HOUSTON—World-renowned innovator and inventor of the balloon catheter Thomas Fogarty, MD, delivered a robust pitch against the singular pursuit of financial gain during the process of innovation before a gathering of surgical colleagues at the inaugural International Society of Endovascular Specialists (ISEVS) Symposium.
Too much of a focus on economic reward can often cloud the core mission of innovation, Fogarty told his audience during the keynote lecture at the three-day meeting in Houston, Sept. 16, 2019.
“Sometimes people want to make so much money, they lose sight of what they’re here for,” he said of his experiences as both an innovator and an investor. “We all like to make money but if that’s all you’re focused on I don’t want to be around [people like that].”
The remarks came in answer to a question posed by Alan Lumsden, MD, medical director of Houston Methodist DeBakey Heart & Vascular Center, that sought to establish the most common mistakes young surgeon-innovators make when attempting to follow in the footsteps of people like him. Fogarty, founder and director of the Fogarty Institute for Innovation, Mountain View, California, answered by talking about his experience with a venture capital company, which he helped found.
“Do you know what a venture capitalist is?” he said. “Well, I was one of those once. The fact that I co-founded [one]. I think it was 18 months later that they kicked me out. Why? Venture capitalists are nothing but vultures. I call them vulture capitalists. That’s a very appropriate name … you can’t work with people who have the wrong motives.”
Fogarty pointed out another innovation hazard among emerging inventors: “If they’re very young, they think they know so much, and they’re so focused on being important by knowing so much,” he said.
“Some of the biggest deterrents you don’t recognize until you’ve experienced one of those deterrents. The thing I’ve learned is that very brilliant people from very prestigious institutions with all kinds of awards are easy to like but many of them are full of it. And that can cost you.”
Fogarty, whose inventions include the balloon catheter and the AneuRx stent graft, required little introduction owing to his stature in the cardiovascular surgery world. But Lumsden, ISEVS president and host of the symposium, kicked off proceedings by briefly telling the story of the Fogarty catheter’s genesis in the inventor’s passion for fishing: the tale of how Fogarty came up with the idea and produced a prototype by tying the fingertip of a latex glove to a hollow tube with a piece of fishing line. “To this day, it moves clot unlike anything else,” said Lumsden.
Rod White, MD, medical director of vascular surgery at Long Beach MemorialCare Heart and Vascular Institute, Long Beach, California, then kicked off the lecture in a formal introduction, setting a mirthful tone that was to run through the lecture: “If you look at this whole list of things [that Tom’s achieved], he started off as a boxer—so that explains some of the stuff that’s going on.”
More seriously, White also referred to an important lesson he learned while working with Fogarty: “Be the first one to know when a technology is not going to work.”
Mentees and mentors
The address, entitled “What’s Innovation?”, saw Fogarty open by proclaiming: “Some of my best mentees are now my best mentors. I’m very proud of that. A lot of guys are now teaching me that I was a mentor for.”
He continued: “If you innovate, that technology can be used by other physicians. That’s rewarding because you multiply what a surgeon does. It’s a really interesting cycle that we go through, the process of learning. I’m still innovating and I do so in a private environment, a private hospital.”
At his institute, Fogarty said, they do so with the primary purpose of reducing healthcare costs. As an example, he spoke about its work on the portable wound vac. “It costs less, it does the same job [as the wound vac], it very significantly reduces costs and we can afford to have it in nursing homes. This was something I never thought of but it came to us at the institute to help in the process. The product is completed.” Investment in the portable device should see it commercialized in the next year, Fogarty added.
He highlighted another example: “Does anyone know Chris Zarins?” he asked the audience. “He was the first company that we took into the institute. He and an engineer developed the technology called HeartFlow, a major, major change in the way we are going to treat cardiac disease, primarily coronary disease. It can diagnose coronary disease without an angiogram.”
The result: Reduced costs, Fogarty added.
“It’s very interesting how innovation in many different fields can bring better technology but at reduced cost,” Fogarty said. “That is something that we have to do. Everybody knows medicine costs too much. Now, we can’t get rid of all the doctors. They’re expensive. But we’re kind of heading in that direction. Watch out for socialism!
“So the implications of what innovation can do for our patients, and how we can innovate: at the same time provide better care with better technology but at a reduced cost.”
Another question from the audience queried Fogarty on the importance of persistence in innovation, referring to his work on an atrial fibrillation intervention with nuclear devices that initially received little support, an advance 14 years in the making. “Part of the problem was the concept was so outlandish, everybody said it wouldn’t work,” he said. “A lot of innovators have that same problem. The concept is so outlandish you can’t get anyone to invest in it. It’s the biggest problem we have in raising money. Far-out ideas are the most valuable to human kind—our patients. But they cost a whole lot. It takes a long time. It takes a lot of personnel. It’s very expensive. But if you stick with it, you overcome those obstacles; you’ll finally get there.”
On a question addressing protecting an idea, Fogarty recalled his journey with the balloon catheter. “I had no money,” he explained. “My mentor, Jack Cranley, Cincinnati, Ohio, a vascular surgeon, told me, ‘You’ve got to patent this, Tom.’ Well, I found an attorney. He said, ‘That’s ok, pay me when you can.’ An attorney!”
He added: “You’ve just got to keep at it. Know what the obstacles are.”
The queries continued: How might an inventor manage the risk that follows innovation, Fogarty was asked. “Well, follow the rules,” he answered. “That’s number one. Pay attention to the FDA [the Food and Drug Administration]. If you don’t you’ll be in deep … Because they’ll get you. Think of all the entities that could get you into trouble, and all of the regulations that you have to follow.”
What does Fogarty see for the future? “Innovation in the field of medicine is going to be even more critically important. Because there are many problems in many different areas. I think if we handle our innovations right, we’ll end up reducing cost.”
As the lecture was drawing to a close, Fogarty was asked how surgeons might balance promising ideas with maintaining patient care. He answered by referencing the importance of conducive environments. He circled back to his time at Stanford University.
“At Stanford, I was hired and re-fired two different times because I was interested in commercialization,” he said. “Academia feels very often that those who relate to commercial entities are evil. Industry and the representatives of industry are often there only to contaminate the academic mission. That’s why they don’t like salespeople getting into hospitals. At Stanford they were so adamant about salespeople… they used to give you pencils or pens that the dean required them to put in a large basket outside his office because they were contaminating by bribery with a pencil. That’s one reason I left Stanford the first time.”