David Yakobi, MD is a Board Certified Cardiac Surgeon and specialist in Cardiology, Intensive Care, Emergency Medicine, Hemodynamics, and Physiology. Dr. Yakobi has vast experience in Coronary Artery Disease (CAD), Valvular disease, and Pediatric congenital heart disease. 

He also plays a key role as a medical consultant to major startup companies in the healthcare industry with particular emphasis on medical devices and digital-health. 

SPEAKERS

Tobin Arthur, David Yakobi, MD

Tobin Arthur  00:07

Hello, everybody, this is Tobin, Arthur, your host for Innovation4Alpha and I am joined by a very special guest. Today Dr. David Yakobi, who is a cardiac surgeon based in Israel. He has got incredible experience working with innovation startups industry. So we’re gonna have a fun conversation and talk a little bit about innovation and cross border issues. But Dr. Yacobi, welcome to the show. Thanks for joining me.

David Yakobi, MD  00:45

Thanks for having this will be fine.

Tobin Arthur  00:47

Why don’t you just start by giving us a sense of your background maybe training and some of your experiences to date.

David Yakobi, MD  00:53

I am a cardiac surgeon adult as well as pediatric. I’ve been doing it for quite a while now. Maybe I’ll start from the end of 2019. Being a senior cardiac surgeon in a very busy hospital here in Israel, obviously operating on adults as well as pediatric cases ECMO service oncologic thoracic surgery. I just decided with myself that I want to spend more time with my family and something that most of the cardiac surgeons cannot afford to themselves. So I started my own exploration of the medical and the digital health industries. I met hundreds of companies starting from Israel than Eastern Europe, Western Europe, US, Canada, India, China, even Australia. And I realized that at that time in 2019, my knowledge about basic terms like brainstorming, proof of concept, r&d, IP, regulations, sales, fundraising, it was quite poor at that time, because the only thing I knew about the hospital was the end product. I used to get the end product. I used to call my purchasing manager you would ask me, David, is it easy to master? Is it a nice to have? And obviously, my answer was always okay. It’s a must. But you know, I had to be convincing. Eventually, after meeting all these companies, I had enough courage I say courage because the hospital is a is a nice golden cage. But it’s a it’s a cage. And you know, I had my nice salary, I had a little ego. So I left the hospital.  Currently, I’m operating but mainly in the private sector in very small volumes. But my main activity, I’m consulting to digital health records and med tech companies, especially in the structure heart field, but also electrophysiology, coronary artery disease ICU, by the way, I’m an ICU physician, as much as a cardiac surgeon, emergency medicine, some digital health projects. I’m also an external expert for one of the notified bodies in Germany. And I’m also involved in some projects that deal mainly with really, really early stage innovation. So I’m really satisfied from the decision I’ve made. And I’m really happy to talk with you guys.

Tobin Arthur  03:20

That’s a really interesting background and and unique in many ways, because you made the decision to back off, like you said, for lots of reasons you’ve made this work. Let’s go back a little bit further, why don’t you just talk about your experience over the last couple of years, as you went on this educational journey, you started doing more and more consulting? What are some of the things that you’ve learned and observed? Maybe a couple of highlights in that?

David Yakobi, MD  03:50

When I just started doing this exploration, I was still operating. And, you know, I was sitting with some CEOs, and they would ask me, David, you know, what, we need the guy in IQ. But what do you want to do? And you know, I was embarrassed. I mean, what do you mean what I want to do you know, who am I, you have my CV, you know, we just talked about it. What do you mean, what I want to do? Please tell us, what do you want to do? What, what like, ignites your imagination? And this question, this CEO was not the only one that asked this question. The I got this question several times for several seals. And then I realized that as a physician in the med tech industry or in the digital health industry, you have to bring an added value. You have to say, what do you want to do? What kind of how can you make the company you are working for you’re working with or you’re part of being better? And it’s very important to understand that as a physician, you cannot confine yourself solely to them. add the color the clinical part, you have to be a good business development, you have to be a good ambassador for the company you’re working for. Why? Because for physicians, sometimes it’s easier to open doors, once you open the door for sales for fundraising for some strategic partnerships. From there, it’s easier for the other executives to take over. And I really think that this is something that we as physicians in this industry, we must do. So this is one thing that I really wanted to emphasize.

Tobin Arthur  05:32

That’s incredibly well said, I couldn’t emphasize everything that you just said more. The doors that you’re able to open because of your credentials, your experience, are something that a lay person, like myself, or an entrepreneur just can’t open. And so the more physicians understand that, the more they really tap into their value. Let me just touch a little bit on your observations, because you’re in a unique position in Israel, which is a very innovative country, a lot of innovation comes out of Israel, particularly relative to its size. Compare a little bit your observations, say, between Israel, and what you see in Europe, what you see in the US, what are some of the differences between those different markets?

David Yakobi, MD  06:14

So I’ll start from a topic, which is kind of usually people are embarrassed to talk about fundraising. Obviously, most of the startups they fail, they fail not because the idea was bad, or that there was the unmet clinical need that didn’t  exist, or the CEO did something wrong? No, usually, because there was there was no luck. And sometimes it’s a matter of timing. Sometimes you have to come to the to the correct or the proper VC or Angel, or someone that will promote the company and will take it to the next step. Sometimes it’s a matter of creating a nice slide. Sometimes it’s about when do you come to this particular VC, and you have to know what to say, because this VC wants to hear that we did this and that in our preclinical studies in our animal studies, some VCs, what they put a huge emphasis on the on the market part, some of them want you to be really good in, in regulation, so on. And obviously, you cannot be good in everything. Because early stage startups, you know, usually the CEOs are not that experienced, because you know, the the more seasoned CEOs they go, and they get these nice positions in the in the larger companies that already have, let’s say, 20 to 100 employees and so on. And in Israel, we are unique in the fact that the government actually there is a an authority called the Israeli the innovation authority. And this authority actually, are they partner with some Mechtech or digital health hubs. And actually, this governmental money is invested within this company. And actually, they don’t want much, you know, they I don’t know, actually the know the exact terms, but they don’t want much, because actually, they believe that even if the company fails, the knowledge will remain in Israel, they do put an emphasis on the fact that if you want to get some contractors, so it’s better for you to pay this money within Israel. So you want to pay for for a delivery system manufacturer you want to pay for to physician you want to pay for some, I don’t know molding and stuff. It’s better to pay in Israel, the model is the following. So the government brings 85% of the money immediately I’ll tell the exact amount. And this med tech hub, they bring 15% of the money. And then actually the total amount is is around let’s say 700 or $800,000 for two to three years. This money should be enough to achieve some milestones. These milestones are determined by the same integration authority. And once you reach these milestones, actually you are ready to approach some VCs and you are ready to get your controversially some would call it a series say some would call it seed seed money. But anyway, you are ready to to ask for your $4M, $5M, $6M or $10 million. In Israel, the fact that it’s really crowded so there are a lot of ideas, a lot of entrepreneurs, a lot of companies it’s harder to get these series around.

Tobin Arthur  09:59

I think that from my, from my knowledge, or I’m familiar with, with quite large number of companies in Europe, I think that raising funds in Europe, it’s, it’s a bit easier is a bit easier. In the US, it really depends because in the US there are obviously some VCs. But in the US, I think that also there are a lot of ideas. But sometimes I think that they did not do the correct market research before this idea came up. On the other hand, in the US, there are a lot of angels. So it’s usually it’s easier to find the first, let’s say, $200K,  $400K, $600,000, but then something gets stuck. And with $200,000, it’s really, it’s hard, it’s difficult to achieve milestones, you cannot perform animal studies, you cannot approach the regulatory bodies. So I think that it’s a double edged sword. On one hand, when it’s easier to get money, you do things, you get a lot of confidence. But on the other hand, you have to get this substantial amount in order to get some good, very good employees, in order to proceed with your regulatory thing. In order to perform, obviously, your preclinical and sometimes some first in human trials. So it really depends on the company. And it really, really depends on the board of the company. Sometimes they put guys in the board that they have a lot of experience, they did already one or two acquisitions, so exits. And I think these guys, they have a lot of added value. Also, sometimes ideas come from entrepreneurs that are not physicians, usually they are not physicians, sometimes they have some background in Biomedical Engineering, Science, sometimes they have background in some would say paramedical field. But I think that it’s really important to incorporate a physician, a physician that comes from the same field into the company, even as a part time consultant, or just, you know, just someone in the in the Scientific Advisory Board, just because it’s very important for this physician to always to communicate with the engineers, the software engineers with which it’s really important because the input or the feedback that the physician can get, and also vice versa, the physician is getting from the from the engineers, I think that it’s really, really valuable. Because talking all only on the on the on the C level on the executive level, it’s nice, but at the end of the day, someone has to tailor the device, someone has to actually sell it or someone has to do something with it. So that’s my perspective about it. Definitely there are differences between Israel, Europe, US. And there are also some other scenes like Asia and, you know, Chinese market, obviously, we can talk about it as well. Again, great perspectives. Tell me a little bit about your goals. As you move forward, you kind of indicated that at some point, you may want to take some of your own innovations to market but as you think through let’s just look at the next 12 to 24 months. So a near term lens. What are your objectives when you balance your advisory work, maybe in the startup space, working with industry, and then maybe starting to pursue some of your own ideas? How do you think about all of that as well as a surgery.

David Yakobi, MD  13:38

So as I said before, I have maybe 15, or 20, unmet clinical needs that I bring from, from my time in the hospital. For some of them, I have a solution or a partial solution. And I’m definitely looking for some business personnel for some technology guys, that would partner with me looking for these guys, obviously, I can find them in a couple of hours. That’s not a problem. We know LinkedIn is always there. But you want to find individuals that you already work with, or you worked for guys that you trust them that you know, their mindset, that they know how to take something from point A to point B, you don’t want to waste your great idea, something that you thought about with someone that you don’t even know. And it’s not only about you know, that he will, you know, steal my idea or something like that. You just don’t want him or her to jeopardize your idea to take it to the wrong direction. On the other hand, sometimes I had three or four ideas that sucked. I had it in my mind for 10 or 15 years, but someone else also thought about it. And they actually opened the company and they know they have an IP. So again, it’s a double edged sword. And you always have to be really realistic about So one of the best ways, and this is a very important thing is to always to keep to maintain and to develop your network. And your network is not only about you know, I know someone in in Denver, Colorado, no, it’s people that you are in intimate relationship with people that you drink coffee with people that you, you know, eat with them, you know, you have lunch with them, people that you trust, okay, that you are comfortable enough to talk about your ideas, and you are sure that no one is going to steal it from you. This is very important, because at the end of the day, we are all humans, we cannot behave like robots. And sometimes you share your idea with someone this someone can tell you, you know what, I know a company that did the same, but they failed. And sometimes this guy knows why this company failed. Because the management was bad because the IP was because they fail to perform the clinical trials. And they, they took it for a third world country and you know, the clinical trials failed. So it’s networking is really, really important. And you have to create some sort of family around you. People that behave as your consultants, and obviously you you are there for salt.

Tobin Arthur  16:20

Very well put, our CTO has a phrase that I think aligns very well with what you just said. He says, Your network is your net worth. And he talks about how there’s nothing more valuable than those connections that you’re building. Talk a little bit about how you build them. You talked, you mentioned LinkedIn, which is obviously a great resource. And Angel MD, you know, in many ways, this community is one all about creating connections. That’s why we created it, what have you done over time to continue to foster and build your own network?

David Yakobi, MD  16:56

When I just started this exploration, I was I was talking about I met a physician, and this physician left the hospital 20 years ago. And now is a is a very successful, successful executive is the president of one of the largest startup companies here in Israel. And he told me, David, you know, what, you have to meet some people. And I told him, Okay, please give me a list, or just make some introductions. He said, No, you go to LinkedIn. And you just write people, you know, you write, you introduce yourself, most of them are not going to answer most of them will just, you know, ignore you, the ones that will actually respond, they are the guys you want to work with. Okay. And you know, what? Yesterday, I had an intro meeting an actual intermediate. And this intro meeting, was an introduction of some other intro meeting. And I could trace it back, one and a half years back. So it was like a seventh or eighth generation of an intro meeting, that one led to the other. Just imagine you talk about this individuals, you share experience, you share your thoughts, this is a really, really valuable, because I think that when someone introduces you to someone else, it’s got a huge value.

Tobin Arthur  18:24

I love that. That’s great advice.

David Yakobi, MD  18:27

And also, you know, someone drops you a message in just the message said, David, do you know someone in Israel? You know, you don’t have to be always a finder or something like that, you know, to ask for 5% or something? No, you just do the introduction, you know, it comes back to you like later on.

Tobin Arthur  18:44

That’s right. This is very important. We talk a lot internally with the management team at AngelMD, that I would venture to guess 95% of what we do, we don’t have any economics tied to those things. We just do it to sow seeds, believing that over time you reap what you sow. And sometimes they come back to benefit us. Sometimes it’s just a benefit to community. But in the end, we want to see people be successful regardless of whether we have anything you know, connected to that economically. Talk a little bit about if you would startups that you advise, you mentioned some of the things which I think were spot on, in terms of the value add just a little bit procedurally, and I’m thinking about physicians that don’t have a lot of experience working with startups. How do you go about this? Do you wait for them to say Dr. Jacoby, here’s something we’re working on or do you set up regular discussion so that you’ve got some structure or is each one different? How do you approach it?

David Yakobi, MD  19:44

Every and each company is totally different. The CEO is different. The company is different because sometimes you both companies are early stage, but one company you have a CEO with 20 years to fix period in the industry hands on experience, the other company has got the CEO, which is relatively young. So you cannot say the same thing about both companies. You also have to understand what is the DNA of the company. And I’m going back to the to the thing I just said before, what can I bring to the company, sometimes one of the founders of the company is a physician. So you cannot be the Chief Medical Officer of this company, or the VP medical or the VP clinical. So you have to incorporate yourself into a position like being some kind of eligibility committee or a monitor or something, something like that. On the other hand, some companies want you to escort their r&d processes, which is really important because sometimes the founder is a biomedical engineer, the team is a great team, there is a business there is a very, very good business plan. But the appreciation of the tissues and how their device Okay, let’s talk about an intravascular device, class three intravascular device, once you’ve put you this device, how do the radial forces of the device influence the native tissue? What, how do I anticipate the longevity of this device? What do I think about issues of anticoagulation? What do I think about issues of, of the potential of this device to cause arrhythmias? How, how destructive Do I think that the device is? How would other physicians accept this device? And obviously, these questions can be answered only by someone that was in the operating room was in the cath labs attended these heart team meetings, this is very important. And sometimes, you know, the feedback can be just you know, within 30 minutes, you don’t have to sit with them for for, you know, two years in order to express your thoughts and, you know, to to be meaningful for the company. Mm hmm.

Tobin Arthur  22:20

Speaking of that, what about your colleagues, how have they embraced this shift this transition in your role? Do you find, oh, you know, as an adjunct to that question, that physicians in Israel tend to be more entrepreneurial, or less than you observe, say, in the US, or in Israel, or in Europe? Or all pretty similar? In other words, are they mostly sitting there thinking about how to make things better, faster, cheaper? Or are they just going about their business?

David Yakobi, MD  22:51

Yeah, you know, I don’t want to discourage the young generation from actually going and studying medicine. But I think that this profession is, is really problematic one, because I think that the the motivation that drives us to assist the community to help some poor individuals, people that are suffering people that suffer from cardiovascular disease, cancer, and so on. This drive, I think that is sometimes is abused by the general community or the general population. And this same drive that we have, it embraces us, or it hugs us in a way that we are really scared to leave our positions, because we haven’t. I call it a nice salary. Obviously, you know, physicians usually are not reached this in Israel. But we have a nice salary, we have our prestige in the hospital. And this way, somehow, you are led from being a 18 year old, you know, enthusiastic guy that wants to study medicine, and you do your best. And you find yourself at the age of 67 or 70, being you know, almost, you know, pre retirement, and you realize that you spend your time in the hospital and you don’t have any other experiences and you’re hearing stories, stories about you know, Michael DeBakey and Dr Cooley and about these big surgeons and so on. But what I what did I do in order to bring my ideas? Why did this surgeon had these ideas and was skilled enough or motivated enough in order to implement them and he was actually a pioneer? And why did I only you know, open the chance to the Patient and cardiopulmonary bypass deed, you know, this bypass surgery or or our tube replacement or replacement, I closed the Chino revived the heart, close the chest and they went home. So why was that? You know, dogmatic? The answer is that in our world, people are really skeptical when you think about something, usually if you sit with your friends, they usually tell you, Oh, someone probably thought about it before, know that this should not be the approach. And even if you’re convinced that someone actually thought about it before, you have to check, what did this someone do with this is idea. Second, and if you was not successful, and most of them are not successful, why you was not successful. The third, maybe you can do the same, but you can do it in the in the on the better, better way. So this is really important to study from mistakes of others. And I think that in Israel physicians, they really want to be innovative. But I think that most of them, they don’t have enough courage to leave the hospital to leave their practices and actually do only innovation. But I want to tell you, the physicians that actually did it, that left the hospital, and they are dealt only with innovation. They were really successful.

Tobin Arthur  26:36

There’s a saying that reflects what you were referring to. And they say that physicians have golden handcuffs. And the golden handcuffs are like you said, it’s a prestigious role. It pays pretty well. And so it’s very tough to leave that particularly after having committed so many years to training. Exactly. But you’re right, there are so many opportunities out there. And partly what we’re working to do inside the angel and D community is exposed all of those entrepreneurial activities, because everybody’s going to be different, they’re going to have different things that interest them. And our chief medical officers a good example, he is blended his time, half of it he spends with industry consulting, larger organizations. And then the other half was startups. And that’s a really interesting blend, because on the one hand industry, they have budgets, they have cash, they can afford to pay physicians for their advice and their expertise. On the other hand, startups have a lot of promise, it’s exciting, there’s energy, and they have equity. And if those companies go well, and in many cases, that’s because the physicians helped them, then there’s a lot of financial benefit to that as well. I’m very excited about having you involved and getting to know you more. So many of the things you’re talking about, are really clearly aligned with what we’re working on. You may know we’re launching an educational program called Angel MD Academy. And it’s exactly what you were talking about earlier, so many physicians want to participate in this, but they’re not even sure where to start. Even some of the language that you used, as you mentioned, raising capital series, a seed, round, etc. Even just these, these things, intimidate people because it’s not the language they speak. But it’s not hard to learn. It just we need a resource and a place to come create that common language and then point people in the right direction. Maybe as we close up, are there any things that you would like to share? Maybe from the perspective, one thought for fellow clinicians, and you’ve shared a bunch already, but maybe something that we’ve missed, and then maybe one thought for startups, and how they can better leverage physicians that are working with them to get the most out of that relationship?

David Yakobi, MD  28:59

I think that most of the physicians that actually work in the hospitals in the in the public sector, they have their own private practice, I think that they have to get involved in one or two companies, at least from the beginning. Sometimes when you look retro, in retrospect, you will be disappointed from yourself, okay, why? Why did I do it? For them? It was a waste of time. But those are the most valuable lessons. Those are the lessons who know who to deal with, who you are not dealing with. You know, now I have enough experience when I just talked, you know, two minutes with someone I already know if this guy is serious, or what does he do? I can ask the proper questions in order to direct myself from point A to point B and to actually to understand the DNA of this individual. What does he do? Sometimes they have bombastic ideas, and this is The US, you know, it’s a huge market, it’s a $50 billion market annually, and we’re going to sell and this and that. And then you ask a question. It’s like, you know, pain in the balloon, you know, it just, you know, then they don’t have the answer. And you know, the purpose is not, you know, to be bad or strict or harsh with them. The idea is to just see if this individual is prepared to answer your questions. So that’s for the physician. So always get involved in something this something can be digital health, it can be a medical device that he’s got is an intimate relationship with your profession. So if it’s, if you’re a nephrologist, so you don’t just go to a medical device that monitors urinary output, or there are some great technologies now of, of stem cell implantation, for some kidney diseases, and so on. On the other hands for startups, I do realize that most of the startups, they are running on a very, very low amount of fuel. And I do realize that these startups cannot afford themselves to keep a physician as a full timer. But it’s really important to ever physician at least 5, 10, 20 hours a month, in order to always to escort these r&d processes. This is very important because early stage startups in contrast to companies like a doors or a boat, or Boston Scientific or Medtronic, they have only one time chance, you have a one time chance to perform preclinical studies and larger animal studies, you and you may also have one chance to perform actually first in human or early feasibility studies. If you fail, the company is closed. So that’s very important to allocate the correct funds to correct resources towards having a physician that actually sits with you and can say, okay, stop, guys. Okay, let’s wait for one month, let’s refine our activities. And let’s do it in a better manner. This is very important.

Tobin Arthur  32:15

It’s a great piece of advice on your former point, to physicians. I had a conversation years ago with a very smart investor. And he shared with me that when he talks to a startup, and he’s asking them questions, he doesn’t expect to find out anything, or ask them something that they don’t already know. He said, what I’m really looking for is to, to see how they think and how they articulate the answers. And to see if they’re self aware enough to know what they don’t know. He said, Because I don’t expect them to know everything. If they did, the problem would have already been solved. What I expect them to know, is here’s the set of experiments that we need to run in order to get to the right answers. And I thought that was a very interesting approach to, to how you, you know, you deal with startups. Well, Dr. Yakobi, this has been a real pleasure, a fun start to our conversation. I look forward to many more, you have got great insights. I think it’s so important that things that you’ve articulated both for physicians and for startups, for how physicians can really be a big asset to these companies if properly integrated into the process. So again, thank you, and thank you for the time difference. It also makes it a little challenging here. You’re doing this late in the evening your time, so I appreciate that.

David Yakobi, MD  33:32

Thanks for having me.