Episode 107

The Life Cycle of Innovation

with Josh Makower, M.D.

April 6, 2023

Share Episode
Share on email
Share on twitter
Share on linkedin
Share on facebook




Josh Makower, M.D.
Professor of Medicine & of Bioengineering, Stanford University

Josh Makower, M.D., is the Boston Scientific Applied Bioengineering Professor of Medicine and of Bioengineering at the Stanford University Schools of Medicine and Engineering, and is the Director and Co-Founder of the Stanford Byers Center for Biodesign, and Founder of Stanford’s Biodesign Policy Program.


Our mission is to train the next generation of innovators.



Nathan Bays: Welcome everyone to the Gary Bisbee Show. Nathan Bayes here, obviously not Gary, but but pleased today to be interviewing Josh Makower. Josh is a professor of medicine in bioengineering at Stanford. He’s also a director of the Biodesign Center at Stanford, which is just a fascinating organization and one that we will dive into today on the Gary Bisbee Show. So Josh, thanks so much for joining us today and and very much happy to have you here.

Dr. Josh Makower: Absolutely. It’s it’s. Pleasure to be here and, my my NCE is to Gary’s family and and to everyone who knew him well.

Nathan Bays: No. Thanks so much, Josh. It was a very impactful, meaningful life that Gary touched so many of us. So we’re happy to be doing this interview and carrying on what you built here at Think Media. Josh, look, let’s jump right into your background. You’ve had a, an illustrious career, which we’ll hope to cover in part we can’t cover it all in the time allotment, but we’ll cover some of it. But tell us a little bit about, how it all started.

Dr. Josh Makower: Sure. I grew up on the East coast. I was a creative kid. I liked music and photography and building things. I had a real fascination with the intricacies of the human body. And I was really inspired by a television program back in the day called the Bionic Man. And that the idea of creating a superhero with technology making people, curing people, making them be able to walk or see or be strong or stuff like that was really a, an inspiration for me as a kid. And I. Sort of sketched in a notebook at the age of I don’t know, five or seven, like my first invention notebook back then. So it was a calling. I think,

Nathan Bays: So when did you decide that medicine was a, a career path? When did medical school come into the picture?

Dr. Josh Makower: As I was finishing engineering school at m I t I wanted to experience. I wanted to understand the human body. I wanted to understand disease. I could have pursued a path at the PhD path, but I think the idea of learning how to be a physician and understanding it from the physician’s perspective and getting a holistic understanding of the entire body system was. It’s drew me to medicine. And at that time I thought that I, maybe I could be a practicing physician and an inventor and do both. And so I entered medical school, a classic in medical school, nyu to really of learn it the way, learn it, the way doctors learn it. And that was my intent. I wanted to, go through the full training just to understand. You know the treatment of patients from the ISO doctor.

Nathan Bays: That makes sense. And what about business school? So you were engineering medical school and you went to business school. So you got the tri trifecta from a degree perspective. How, when did interest kind of business come

Dr. Josh Makower: Yeah, that came later. After I graduated from medical school, I went into the business world. was brought in, I was hired at Pfizer and as a technology analyst in the business development department, working on a variety of things. This group was also responsible for overseeing all the r and d projects for all of Pfizer, which had a. 2 billion medical vice business at the time. So I was in the medical technology side that Pfizer used to have. And a few years into that I realized that I was being viewed as the technical person, the medical person, and all the business stuff was happening in another room. And I really wanted to be in the room where it was happening and didn’t seem like I had the the understanding of the language or what was. How people were framing why they were making certain decisions. It was all accounting and and finance and I felt like I really needed to understand that. So I lobbied to have Pfizer pay for my for my business education. And I went to the executive program, gonna Columbia. And that was a great experience and. I’m so glad I did it and really gave me that perspective that I needed to operate on at a business level.

Nathan Bays: So Pfizer was your first job after medical school. How long were you in that job and when did your kind of the more entrepreneurial interests start to emerge?

Dr. Josh Makower: I was there for about six years and during that time, I had an opportunity and experience that really shaped my entire career. To this day, honestly. Which was that Hank McKinnell, who was the C F O at the time, he later became the president of Pfizer, but he’s the guy that picked my resume out of a stack, asked me to do a special project, and the project was focused on trying to understand why these little businesses in the med tech world that they would buy or be so in. And before they would be bought and then after they would bought, everything was really incremental and what were the reasons why, and and that was a like a side project, not part of my everyday job, but it was the thing that really shaped everything I did next. Because what I saw there was that as an in. Innovator. These founders were going after solving a problem without a particular technology in mind, and they would find the best technology to solve it, and they’d really just create a whole field a whole new product category by doing that. Yet, once they were an established company and they were, let’s say a balloon and they were purchased by Pfizer. They were just looking for new ways of improving the balloon or using the balloon. They really weren’t thinking about, how do we get the next big advance for our customer that could be a technology that we don’t even have today. And so I came back and showed that to ’em. And said, I think, the key difference here is we just need a different process. One that starts on needs and, but starts with a strategy of where you want to be, but starts with those customers and is agnostic to technology and solves a problem with the best technology and said, okay, that sounds. Logical, but why don’t you prove it? And so he gave me the resources to set up a little incubator inside of Pfizer. And over those years that I worked on that incubator we developed, we broke the process down because the whole idea was that we needed to teach it to the rest of the r and d organization. So I segmented it out into steps and, we took a lot of learnings from others that were working on innovation processes. Adapted them and created a, an innovation process that was pretty novel. And that was the origins of the biodesign process, honestly, that, that is the process that I’ve used as a, in inventor myself, as well as what we’ve taught to, thousands of people at this point.

Nathan Bays: What are some of the things you can do in addition to what you just shared, but thinking about it from the governance leader, leadership perspective, which was a focus of, of Gary’s show here, how should management teams and boards be thinking about that?

Dr. Josh Makower: That really is something that I, obviously some people are, have it innately. I don’t think I do. I’ve had to learn it. And and it’s super important and if you want to have an innovative organization, You really need to have one that’s really accepting of wild ideas. Give them a little bit of space in the room and in the air to, to be considered consider the disruptive ideas, the frustrating ideas that, you don’t necessarily wanna listen to, but you really should. And create an atmosphere that allows for that disrupt. At the same time, once you’ve committed to something, setting a very high bar for tweaks and add-ons, cuz you could be in r and d forever, so you have to be able to switch moats. We go from this mode of anything’s possible. How do we solve this problem? Let’s throwing against the wall, yet we’re matching them to this criteria set. And when we find one that matche. And we think, wow, this could actually be a reasonable solution. The next thing we do is after we fully formed it then maral. A goal is why should this survive? How do we kill this as soon as possible? What’s the killer thing that’s gonna tell us this is the wrong way to go? And we try to do that as soon as possible. We’re shifting between those types of modes and similar. In the mode of let’s go solve something. Let’s come up with a destructive idea. Once we lock in and we can’t kill it, then it’s we’re on this thing. Stay the course.

Nathan Bays: In, in studying a little bit about your background completely amazing. 300, plus, patents. Just talk a little bit about, that, the, the inventor, right? And how that’s meshed throughout your career with, the different,

Dr. Josh Makower: Yeah.

Nathan Bays: Pfizer, the first shot, the incubator, what you’ve done. How do how do you think about the invention piece and where do you get your ideas from?

Dr. Josh Makower: Honestly, I get my ideas by following the process. People are like, Hey, you got another idea for your next thing? I’m like, no, I have no idea what’s next. I’m I’m very disciplined. If you look at my patents, I would say 98% of them are attached to projects that we actually did, that we actually attempted to, or actually did bring to market. That means we’ve given a lot of stuff away. If I have an idea and I’m not gonna pursue it, I’m not gonna patent, even if it could be successful in someone else’s hands, I figure. That might prevent someone from actually doing it. So I don’t want to stop innovation, I don’t wanna block others. I just want to do something good. So I’m gonna focus my efforts on the things I’m actually gonna do and try to protect those, like all get out. But but I’m not going to prevent other invent.

Nathan Bays: I that, that makes a lot of sense. I, you this is obviously a healthcare show and our conversation will be focused on healthcare, but feels like a good time to ask you about is it cor it is that how you,

Dr. Josh Makower: How are, yeah,

Nathan Bays: Which is a company slash invention that you had, which is. It’s not healthcare related. Although I’m sure there we go. I’m sure many guests on the the Gary, or many guests and listeners on the Gary Bibe show are are wine connoisseurs and wine drinkers. So would love to hear a little bit more about about that invention in that company.

Dr. Josh Makower: Yeah, sure. So this one I’m co-founder of my, so at Pfizer I brought in hired a great guy named Greg Lambrecht, who’s an incredibly creative guy. And Using the biodesign process, Greg identified the need of, needing to ha, if you want a glass out of a bottle, there’s really no way to do it without destroying all the wine in the bottle. The the, using that neat spec, neat statement, as we would call it, in a formal process of biodesign. Created, what are the criteria? You have to be able to take out as much as you want, and it has to not in any way impact the wine in the bottle and realize that the only way to do that is to never open the bottle, but to exchange the wine out. Of the bottle at the same time as passing in an inert gas. And so what it does is it any experimented with a number of different gases and wound up with argon which is used in, food packaging. It’s completely inert. And uh, what’s cool is you could take a glass out of this bottle, and the glass, the wine in the glass of course will be exposed to air and it’ll start to go through its maturation process, which is part of the good thing about it. But the wine in the bottle is completely inert and you literally can leave it for years and have one glass out of a bottle every, for five years or more. It’s a half a glass, 10 years, and the wine continues to evolve normally, and it’s amazing. It’s just an amazing technology and. It’s really a na, it’s a global brand now. And I’m still on the board and it’s been fun.

Nathan Bays: Let’s talk a little bit about the biodesign process and, the, the buyer center for Biodesign at Stanford, where you’re the director. So you were an initial kind of founder of the center 20 plus years ago, and then recently, come back to, to lead the center as director, maybe share with the audience, what is the buyer center for Biodesign. What kind of work do you do and dive into the biodesign process.

Dr. Josh Makower: Yeah. Look, our mission is to train the next generation of innovators. What we’ve done is like I said, we’re ta. We’ve broken out the steps of in, of innovation so that it’s not as daunting and it can be approached by anyone. And we believe that it can, innovation is something you can teach people, you can learn it you can get good at it, you can practice it and you can really build a career around it. And more formally, I. We actually now, I now see the potential of the biodesign process being an incredibly useful tool for economies that are looking for how do they grow and also for addressing global health equity. But the biodesign, the biodesign center. Is really focused on that. We want to train people. We train undergraduates, graduates, fellows. We actually train faculty here on this so that they can Find the right places to apply their research ideas and clinical faculty, the right way to solve the problems that their patients are having. We train global faculty. We have and several here right now from across the world faculty, from other institutions who are training on how to teach it. And so they will go back to their organizations and at this moment there are 80. Plus programs across the world, literally in almost every, on every continent. Using biodesign, teaching students biodesign and using her textbook. And and our students. Themselves while they’re training, have invented and created over 56 companies which have touched the lives of almost 8 million people so far with their products. And that’s just while they’re training, there’s double that amount of companies that they created after the program. I’m very thankful. I have the support of several organizations like Edwards and others to, to set. To set this up, but the goal is really to identify all the roadblocks to innovation and inform policy makers through research that brings those issues to light, but also train the next generation of policy makers as well, that will focus on innovation.

Nathan Bays: When we’re talking about, innovations that could potentially extend life, improve life, that’s a long time. To go from a creation, and discovery to the actual, widespread implementation. Any type of improvement, that around speed while protecting from a safety perspective, of course, is critical. What are just a couple of lessons learned from, everything that’s, crossed you, that crossed your desk as as a leader, as a board member, any words advice to, fellow board members or aspiring entrepreneurs, how they should think about, building businesses and then also, the governance structure around early stage and growth stage companies.

Dr. Josh Makower: Lots of lessers learned. I’m still learning them. I keep on thinking, when am I gonna get this down. Why am I still learning now? But but yeah, some things that are essential themes are people are everything. People are a company. The idea is important, but it’s not the most important thing. Having good people, good culture that’s everything. If you got that you got some good people with you you can accomplish almost anything. Next one is perseverance. There are a million ways to fail and failure is. Always just, licking at your heels. It’s just always there. And and sometimes, early on failure’s good. If you can, before you’ve brought all the investors on board and before you’ve made all sorts of commitments, if you can kill something early, that’s great, then you save yourself so much hassle. But once you’re on the journey it’s. Landing the plane. You can’t pilots can’t go, ah, we’re bailing out. Hey, see you all passengers we’ll see you maybe good luck flying, landing the plane. I think you have to land the plane. And and I think that takes tremendous perseverance. Whether it’s financing challenges or building the right team. Overcoming regulatory, reinforc. There’s just technical even clinical challenges. It’s just so hard. But you have to see your way through and I think the guiding light through all that is focusing on what’s best for the patient.

Nathan Bays: Let me. Question may, maybe not a fair one but I’ll ask it anyway. Which is, of everything that’s going on in, let’s call it, I would call it kind of medical innovation, broccoli. You’ve got old gene therapies and the advancement that’s going on there, just tremendous. You’ve got a lot of really, interesting, know, kind of step function advancements around cardiac, and what’s going on in the cardiology heart. What are you most excited about if you just step back and look at the entire eing.

Dr. Josh Makower: Yeah, I I love breaking new ground and I love people when my, our fellows and students break new ground. That, that is the biggest. Most exciting moments of my life, to do something that’s never been done before. See something that no one’s ever seen before. At this stage in the evolution of humans and technology to be on the edge and do something, oh my God, this actually works. And no one believed it or no one saw it, or, and to be, in the room where that happens. It’s just, that I. That’s why I’m still creating companies and working on new technologies myself as well as, teaching others to do it. But it’s the best.

Nathan Bays: You’ve certainly been on the edge for your entire career and you’ve created a lot of the future. Josh, thank you for for joining us on the Gary Bisby Show.

Dr. Josh Makower: I appreciate it. Thanks for the invitation.

Subscribe for Updates​

For exclusive access to Think Medium content and program updates, subscribe here.