, when the USPTO ruled in CSI's favor, we sort of, you know, that was sort of the the why now moment for us to kind of pursue this project with more rigor. And so we thought there's maybe a little bit more freedom to kind of operate than maybe others, others would proceed. And that's what's kind of led us to let us start working on this project versus others. 

 Frank Jaskulke  06:58

Yeah, I love hearing that the, the kind of the strategic analysis that's in there about a growing market, IP and technical opportunities, and then the ability to bring something new into the space to improve clinical care and create a new business opportunity. And as I understand it, you're part of — FastWave is part of, and you're also part of an effort, incubator, or an accelerator in town called Big Sky Biomedical, which I find fascinating this trend of incubation and of new models of developing medical device startups that can be more productive, more efficient than, you know, single product, single company, replicate the team over and over again. Could you tell the audience a little bit about the relationship to Big Sky and the the idea behind Big Sky more broadly? 

 Scott Nelson  07:52

Yeah, no, it's a great question. And so FastWave is actually spun out by Big Sky partners. So it's not a direct spin out of the incubator, but partners of Big Sky spun FastWave out. But I think our approach, I mean, there's a lot of, as you know, Frank, there's a lot of different accelerators and incubators. And they all have kind of various models, some work, some have a very proven track record, others are kind of newer in their sort of evolution or lifecycle. But our take on the projects that we pursue kind of out of Big Sky are kind of under that kind of broader umbrella are folks involved with Big Sky and what projects we look at are typically those that we feel are kind of opportunities that we where we can really optimize for speed. And so most of the programs that we would pursue, you know, have a reasonably straightforward clinical and regulatory pathway. Insurance coverage and reimbursement is already in place. We're not - we don't want want to, you know, typically, we want to avoid having to kind of create new CPT codes as an example, right? So they're relatively straightforward where we can kind of leverage our deep domain expertise and speed to get that particular project to the next major inflection point pretty quickly. So generally speaking, I mean, I'm obviously staying fairly high level, but those are typically the projects that we'd like to work on.

 Frank Jaskulke  09:08

Right on. And I think it's a great exemplar for the broader ecosystem have multiple different ways to advance medical innovation, and that there can be ways of doing it that create efficiencies. It never is easy, like, I'm always sympathetic to the journey of the entrepreneur, but ways to do things that can boost productivity, improve patient care, and generate superior financial outcomes hopefully. I want to shift then slightly because you've mentioned a couple of other ventures, this entrepreneurial journey. And as I was reading up preparing for this, I've seen you talk about in other forums that you enjoy, you know, kind of the Peter Thiel concept of taking something from zero to one. And we work with a lot of entrepreneurs who are for the first time doing that, right, and they don't know what they don't know. They're learning on the job, best way to do it, but also a high risk way to do it. As you've gone on your journey, are there things that you look back on and you go, gosh, now that I know this, I can do it better? Or I wish I knew that then. Like, basically, what are those words of wisdom you might impart out to some of the other entrepreneurs out there as they're on their journeys?

 Scott Nelson  10:20

Yeah, no, I'm glad we're talking about this. Because I like to kind of use the analogy that, you know, startups in general are hard, right? I think most people that are listening kind of understand that, at least peripherally, but I'm doing a startup inside kind of within the med tech space, really, the broader Life Sciences arena, is like playing the game on hard mode. And so, all of that said, that's probably the first thing that I've mentioned is that, that's one of the key lessons, sort of that I've gleaned over the past whatever, eight, nine years of working mostly in early stage companies is that from a distance startups can look fun and sexy and fast moving, and there's a lot of gravitas, etc. But they're incredibly hard. They're very, very rewarding if you'd like to kind of build things and enjoy sort of pushing a boulder up the hill. But that's probably one of the key lessons learned, I guess, having done this for a bit now is that they're just really hard, so you need to go into it kind of eyes wide open, right? It's a lot different than, you know, being involved in a large strategic with endless, you know, nearly endless resources. And so that's probably one of the things that I mention at the kind of the outset. But a couple other things that really come to mind are one of the things that I often see a lot of entrepreneurs, especially in med tech, one of the mistakes, it's not necessarily a mistake, per se is that they may have a really great idea, right? For this new thing that solves this very acute need that's very real, right? And they'll get stuck on this idea. And it may be, again, it may be a really, really great idea. But however, it's not a venture backed idea, right? And I think, you know, in this environment, and in med tech, in almost every scenario, you're going to need to raise capital in order to get this project or this idea to kind of to the next milestone, the next inflection point. And yeah, I think, you know, every entrepreneurial minded person that's listening to this to kind of, I think I just encourage them, if you're working on an idea, just consider that from the outset. Right? Is this something that can be supported by venture capital? And so that's another thing I think that's really important. And then probably the third major kind of key learning that I'd like to call out, I think it'd be helpful for a lot of, you know, startup folks that are listening to this, maybe you're at a strategic and have an interest in startups is product market fit is so, so crucial, right? And I think, you know, you can learn a lot, you can read a lot of books about product market fit and how to look for that. But I think I can't underscore enough the importance of trying to look for that as early as possible, right, and as fast as possible without committing too many resources. So that the sooner that you can find sort of those traction signals that I like to call where you've got some sort of some some strong signals, some strong metrics, etc, that this thing that you're working on resonates with your end users, your key stakeholders, the sooner you can find those traction signals, I like to refer to them, the better. And just add a little bit more color to that, what you want to avoid is getting into a scenario where you've got this great idea, and you end up spending, you know, years, potentially years on it. And kind of allocating, you know, some of your own budget towards something that eventually just doesn't have legs, you know, whether it's something that's not going to resonate with your end users, maybe it's a payer that's eventually not going to pay for it, etc. So again, that the sooner that you can find some semblance of product market fit, the better.

 Frank Jaskulke  13:54

I think a theme I heard in all of that, in all of the comments you just made there is the importance of the external stakeholders, right, that like, you may have an idea, you may have a company, but if you're gonna raise money, other people have to want to give you money. And if you're going to sell a product, other people have to want to buy the product. So having a mindset and then taking action around well, who are the other stakeholders that are going to need to buy into this? And then what do they think versus, you know, what's in your head? That sounds like a theme that kind of is coming through your commentary.

 Scott Nelson  14:38

Yeah, definitely. And I think most of us would say, well, the obvious kind of end user in the world of med tech is physicians as clinicians, right? And I think sometimes we'll get stuck in this idea of running maybe a voice of customer kind of process. And the questions related to kind of what we're trying to ask are too high level or too superficial. Where in reality, we need to kind of sort of get down to brass tacks and ask that physician in this example, is this idea that that we're talking about, is this something that you'd go to bat for in a committee at a hospital that's looking to possibly bring in this technology? You know, would you put, if you've got very limited sort of arrows in your quiver, is this one that you would use? Right? And so that's a good example of kind of really like trying to try to look for those sorts of signals that sort of buy in as early as possible. Another one that you mentioned, too, Frank is on the on the payer side, right? Is this is this really something that an Optum, a Blue Cross Blue Shield, are they actually going to cover and pay for this? You know, and so there's a lot of there's a lot of different stakeholders involved right in the healthcare ecosystem, and really kind of getting into the weeds and getting in the mix with all of them is really, really crucial to to find, you know, product market fit again as early as possible.

 Frank Jaskulke  15:56

Indeed, and for the audience, one comment we'll make on the payer piece, because it just, every time I think about it, it blows my mind. But our friends at UnitedHealth Group, right, headquartered right here in Medical Alley, they employ in the US more people than the entire US medical device industry. And they have a higher revenue than the entire US medical device industry. And one of our board members, we have a former UnitedHealthcare executive, he made a comment once, it just struck me, which was, he would talk with device companies, and they would talk about billion dollar market opportunities. And he goes, you know, quite often, that's things we have interns working on, because their scale is so fantastic. And I think as a device industry, we sometimes don't take into account that other stakeholders are dealing with the same challenges, right, cost and quality. But from a different scale and a different point of view that increasingly, we need to get, we need to understand if we're going to drive adoption. And I take your point earlier, very well of if you can bring a product to market where you don't have to go and create new codes create new pathways, that's often a very good route to go.

 Scott Nelson  17:17

Yep. No doubt. And that's sort of the power of getting involved with organizations like Medical Alley is that the the more conversations you can have with all stakeholders, right, including payers into that mix? Because I would argue, that's, you know, maybe equally as important as even kind of your regulatory path as an example, the more conversations you can have some of those key stakeholders early, early in the process, the better.

 Frank Jaskulke  17:40

Right on. So you mentioned at the start of this line of questioning about it's kind of like playing on hardmode. And I always think, you know, like, we have lots of smart people in this industry, they do amazing things, and they could go and do amazing things other places and probably not grind their gears as much. What keeps you motivated to, well, to play on hard mode?

 Scott Nelson  18:02

Yeah, it's an interesting topic, right? Because, you know, that's always been amazing to me is how, like, how many smart individuals that are really, really sharp and, you know, come with really impressive backgrounds, continue to kind of grind away, right, in the world of, you know, medical devices, or med tech or the life sciences. And, you know, I've got a lot of friends, entrepreneurial friends that, you know, run very successful startups outside of this space, right, in a completely different vertical, whether it's SaaS or something else. And maybe it's just my own personal bias, because I've been in this in this space for quite some time, but the reward of like building something despite all of the friction, all of the challenges, the ebbs and flows, the ups and downs, the reward of like building something that has a very, very meaningful impact and in someone's life, you know, that you can't you can't under appreciate that. Yeah, you know, it's especially if what you're working on is, you know, hits home, and it's sort of a inwardly passionate or there's something that you're really passionate about. That's like icing on the cake, right? And so I think that at the end of the day, that definitely helps kind of overcome the the ebbs and flows and the ups and downs that inherently come with the the world of startups.

 Frank Jaskulke  19:13

Right on. I hear that from so many people, and it makes me enjoy this work so much more that there is that a deeper motivation that the entrepreneurial community has around this field. And I think we're very fortunate particularly in Minnesota to have such a concentration of it. And if I remember right, you're also, you have another venture,  a slightly different kind of venture that I found very interesting to to observe and watch, especially even the work Medical Alley does. You're involved in a thing called Medsider. Could you tell the audience a little bit about that? And I would be personally curious, like, what's your what is your motivation around building up this kind of this media platform? 

 Scott Nelson  19:54

Yeah. So I'm a bit of a podcast OG, as I refer to myself. I actually started Medsider, which is, by and large, you know, kind of a podcast centric kind of outlet, if you will. But I started it nearly 15 years ago. And this is when I was in, largely spent most of my med tech time in the field, right, kind of from 

 Frank Jaskulke  20:16

Were they called podcasts then?

 Scott Nelson  20:19

That's right. I'm not that old. But yeah, I mean, this was I mean, just to kind of date this is like, this is before, like, all, you know, this is definitely before Spotify. You know, it was kind of the days where the only way to listen to podcasts or consume them was like, the native Apple podcast app. I mean, there wasn't, you know, there's pretty limited options. In fact, I think when I first started recording, you know, I think most of it was done, like just streaming online. But, um, but yeah, pretty old. But the reason I started doing it was, um, I got a lot of value from other startup podcasts, right, consuming that content, it was just really interesting kind of media distribution channel, and I just found a lot of value out of it. But at the time, there was nothing really being recorded that was specific to med tech. And I saw all of these like, new kind of innovative devices, you know, being used in clinical trials or being launched, you know, in operating rooms and cath labs, you know, across the Midwest. And I was like, I always have the question of like, what are these things come from? Right? And, you know, how did they come to be? And so, again, I was sort of a classic story of scratching my own itch, I was like, Well, I'm going to just start my own podcast to try to learn a little bit more about like, where these, you know, where these startups come from. And so that's sort of like what started me on this journey. And, you know, I've kind of stayed at it ever since. But it's pretty rewarding. I mean, it's definitely I would say, I've got a well enough, sort of an oiled process down at this point where it doesn't take up too much of my time. But it's really rewarding, because one, I get to selfishly learn a ton from other much more experienced folks. And then secondarily, you know, like I said earlier, building a med tech startup is really, really difficult. And I love being able to kind of tell the stories of other people that are doing it, and I'm sure you probably get the same sort of reward, right, like highlighting other founders, CEOs of early stage companies, because it's a grind, and it's very challenging, but yet really rewarding. And I think it's really just fun to see other other kind of other podcasts, including Medical Alley, right, kind of highlight some of these some of these stories. 

 Frank Jaskulke  22:19

Oh, that's very cool. For the audience's benefit, can you give the spelling on that, tell them where they could go find it?

 Scott Nelson  22:26

Yes, it's Medside. So not Med Insider, which I think I think is an easy to spell. So medsider.com. Or you can just search for it in your in your podcast app, and you'll probably find it.

 Frank Jaskulke  22:38

Perfect. And folks will make sure to include that in the show notes so you can track it down. He's interviewing fantastic people, many of which you'll recognize, hopefully, some you won't. And you'll learn about some really cool new companies. Scott, thank you. That was really informative. I really appreciate you sharing the story of you know a little bit about you and what you've been working on. And thank you for being on the podcast. 

 Scott Nelson  22:58

Yeah. Thanks for having me, Frank. And again, I love what you guys are doing at Medical Alley and keep going. Keep going. You guys are doing great things a lot. A lot of fun ahead in the Minneapolis area for sure.

 Frank Jaskulke  23:10

Heck yeah. Well, we appreciate it. Thank you. And folks, we appreciate you for listening. This has been another episode of the Medical Alley Podcast. If you're not already a subscriber, make sure you check out medicalalleypodcast.org or you find us on Apple, Spotify, or now also on YouTube. And will you do me a favor? Would you share this episode with one other person? If everyone listening did that, we'd help this story in so many other great stories out of the medical ally community reach further. I'd really appreciate it. Until next time, have a great day.