MD Next | Q3 2022 by AngelMD

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PRE MIE RE ISS U E

THE MAGAZINE OF HEALTHC AR E INNOVAT I ON

Startup profiles to inspire Project C.U.R.E.—serving Ukraine and the world Cricket is making a splash in America Professional sports physician Dr. Douglas Freedberg

Simulation

Prescriptive Analytics

Pro-ficiency provides custom, online, protocol-specific, simulation training to help boost site performance, optimize enrollment, and improve protocol compliance and execution.

Every decision taken within Pro-ficiency's simulations is tracked, collected, and illustrated in our easy-to-interpret behavioral performance reports.

What is Simulation-Based Training?

Through these performance reports, study teams are informed of site performance BEFORE mistakes turn into deviations.

Simulation-based training is a consequence-free, interactive form of training that presents learners with scenarios similar to those they will encounter in a clinical trial. These simulation modules train don't just train for completion, they train for comprehension.

These reports do more than just predict likely site performance, they give you clear guidance for action.

Pro-ficiency Investigator Support Whether you are involved in clinical trials or aspire to be, we can help. Pro-ficiency is currently updating our investigator support resources to reflect evolving professional needs and performance gaps. If you'd like to be notified when our platform is live, please provide your contact details here: https://pro-ficiency.com/investigator-support (we promise not to sell, share or otherwise misuse your information to any 3rd parties).

Interested in learning more? Feel free to reach us anytime at: https://pro-ficiency.com/contact-us

Pro-ficient Sites, Pro-ficient Study Teams, Pro-ficient Studies

Reimagining Rehab. Recalibrating Motion. Rebuilding Lives.

Alyve Medical Inc. is a commercial-stage medtech company focused on reimagining the management of musculoskeletal care. We have two FDA-cleared innovative and novel platforms that, used together or individually, aid clinicians in diagnosing, treating and preventing musculoskeletal injuries.

The next generation in performance and rehabilitation

Motion Activated Stimulation

Patient begins exercise motion

Motion Activated Stimulation technology senses and responds to patient movement

Neuralign senses patient movement

Progressively stimulates muscles

Tri-model biofeedback system elicits neuroplastic response to movement patterns

Body learns optimal muscle sequence and path

App-based instruction, tracking and personalization of therapeutic programs

Transforming the way human movements are evaluated and measured

Assess treatment progression over time

Correlate the results of treatment to expected outcomes

Identify alterations in motion

w w w. aly vemedical.com

Detect deviations from norms

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Contents

20 62 50

Vail’s Off-Season

Features

Yes, Vail is known for skiing. But there is so much more to do when the temperatures rise. By Tobin Arthur

Everybody has a plan until they get punched in the face. When the facts change so should your investment plans. By Michael Schmanske

Maintaining bodies and performance in professional sports. By Alex Raymond

Closing Time

Read the fine print of the purchase agreement before you buy a boat.

A sit-down with innovative wine industry leader Chris Pearmund on his latest endeavor—the first of its kind.

On the Right Tack By Jeffrey Dorfman, D.M.D.

Revolutionary Vintner By Julie Fanning

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Team Doc: Doug Freedberg, M.D.

Bowling Over the American Market The rise of cricket.

By Ramesh Donepudi, M.D., MRCP

MD Next

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From the Publisher By Tobin Arthur

From the Editor By Berry Brunk

35 / ALPHA CREATIVE

Optimizing Your Practice

Calendar of Events

76 / NEWS OF THE WEIRD The Last Laugh

Columns

TECHNOLOGY & INNOVATION

9 / STARTUP PROFILES

Healthcare Startups

Profiles of promising healthcare startups showing the greatest ability to make it to market and disrupt or improve the current standard of care.

17 / ALPHA PARTNERS

Pacific Northwest’s 2022 LSINW Conference Retrospective

The Pacific Northwest’s largest annual life science showcase, highlighting the region’s most exciting and promising companies and research institutions.

26 / IMPACT PARTNERS

How a Zombie Hospital in Pennsylvania Was Reborn as a Startup Accelerator

POLITICS & POLICY

40 / CAPITAL ALPHA PARTNERS

Physician Policy Issues

The range of legislative and regulatory issues impacting physicians’ practices are widely varying and constantly in flux. By Kim Monk, Rob Smith

AlphaLab Health gives entrepreneurs access to early customers, corporate partners, potential investors and knowledgeable staff and mentors.

MONEY & FINANCE

30 / TECHNOLOGY

Stick to Your Knitting

The Bleeding Edge

A selection of the newest and coolest technology solutions we’ve come across in the last three months.

47 / INVESTMENTS

It’s important to have a long time horizon when it comes to investing. Focus on your job, invest regularly, and everything will work itself out. By Jared Dillian

68 / GIVING BACK ABOUT THE COVER Community among forward-thinkers and innovators is essential to getting things done. The results can be incredible versus going it alone.

Project C.U.R.E.

The world’s largest supplier of medical relief has delivered life-saving medical equipment and supplies to hospitals and clinics in more than 135 countries. By Alex Raymond

Original image by Ante Hamersmit

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MD Next

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CHAIRMAN | PUBLISHER

Tobin Arthur

——— EVP OMNICHANNEL MEDIA | MANAGING EDITOR CHIEF CREATIVE OFFICER ASSOCIATE EDITOR | HEAD OF RESEARCH CHIEF MEDICAL OFFICER HEAD OF COMMUNITY EXECUTIVE MEDICAL DIRECTOR, WRITER

Berry Brunk Julie Fanning Michael Schmanske Mark Foimson, MD Katie Richardson, MD Ramesh Donepudi, M.D., MRCP

EXECUTIVE DIRECTOR, ANGELMD ACADEMY

Saya Nagori, MD

WRITER

Amir Baluch, MD

TECHNOLOGY ARCHITECT

AngelMD Omnichannel Media

Yuri Sernande

—

CONTRIBUTORS WRITER

Sam Kessel, MD

WRITER

Manish Bhandari, MD

PRODUCTION ASSOCIATE

Cam Douglas

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ADVISORS Nirv Amin, MD

Amir Baluch, MD Thomas Biggs, MD Asheesh Gupta, MD Aaron Kaplan, MD James Lee, MD

AngelMD Blog

Luke Oh, MD Nitin Patel, MD Ramin Rafie, MD Jaffar Raza, MD

AngelMD Newsletter

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——— ADVERTISING

AngelMD Subsidiaries

Berry Brunk 757.340.3625 berry@angelmd.co

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MD Next

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FROM THE PUBLISHER

Community

Tobin Arthur Tobin Arthur, a 25-year startup, investment, technology and operations expert, is Founder of AngelMD and Publisher of MD Next.

The AngelMD Community has grown considerably over the past few years and is synonymous with healthcare innovation. Through our website, blog, VitalSigns daily briefing, weekly newsletter, the Innovation4Alpha podcast, AngelMD Academy, Pitch Club events, Impact Summit Events and Investor Road Shows, we aim to provide information, resources and community for the tens of thousands of members comprised of investors, entrepreneurs and other stakeholders working on the future of healthcare. MD Next is the latest forum to join our omnichannel strategy for sharing the stories of those engaged in transforming, disrupting and innovating the healthcare ecosystem. We are incredibly excited to have a full-color magazine format to codify and deliver content that will both entertain, inform and inspire. As with everything tied to AngelMD, MD Next will be a by-product of the community. We invite you to contribute by bringing noteworthy people and cutting edge products and technologies to our attention. Submit photos from your latest conference, meeting or startup activity. Want to guest author a piece? Let us know. Thank you for your time and we look forward to bringing you a steady stream of high value content. Sincerely,

Tobin

STARTUPS:

Get your concept out of the incubator and in front of an expert network. Virtual events held every other Tuesday

When Shark Tank and Open Mic Night Had a Baby APPLY EARLY! angelmd.com/events/pitch-club-events

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MD Next

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FROM THE EDITOR

The Content Is You

Berry Brunk Berry Brunk is the EVP, Omnichannel Media and the Managing Editor of MD Next. He has an extensive background in publishing along with healthcare and technology ventures.

Welcome to the premiere issue of MD Next—the new magazine that is a central component of the AngelMD portfolio of omnichannel media properties. We have produced this publication to meet the professional and lifestyle interests of our entrepreneurs and physician members. For the next year, we’ll be publishing MD Next on a quarterly basis, with the intention to expand the frequency to six times per year in the future. In the debut issue you will find features on exciting and innovative startups that deserve your attention. We will also highlight the movers and shakers helping to evolve and ultimately transform the delivery of care in the world. Because work is only one element of a rich life, we will also explore trends in recreation, travel, sports, social issues, and the enjoyment of our leisure time. MD Next will have a talented team of photographers at most all major events throughout the year to chronicle our members’ speaking engagements or our portfolio companies’ presentations. We welcome and encourage your suggestions on events and happenings—where we can engage with the industry and report our findings back to our readers. Many of you are distinguished authors and frequently write or speak about topics of interest that are close to your heart—or where you have specific subject matter expertise. We believe MD Next will become your preferred forum to share these insights and opinions with your peers. This is an exciting time at AngelMD, so please join with us in celebrating our new quarterly magazine: MD Next. All the best,

Berry

Share your knowledge, experiences and thoughts with the MD Next readership. Submit your story ideas via the web form: mdnext.co/contact-us

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MD Next

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STARTUP PROFILES

Light Line Medical Catheter-Associated Infections (CAI) have a tremendous toll on healthcare, individuals and their families; it is one of the greatest causes of morbidity and sources of cost in medicine today. This is one of the reasons Vicki Farrar, Light Line Medical’s (LLM) CEO, joined the company. She has herself lost dear friends and colleagues to these infections. The team is committed to the financial success of the company but also to addressing this tragic healthcare crisis. Light Line began at the Center for Medical Innovation (University of Utah). In partnership with the Lassonde Entrepreneur Institute, the Center provides undergraduate students with a small stipend to solve an unmet medical need. The student co-founders recognized CAI as a huge global health problem that is becoming difficult to treat because of the increasing prevalence of microbes resistant to antibiotics (i.e., MRSA and ERSA). The current standard of care—sterile technique and antimicrobial catheters— is simply not effective. The student team developed the PhotoDisinfection™ System (“System”) using visible light (i.e., light the human eye can see, not harmful UV light) to disinfect the catheter preventing infection. The idea garnered immediate support and was awarded many prizes to support the development of this game changing idea (AMA, NASA, NSF, and others). Once the proof-of-concept studies (animal and in vitro) were completed and patents were filed, it was clear an experienced management team was needed to drive this technology to commercialization. To bring LLM’s lifesaving tech–

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Healthcare Startups MDNext is the magazine for healthcare innovation. But breakthroughs do not spring wholly-formed from a vacuum. Successful entrepreneurs are assisted by a robust innovation ecosystem and central to that ecosystem must be expertise. AngelMD’s clinical experts possess the ability to winnow those solutions most likely to overcome both development and adoption hurdles from the chaff of ideas that will never reach the finish line. The AngelMD expert network is proud to support a wide range of promising healthcare startups. We rely on our community of practicing clinicians to not only source promising ideas but to also select those companies with the greatest ability to make it to market and disrupt or improve the current standard of care. For more information on any of the companies featured here, contact us at MDNext@AngelMD.com. Some of these companies are actively seeking investment and/ or clinical advisory support from practicing specialists.

nology to market, Vicki tapped Bob Hitchcock, her co-founder at Catheter Connections, to be the CTO. This powerhouse team, who successfully exited via acquisition to Merit Medical Systems, Inc., understand distribution channels, regulatory needs, and IP needed to succeed. LLM also has the support of Alligator Holdings, lead investor, with over 40+ years’ experience in manufacturing and commercialization, an oftenunderappreciated determinant of medical device success. Sunlight is often said to be the

best disinfectant, mainly crediting its ultraviolet (UV) component. While UV light is well known to work as a natural disinfectant, it is also harmful to tissue and degrades catheter material (think sunburn). Interestingly, the visible light spectrum (i.e., light that the human eye can see, also present in sunlight), is also a natural disinfectant that kills the microbes that cause infections without harming tissue or catheter materials. Light Line’s patented System delivers visible light to a fiber optic inside an off-the-shelf catheter. The light uniformly irradiates the internal

MD Next

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STARTUP PROFILES

and external surfaces of the catheter, disinfecting it and thereby preventing microbial formation on all catheter surfaces, resulting in the safe and effective prevention of CAI. The System has successfully killed fungus, as well as drug-resistant grampositive and gram-negative bacteria (e.g., E. coli, S. epidermidis, S. aureus, S. pneumoniae, P. aeruginosa and C. albicans). It can be delivered either as a prophylactic measure (for uninfected catheters) or therapeutic treatment (for already-colonized catheters). The kill rate exceeds the 99.99% rate required by FDA for an antimicrobial claim. A laser is used to generate 405 nm visible light which is delivered down the length (uniform 360°) of an indwelling catheter through specially treated fiber optics. The light excites endogenous porphyrins in the microbe cells, creating activated reactive oxygen species (ROS) which damages the lipids, proteins and cell membrane of the microbe resulting in cell death. (Photos at right) The method of delivery of the visible light is unique and innovative; protected by 23 issued patents and 16 pending applications the technology provides some important competitive advantages: • The System delivers the visible light so that it promotes healthy cell growth and treating infections, not just preventing them. • It irradiates the both the internal and external surfaces of a (standard of care is to use aseptic technique only outside the catheter) Most recently, LLM’s engineering team recently experienced a breakthrough—eliminating the hardest to kill microbe, Candida albicans, in 35 minutes—this meets stringent performance targets of infection control with no added time to treatment. The next challenge is to finalize the design of their light engine, the component delivering visible light to the catheter. They hope to be commercially active soon after by maintaining and growing strategic deals and collaborations across the healthcare ecosystem.

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MD Next

UNHEALTHY

HEALTHY

Comparison of results from large animal trial. Bacterial films and photo (left) show massive infection and damage. Light Line’s device noticeably reduces the bacterial infection and resulting symptoms (right).

LightLine will leverage this success to deploy their technology across four major use cases (peritoneal dialysis, followed by urinary, respiratory, and vascular).

To learn more about the company and investment opportunities sponsored by AngelMD Capital, contact us at MDNext@angelmd.com.

Light Line Medical, Inc. CEO—Vicki Farrar is a serial entrepreneur who has built and led companies to successful exits. She has over 40 years of experience as an Intellectual Property attorney representing companies in the medical device and pharmaceutical fields, and more than 25 years of experience as a Senior Executive in startup companies. In 2008, Ms. Farrar founded Catheter Connections, Inc., an infection control company which changed the standard of care for infusion therapy and was successfully sold to Merit Medical in 2017. Catheter Connection’s products are now being sold in more than 30 countries and are part of a $100M annual revenue market. Prior to Catheter Connections, she served as VP Regulatory and Intellectual Property at Q Therapeutics, Inc.; and previously as acting CEO and VP of Legal, Intellectual Property and Regulatory Affairs at Cognetix, Inc., developing CNS products that required delivery through an intrathecal medical device. Currently, Ms. Farrar is the CEO of Light Line Medical, Inc. developing a visible light-based infection prevention system for catheter associated infections. Light Line has the potential to change the way the world prevents infections, with no antibiotic resistance issue which is the third leading cause of death worldwide.

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STARTUP PROFILES

Etta

Tear Solutions Dry Eye Disease (DED) is a leading reason for patients to visit an eye care professional. It occurs when the sufferer doesn’t produce high-quality tears, leading to corneal cell stress and/or death. Globally, about 2 billion people have signs and/or symptoms of DED yet only about 225 million are diagnosed. Currently approved DED drugs in the U.S. (all topical ophthalmics) are underpenetrated primarily because they attempt to reduce symptoms through mechanisms of immunosuppression. The products essentially immunocompromise the eye, reducing symptoms for a minority of patients but without addressing the underlying cause of the disease and potentially leave the eyes susceptible to other infections. Current treatments also may take months to generate relief and can burn and sting in over 20% of patients. A successful treatment must address the underlying disease by restoring tear film homeostasis and corneal health. TearSolutions’ lead product, LacripepTM, is a topical ophthalmic drop that has shown that it can deliver relief for a majority of patients with the speed of a steroid (within 2 weeks) but with the safety and comfort profile of an over-the-counter drop (less than 3% reporting any discomfort). Lacripep is derived from a human protein called Lacritin, discovered and developed by Dr. Gordon Laurie, TearSolutions’ founder. His aim was to discover the biological cause of DED rather than just another antiinflammatory agent. Through his work, and the support of an international group of collaborators, extensive articles on its efficacy and promise have been published in peer-reviewed publications. The therapeutic possesses

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Ninety-eight percent of skin cancer fatalities are preventable with an early screening, yet Dermatology triage in health systems remains a challenge as the time it takes to complete a total body skin exam exceeds the value of reimbursement for the exam. Etta’s solution provides a specialist-grade total body skin exam that a non-specialist member of the Dermatology team can use as an assistant to rapidly conduct a total body skin exam and provide the patient with longitudinal monitoring ability. Etta is an AI-based Dermatology decision support tool that instantly identifies, screens, and scores the whole body for cancerous lesions and rashes. Developed by a team of engineers and Dermatologists, Etta’s total body skin exam uses just a tablet and AI to analyze the body in real-time and search for the ugly duckling—the lesion that looks different from other lesions on the whole body and in the context of the body surface area. Etta also has a remote patient monitoring component that allows a patient to map and monitor lesions and rashes on their body, track changes, and alert their dermatologist when a suspicious growth occurs. Etta’s technology is driven by data, computer vision, and built with a Dermatologists’ skin exam methodology, as well as clinical workflow in mind. With grant-funded trials set to kick off later this year, Etta is on the path to clinical validation and quick growth. In addition to this, Etta is expanding into other specialties, with urology at the forefront. Etta is developing a tool to identify non-muscle invasive bladder cancer (NMIBC)—and more specifically, carcinoma in situ (CIS)—as it can be challenging to identify during cystoscopies. Half of the patients treated with existing methods have a recurrence of the disease. Etta aims to solve this by helping urologists identify issues at the start, as well as assisting during routine maintenance.

a novel mechanism of action, targeting the major components of the lacrimal functional unit optimizing the function of each of the three layers of the tear film. Lacritin also promotes the protection of corneal cells from

inflammatory damage while helping to repair and regrow corneal epithelium AND corneal sensory neurons. The neurons are critical for communication amongst the multiple components of the lacrimal functional unit. In short, if the lacrimal functional unit is an orchestra, Lacripep is the conductor. Lacritin was discovered using an unbiased biochemical screen of the tear proteome to identify what was missing in DED tears compared to healthy, normal tears. Lacritin, was found to be deficient in all forms of DED. Lacripep is a short 19 amino acid peptide designed to preserve Lacritin’s bioactivity,

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STARTUP PROFILES

capture the active binding domain and all of its signaling activity. TearSolutions chose to first address patients exhibiting DED associated with Primary Sjögrens Syndrome. These sufferers exhibit the lowest levels of naturally occuring Lacritin, and provided an optimal cohort for first in-human clinical trials. Notably, patients with Primary Sjögren’s also experience a severe form of DED and are often excluded from DED trials because of treatment difficulties. The first-in-human trial [a dose ranging Phase IIa trial of 204 Primary Sjögren’s patients] demonstrated clinically and statistically significant improvement in as quickly as two weeks for both sign and symptom of dry eye (both required for FDA approval). During trials in moderate/severe patients, Lacripep efficacy on sign (Inferior Corneal Staining) was 3x better than Xiidra; a product which was recently sold to Novartis for $5.3B. Company management is highly bullish on Lacripep’s disruptive potential. TearSolutions has opened a managed SPV using AngelMD Capital’s new syndicate platform. If you would like to learn more contact us at MDNext@AngelMD.com. TearSolutions, Inc. President— Anil Asrani joined TearSolutions as President and CEO in 2020 after spending more than nine years with Medtronic PLC, a medical device company where he held positions of increasing responsibility in marketing, investor relations, business development and strategy. Prior to joining Medtronic, Mr. Asrani led sales and marketing for Devicix, a medical device design firm that was acquired by Nortech, and spent more than a decade performing academic medical research. Early in his career, Mr. Asrani worked in the UVA laboratory of Dr. Gordon Laurie, TearSolutions co-founder and current Chief Scientific Officer, and was an early investor in TearSolutions.

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MD Next

ParaNano

ParaNano Wound Care (PWC) solves a global problem in treatment of infection in chronic wounds: detection, notification, and early intervention.

Chelsea Larson / CEO and Co-founder Q. When did you start ParaNano? A. A former professor encouraged me to enter a business plan competition in 2015. The University of Central Oklahoma has a large IP portfolio; and we worked with the tech transfer office on licensing a nanofiber technology. We ended up doing quite well in the competition and that was the genesis for forming the company. Q. Where is the company based? A. Oklahoma City Q. Tell us a little more about nano fibers. A. We use electro spinning, which takes a polymer and uses electricity to create a solid strand. And then our proprietary element is in how the electricity interacts with that to create alignment. You can read about our patent on our website. Q. Tell us about the NSF i-Core program. A. One of our investors challenged us that he would invest if we went through the i-Core program. It forced us to really sit down and think about how customers would interact with our intended product and to conduct extensive research with potential customers. We were able to talk to nurses, doctors and surgeons across the gamut of the wound care space. We explored applications in surgical site infections, burn wounds, diabetic foot ulcers, outpatient, inpatient,

Lazurite For Lazurite’s inaugural device, the necessity of safety served as the mother of invention. While observing a surgery in 2015, CEO and Co-founder Eugene Malinskiy watched helplessly as a physician’s assistant tripped and fell over cables connected to the surgical tower. “The patient was already

under anesthesia,” Eugene recalled. “It should have been a ‘never event.’ The PA was injured, and the staff canceled the surgery. Unfortunately, these things happen all too often.” The accident drew Eugene’s attention to two cables in particular: the light and power cables that connected at one end to the surgical tower, snaked across the patient into the sterile field, and connected at the other end to the surgical camera. “I thought, ‘That’s just downright crazy,’” Eugene recalled. “Everything

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www.parananolabs.com you name it. And that was essential for not only being able to gather critical data, but also to validate our business model. It helped us understand that we are definitely going in the right direction targeting the outpatient sector of wound care. Because of Covis, we weren’t able to do our normal work face to face. This became an advantage because we were able to get to a lot more people efficiently using video conferencing when this was normally frowned upon. Q. Specifically what are you targeting with the product? A. We address chronic wounds or non healing wounds. These are wounds that patients have for weeks or years. And then people can also develop chronic chronic wounds, which means they will have recurring chronic wounds. 8.2 million Medicare beneficiaries, just Medicare beneficiaries, suffer from a chronic wound. And it’s estimated in current research published in 2020 by Dr. Chandan Sen that it’s a $96.8 billion burden on Medicare. The mortality rate for diabetic foot ulcers over the span of five years is 34.5%. So 34.5% of those with diabetic foot ulcers will die within five years! Q. What makes this problem so extreme? A. The number one complaint when we talk to providers is non-compliant patients. Our product helps address this. Our product is able to go directly on top of a wound. It is a biosensor, a nano fiber membrane biosensor. We are designing it to go directly on top of a wound, applied in clinic, by a clinician in an outpatient setting. And so the clinician will tell the patient and caregiver, ‘Hey, I need you to change these outer layer dressings three times a week or every day’…whatever the wound calls for. And during that time, the absorbent layers that can be used with our bio sensor will be changed. The bio sensor remains in place, and the patient will receive indication if there is infection from the sensor. Chelsea Larson is the co-founder/CEO of ParaNano. She has co-founded three companies, each with license agreements to technology from institutions including the University of Central Oklahoma, the University of Manitoba, and NASA.

else is wireless. Why not the surgical camera?” The ArthroFree™ System—the wireless surgical camera + receiver— was born from Eugene’s long-standing refusal to regard the status quo as good enough. The wireless camera will allow a surgeon and their staff to perform procedures with a true sense of freedom—from cable-related hazards, yes, and full freedom of movement during surgery. The days of arthroscopic and endoscopic procedures constrained by cumbersome cables tied to a bulky surgical tower will soon come to a close.

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Innovation takes time, diligence, and perseverance. Nearly seven years elapsed between Eugene’s a-ha moment and FDA market clearance for the ArthroFree System. With the market launch of the ArthroFree System, Lazurite is ready to demonstrate that wireless surgical visualization is good business for hospitals and ASCs, too. “The wireless ArthroFree camera sets a new standard for operating room efficiency, safety and

ease of use,” said Mark Schickendanz, MD, Mark Schickendantz, orthopedic sports medicine surgeon at the Cleveland Clinic and head team physician for the Cleveland Guardians Professional Baseball Club. “We are excited to be at the forefront of bringing wireless visualization in the operating room,” notes Eugene. “Given the technology platforms underlying our system, we may be at the forefront of a big pivot in the history of minimally invasive surgery. We certainly plan to play our part to drive innovation and impact with better people outcomes via new medtech devices.” The ArthroFree wireless surgical camera system allows surgeons to perform wireless arthroscopic/ endoscopic surgery freeing them from the cables of traditional wired camera systems. The novel Meridian light engine, wireless technology and light weight rechargeable battery are the innovative IP that makes the ArthroFree system possible. The beam from a cold laser directed at a volumetric phosphorus disk emits a bright cool light. An encrypted wireless technology communicates solely between the ArthroFree camera antenna and receiver with no interference to any other OR equipment. The lightweight rechargeable battery (like the Mars Rover battery technology) lasts 75 minutes and can be recharged over 500 times. The current traditional wired camera systems have evolved through the years but remain tethered to a tower system by light and

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STARTUP PROFILES

power cables. These light and power cables have the potential to create OR staff trips and falls, sterile field contamination, and OR fires and patient burns. The ArthroFree wireless camera system eliminates all these potential pitfalls and yet is compatible with nearly all industry-standard lens, couplers, monitors, and patient data/information boxes.

2015. While at DragonID Mr. Malinskiy not only incubated the idea behind Lazurite, but he also earned a number of accolades including being named to Forbes 30 under 30. Before his time with DragonID, Mr. Malinskiy began his entrepreneurship journey when he founded and ran Dragon Intelinet Development, an information technology company that was acquired by a leading company in the SMB computing segment, from 2000 to 2008. Mr. Malinskiy holds a Master of Science degree in biomedical engineering from Cleveland State University.

to a reduced quality of life for patients. Many of the newest and most beneficial cancer drugs are also very expensive, a single dose can cost more than $20,000 USD. Unfortunately, many patients are exposed to toxic therapy with no improvement in survival and experience adverse side effects that require hospitalization. While cancer diagnostic tests from companies like Foundation Medicine, Guardant and others enable physicians to target treatment for specific types of cancer tumors and mutations, there is limited precision regarding which cancer patients will actually benefit from a targeted therapy versus those who will not. Cancer therapy monitoring identifies those patients who are not responding to cancer drug therapy. The

current standard of care uses radiologic imaging techniques to measure a cancer patient’s tumor growth or shrinkage at regular intervals, usually every 8 to 12 weeks. If the imaging results indicate the patient’s tumor is growing, the physician and patient know that the drug therapy is not working. Current tumor imaging techniques often lack precision, can be expensive, timeconsuming and expose the patient to radiation. Imaging usually requires weeks or months, after the initiation of therapy, for tumor response to be visible. If a tumor is not responding to therapy, patients wait those weeks or months on an ineffective therapeutic regime to switch to a new treatment that may provide better results. A quick assessment of therapeutic effectiveness would avoid continuing an ineffective therapy and enable the patient and physician to make earlier decisions about alternative treatment options Several diagnostics companies are working on real-time cancer therapy monitoring tests. Most work by measuring the cell-free DNA (cfDNA) fragments found circulating in the blood. The release of cfDNA into the bloodstream is driven by the primary tumor, tumor cells that circulate in peripheral blood, metastatic deposits and normal cell types. Tumor cells and cfDNA circulate in the bloodstream of all patients with cancer.

©ADOBE STOCK

Lazurite CEO—Eugene Malinskiy is one of three co-founders of Lazurite, launched in May 2015; the first product to market is

the ArthroFree wireless surgical camera system. To date, Mr. Malinskiy has brought Lazurite through three rounds of funding, raising more than $18 million. Previously, Mr. Malinskiy founded and served as CEO of DragonID, LLC, a healthcare innovation and engineering consultancy specializing in medical devices for the fields of cardiology and orthopaedics, from June 2012 to May

Cadex Genomics Most patients with metastatic cancer (a stage IV cancer diagnosis) ultimately die from their disease. For these late-stage cancer patients, the goal of treatment is to extend survival while maintaining or improving the quality of life for the patient. Physicians make difficult decisions balancing the perceived benefits of cancer drug therapy versus the toxicity and side effects impacting the quality of life for the patient. Cancer drugs are designed to attack, destroy, and shrink cancer cells and come with a spectrum of sideeffects which often are toxic and lead

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MD Next

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Cadex Genomics

Cadex Genomics is working to improve the lives of cancer patients. They develop novel, blood-based assays for patients with cancer.

Bill Haack / President, CEO and Co-founder Q. Tell us about your background. A. I’ve been in the life sciences industry, since the late 90s. I started off at Genentech. When I joined, we had no oncology products. And I was fortunate enough to be there when we launched our first several oncology products. My particular background is economics. I was involved with a lot of the commercial areas, their sales, sales force effectiveness strategy. Little did I know that I would actually eventually get really up to my eyeballs in molecular diagnostics, when I joined a bunch of folks from Genentech who went over to a company called Genomic Health and I’ve been in molecular diagnostics ever since. Q. What was the genesis for forming Cadex? A. I was at Onkosite at the time, and we were having trouble validating our assay. I was doing some side work pro bono, really helping some physicians at UCSF get Medicare coverage for their lung cancer test, which Onkosite eventually acquired. At the time they were still independent. And in the process of working through that I was introduced to a molecular chemist who had developed the tech around which Cadex was formed. And so we got to talking and we decided to form a company. Q. Tell us about what your technology does. A. The concept behind our technology is actually really simple and easy to understand. When tumor cells die, normal cancer cells— there is a continuous process of cell renewal— and when those cells die, the DNA that’s in every cell, virtually every cell has a full complement of DNA in them, and when they die, that DNA is shed into the blood. And that’s known as CF or Cell Free DNA. And with the various technologies like PCR, or next generation sequencing, we can detect that DNA in the blood. Those are often referred to as liquid biopsies. I’m not a particular fan of that term,

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www.cadexgenomics.com

but that’s what it is. I’d prefer to call this a bloodbased assay. So we’re really interrogating the patient’s blood to determine if their tumor is growing. Q. How would this get inserted into the treatment process? A. Imagine you’ve just been diagnosed with colon cancer; the physician says, based on your tumor, the prognosis is that you have about six months, but we can extend that to maybe 12 months, 18 months with treatment. And so the physician asks if you want to move forward with treatment. Most patients do. And then the physician tells you that the treatment is very toxic. It’ll likely make you sick, there’ll be side effects, potentially adverse events. So you visit the doctor’s office, you’re in the chemo chair, you get your chemo, you come back for your follow up visit with a physician. You ask, “Doctor, is it working?” And the physician says, “We have no idea if it’s working yet. It’s going to take another 12 weeks before we can tell you whether it’s working.” And so you go through 12 weeks of this, maybe a visit to the emergency room with an adverse event somewhere in there. You start receiving bills from your payer for co-pays, deductibles...and at the end of that 12 week period, the physician does another image, typically CT scans. The physician says, “Well, your treatment is not working. Your tumor has grown.” And so obviously, you’re very disappointed. The question is: What’s next? The physician says, “Well, we’re going to try another therapy.” And you go through that again. And that happens 1000s of times across the U.S. and around the world. And we think we have a solution to greatly reduce the anxiety and the amount of toxicity delivered to patients, both the toxicity from the treatment and of course, the financial toxicity. Q. How soon do you think you can get to market? A. We feel confident we’ll be in market sometime in 2023.

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STARTUP PROFILES The acronym ‘cfDNA’ refers to DNA found in the noncellular component of the blood that is part of the normal programmed death cycle of cells in the body. In healthy individuals, the cell-free DNA fragments tend to be uniform in length whereas cell-free DNA fragments arising from cancer cells vary in size or what is called ‘fragmented’ cfDNA. Cancer associated cfDNA tends to be fragmented in smaller sizes vs normal healthy cells. With this basic understanding it is possible to differentiate normal from cancer cellfree DNA and, through a proprietary process, measure short and long fragments or the ratio of cancer cell-free DNA fragments correlating with early progressive disease (or non-response to

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cancer therapy). Cadex Genomics has developed Alibrex a quantitative blood-based diagnostic test that can measure the quantity of cfDNA in a patient’s blood before cancer drug therapy starts and then 14 to 21 days later to determine if a patient’s cancer tumor is progressing (i.e., tumor size is increasing)— indicating that the drug therapy is not working. The turnaround time for Alibrex is 24 hours or less Initial clinical studies with Alibrex have delivered promising results. A clinical validation study is scheduled to commence in late 2022 with results ready for publication in early 2023.

Cadex Genomics President, CEO and Co-founder—Bill Haack has over 20 years of experience in life sciences. He started his career at Genentech where he led the sales operations team and successful launch of Rituxan, Herceptin and Avastin. He was also an early employee at Genomic Health, where he was instrumental in the launch and commercial success of three Oncotype DX products and helped grow the company to more than $300M in annual revenues. He also led the launch of Genomic Health in Europe. Mr. Haack holds an MA degree in Economics specializing in econometrics. n

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Pacific Northwest’s 2022 LSINW Conference Retrospective PHOTOS BY SCOTT EKLUND | REDBOX PICTURES

The Pacific Northwest’s largest annual life science showcase, the Life Science Innovation Northwest Conference (LSINW) 2022, was held at the Seattle Convention Center April 20–21. The event highlighted the region’s most exciting and promising companies and research institutions and had over 600 attendees, 88 organization presentations, 14 device and research tool exhibit booths in the inaugural Device Showcase, 12 seed-stage investor pitches as part of the Fast Pitch Competition, and 40 poster presentations. Presenting companies raised more than $3 billion in 2021 and over 120 investors registered.

Device Showcase

The inaugural Device Showcase consisted of ‘hands-on’ device and equipment exhibits from many of the region’s medical device and research tools companies including, NanoString, Prevencio, Curi Bio, Fusion Genomics, Pattern Computer, Xonotiv, Nanodropper, and Inmedix, among others. Nearly half of the exhibit hall was dedicated to the showcase.

Poster Sessions

This year’s conference included poster presentations with 40 pre-screened posters from regional research organizations. Posters were judged by a team of investors from Madrona Venture Group, Propel Bio Partners, Takeda Ventures, APIS Health Angels, Alexandria Venture Investments, among others. Several presenters were highlighted in an article by regional news outlet, GeekWire. The 2022 Most Outstanding Poster presentation went to Nano

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PharmaSolutions. Their vision is to make good drugs great by improving their bioavailability using their proprietary nanotechnology. As Kay Olmstead (at right), CEO, explains, “Approximately 70% of small molecule drugs have poor water solubility and their bioavailability can be improved by solubility enhancement. We help pharmaceutical companies developing these drugs in early clinical stages by bringing the best formulation of their drug into the market quicker with less time and cost. Our mission is to facilitate more effective and safer drugs through our disruptive nano drug delivery technology.” Nano Pharma has completed an NSF Phase I SBIR and already supports paying customers.

Kay Olmstead, CEO of Nano PharmaSolutions, was presented the Most Outstanding Poster presentation award.

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Left: Exhibitors at the Medical Device Showcase interact with attendees. Bottom: The 2022 Fast Pitch Competition winner, Mesintel Therapeutics, presented their proprietary target discovery platform that incorporates fibroblast biology to accelerate the development of therapeutics in areas of high unmet medical need.

Fast Pitch Competition

LSINW’s Fast Pitch Competition brought twelve preselected start ups to the stage to give a one minute pitch to a panel of investor judges for a $5K grand prize and $1K audience choice award through a sponsorship with Fenwick. This year’s winner was Mesintel Therapeutics with Precision Sensing taking home the audience pick. Other finalists included: Parrots, Crimson Medical Solutions, Precyte, DropCite, Ignyte Bio, Pataigin, Intracranial Pressure Solutions, Januity, Xonotiv, and Voxcell Bioinnovation. Early-stage venture, Parrots, Inc.,

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exhibited their A.I. enabled wheelchair technology. Parrots’ CEO, David Hojah, explains, “For many people with neurological conditions like ALS, their access to healthcare and ability to communicate can be severely limited. Polly is unique SaaS solution harnessing the power of AI/ML to advance the freedoms & independence of anyone with physical challenges. Their hardware-agnostic services provide intuitive real-time communication capabilities, smart home integration, advanced telecare monitoring, and so much more. “Three C’s”, Parrots believes that all human beings— regardless of their disabilities—have the

right to Communicate freely, Control their surroundings, and Connect with caregivers. Moreover, we can do it at a fraction of the cost of current cumbersome and dehumanizing solutions.” In 2021, Parrots won the SXSW Pitch competition in the A.I., Robotics & Voice category and was honored as the ‘Entrepreneur of the Year’ by the Association of Washington Business. Co-Founder and Chief Business Officer Jonathon Jafari presented for Mesintel Therapeutics and summarizes the problem and solution as, “Fibroblasts are vital players in health and their dysfunction underlies numerous diseases. Mesintel has developed a proprietary target discovery platform that incorporates our extensive knowledge of fibroblast biology to accelerate the development of therapeutics in areas of high unmet medical need, including cancer, fibrosis, and age-related disorders.” Mesintel is in the process of raising pre-seed funding for further development of the platform and to generate in-vivo proof of concept for a number of therapeutic targets in 2022. Next year’s LSINW event is scheduled for April 25–26. n

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Off-Season

©JACK AFFLECK

edical conference destinations are not all created equal. For those fortunate enough to attend conferences in the Vail Valley of Colorado, there is a lot to do year-round. Year round? That’s right. While you may know Vail for its world class ski options, the valley is an amazing place to spend time, bring family and explore at any time of the year. If you are based in a part of the country that includes high heat in the summer months, you may especially appreciate the mild weather in the Vail Valley from June through November. If you are looking for outdoor adventure, there are plenty of trails to explore on foot, on bike, or even on horseback. To add range to your experience, there is a year-round calendar of cultural events such as dance, orchestra and art shows. And don’t feel like you need to have an agenda. There are plenty of relaxing options that include visiting quaint villages, enjoying worldclass dining and shopping, relaxing at a spa and just taking in the beautiful mountain air. Here you’ll find a variety of activities and opportunities for summer and fall visits along with some resources at the end of this piece courtesy of Discover Vail to get your planning started.

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Yes, Vail is known for skiing. But there is so much more to do when the temperatures rise. by Tobin Arthur European Atmosphere

Vail’s Bavarian villages will embrace you in warmth and hospitality, with a variety of accommodations from romantic lodge rooms to fully-equipped multi-room condos. And, whether you stay in the center of the village action or tucked in a nearby neighborhood, the world-class dining, cosmopolitan shopping and energetic nightlife is always available. Summer and fall in Vail welcomes hiking through majestic forests, biking down thrilling mountain trails or meandering paved paths, as you discover Vail’s many adventures, taking time to recharge and discovering unique experiences that only Vail can offer. Vail’s outdoor events are yet another reason to visit Vail, with an incredible line-up of live music, internationally recognized arts and cultural events, delectable culinary offerings and more surprises from May through October. The summer-long concert series at Vail’s Ford Amphitheater returned in 2022 with more headliner music from well-known rock, pop, country and bluegrass musicians. There’s no better

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Photos courtesy of Discover Vail unless otherwise noted

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your need and fitness level. [2] Biking is one of the most popular warm-weather activities at Vail, and we know the AngelMD community is full of cycling enthusiasts. From the unmatched on-mountain views to the rush you get riding down the mountain, biking is one of the best ways to enjoy all that Summer and Fall in Vail have to offer. Vail is home to miles of mountain biking trails for all abilities as well as MARK WOOLCOTT

kids’ ziplining and tubing to organized camps and mini golf. Kids and spouses will thank you later. [1]. Mountains and hiking go handin-hand, especially during Colorado’s sunny summer and colorful autumn seasons. Whether you’re looking for a challenging workout or a leisurely stroll, there are hikes to fit every level at Vail. Check out the resource with links to find the type of hike that fits

©JACK AFFLECK

place to see these bands than the natural, outdoor Ford “Amp”, set under the stars, surrounded by the mountains of Vail. Get up close and personal with covered reserved seating, or spread out with general admission lawn seating. There are regular high-adrenaline options during the mild weather months including: Vail’s Whitewater Race series in the Spring, the iconic GoPro Mountain Games in June, the Kids Adventure Games in August, and trail running and mountain bike races throughout the summer. Each offers the chance to participate, if you’re up to the challenge, or watch and cheer on the competitors’ incredible athleticism giving their all! While there are plenty of medical conference destinations that may have limited offerings for the family, Vail is not one of those. On the contrary, there are a plethora of options available. From bike rides on mountain trails,

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©JACK AFFLECK

miles and miles of recreational paved trails, perfect for a relaxing ride on the valley floor. [3] When the temperatures are milder, there are spectacular opportunities to get out and enjoy the Rocky Mountain region from a kayak, canoe, paddleboard or raft. Boasting its own Whitewater Park in the center of Vail Village, as well as Class I to Class V river trips on the Eagle, Colorado, or Arkansas rivers, the choices are amazing. And combined with spectacular high alpine lakes, you cannot go wrong exploring the water options in and around Vail. [4] For nature lovers, Vail’s amazing parks and gardens are a relaxing experience for adults as well as children to explore. Worth noting is the Betty Ford Alpine Gardens & Eduction Center—the highest botanical gardens in the world. There is truly something for everyone and the beauty of the Rocky Mountains is unparalleled. [5] If golf is your thing, there are incredible views and terrain challenges in the Vail Valley. Within the city limits, The Vail Golf Club is nestled at the base of the Gore Mountain Range and presents golfers with a unique 18hole, par 71 experience at 8,200 feet elevation. The Vail Golf Club is open to the public, and offers a full service golf shop, group and corporate outings, professional instruction, launch monitor, driving range, practice area, club storage, golf swing analysis and more. [6] Vail Valley offers anglers more than 500 miles of rivers and plenty of lakes to reel in award-winning trout, whether you go solo or want an expert to guide you. There are also plenty of walleye, perch, catfish and bass to catch if fly fishing isn’t your thing. Refer to local regulations on the protected fish that are catch and release. And other than the first weekend in June, a license is required to fish—although it is less than $11. [7] There are very few places as scenic and relaxing as Vail. There are so many opportunities to unwind, renew and relax. A spa visit, goat yoga, art

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walks—even llama excursions—are among the options from which to choose. [8] The Vail Valley offers worldclass art and cultural experiences, with a diverse range of options to suit just about anyone. During the milder months you can enjoy outdoor concerts, art installations and festivals. There are also plenty of galleries and unique theatrical and dance venues. [9] Vail’s reputation as a stellar ski venue can probably be challenged by its food and drink options. Vail’s culinary scene is a tour of its own. With a plethora of options, ranging from out-of-this-world gourmet experiences to more casual family spots, Vail’s restaurants will leave you with a full stomach and a smile every time. And, if you’re in the mood to unwind with a specialty cocktail, artisan brew or a big night out on the town, Vail’s nightlife scene ranges from quiet piano bars to

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rowdy live music, hot dance spots and everything in between. We’ve got a partial list to begin your planning. [10] PRO TIP: Always make dining reservations in order to secure a table at your favorite spot! And please be aware that some dining locations may be closed on select days. Plan ahead and call restaurants in advance to be sure they have a seat for you, or leverage the concierge if your hotel of choice has one on hand. And we would be slacking if we didn’t mention an annual Bavarian tradition during September: Vail Oktoberfest. USA Today has ranked this as one of the 10 greatest Oktoberfest celebrations in the country. This year Oktoberfest will be celebrated in two different villages and on two different weekends. Enjoy the timehonored oom-pah music and dancing, along with beer, pretzels, brats, and strudel. Entertainment also includes

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competitions such as keg bowling, bratwurst eating and full stein lifing. If you arrive dressed in Oktoberfest attire, you could also win a prize in the costume contest. [11] If you do find yourself in Vail, drop us a note and let us know what you found most enjoyable. We’ll share your tips via the MD Next website so other members of the community can benefit from your insights: mdnext.co/ contact-us/. Special thanks to our friends at Discover Vail [discovervail. com], the official website of all to do, see and taste in Vail—in any season. n Tobin Arthur is the publisher of MD Next and executive chairman of AngelMD. He also happens to be a Colorado resident and an avid fan of what the state has to offer regardless of the season.

Resources 1 2 3 4 5 6 7 8 9 10 11

Family-friendly activities: discovervail. com/things-to-do/family-friendly/ Hiking: discovervail.com/things-to-do/ hiking/ Biking: discovervail.com/things-to-do/ biking/ Lakes & rivers: discovervail.com/onthe-water-in-vail/ Gardens & parks: discovervail.com/ things-to-do/gardens-parks/ Golf: discovervail.com/things-to-do/ golf/ Fishing: discovervail.com/things-to-do/ fishing/ Unwind: discovervail.com/things-todo/health-relaxation/ Arts & Culture: discovervail.com/ things-to-do/discover-arts-culture-invail/ Food & drink: discovervail.com/dining/ Oktoberfest: oktoberfestvail.com/

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IMPACT PARTNERS

Three miles north of downtown Pittsburgh, nestled between the Ohio River and the rolling Allegheny foothills, lies the town of Bellevue, PA. The borough is emblematic of many American towns which once depended on a local manufacturing base for their livelihood. The communities suffered as the national and local economies transitioned away from steel production and manufacturing and are now home to many industrial buildings and houses that have seen better days. What many of these postindustrial neighborhoods do not have is proximity to some of the most advanced research capabilities in AI, machine learning, robotics, emerging tech, and life sciences in the world, supported by billions of dollars in non-dilutive funding from the federal government. The intellectual property engines at Carnegie Mellon University and The University of Pittsburgh are a big reason why Pittsburgh, once a classic rust-belt city, now has a life sciences and biotech ecosystem that has recently been recognized as one of the top emerging innovation clusters in the world. Innovation doesn’t always mean technology; sometimes it means looking at problems and assets in a new way. Welcome to Allegheny General Hospital’s Suburban Campus: a sevenstory, 230,000 square foot brick building that shuttered most hospital operations in 2010. It took a physician turned entrepreneur with the right mix of business acumen and creative courage to envision how an empty “zombie” hospital could come to embody the transition from old economy to new and create opportunity and growth for the entire region.

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PETER PARKER

How a Zombie Hospital in Pennsylvania Was Reborn as a Startup Accelerator

The team at AlphaLab Health is leading the way in policy innovation by saving the Suburban Hospital Facility from being mothballed and converting it into a community resource center and innovation hub.

Support services are important, but to drive economic development we need to assist entrepreneurs and innovators to become the employers of tomorrow. Jeff Cohen, M.D. recognized the facility possesses the infrastructure and connections to house a fully integrated innovation hub and incubator in health sciences. In 2019, when he became the first-ever Chief Physician Executive for the newly formed AHN Innovations, he quickly recruited Innovation Works— the most active seed stage funder in southwest Pennsylvania and one of the most active in the country. They joined their expertise to create a new life sciences and bio tech accelerator: AlphaLab Health.

AlphaLab Health gives entrepreneurs access to specialized clinicians, insurers, hospital administrators and domain experts that accelerate the new company’s growth. The program links emerging companies with early customers, corporate partners, potential investors and knowledgeable staff and mentors. The companies also receive up to $100,000 in pre-seed investment. “While AHN has long been a leader in clinical research and innovation, AlphaLab Health is a transformative partnership that takes our commitment to an entirely new level and further elevates the Pittsburgh region’s profile as a wellspring of pioneering, game-changing ideas and solutions in

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IMPACT PARTNERS

healthcare,” states Cohen. To date, the accelerator has completed two cohorts totaling 14 companies from a wide range of disciplines covering diagnostics, therapeutics, medical devices, healthcare IT and packaging solutions. Most of the companies are hitting growth milestones since completing the program, including raising additional venture capital and nondiluted funds, hiring new local FTEs, and launching significant trials, pilots, and beta tests. “AlphaLab Health wraps entrepreneurs with a network of clinical and business experts who know how to help them succeed in the complex healthcare system,” said Megan Shaw, managing director for life sciences at Innovation Works. “The program brings together all the strengths of IW and AHN and then adds in mentors, access to customers, clinicians with deep experience and domain knowledge, and other resources that can help these talented founders leapfrog past the challenges they would otherwise face,” Shaw continued. The accelerator operates out of a 10,000 sq ft former intensive care unit that was renovated to create open collaboration and educational space and wet and dry labs with money from philanthropy, the PA Department of Community and Economic Development, and the health system. The larger facility also has technologies that are difficult for smaller companies to access, such as a mass spectrometer. But as Shaw mentioned, the real differentiating factor is the close relationship AlphaLab Health can provide with clinical mentors which creates a real-time feedback loop for the companies. “AlphaLab Health helped derisk key aspects of our business plan so that we could take this surgical planning technology from the bench to bedside at scale,” says Max Sims, MBA, co-founder and CEO of MindTrace, a company that is developing technology that allows neurosurgeons to remove brain tumors and seizure-

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Jeff Cohen, M.D. is a practicing urologist with a concentration in oncology. He graduated in 1976 from Syracuse University with a BS in Biology and earned his medical degree from SUNY Upstate Medical University in 1979. Dr. Cohen completed a residency in urology at Case Western Reserve in 1984 followed by a fellowship in urology at The M.D. Anderson Cancer Center. Upon completion he entered a clinical practice at Allegheny General Hospital (AGH) in 1985. Dr. Cohen has developed and introduced several technologies and procedures including Laser Lithotripsy, fiber optic based endoscopy, piezoelectric biplanar transrectal ultrasound and Cryosurgery. Dr. Cohen was director of urology at AGH from 1998 until 2016 and chief medical officer of AGH from 2013–2014. He became president of AGH, a large quintenary hospital in downtown Pittsburgh that is part of the 14-hospital Allegheny Health Network, a fully owned subsidiary of Highmark Health—one of the largest integrated and financial delivery systems in the nation. He served in that role until 2020, when he became chief physician executive, community health and innovation of AHN. Dr. Cohen is president of ChemImage, a privately held company specializing in hyperspectral identification of chemical/biological agents, drugs, explosives, anatomic structures and/or malignancies. He is married and has four children and resides in Pittsburgh, Pennsylvania. In his private life he has started multiple life science-based companies, is named on over 30 patents, and sits on the capital table for dozens of startups in the region. As the head of AHN Innovations, Dr. Cohen saw the potential of a facility that could capitalize on local support and community integration to deliver a wide range of support services including daycare, mental wellness and community support. An example: renovating the hospital’s industrial kitchen to support food entrepreneurs and culinary job training. Recently they converted the kidney dialysis lab to support STEM programming for K-12 students that introduces coding, robotics, and other pathways to economic opportunity in Pittsburgh’s new economy.

Jeff Cohen, M.D.

“AlphaLab Health wraps entrepreneurs with a network of clinical and business experts who know how to help them succeed in the complex healthcare system.”

Megan Shaw

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IMPACT PARTNERS

of Pittsburgh’s life science investor community successfully prepared us for the next round of funding and navigating the regulatory process,” Sims concluded. If you are interested in learning

PETER PARKER

generating tissue, while ensuring each patient leaves the hospital the same person they were when they arrived, preserving personality and skills. “The introductions to clinicians, business administrators, and members

more about this project or any of the companies participating in AlphaLab Health you can follow @alphalabhealth on Twitter or LinkedIn. The accelerator will also began accepting applications for its next cohort in August, so if you are participating in a pre-seed startup as a founder or family and friends investor, consider applying and joining this inspiring community of health innovators in Pittsburgh. n

Promising AlphaLab Health Alumni

Is There Room for Community Center “Innovation”? By Michael Schmanske

While not every underperforming hospital has the advantages of close proximity to the Pittsburgh research ecosystem, they do have one thing in common: proximity to their local community. Economic and demographic difficulties plague the local residents alongside their hospital. If a hospital is forced to close, it is likely that the local economy is suffering similarly and suddenly a community service center is vacant and becomes a potential focal point for urban blight. By keeping these facilities operating via innovation and incubator partnerships we may also learn how to use them to provide community support. At the Suburban Hospital Campus they converted the industrial-sized and outfitted kitchens to support a range of community services—from healthy eating classes to a production hub for local food security programs. The dialysis ward was converted into a STEM lab supporting after-school science programs including a robot battle competition. One patients’ ward was remodeled as a training facility for cleaning crews while another will live its next life as a day care center. All of which will be operating within walking distance of a community suffering from a lack of support services. Dr. Cohen and his team are passionate about this project; they know the hospital is as important to the economic and social health of the community as it is to the medical health of the residents. More than 100 U.S. hospitals have shuttered in the past decade, and industry experts think 1,000 more could close in the decade to come. The opportunity to convert underperforming liabilities into community assets should not be ignored. Do you know of a local hospital facility near you that is facing closure and might live a second life as an innovation hub and/or community center? Contact us at MDNext@AngelMD.com.

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MD Next

Telling.ai answers the question “how are your lungs doing” by giving users a detailed lung performance report by simply speaking into a smartphone. The company’s vision is to turn every smartphone in the world into a powerful remote respiratory monitoring device through a simple app and that will improve wellness and prevent unneeded hospitalizations and ED visits. | telling.ai Spoken helps people with aphasia or other language disorders speak again by predicting likely words and phrases.The company has taken the same machine learning algorithms that power a phone’s autocomplete function and applied them to much bigger data, giving suggestions that fit the context and improve with time. It’s a radically different approach to treating disabilities that aims to serve a growing global market. | spokenaac.com CytoAgents is a clinical stage biotechnology company focused on the development of innovative pharmaceutical products for the treatment of life-threatening symptoms associated with Cytokine Release Syndrome (CRS), an overreaction of the immune system causing systemic inflammation. There are many causes of CRS and our mission is to develop a broadly accessible treatment for multiple indications of high unmet need. | cytoagents.com

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TECHNOLOGY

Sonify Sonify is building better hyperthermia equipment. Hyperthermia is a broadly active cancer therapy that treats many types of tumors. In clinic, hyperthermia sensitizes tumors with gentle heat, significantly boosting the therapeutic effects of radiation, chemotherapeutics, and immunotherapeutics. There is no question that hyperthermia therapy works, but poorly performing equipment has defined and held back the field for nearly half a century. Sonify is changing this by combining well-understood technology to deliver heat and control temperature. Sonify’s hyperthermia solution uses ultrasound to deliver heat and passive microwave radiometry for temperature feedback. They offer the only affordable, accurate, and noninvasive hyperthermia solution. Sonify’s technology meets all clinical and patient requirements and represents the most significant advance in the field in nearly 50 years.

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The Bleeding Edge “Life moves pretty fast. If you don’t stop and look around once in a while, you could miss it.”—Ferris Bueller Here at the bleeding edge of healthcare innovation, we bring you a selection of the newest and coolest technology solutions we’ve come across in the last three months. For our inaugural issue we asked The Life Sciences Institute North West (LSINW) to select six of their favorites from their recent conference in June (conference highlights on p. 17), starting on the next page. If you have any questions about these companies or would like to recommend any “gee whiz” technology yourself, please contact us at MDNext@AngelMD.com.

Corneat Current artificial ocular implants are either sutured to or attempt integration with the native corneal tissue—a tissue that lacks blood vessels and heals very poorly. The reality is that the human body has many unique microstructures which are extremely hard to mimic. CorNeat’s EverMatrix™ manages to harness a few of these microstructures’ specific characteristics, creating an endless amount of different uses such as their ophthalmological implants. All implants are non-degradable and 100% synthetic, they mend, reinforce, replace and bio integrate with resident tissue. When implanted, the EverMatrix™ stimulates cellular proliferation leading to progressive tissue integration, without triggering an adverse immune system response. The company’s flagship product, the CorNeat KPro, is an artificial cornea. Utilizing the EverMatrix™ platform technology, this artificial cornea provides a long-term solution for corneal blindness, pathology and injury. Currently undergoing human clinical trials, it has already restored sight to a number of previously blind patients. The CorNeat KPro integrates artificial optics with resident ocular tissue. While their initial set of biomimetic implants address unmet needs in the

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TECHNOLOGY

Neobe Immunotherapy has changed the face of clinical oncology, but it only generates stable responses in 15-20% of patients with solid tumours. This is partly due to the local microenvironment, which creates barriers to effective immune cell infiltration. Immune excluding tumours trap the reaction in their periphery limiting treatment access. The defensive behavior is particularly prevalent in patients with highly fibrotic tumours such as colorectal cancer and pancreatic adenocarcinoma. Previous attempts to disrupt these barriers have mostly failed, either unsuccessful at penetrating this fibrotic environment, or due to toxicities associated with systemic delivery. Neobe is genetically engineering safe strains of therapeutic bacteria with tumour colonizing properties to locally disrupt microenvironmental barriers to immune infiltration and enable immunotherapy success in patients with immune excluded tumours. By harnessing the tumour colonizing properties of bacteria, together with engineered inducible biosensors, their products will be able to remodel specific components of the microenvironment without affecting healthy tissues. By locally removing barriers to immune infiltration their engineered live biotherapeutics could double the number of cancer patients that respond to existing immunotherapies.

fields of ophthalmology and periodontology, they demonstrate the business potential and social impact of the EverMatrix™ platform. Its promise to offer new and disruptive implants significantly superior to predicates extend into a wide range of connective tissue indications.

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The LSINW conference featured their inaugural Device Showcase. We are proud to support their valuable work as one of the founding members of the AngelMD Alpha Partnership.

LSINW Top Picks

Parrots For many individuals with neurological conditions like ALS, their access to healthcare and ability to communicate can be severely limited. Parrots, Inc’s Polly platform is a unique SaaS solution harnessing the power of AI/ML to advance the freedom & independence of anyone with physical challenges. Their hardware-agnostic services provide intuitive real-time communication capabilities, smart home integration, advanced telecare monitoring, and more. Parrots believes that all human beings regardless of their disabilities have the right to communicate freely, control their surroundings, and connect with caregivers.

MD Next

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TECHNOLOGY

inSTENT Connection

Xonotiv Each year 60,000 people need a prosthetic knee because of leg amputation. It is easy to imagine that the solution might involve microprocessors, bionics, or other technology. But in reality, most amputees face a limited choice of legacy mechanical knees. In fact, only 10% of amputees will ever receive a high-tech, computer-controlled knee because of their high cost and stringent physical requirements. Xonotiv (“Zohnoh-tiv”) is developing a novel passivemechanical knee that any amputee can qualify for, and that provides stability without the need for expensive power or electronics. It prevents buckling while simultaneously allowing the user to walk safely with whatever leg motions they are able to generate, providing the benefit of knees costing ten times as much. As a Class I medical device, it is not subject to FDA premarket approval or notification. The Xonotiv Knee fits within existing Medicare reimbursement codes, and will increase clinicians’ throughput and profitability.

Gastrointestinal (GI) anastomotic leakage has been considered the bane of intestinal surgery for over a century. Traditional methods of creating these surgical connections have alarming leakage and mortality rates. This is attributed to the fact that there are no standardized approaches other than good technique when using staples and/or sutures. To address this, inSTENT Connection has created a patent-pending bioresorbable stent and compressive band combination that eliminates the need for staples and sutures and prevents these complications. Their stent features micro-barbs placed on the surface of the stent to prevent migration during peristalsis. Both the stent and band will be resorbed by the body after the tissue has healed, eliminating the need for follow-up procedures to remove the device. inSTENT Connection believes that GI surgical patients worldwide deserve a safer and more cost-effective surgical connection that relieves the emotional and financial burden of these procedures.

Pattern Computer The world has been inundated with countless AI/ML companies claiming they can solve problems in the biomedical space with pattern recognition. Their results are incremental and add to the dull roar of hopes to get ahead of their opponents. Pattern Computer developed a brandnew mathematics being used in their advanced machine learning system that rises above the noise and discovers new patterns in complex data. These discoveries are being used in different biomedical areas including drug

[ Q3 ] 2022

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repurposing for treatment of the top cancer killers worldwide. This system is also the platform for their ProSpectral® device that can detect COVID-19 in three seconds with no reagents while having a 98.8% balanced accuracy. Pattern Computer’s work will continue to raise the bar on diagnostics and treatments of diseases for the betterment of global communities.

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TECHNOLOGY

Inmedix Inc. Despite 14 marketed immunosuppressives for Rheumatoid arthritis, the remission (successful treatment) rate remains stagnant at 25%. Rheumatologist Andrew Holman, M.D. founded Inmedix Inc.to quantify stress, controlled by the autonomic nervous system (ANS), as the driving force behind remission. As the most precise measure of ANS stress state, proprietary, 5-min, Inmedix’s next-generation heart rate variability (HRV) is light years more sophisticated than current HRV. It predicted 52-week biologic treatment outcome in RA in a prospective, doubleblind trial with 90% sensitivity and 95.7% specificity. Actionable to increase remission from 25% to 79% and utilizing known reimbursement pathways ($100 to MD + $80 to Inmedix), FDA clearance is expected 1QTR2023.

Nanodropper Nanodropper is a medical device company offering high-value solutions to adherence barriers in eye disease management. Current packaging of prescription eyedrops wastes medication by producing oversized drops that are about 5 times too large for the human eye to absorb. With medications, like those for glaucoma, costing up to $500 per bottle, this waste contributes to enormous financial barriers to visionsaving medication access. Nanodropper Adaptor, the company’s flagship product, is an eyedrop bottle adaptor that solves the problem of oversized eyedrops. The FDAlisted, award-winning device reduces eyedrops to the physiologically appropriate volume, reducing financial barriers and improving access to vision-saving medications. Nanodropper adds value at every level in healthcare, with the potential to save billions of dollars in medication waste, one drop at a time. n

LSINW is one of the founding members of the AngelMD Alpha Partnership. The Alpha Partnership was formed to create a neutral supportive venue where Innovation Hubs and Incubators around the world can share educational materials, influencers and advisors. Our goal is to highlight early stage healthcare companies from all of the many regions and development channels to create a critical mass and attract institutional investment interest in these exciting and valuable investment opportunities.

By pooling our resources we can support global innovation more effectively. If you would like to see any of your companies or technologies featured in “The Bleeding Edge” in future issues, contact us at MDNext@AngelMD.com.

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MD Next

[ Q3 ] 2022

BEST OF 2022

From the largest community of healthcare startups in the world, comes the premier industry recognition. VOTED ON BY: Physicians • Dentists • Industry Executives • Hospital Leaders Entrepreneurs

NOMINATE STARTUPS (including yours) IN 1 OF 5 CATEGORIES: If applicable in multiple categories, pick the best fit

Digital Health • Diagnostics • Orthopedics • Cardiology • Oncology

Nominations Due November 15 Voting Begins December 1

[Register as a member of AngelMD to make sure you get to vote]

www.angelmd.com NOMINATE

ALPHA CREATIVE

Optimizing Your Practice Physicians and dentists in private practice wear at least one additional hat at all times: business owner. Unless you are in very rare territory, it’s important to constantly stoke the pipeline of new patients. That said, most of you don’t have time to become experts in marketing because you are focused on delivering optimal patient care. This article is focused on giving you some essential tips to optimize your practice marketing. 1. Web Site—This is the most important tool in your toolbox and should receive commensurate attention. According to Pew Research Center, 72% of U.S. adults have searched for health information online. This means that if you want to attract new patients, you’ll need to market yourself online. The site should reflect the elements of your practice that you deem important. It should distinguish you from the rest of the crowd. In other words, a vanilla, cookie-cutter site is not adequate. Another key consideration is to make sure the site is mobile friendly. This is easy to check. Take out your phone and open the site. Can you easily find the important information and connect with the practice if you were a potential patient? Online traffic patterns will put mobile search anywhere between 40% and 60% of your prospective patients. By the way, this does not mean developing a native mobile app. In fact, that would make no sense. Instead, you simply want whats referred to as responsive design. Mobile is critical.

need not be daunting. You’ll want to put some basic tools in place to optimize your site, but here is the gist: content is king. Get rid of low-quality or duplicate content. Focus on topics specific to your patient population and include content that has a geo or local element. SEO is an area where you will absolutely get a return on your investment working with an expert consultant/firm. Getting an outside writer can be helpful, but this doesn’t need to be complex. The reality is you know your topic better than anyone. By the time you hire a ghost writer and get them up to speed, you could have written the content yourself. Hire an editor, not a writer.

2. Search Engine Optimization—Most of you have probably heard of SEO by now, but it’s likely a bit mysterious. Yes, there are lots of technical idiosyncrasies tied to ensuring your website is optimized for the search engines, but it

3. Local Listing—It’s extremely easy to claim your local listing in places like Google, Bing & Yahoo. Changing addresses or hours of operation? Keep them up to date online. Part and parcel with your listing

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UPKLYAK

is reviews. This is both an art and a science. You may think they are trivial, but patients use them. Make sure to ask patients to leave you a review. This can be a seamless part of check-out or part of a follow-up email survey. Suggest that if your patient has appreciated the service they received, that you would be grateful for a review online. We get that this may seem odd…after all, you are not a restaurant. However, right or wrong, patient reviews matter for patient traffic so be proactive. n Alpha Creative is a full service digital marketing agency specializing in both medical/ dental practice marketing and medical startup marketing. In the era of digital, we focus on building assets to help tell your story online and drive the traffic that’s important for your mission. Specifically, we focus on logo development, web sites and video.

AlphaCreative.io

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[ Q3 ] 2022

Events — Fall 2022 August August 22–24

Epic UGM (User Group Meeting) 2022 Wisconsin | Verona

An in-person event and streaming of executive messages and audio recordings of other sessions available after the conference. Designed for executives, directors, clinical staff, and other leaders with strategic focus. Different councils will also be presenting here. COST: $600–$1200 ugm.epic.com

August 26–29

ESC—European Society of Cardiology Annual Congress Spain | Barcelona / Virtual

Celebrating 70 years since the first ESC Congress. Experience the most innovative scientific updates from late-breaking clinical trials and ground-breaking studies. The spotlight in 2022 is ‘Cardiac imaging’, with its profound implications for prevention, diagnosis, clinical decision-making, guiding of interventions and follow-up of therapeutic procedures. COST: $765–$995 www.escardio.org/Congresses-&-Events/ ESC-Congress/About-the-congress

Categories INDUSTRY CONFERENCE POLICY EDUCATION INVESTMENT/PITCHES MEDICAL ASSOCIATION

September September 3–7

ERS—European Respiratory Society Congress

September 6–9

PAINWeek Conference Nevada | Las Vegas

PAINWeek remains the U.S. pain conference with the most expansive curriculum and is the favorite destination for frontline practitioners to enhance their competence in pain management. COST: $600–$900 www.painweek.org/conferences/painweek/ painweek-2022

September 7

American Heart Association: Hypertension Scientific Sessions 2022 California | San Diego

Spain | Barcelona

The ERS Congress is the once-a-year occasion when the world’s respiratory experts come together to present and discuss the latest scientific and clinical advances across the entire field of respiratory medicine. The reputation of ERS derives from the outstanding scientific programme of our Congress, which is now the largest respiratory meeting in the world. COST: $700–$1000 www.ersnet.org/congress-and-events/ congress

The conference includes oral and poster presentations selected from abstracts submitted by clinical and basic researchers, followed by discussions led by leading authorities. This meeting also offers sessions specifically designed to benefit trainees and early career investigators, as well as Clinical Practice Clinical Science topics focused on applying clinical science to the clinician’s practice and Primary Care programming dedicated to practical advice for the Primary Care Provider (PCP) interested in clinical hypertension. COST: N/A professional.heart.org/en/meetings/ hypertension

September 7–8

Citibank Annual BioPharma Conference Massachusetts | Boston

Investment banking conferences are generally exclusive to clients and potential clients of the banking firm represented. These events provide opportunities to mingle and network with institutional investors and to receive valuable feedback from investment funds and industry representatives. Contact a bank representative for access. COST: N/A citiconferences.com

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MD Next

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Fall 2022 September 7–9

Wells Fargo Healthcare Conference Massachusetts | Boston

September 9–13

ESMO—European Society for Medical Oncology Congress France | Paris / Virtual

ESMO is committed to making the latest scientific data and the highest quality education available to all professionals working in oncology wherever they are based. The ESMO Congress 2022 will offer a return to an in-person experience, accompanied by unique networking opportunities, as well as the convenience of an interactive virtual format for those who may choose to take part from a distance. COST: $600–$1100 www.esmo.org/meetings/esmocongress-2022

September 11–14

SHSMD—Society for Healthcare Strategy & Market Development Washington D.C.

The Society for Healthcare Strategy and Market Development of the American Hospital Association is holding its annual conference to advance excellence in healthcare strategy. You can expect to hear from healthcare marketing professionals as well as experts in public relations and digital engagement. Attendees will also learn the latest on topics such as analytics and improving the customer experience. COST: $1095–$1245 web.cvent.com/event/f0cfc13b-0ee7-4d3d943e-fe26755bf6eb/summary

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— Events

Categories INDUSTRY CONFERENCE POLICY EDUCATION INVESTMENT/PITCHES MEDICAL ASSOCIATION

September 12–14

Modern Healthcare Event: Leadership Symposium Arizona | Scottsdale

Join industry leaders at the highest level for invigorating dialogue about the future of healthcare, including big-picture challenges, bold solutions and opportunities for collaboration to move forward in the industry. COST: $1000 www.modernhealthcareevents.com/event/ c6517464-6257-443f-8359-90b68662395d/ summary

September 13–14

Baird Global Healthcare Conference New York | New York

Baird is delighted to host its annual Global Healthcare Conference. This conference brings institutional and private equity investors together with senior management from over 100 public and privately-held companies. The conference will feature companies across the following sectors: Biotechnology, Healthcare Supply Chain & Pharma Services, Healthcare Information Technology, Life Sciences & Diagnostics, Medical Technology and Facilities & Services. Baird conferences are by invitation only; reach out to your Baird Representative for additional details. Cost: N/A www.bairdconferences.com/conference2/ Index/50

September 13–14

D-Pharm: Disruptive Innovations US Massachusetts | Boston

Hear from leaders in the pharmaceutical industry from companies like Merck, GSK, Pfizer, Janssen, and more at this event. At D-Pharm, speakers will discuss ways to host decentralized clinical trials so the burden on doctors and patients is reduced. Each year, leaders report back on what they’ve done and how it could potentially help advance clinical trials. One session that looks beneficial is about unlocking unconscious bias, presented by Lisa Coleman, Ph.D., who is the SVP of global inclusion and strategic innovation and chief diversity officer at New York University. COST: $750–$1495 theconferenceforum.org/conferences/ disruptive-innovations-us/overview

September 13–15

HAS 22—Healthcare Analytics Summit Utah | Salt Lake City

HAS 22, the Healthcare Analytics Summit, bills itself as providing the most comprehensive educational and leading edge forum for discussing improvements in data-driven outcomes. At the 2022 event, presenters are focusing on a strategic, long-term version of the importance of big data in healthcare. Representatives from data-driven healthcare organizations will be in attendance to showcase their latest innovations. How data and analytics become a central function for healthcare organizations both big and small will be the main topic for discussion at the panels and breakout sessions. The experience will be all the richer if you use the HAS smartphone app to access real-time event polling results, check out session analytics, or ask questions. COST: $699–$899 hasummit.com

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[ Q3 ] 2022

Events — Fall 2022 September 19–23

IASP—International Association for the Study of Pain–World Congress on Pain Canada | Toronto

Categories INDUSTRY CONFERENCE POLICY EDUCATION INVESTMENT/PITCHES MEDICAL ASSOCIATION

The World Congress on Pain is the largest global gathering of pain professionals. This event brings together more than 7,000 scientists, clinicians, and healthcare providers from around the world and across pain disciplines. COST: $999–$1855 iaspworldcongress2022.org

October

September 21–24

October 12–14

AANEM—American Association of Neuromuscular & Electrodiagnostic Medicine

National Association of Health Services Executives (NAHSE) Louisiana | New Orleans

Tennessee | Nashville

AANEM is an annual event where experts from around the world come together to collaborate and learn about different topics in the healthcare industry. This event is known as the “premier organization” to learn about EMG (electrodiagnostic medicine). COST: $999 www.aanem.org/Meetings/Annual-Meeting

NAHSE is the premier professional membership society for Blacks in healthcare management. NAHSE strives to improve the health status, economic opportunities and educational advancement of the communities we serve. The theme for the 37th Educational Conference is Advance. Develop. Elevate: Reimagining the Future. The conference will also host the 27th Everett Fox Student Case Competition, where graduate students from across the U.S. compete by developing solutions to a management case. COST: $1000–$1500 www.nahse.org/educationalconference/

October 13–14

American Psychiatric Association: 2022 Mental Health Services Conference Washington, D.C.

September 30–October 3

AAO 2022—American Academy of Ophthalmology Annual Meeting Illinois | Chicago

The mission of the American Academy of Ophthalmology—a global community of 32,000 medical doctors—is to protect sight and empower lives by serving as an advocate for patients and the public, leading ophthalmic education, and advancing the profession of ophthalmology. COST: $250–$500 www.aao.org/annual-meeting

[ Q3 ] 2022

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The 2022 Mental Health Services Conference will bring psychiatrists and other mental health professionals together to collaborate on practical advice to influence systems-level change for their patients. Join in-person in Washington, D.C. at the Capital Hilton Hotel as we work together to develop practical solutions to solve real-world issues. COST: $250–$500 psychiatry.org/psychiatrists/meetings/themental-health-services-conference

October 20–21

Reuters Events: Total Health 2022 Illinois | Chicago

While the pandemic showed us the power of what’s possible when the health system unites, healthcare leaders must work out how to embrace data-sharing regulations that provide more choice and power to the patient while transitioning business models toward a system of value-based care. It is paramount to facilitate employer collaborations in line with new standards in working-life, and work handin-hand with a host of new direct-to-consumer disruptors that enter the market, vying with incumbent providers or health plans. At Total Health 2022, CEOs, innovators, disruptors and policymakers will join forces behind a vital mission: building a resilient health system through innovation to ensure a gold standard of health for all. COST: N/A events.reutersevents.com/healthcare/totalhealth-usa#about

October 22–26

ARSM 2022—American Society for Reproductive Medicine California | Anaheim

Top experts in reproductive medicine discuss the latest in reproductive care. Find answers, learn, and network all in one convenient location. At ASRM 2022, multi-disciplinary professionals will discover the latest in reproductive endocrinology and infertility, basic science, genetics, male reproduction, access to care, mental health, practice management and more. COST: $750–$1095 asrmcongress.org

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Fall 2022 October 23–27

ASTRO–American Society for Radiation Oncology—Annual Meeting Texas | San Antonio / Virtual

AI & EI: Caring for the Patient in a Wireless World—ASTRO’s mission is to advance the practice of radiation oncology by promoting excellence in patient care, providing opportunities for educational and professional development, promoting research and disseminating research results and representing radiation oncology in a rapidly evolving healthcare environment. ASTRO provides its more than 10,000 members with the continuing medical education, health policy analysis, patient information resources and advocacy that they need to succeed in today’s ever-changing healthcare delivery system. The annual meeting delivers the top scientific and educational programming related to the field of radiation oncology. COST: $699–$1449 www.astro.org/Meetings-and-Education/ Micro-Sites/2022/Annual-Meeting

October 25–29

ASHG—American Society of Human Genetics—Annual Meeting California | Los Angeles

The ASHG Annual Meeting is the largest human genetics and genomics meeting and exposition in the world. Held in October, it provides a forum for the presentation and discussion of cutting-edge science in all areas of human genetics. Highlights include invited symposia; abstract-driven plenary, platform, and poster sessions; education/trainee workshops; and career opportunities and networking events. COST: $535–$1135 www.ashg.org/meetings/2022-annualmeeting/

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— Events

Categories INDUSTRY CONFERENCE POLICY EDUCATION INVESTMENT/PITCHES MEDICAL ASSOCIATION

November November 3–5

North American Cystic Fibrosis Conference Pennsylvania | Philadelphia

The North American Cystic Fibrosis Conference provides a collaborative and educational forum for all CF professionals. The educational elements of the meeting program are targeted to physicians, nurses, research scientists, respiratory therapists, physical therapists, nutritionists, social workers, pharmacists, and all members of the CF healthcare team. COST: N/A www.nacfconference.org/

November 7–10

Credit Suisse Annual Healthcare Conference California | Rancho Palos Verdes

November 12–16

SfN—Society for Neuroscience— Annual Meeting California | San Diego / Virtual

Neuroscience 2022 will be held in-person and will also offer a sampling of content virtually, including the opportunity for virtual posters. Each year, scientists from around the world congregate to discover new ideas, share their research, and experience the best the field has to offer. Attend so you can present research, network with scientists, attend sessions and events, and browse the exhibit hall. COST: N/A www.sfn.org/Meetings

November 13–16 HLTH 2022

Nevada | Las Vegas Taking place on an open show floor, the fourday event will convene the entire healthcare ecosystem, connecting and developing relationships that truly move the needle. HLTH breaks down silos to unite all participants within one holistic environment. Experience an event unlike any you have seen and be part of a movement pushing boundaries in the healthcare industry. COST: $2295 (discounts available) www.hlth.com/2022event

November 27–December 1

RSNA—Radiological Society of North America—Annual Meeting Illinois | Chicago / Virtual

RSNA 2022 offers 400+ educational courses and scientific sessions from every subspecialty, providing you with the opportunity to refresh your knowledge and immerse yourself in a wide breadth of research. And be sure to check out the latest insights and innovations from our partners during industry presentations and product demonstrations. COST: $210–$1155 www.rsna.org/annual-meeting n

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[ Q3 ] 2022

CAPITAL ALPHA PARTNERS

Physician Policy Issues By Kim Monk, Rob Smith Politics and policy mandates from Washington, D.C. may feel like they exist in a parallel dimension to the daily experience and careers of healthcare professionals, but every regulatory decision, billing code or clinical approval process began as a policy proposal inside the beltway. The range of legislative and regulatory issues impacting physicians’ practices are widely varying and constantly in flux. Congress and agencies like CMS tend to be driven by catalysts that force action. Here we will distill the major issues currently under debate and identify the most important upcoming catalysts. For instance, regulatory flexibility around telehealth, scope of practice, free COVID tests and treatment, and continuous Medicaid coverage will expire at the end of the Public Health Emergency (PHE) barring action by Congress to make some of these flexibilities permanent. We think HHS is unlikely to end the PHE before at least early 2023. Although the agency has started taking substantial steps to wind the emergency down, it’s going to be a very complicated process, and Congress has done little to ensure favorable waivers for telehealth, scope of practice expansion, and other policies will be made permanent. Telemedicine: Good news—unlikely that Congress will greatly curtail the expansion as a result of COVID. Bad News—it is going to be some time before regulators will have sufficient confidence to make any permanent decisions. For telemedicine, we think it will likely take several years of data analysis and policy development before legislation is enacted to provide stable coverage and reimbursement. Currently, CMS’ telehealth emergency

[ Q3 ] 2022

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waivers will be extended for five months after the end of the PHE under legislation enacted earlier this year. We think several more temporary extensions will be necessary until Congress agrees on a permanent policy.

rate updates for 2023. However, relief for some specialty groups from reimbursement cuts stemming from updated E/M and clinical labor policies will require action from Congress, which is far from certain at this point.

Reimbursement: Moving on and with a greater awareness of the value of medical workers. Congress is quickly closing its COVID wallet, and further relief from the 2% Medicare sequester or replenishment of the provider relief fund are unlikely to pass despite strong lobbying from AMA, AHA and other provider groups. Increasing medical inflation is likely to lead to favorable CMS physician

Coverage: BBB is dead but ACA is setting up to come back to life as an election battleground. Although the BBB may be dead, health coverage remains a huge priority for Dems, which is why we think they will use the reconciliation vehicle to extend the enhanced ACA tax credits, presumably paid for with drug pricing reforms. The end of the PHE will also kick off a massive effort by states to

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conduct eligibility redeterminations for some 80 million Medicaid/CHIP enrollees for whom states were prohibited from dropping from the roles during the pandemic. Although CMS is giving states 12 months to conduct redeterminations, increased federal Medicaid matching funds from the Families First Coronavirus Act expires at the end of the quarter in which the PHE ends, likely prompting some states to move quickly to drop ineligible enrollees. It’s estimated that some 15 million people could lose coverage as a result of the redeterminations. Many will have access to other sources of coverages, particularly if Congress extends the enhanced ACA subsidies, but there is sure to be confusion and disruption in coverage as this is sorted out. Drug Pricing: Likely a sub-headline item if a reconciliation package is passed. We doubt CMS will make any substantial moves on drug pricing demos or other rules that could affect physician’s ASP +6% reimbursement until at least 2023. If Democrats can pass broader drug pricing reforms in a reconciliation package later this year, it would considerably lower the pressure on the administration to address pricing via regulations. Broader drug pricing legislation might include a Part B inflation cap and limited measures giving Medicare the authority to negotiate prices for certain drugs, but whether this can get done depends on whether Dems can make a deal with Sen. Manchin (D-WV). The deadline for moving a “drug pricing plus” reconciliation package is Sept. 30th. Surprise Billing: Bipartisan support, operational complexity. Litigation and implementation of the surprise billing law is likely to have significant implications for physician billing and network contracting in the commercial market. When Congress passed the “No Surprises Act” (NSA) at the end of 2020, it sought to create an independent resolution process

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(IDR) that balanced provider and plan concerns. However, in implementing the law, HHS and the other agencies said that the arbiter should pick the amount closest to the qualified payment amount (generally the median contracted rate) and may consider additional provider factors if that information clearly demonstrates that the value of the disputed item or service is materially different from the QPA. Earlier this year a Texas court struck down this controversial portion of the rule. In our view the Texas court got it right and HHS will ultimately lose the legal battle if it appeals the decision. We think the agencies will instead issue a final rule—as soon as this quarter—that requires arbiters to consider key factors, such as provider’s level of experience and training, and that is consistent with statutory intent and the Texas ruling. Finally, we’d note that that even for physicians who are

in-network or who don’t balance bill, the NSA will still require all physicians to provide a good faith estimate of costs, diagnostic and billing codes as part of an advanced explanation of benefits, though the regulation for this is delayed as HHS seeks to harmonize it with the Trump-era price transparency rule. n Capital Alpha Partners, founded in 2007, is a leading provider of strategic policy research and political forecasting. Co-founder Kim Monk and managing director Rob Smith draw upon their rich, collective experience on Capitol Hill and in the private sector to accurately pinpoint investor-relevant theses; predict challenges and opportunities; and ascertain the market significance of political developments across the healthcare sector. Services range from pre-diligence consultations and extensive research reports to post-transaction advisory. For more details or to request trial access to their weekly reports, please contact info@capalphadc.com.

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[ Q3 ] 2022

MOHAMED MASAAU

Read the fine print of the purchase agreement before you buy a boat 42

[ Q3 ] 2022

MD Next

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here is a common saying in the boat world: “The best boat is your friend’s boat.” While there is some truth in the statement, the allure of having your own vessel to navigate lakes and oceans is compelling. Physicians, dentists and entrepreneurs all work extremely hard, and if you find yourself in the fortunate position to afford a boat, then by all means don’t let the naysayers ruin your fun. That said, in this article I want to provide a few practical tips related to the actual purchasing process to ensure your transaction is what you intended.

By Dr. Jeffrey Dorfman Commodore, Rye Yacht Club PHOTOS COURTESY OF THE AUTHOR UNLESS OTHERWISE NOTED

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All Fine Print can be modified on the written Purchase Agreement (PA) if the Seller really wants to sell a boat. Note that a Seller can be a local boat dealer or the manufacturer who sells directly to the Buyer. Potential boat buyers should carefully read the Fine Print on the back of a boat PA and also seek professional opinions from both an attorney and insurance advisor before signing it. It is hoped that if enough people refused to sign standard boat Purchase Agreements as many are currently written then boat manufacturers and local dealers would make changes.

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[ Q3 ] 2022

The National Marine Manufacturers Association (NMMA.org) states that U.S. expenditures on boats, engines, accessories and related costs totaled $35.4 billion in 2014. It also states “Boating is primarily a middleclass lifestyle as 71.5% of American boat owners have a household income less than $100,000.” What government agency is protecting Americans who may not read or understand the Fine Print on the back of the boat PAs they sign?

Some things to look for in the FINE PRINT of a boat PA

Price: Can the sales price be changed AFTER you sign the PA if: 1) the manufacturer “unexpectedly” increases the price to the dealer, or 2) the boat is not in their current inventory? A Seller should provide the exact price of a boat before you sign a PA. Sales Tax: If you live in and enjoy boating in one state—but purchase a boat in another state that has a lower sales tax—you will still owe the difference of the higher state tax even though you might not be charged it on the boat PA. This can make the total purchase price appear artificially low. It is better to pay the correct sales tax at the time of the purchase so you don’t receive an unexpected sales tax bill later from the state in which you live and/or enjoy boating.

find it acceptable—which would be illogical if the boat hasn’t yet been built or delivered? Seek out a reputable local boat surveyor to inspect the boat and a separate factory-certified mechanic to survey the engine(s). Warranty: Does the Fine Print refer to Manufacturer and Component warranties that were not provided to the Buyer in advance of signing the PA? If the Seller states they are NOT saying the boat is fit for any particular purpose, you might want to ask why. If the Seller says that in no event shall they be liable in the event of any damage arising from the purchase and use of the boat—then in the event of a serious manufacturing defect that could cause injury or death, you might be giving up your right to sue.

their marina during the winter. Ask your insurance advisor. Reappraisal of Trade-In Price: Can the Seller change the price of the trade-in AFTER the PA is signed? Instead, can you bring in your trade-in for a survey BEFORE you sign and thereby make the trade-in price unchangeable? This protects both Seller and Buyer. Transfer of Title of the Trade-in: Some sellers expect to own your trade-in immediately after signing the PA—even though you may not receive your new boat until sometime later. You could be without any boat for quite a long time. Also be aware, that sometimes the Fine Print can require the Buyer to pay an

Indemnification: If the Seller seeks “Indemnification” from any loss, liability or legal action, then the Buyer may ask why this is necessary. The Buyer may be giving up the right to sue in the event of misrepresentation—or fraud. Insurance: Does the Seller pass all insurance coverage requirements onto the Buyer even in some situations where the Buyer may not actually be insured—even if they have insurance? Examples: 1) during delivery of the boat by truck, 2) use of the boat in a boat show or 3) dealer display of the boat at

Delivery Date: Can the delivery date be extended without any limitation due to what the Seller calls a “Force Majeure,” or any other reason “beyond their control?” If so, you could end up waiting for a boat indefinitely without any option of canceling the agreement. It’s reasonable to set a maximum time limit beyond the expected delivery date where the Buyer can cancel the purchase without penalty. Note that a “Force Majeure” has a specific legal meaning and is really not just ANY delay beyond the Seller’s control. Inspection: Is there a paragraph that says you have examined the boat, and

[ Q3 ] 2022

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unspecified amount for the registration of their Trade-in in another state. Entire Agreement: Is the Seller verbally telling you something different than what is written in the Fine Print? Despite his/her assurances, get it in writing. The “Entire Agreement” paragraph will typically say that any verbal agreement means nothing unless it is written as part of the PA.

Batten Down the Hatches

It is highly recommended that potential boat Buyers do NOT begin picking out boat engines, colors, cabinets, flooring and fabrics with family members until after ALL aspects of the PA are resolved. Otherwise, you might find yourself being subjected to unpleasant sales pressure and give in to key legal points of the PA in front of your family—who just completely helped you design a boat. Speak to an attorney and/or insurance advisor BEFORE signing a PA for any new or used boat. It is better to take the proper time and give advisors time to carefully review a PA before signing. However, if you are at a boat show and believe you have found the deal of the century, then at least use your cell phone to take a picture of the entire PA—including the Fine Print— and email it to your advisors for their professional opinions BEFORE signing.

[ Q3 ] 2022

MD Next

While this highlights some important aspects of the fine print of a boat PA, it’s not exhaustive. Legal questions are raised in this article, but no legal advice is provided. n Jeff Dorfman, DMD, is the retired founder and director of a high-end 16-dentist and specialist group practice in midtown Manhattan. He is a technology innovator, professor and author. Owner of several IP holding companies, including 1dentist LLC and Rye Yacht Inc., he has been a yacht owner, advisor and enthusiast for decades.

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INVESTMENTS

Stick to Your Knitting There is a trope on Wall Street that doctors and dentists are legendary poor investors. That’s a broad generalization, and there are exceptions, but in my experience, healthcare professionals tend to have bad instincts when it comes to the capital markets. Being a clinician is an allconsuming job, it takes a great deal of training and education, and the hours are long, which means that for most, investing is a hobby, and it’s hard to succeed at investing if you’re doing it as a hobby. So doctors rely on the advice of others, frequently financial advisors, newsletter writers, gurus, and fake gurus who ply their wares on YouTube. I work in the investment business full time, as a financial writer, and I am not an exceptional investor. At best, I stay out of trouble. If you are trying to beat the markets, your odds are not very good—in any given year, about 1 or 2 out of 10 portfolio managers outperform the index. For every hedge fund manager that scores big, there are a couple of dozen who are forced to close their funds. Investing celebrates the illusion of success because we do not see the cemetery, the people who failed and got spit out the bottom of the business. If you are not engaged in investing full-time, then you should probably just build a diversified portfolio and leave it the hell alone. But which portfolio? The classic 60/40 portfolio of stocks and bonds has been doing terrible lately, and in a rising interest rate environment that portfolio is going to be pretty terrible for a while. In an inflationary environment, portfolios must include exposure to other asset classes: commodities, real estate and private equity come to mind. The good news is that it is easier than ever to get exposure to commodities and real

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MINDANDI

By Jared Dillian

estate, and as healthcare professionals you DO have a competitive advantage in one area above all else: early-stage healthcare investing. My advice to healthcare professionals is to ignore the noise in the financial markets as much as possible—and focus instead on building your earnings potential. In finance, we talk about the concept of compounding—the idea of interest on interest and the exponential effect of growing your earnings over time. But compounding doesn’t just exist in the financial markets—it’s also present in your job. Roughly speaking, anyone who has the ability to compound—to increase their earnings at a rate of 40% a year—will someday become a billionaire. Not many people have the ability to do that. But if you can compound at 20% a year, you will have a very comfortable life. The reality is that what goes on in the financial markets on a daily basis is

not all that important. People working in the markets think it is important, but it is mostly just sound and fury. That’s why the advice to invest in good times in bad, throughout the ups and downs—is generally good advice. Not many people have the ability to call big turning points in the market, and it almost never makes sense to be short. We have really only had one period of time in the history of the stock market where a patient investor wouldn’t be able to wait out a bear market—the period from 1929 to 1945. We have only had four great bear markets in the last 100 years, along with several corrections, which have been much more manageable. It’s therefore important to have a long time horizon. And the problem with being focused on markets in an attempt to time the market or individual stocks is that you must engage in short-termism. Focus on your job, invest regularly, and everything will work itself out.

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[ Q3 ] 2022

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INVESTMENTS Although I will say that the obsession that Americans have with the stock market is without precedent in the developed world. We are the only country that invests in risky, volatile stocks as a means to save for retirement. They do not do this in France. They put money in the bank. Americans are crazy gamblers, and healthcare professionals take more risk than most. The most simplistic explanation is that since stocks have gone up for the last 100 years, they must go up for the next 100 years. But there is no guarantee. The conditions that led to the gains in the last century may not be present for the next century. Hence, the need to diversify across asset classes. Minimize debt, compound your earnings, diversify across asset classes, and you will be very wealthy—with not a lot of stress. That is the key—the minimization

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of stress. Medicine can be a very stressful profession; why introduce additional stress into your life? The interesting thing about financial stress—a lot of people—doctors in particular—seek it out. It’s tough to focus on your job when you are worried about the bulletin board marijuana stock that you just bought. I try not to do things in the markets that get my heart rate up. Not to mention the other stressors that people deal with—family stress, marriage stress—introducing financial stress into your life is completely unnecessary. One last thing: Never make a financial decision based on something you saw in the media—whether TV, newspapers, or social media. Financial journalism is a big business, and they report on the here and now, not what is going to happen in the future. They have no predictive power. I cured myself

of reading newspapers a long time ago. Financial television, particularly CNBC, focuses on shiny objects—they talk about stocks after they have already gone up. They occasionally have some good interviews, but it’s mostly just noise. And the goal is to minimize or eliminate the noise that signifies nothing. n Jared Dillian is the editor of The Daily Dirtnap, a daily market newsletter for investment professionals. He holds degrees from the United States Coast Guard Academy in Math and Computer Science, and an MBA in finance from the University of San Francisco. Jared was a trader for Lehman Brothers specializing in index arbitrage and ETF trading. He is the author of STREET FREAK: Money And Madness At Lehman Brothers, and the novel ALL THE EVIL OF THIS WORLD, is a regular contributor at Mauldin Economics, Bloomberg, Forbes and TheStreet.com and is the host of The Jared Dillian Show, a nationally syndicated radio show on personal finance.

MD Next

[ Q3 ] 2022

By Michael Schmanske

Everybody has a plan until they get punched in the face. When the facts change so should your investment plans.

t’s official folks, the dance is over. Turn off the music and the last one out gets the lights. You don’t have to go home but you can’t stay here. The Fed (the Federal Open Market Committee) busted into the school gymnasium and stole the punchbowl by raising rates and ending Quantitative Easing. The impact started in May and the equity markets as a rule get ahead of the action, but be clear. This bear market will not be complete until we know that the Fed will be done tightening soon. In the meantime, the central bank is attempting to unwind the longest and largest monetary policy experiment in history.

[ Q3 ] 2022

MD Next

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If you read my blog, “Life, Inflation and the Pursuit of Alpha” from early 2021 (mdnext.co/finance/), you’ll know I was highly suspicious of both the Fed’s monetary policy and the crazy valuation it was driving in the public markets. Especially for those companies targeted as “growth at any price.” Unfortunately the same monetary bubble pandemic that infected retail investing during the rally from March 2020 through the end of last year also spread to many areas in Venture Capital (VC) and the

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[1]

Private Equity (PE) markets. Later pre-IPO rounds in particular became inflated, and many investors new to private markets jumped in heavily.

Global VC Deal Activity with Tiger Global Involvement

He who rides a tiger is afraid to dismount.

* As of July 26, 2021

[2]

[3]

Top 10 VC Investors in Q2 2021

SOURCE: YAHOO! FINANCE

Let’s use an example. Tiger Global is a hedge fund group that was widely recognized as a leader in the new race for expanding the investment landscape into private companies. They had $95 Billion assets under management as of October, ‘21. By the end of that year between fundraising and portfolio appreciation that had grown to more than $150B. Now? $75 Billion in AUM. Ouch! What happened? (hint, not withdrawals). Short answer—they jumped into a very frothy market with both feet. At the wrong time. Like a madman barista they were responsible for creating that very “froth”. (I wonder if they know how to make those cool shapes in the foam?). Let’s look at when their strategy changed. Initially, things were going swimmingly as they tore through the Venture Capital marketplace. Look at their growth [1]. In fact they were the single largest investor in VC in 2021. See the data for the second Quarter [2]. Unfortunately, the 3rd Quarter of 2021 was the absolute peak of speculative activity in these markets.

ARK Innovation ETF (ARKK)

NYSEArca - Nasdaq Real time Price. Currency in USD

OOPS! Did anyone get the license plate of that bus?

As of June 2nd the flagship fund had dropped 52% this year alone. Management is cutting fees and attempting to placate investors. It hasn’t stopped the bleeding. They recently created liquidation sidecar funds for investors to process redemptions in illiquid assets. Don’t blame Tiger or Private Equity alone. The bloodbath happened because of the growth obsessed activity in the public markets. Cathy Woods was a hero for years for the performance of her ARK fund. Followers of the market know what has happened there…. [3]

[ Q3 ] 2022

MD Next

Big outperformance (mountain)— and now back to in-line with the broader market (the S&P 500 index—the lower line). From a hero to a zero? No! That’s what a speculative asset does. Cathy is an intelligent investor who was also in the right place at the right time, then. Nowadays, not so much… Let’s look at the ultimate benchmark for speculative activity.

Bitcoin vs. the USD. [4] We could overlay lots of assets. The SPAC index, a meme stock index, daily trading volume. If I had the space I’d overlay the market data from 1999-2001. But I likely would not be highlighting things you have not heard already or know from personal experience. That’s one heck of a round trip!

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CCC – CoinMarketCap. Currency in USD

[5]

Utilities vs the Broad Market

SOURCE: YAHOO! FINANCE

Bitcoin USD (BTC-USD)

SOURCE: YAHOO! FINANCE

[4]

semiconductors and industrials—which do poorly as we anticipate a recession later this year or early in 2023. To be fair, I am at heart a value investor, so at the time of publication I actually like those cyclical and value sectors along with financials, homebuilders and many of the other hated sectors from the last decade. Value investors like to invest where no one else is looking because they believe “the truth will win out.” Growth investors like to buy ahead of other investors and sell to them as the asset appreciates. But I’ll like those sectors a lot better when I know the recession and fed rate hikes are past us. In the meantime, cheap stocks can get cheaper. Your broker will likely advise you to hide in MSFT, AAPL and other high power, cashflow-strong tech names. This is not a bad idea but they also won’t outperform the market greatly over the next five years because that’s where everyone is already hiding.

Where do we go now?

The times they are a changin’.

The fact is money wants to go where it will be rewarded. In speculative markets one is not rewarded by being right about a company, rather you are rewarded for being right about where everyone else is going next. Economists call it the “Keynesian Beauty Contest”; judges “win” by selecting the faces they believe the rest of the voters will find most attractive, rather than those they may personally find the most attractive. Think of it as gambling on who the audience will pick for America’s Got Talent. It is a valuable model to keep in mind to help view the financial markets with healthy skepticism, but not particularly informative for good investing. More importantly: What does this mean from here? Are you looking to

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manage a fully invested portfolio or do you have money to allocate—“Dry Powder?” Let’s focus on investing your dry powder, because discussing what to do if you are completely all-in already will likely require some therapy first. Or at least a double of good bourbon. Classically, in this phase of the market we are meant to look for defensive stocks: Utilities, Consumer staples, etc. [5] That chart is Utilities vs the broad market…. So that was a good idea—but you’re late; grab a seat where you can because it has outperformed by 20% in the past year. Staples and other defensive sectors are all similar. Energy ripped on inflation fears but has come back down quickly as we pivot to recession risks and growth fears. That fear of slowing growth also precludes other pro-cyclical sectors like

I’ve said it before, I’ll say it again: I’m working in this field because I believe early-stage healthcare represents the single greatest secular investment opportunity in any field, sector or asset class. Repeat after me: “You can find growth and good value in an inflationprotected, uncorrelated investment with strong long-term trends.” (Hmmmm, I might use that as a meditation mantra. It just makes me feel all warm inside.) Why is that early stage healthcare? • Valuations: These companies need money, so your entry point is cheap. • Growth: If successful they grow like crazy but that’s on a case by case basis so you need to travel with educated companions. • Healthcare is inflation protected: In fact most innovation is helped by inflation as providers seek to improve productivity to offset increased costs. • Demographics: The need for and money spent on healthcare will only increase over time both due to aging and global economic integration.

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[ Q3 ] 2022

(To manage this see productivity concerns above as an example). • Isolated from the investment cycle: The nature of early stage healthcare means you do not blow in the wind of the broader markets. Don’t invest like a Tiger, invest like a Builder. How are they different from the aforementioned Tiger global strategy? Their philosophy of “move fast and move on to the next deal” led them to invest primarily in companies that were hot or sexy. They based their investments on the Keynesian Beauty Contest model I mentioned earlier. Specifically whether the market will continue to finance the company at higher valuations during follow-on funding rounds by feeding off of later investors. This is a great strategy so long as the music keeps playing, but now it’s time to find a chair. Flying taxis, multiple Electric Vehicle companies, asteroid mining SPACs and Web 3.0 might play out very well eventually, but I’ll invest in the steak not the sizzle thank you. Here is the thing: you can participate in market timing if you like. I prefer to believe long term returns are generated by choosing great companies, investing at the right price and working with the company to create value. If you agree with this philosophy, I highly recommend checking out the startups in the AngelMD community. Do the work, the most valuable investment is your time. Stay tuned for future finance content and AngelMD Academy classes on these topics and many others. If you’d like to know more please reach out at MDNext@AngelMD.com. n Michael Schmanske is a 24-year Wall Street veteran with experience on trading desks and asset managers. He graduated with degrees in Aerospace Engineering from MIT and a Masters from Princeton University. Mike is the Managing Director for AngelMD Capital and runs research and Analytics at AngelMD where he is happy to exercise his inner nerd on a regular basis by supporting the most innovative entrepreneurs and cutting-edge medical startups.

[ Q3 ] 2022

MD Next

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[ Q3 ] 2022

MD Next

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By Julie Fanning

A sit-down with innovative wine industry leader Chris Pearmund on his latest endeavor—the first of its kind The 400th anniversary of Virginia winemaking was celebrated in 2019. Initially it was quite challenging for colonists and farmers to cultivate the vines brought from Europe in Virginia’s humid climate, soil conditions and plagued by various diseases. By the 1800s real progress took place, from the discovery of the native Virginia grape, the Norton, to the grafting of European vines to make them more resilient to Virginia’s harsh growing conditions. Fast forward through the 20th century, from struggles during prohibition to the second act of Virginia’s wine industry starting in 1967 and really taking off in the 1980s. Winemaking continued to evolve and adjust. This is where Chris Pearmund enters into the Commonwealth’s wine story. Winemaker Chris Pearmund has an eclectic background, from a stint in the U.S. Air Force to coursework in Marine Biology when he was in California. But it was his time taking restaurant classes as a young teen, working in commercial kitchens, becoming a chef and getting more exposure to fine dining and fine wines that solidified his direction to become a winemaker. He basically consumed himself with learning all that he could by visiting various Virginia wineries and by the late 1980s worked for one winery and delved into the entire winemaking process, learning all components of the business. By 1993

he purchased his first vineyard and subsequently aided in 17 Virginia winery openings; his entrepreneural mindset in an industry and art that has flourished for thousands of years took flight. In his career as a winemaker, Chris Pearmund has spearheaded many wine industry programs for producers and consumers alike. These programs include the country’s first barrel racking system (shown on p. 61), designed barrel club ownership for wine club members and the first Vineyard Insurance program via Rain and Hall, which covers vineyard workers. He has held prestigious positions (such as president of the Virginia

PHOTOS BY JULIE FANNING

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[ Q3 ] 2022

Vineyards Association for approximately four years and board member of the Virginia Wineries Association) and is a nationally certified wine judge by the American Wine Society. Additionally, Pearmund has unequivocally been one of the biggest advocates for Virginia winegrowers and Virginia farmers/ agriculturalists, and often his projects take into consideration the historical relevance of the properties on which they reside. Over the years Pearmund has implemented many new technologies and methodologies to the craft of winemaking—increasing efficiency and quality of the wines they produce. I recently caught up with Chris at his legacy winery, Pearmund Cellars—built in 2002 in the middle of Meriwether Vineyard, Virginia’s oldest vineyard—to talk about his latest groundbreaking endeavor: Clearly. Pearmund is the first in the United States to offer these unique clear “cans” of chilled wines, available in three options: a white blend, sangria and rosé. Julie: What made you decide to explore this packaging option? Chris Pearmund: We’ve been looking at cans for about four years. And it’s a very small part of the marketplace. The bigger picture to me is the carbon footprint of glass bottles. When you look at the cost of a bottle of wine, from a manufacturing standpoint, 50% of the cost is actually the packaging: glass, cork, capsule, label. And the carbon footprint is huge. So for the $80 billion wine industry in the United States, that translates to a huge carbon footprint that we are all cognizant of, and what can be done to change the public’s perception of traditional packaging, change how we do things [in our industry] and keep the product long-lived. Innovation in packaging is heavily needed in our industry. And we’ve been looking at it for 10 years as an industry—myself included. So this company, who designed the material of the [Clearly product] packaging, is in Texas. They were

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MD Next

Pearmund is the first in the world to use this special clear can technology in wine packaging. looking for a canning manufacturer in the United States—and there’s a very good one that’s in Milwaukee, Wisconsin, that has high-technology canning ability for wine, and they had just sold a unit of this canning product to a company in Richmond. We are a company that they like and want to do business with. And they came to me and said, ‘Hey, we’ve got this new product in Texas. It’s never been used before. Do you want to be a guinea pig?’ And I have my hand up at every single guinea pig opportunity there is—you never know where it’s gonna go. So last summer we started with this project. Some of the cool factors: It is clear. It has no BPA. It’s unique. It’s environmentally responsible. It’s 100% made in the United States. The can’s material is lined with molecular absorption material which scavenges oxygen from the wine to keep it fresh longer. But because it’s clear, do you have the same concern

as glass bottles, allowing the sun to degrade the wine? Pearmund: That is a concern that isn’t addressed with this can—you don’t want to leave them in the sun or store them in a hot car for hours and toss them on ice when you get to the beach. No, you don’t do that. It’s still a bottle of wine you need to respect. Unfortunately I think this will happen because of the convenience factor. But here’s the unique technology factor: You know sponges absorb water. A molecular sponge is incredibly small, designed to absorb certain molecules of different sizes. In the design of this package are molecular sponges to scavenge and absorb oxygen to keep the wine fresher longer. First of its type. [Previously], canned wine has had a problem because of the high acidity, low pH and alcohol, such that the product doesn’t last very long. Oxygen acts weird. The aluminum on the top acts weird.

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Chris Pearmund

Well it affects the taste….. Pearmund: Not just taste, but a lot of little things happen in a low pH. Wine has not been good for [aluminum] cans and cans have not been good for wine in the past. And this is the first product—we’re the first ones in the world to use this— as a possible answer. It is completely recyclable, it has carbon footprint savings. But when this wine is canned… in the lining of this aluminum cap is a molecular absorption path for oxygen to keep the wine fresher longer. So our longevity issue should be better than [traditional] cans and the technology of not tainting the flavor from a consumer standpoint is pretty cool.

• Winemaker

Well it’s also great because it’s so portable and not breakable. The can’s slim enough to fit into a cooler, you can pop it open, you don’t need an opener or to deal with a screw cap. It’s easy to have a nice glass of wine wherever you might go. But I would think it’s also a convenience factor for someone to have wine without the commitment of a bottle.

Former board member of the Virginia Wineries Association

Pearmund: So this can innovation answers some of the questions of small quantity to people who want this. And one of the misconceptions—often a reality in alternative packaging is— you’re trying to make something less expensive and [appealing]. But you’re also normally putting a really crappy wine into it. So boxed wine, canned wine, magnums…that are packagesaving ideas are often the result of inexpensive wines trying to bring the cost down as low as possible. When you have 50% of your cost in packaging, and 50% in product, if you take your packaging cost and drop it by 30%, your net savings on the entire product is like 15%. And you’re not competitively benefited by a 30% packaged cost drop. So if you drop your package by 50%, you’ll only have a 25% net cost savings of your entire product. You have to put cheaper wine into it to be competitive in the marketplace with alternative packaging.

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• Chef • Restauranteur • Certified wine judge • Instructor ••• Developed the country’s first barrel racking system (shown here) President of the Virginia Vineyards Association 1996–2000 First chairman of the Virginia Wine and Food Society

Publisher, The Grape Press (quarterly professional vineyard trade publication) Instructor at the Masters of Wine program in London Spearheaded a limited edition red blend collaboration, Virginia’s Heritage, with 16 wineries to commemorate Virginia’s 400th anniversary of winemaking •••

CURRENT WINERIES— Pearmund Cellars: www.pearmundcellars.com Effingham Manor: www.effinghammanor.com Vint Hill Craft Winery: www.vinthillcraftwinery.com

There’s a lot of effort with Clearly to be a quality product. If I’m going to put my crappiest 10,000 gallons of wine in the cans and make it sweet and hide the taste, then we as an industry are shooting ourselves in the foot with innovations in packaging. Winegrowers are farmers. Carbon footprint should be

Multiple award-winning wines which include: Chardonnay, Viognier, Riesling, Late Harvest Vidal, Merlot, Cabernet Franc, Cabernet Sauvignon, Petit Verdot, Ameritage, Tannat

primary. Done right, the economics will follow. If the quality isn’t inside the clear can, the customers won’t come back. That method of thinking and packaging model can potentially open you up to a newer, younger demographic; from what I’ve read,

MD Next

[ Q3 ] 2022

24% of wine drinkers are millennials, and 29% of them drink every night. A lot of younger people are environmentally conscious—as are boomers. It’s intriguing to have something palatable in a portable package such as this, but I would think from a marketing standpoint, it may open things up for its sustainability as well. Pearmund: I was in London at the wine show 10 years ago and saw something that I thought was was going to take off and we invested into it, but it never took off. It was a bag in a box. You have a collapsible bag and the box surrounds it. It was a wine-shaped box that was already 90% recycled cardboard, and it folded into itself. As the bag collapses, you’re not getting any oxygen into it and the wine lasts longer inside of the cardboard. It was designed to have wine so it’s not gonna go bad. And when that bag is empty, you rip open the cardboard and you throw the cardboard and the plastic into the recycle bin. You have a lower carbon footprint, lower-cost recyclable container. And we couldn’t get the public to do it. We tried it in three different countries. Innovation does have to happen for a variety of reasons for sustainability of businesses as you move forward, as well as for the globe. Pearmund: Our history in the last 150 years has been a huge amount of innovation at screaming fast pace for economic and lifestyle benefit, not for environment, and that has to change. We all have air conditioning, nice cars, paved roads, cell phones…wonderful. None of these things initially came with environmental concerns. They’re economic business development and lifestyle development. You are not one to rest on his laurels, but seemingly look for the next improvement or idea in the wine industry—and in this case, the environment is a consideration. Any final thoughts?

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MD Next

Pearmund: So, clearly, these plastic cans are not the answer. This can is an innovation. It has some importance, but it is not the answer. And people can like it, ignore it, love it, embrace it, but they need to understand it. And my question and challenge is, what’s next? What can our industry and what can you as an individual do to address

not just economics and lifestyle, but environment? Because those are the three legs we stand on. What’s next? n Julie Fanning is MD Next’s chief creative officer. A graphic designer by trade and occasional writer by opportunity, she loves Virginia wine and how its evolution is finally getting noticed by professional and novice tasters across the globe.

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PHYSICIAN PROFILE

Doug Freedberg, M.D.

Maintaining bodies and performance in professional sports By Tobin Arthur david straight

Anyone who watches football has seen the team physician walking onto the field to look after an injured athlete. What’s not as clear is just who these people are and how they got into such a role. We’ll get a glimpse into this world through the experience of Doug Freedberg, M.D., a team physician for the Arizona Cardinals, and a consultant to the Oakland Athletics for more than 23 years.

[ Q3 ] 2022

MD Next

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COURTESY OF ARIZONA CARDINALS

After generously spending time providing input for this article, Dr. Freedberg was heading to dinner with Reinhold Schmieding, the Founder/CEO of Arthrex. The combination of sporting events and socializing with medical device executives feels like it would be more the norm for physicians in this space than most others. Doug Freedberg grew up and graduated high school in New York. The only time he was out of New York was when he went to Arizona to visit his snowbirding grandparents, who subsequently moved permanently to the state. Later, his older brother attended the University of Arizona,

which got Doug thinking more about Arizona and warm weather. He realizes it sounds trivial, but he had had enough of the cold. In fact, Arizona was the school furthest East he even applied to for his undergrad studies. He even had an advisor in high school who encouraged him to apply to Harvard because he would serve as one of his regional interviewers, and thought Doug would do well there. At that point in his life, he just had no interest. Ironically, he would later end up back in New York doing residency at Hospital for Special Surgery (HSS), the top ranked orthopedic program in the country. Doug Freedberg, M.D.

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[ Q3 ] 2022

School came pretty easy to Dr. Freedberg, but there was no notable family influence encouraging his pursuit of medicine. He did have an uncle who was a psychiatrist, but suggests that had little impact. In school, he was perfectly capable of committing things to memory and performing other academic necessities, but nothing really held a lot of meaning except science and the notion of how the body worked. After entering medical school, he quickly learned that students were split between those who liked the anatomy lab and those who didn’t. Those that didn’t like the lab, and getting into the body, tended to head toward internal medicine, psychiatry etc. In Doug’s case, he felt like he had been given access to an obscure fraternity where you got to dig into how the inner body worked. He was less interested in the general surgery route, but wanted to do something physical. When he had the

[ Q3 ] 2022

MD Next

chance to do some hand surgery, he felt almost like a puppeteer seeing how parts moved etc. Orthopedics had him hooked. While at HSS, Dr. Freedberg and his colleagues would regularly cover sporting events and work with athletes ranging from football to baseball to tennis and even cricket. Residency surely doesn’t pay well, but the ability to work daily with some of the finest orthopedic surgeons in the world and the exposure to NYC’s particular variety of patients from all walks of life, including those well known to many, was an unparalleled experience. After his Residency at HSS, Dr. Freedberg had the chance to do a Fellowship in Birmingham, Alabama, under the tutelage of James Andrews, MD. From high school students to local grandmas to world renowned athletes who would be featured on ESPN, Dr. Andrews treated all patients the same

Dr. Freedberg (left) at Fenway Park with former Oakland A’s Physical Therapist Paul Hospenthal.

and this became a powerful lesson in Dr. Freedberg’s orthopedic practice and in his life. Between this experience, and HSS, he was increasingly getting exposed to team sports in addition to working with individual athletes. As Dr. Freedberg reflects on his decision to go the orthopedic route, he notes that he was attracted to people that were injured versus sick. The difference is that the injured patient is immediately a partner in the process. They got hurt playing basketball, pickleball, skiing etc. and they want to get back to it. They are motivated, and their participation is critical to the process. Dr. Freedberg also mentioned the satisfaction of educating patients

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Dr. Destin Hill (left) and Dr. Freedberg (far right) at the Pro Bowl with ESPN anchor Chris “Boomer” Berman (center)

about the procedures and options available. For example, patients may come in with the notion that a total knee replacement is in fact a total knee replacement. In reality, the procedure is more like shaving and resurfacing the bone. He shared that when he shows people the models and implants in his office, they are often surprised at how small things are in actuality. Good surprises I am sure. Arizona had remained a strong pull and that’s where he has remained ever since. Shortly after arriving in Phoenix, he was playing golf with a physical therapist who worked with the Oakland A’s and asked if he would have interest in getting involved. That began his decades-long relationship with the A’s. Over the years Dr. Freedberg traveled often to Oakland, participated in occasional road series with the team, and took trips to minor-league facilities in Vermont and the Academy in the Dominican Republic. In coordination with the team physicians in Oakland, spring training and draft-time add extra work as does frequent groups of players visiting from Latin America. While plenty of work on the athletes happens in Oakland, or elsewhere, it’s not a hard draw for athletes when they can do their surgery and rehab in Phoenix. Between Spring Training, the long regular season and international markets, the work is pretty much February through November. Football is also now a year-round effort. Between summer training, OTA’s and mini camps, training camp and the regular season (and hopefully the postseason), the work is essentially 12 months a year. The types of injuries are obviously different between football and baseball. Outside of the pro sports work, the Dr. Gary Waslewski (left), Dr. Freedberg and (right) Dr. Destin Hill at the NFL Combine

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MATT DODD

Oakland Coliseum, the A’s home field

majority of the patient volume centers around the amateur and youth athlete. Dr. Freedberg shared that youth injuries are on the rise due to specialization… especially in throwing sports like baseball. In addition to the rise in youth injuries, one of the fastest growing categories of injuries is pickleball. As the sport skyrockets in popularity, Dr. Freedberg is seeing more and more weekend warriors in for treatment tied to the sport. Having worked hard for a lot of years and covering countless games, one of the rewards Dr. Freedberg now enjoys is the ability to periodically sit in the stands with his kids and watch a game as a fan. While this may seem simple, it has taken years to earn the opportunity to not be working the game, and instead to spend time as a dad and a fan. He offered that it’s

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One of the fastest growing categories of injuries is pickleball. As the sport skyrockets in popularity, more and more weekend warriors seek treatment tied to the sport. certainly a lot more fun when the teams are winning, even though his role remains the same regardless. But playing some role in team success has its own reward. Like a lot of physicians, as Dr. Freedberg has become more established in his career, he has branched out into new opportunities here and there. He has enjoyed doing

some advisory work, participating in some startup and industry advisory work, an ASC venture and generally looking for ways to leverage his expertise in areas outside direct clinical work. He has also done other professional sports team work over the years, including basketball and hockey. And, like other physicians, he had to pay his dues. While that meant time away from family, working nights and weekends and much more, you get the sense that the opportunity to serve patients who are partnered in the process of recovery— some famous, most not—has made this an enjoyable career. n Tobin Arthur is founder and Chairman of AngelMD and an avid sports fan. One of the primary reasons he launched AngelMD was to showcase hardworking and forward-thinking physicians.

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GIVING BACK

Project C.U.R.E. PHOTOS COURTESY OF PROJECT C.U.R.E.

by Alex Raymond For thirty-five years, Project C.U.R.E. has delivered life-saving medical equipment and supplies to hospitals and clinics in more than 135 countries. The organization has delivered so many supplies that they are, in fact, the world’s largest supplier of medical relief. They are the Amazon.com of charity medical relief supplies—all of which warrants a deeper look into this incredible organization. Let’s start with some of the incredible numbers behind the operation. On average each week, Project C.U.R.E. delivers 3 to 5 semi truck loads of medical equipment and supplies. During the height of the COVID pandemic, the organization delivered badly needed PPE for U.S. healthworkers equating to 540 shipments of PPE and breaks down to 18,000 boxes sent to over 575 U.S. cities. During the challenging COVID period, they continued to execute on their global mission delivering over $60.7M worth of equipment and supplies using 183 cargo containers and touching 48 countries. Somehow they managed to open their seventh distribution center—this one in Kansas City.

How it started

In 1987, Dr. James Jackson traveled to South America as a consultant to the President of Brazil. Prior to this, he had built a successful career developing ski resort towns in Colorado. During his visit to Brazil, he toured a small medical clinic in Campinas, just outside of Rio de Janeiro. What he witnessed moved him to his core: doctors and nurses without resources to do their jobs, communities without access to basic healthcare, and people needlessly dying without hope. Upon returning to Colorado, Jim and his wife AnnaMarie began to collect donated medical supplies to send to

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Brazil. Through the generosity of friends and acquaintances, they filled their garage with these donated medical supplies and paid to deliver those lifesaving items to the people who needed it most. And from that first humble shipment to Brazil, the foundation of Project C.U.R.E. was laid. Over the last 30 years, Project C.U.R.E. has grown into the world’s largest distributor of donated medical relief. Fast forward, and a young Doug Jackson thought his calling was in the business world. He spent his early adulthood earning a doctorate in Finance with a specialization in debt —specifically junk bonds. Not entirely sure where this was leading him, his father convinced him he should spend his career serving others. Doug has since built on the legacy his father started by guiding and building the organization to its current size: seven distribution centers delivering 200 semicontainer loads around the world each

Recent volunteers from Loyola University Chicago Stritch School of Medicine came together to palletize boxes bound for Ukraine.

year managed by a small staff and more than 30,000 volunteers. Between 30% and 40% of the shipping volume is tied to durable medical equipment. The Cure Cargo program is the primary way in which the organization distributes its donated goods. This, and other elements of the supply chain underneath Project C.U.R.E., were stressed during the COVID pandemic. However, the organization adapted quickly and actually set a new record for shipments demonstrating a truly entrepreneurial spirit. The Project C.U.R.E. International Headquarters is in South Denver; other locations include Chicago, Houston, Philadelphia, Nashville, Phoenix and newcomer Kansas City. Each city includes a distribution center where they accept donations of used medical supplies and equipment, and where

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GIVING BACK

Project C.U.R.E. has grown into the world’s largest distributor of donated medical relief. their cadre of volunteers sort and prepare the items for shipment to locations all over the world. Each of the locations include office space for Project C.U.R.E.’s administrative, development, and operations staff and serves as the intake location for medical donations. By the way, volunteering at one of the distribution centers is a great way to get involved with Project C.U.R.E. and to give back.

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I mentioned the small staff and 30,000+ volunteers. What I didn’t mention is that annually this cadre donates over 160,000 hours of service. While the numbers were hampered during the COVID lockdowns, they are rapidly returning to pre-COVID levels. Over 60% of volunteers become repeat volunteers and hundreds contribute more than 100 hours of service! The dedication is remarkable. The

organization has an internal calculation to estimate the cost savings from volunteers and it places the annual number in the ballpark of $2.5M. In addition to hospitals, medical manufacturers and distributors have contributed significantly to the goods donated. Materials include everything from hospital beds to gurneys, to anesthesia machines and infant incubators. Materials can range

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GIVING BACK

from new to refurbished and often qualify for tax credits for the donating organization. One organization worth calling out for their incredible generosity is Stryker. While they have been helping Project C.U.R.E. for 15 years, in August of 2020 they announced a donation of 22,500 Emergency Relief Bed (ERB) kits, representing the single largest donation to the organization to date. The bed donation was spurred by the expectation that hospitals would run low on bed space during the COVID pandemic. Stryker responded by developing the low-cost, limited-release emergency response bed—designed specifically to serve on the front lines of the pandemic. When U.S. surges didn’t ultimately hit the thresholds set to trigger use of the ERBs, Stryker worked with Project C.U.R.E. to distribute the beds into parts of the world that did have the need. The ERB kit includes a bed frame, mattress and IV pole. In addition to the mattresses, Stryker contributed an additional 6,000 mattresses to serve as replacements as needed. The partnership with Stryker now includes a Neuro Kit, an Orthopedic Drill kit, a Spine Kit, an ENT kit and more. This partnership has literally impacted tens of thousands

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of lives around the globe and is an incredible reflection of the generosity of the Stryker organization which includes its board, management and employees. Project C.U.R.E.’s corporate partners extend well beyond medical goods; companies include shipping and logistics organizations. One notable pair of partners is Boeing and Uzbekistan Airways. In May of 2021, eight pallets of

medical equipment and relief supplies were transported from Seattle to Tashkent by a new 787-8 Dreamliner, the last of seven in a fleet being delivered to Uzbekistan Airways. The supplies were sent into a region where geographical constraints and world events have created substantial need. High rates of disease and maternal mortality are significant problems. After collecting

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GIVING BACK

the needed supplies from around the U.S., Project C.U.R.E. worked with the Uzbekistan embassy to arrange delivery. The total delivery was approximately six tons of material including hospital beds, mattresses and wheelchairs. Prior to shipment, an official ceremony celebrating the donation was attended by Uzbek diplomats and executives from Boeing.

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Project C.U.R.E. relies on significant financial contributions in addition to the volunteer hours and equipment donations. Corporate donations represent just over half of the organization’s financial support, followed by 33% coming from individual donations and almost 6% coming from foundations. The organization achieves an impressive operational efficiency

with a combined administrative and fundraising cost of 2%—meaning that 98 cents on the dollar goes directly to helping those in need. The impact of work being done by Project C.U.R.E. cannot be captured simply by the numbers, but it’s critical that the organization continues to expand its network of supporters. If you are a potential supplier of medical equipment or supplies, a volunteer willing to help or someone willing to make a financial contribution, this organization is worth your investment. Contact information and a donation link are available on their website: projectcure.org. n Alex Raymond is a freelance writer with interests in healthcare, technology and finance. He graduated from Yale and is an avid polo player.

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YOGENDRA SINGH

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By Ramesh Donepudi, M.D., MRCP

Bowling Over the American Market THE RISE OF CRICKET ’m sure many of you have noticed a bunch of Indians getting together and playing a somewhat strange sport on your local fields and wondered what they were doing. Some of you may have even dared to go and watch the game for a little bit to try and understand what was happening, but determined it was too complicated to follow. What is that odd paddle the players were holding and swinging? Why are they running back and forth between those pieces of wood stuck in the ground? Why do they scream collectively in the middle of the game? Weird, it seems at first. Well, this is your chance to make another acquaintance with one of the fastest growing sports in the world: Cricket.

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I am not going to bore you with the origins of the game, as you can Wiki the details on your own. But it’s worth mentioning the trajectory of sport on the world stage. What started as a colonial masters pastime became a national obsession in India over the past century, and now is on track to becoming a mainstream sport in North America. Cricket is played in 104 countries—and that number is growing. Cricket has been in the news recently due to sizable investments being made into the sport. Microsoft’s current CEO Satya Nadella, along with Ross Perot, Jr., has reportedly committed an investment of $120 million in U.S. Major League Cricket (MLC). The money will go to developing stadium-based infrastructures and building a more feasible framework for U.S. cricket. Mukesh Ambani, the world’s seventh-richest man, is seeking his next fortune in a content-streaming enterprise for cricket. There are many active cricket leagues being played in the U.S., with more than 200,000 players playing the game in America. USA Cricket (USAC) is the governing body of cricket in the United States. USA Cricket operates all of the U.S. national representative cricket sides—including the men’s and women’s national teams and youth teams—as well as Minor League Cricket, which is the highest level of domestic American Twenty20 cricket. The game resembles baseball in some aspects, but it is very versatile and has a 360 degree field of play. There are three main formats of the game that facilitate a host of variations in bowling (pitching) and batting (hitting). The T20 format is the most popular format. It’s fast paced, thrilling to watch, and keeps one on the edge. The game is played as two innings and the team batting first sets a target and the second team chases the target. It requires a combination of skill, athleticism, team play, strategy, personal temperament, etc. The longer formats of the game are for purists, as they say, but still exciting to follow. Cricketing nations have tours where a national team visits another

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Florida west coast winter league end-of-season trophy presentation: best batsman, Satish Kumar (left) and league organizer Dinesh Kumar (far right) are featured.

country and plays a series of games over a period of 8–12 weeks.

Cricket 101

Some of the basics: Cricket is played with two teams of 11 players each. As with baseball, each team takes turns batting and playing the field. The bowler (pitcher) tries to knock down the bail of the wicket. A batsman tries to prevent the bowler from hitting the wicket by hitting the ball. Two batsmen are on the pitch at the same time.

Scoring

The batters run after the ball is hit. A run is scored each time they change places on the pitch. The team with the highest number of runs (typically in the hundreds) wins the match. 6 runs: A ball hit out of the field on a fly. 4 runs: A ball hit out of the field on a bounce.

Outs (Dismissals)

Bowled out: Bowler knocks over (breaks) the wicket with a bowl. Caught out: Fielder catches a batted ball on the fly Run out: Fielder catches ground ball and throws it at the wicket, knocking it down before the batsman gets there. Leg before wicket: Batsman’s body interferes with a bowled ball that would hit the wicket.

Cricket has more than 2.5 billion fans across the globe—and many of those fans are in the United States. The Field

There are 11 players per team positioned around the oval.

The Ball

Construction: Core of cork built up with string; has raised seams. Size: Circumference around 9 inches (slightly smaller, harder and heavier than a baseball).

The Bat

Construction: Made of willow wood, with a maximum width of 4.25 inches, and a maximum length of 38 inches.

The Game is Over When...

Sides take turns batting and fielding. Each at-bat, called an “over,” comprises no more than six bowls per batsman. The fielding team must retire or dismiss 10 batsmen to end the innings (always plural). World Cup matches are limited to one inning per team and a limit of 50 overs per inning. Non-elimination games are limited to a single day. Elimination games are allowed a second day if needed.

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Cricket Jargon

MARCUS WALLIS

Bumper or bouncer: A short pitched ball targeted at head height. Bunny: Lower order batsman who is easy to dismiss. Dibbly-dobbly: A medium to slowmoving bowler. Googly or Wrong’un: A ball from the leg spinner which spins the other way. Howzat: What fielders yell when they are appealing for a wicket. Jaffa: Unplayable ball. No Ball: Illegal delivery which adds 1 run to the batting team’s total. Quack or Duck: When a batsman is dismissed without scoring. Ramp: When the ball is intentionally guided over the top of the wicket keeper and slips from fast-paced bowling. Village: Mindless or mediocre play. Waft: An unconvincing shot where the batsman waves the bat at the ball without making contact. Yorker: A full pitched ball aimed at the batsman’s toes or on the crease line. Zooter: A leg spin delivery which skids through low and quick. I highly recommend watching IPL (Indian premier league) action, which attracts top international talent from all cricket playing nations; a brief list of cricket resources is below. It is a great team sport and teaches many valuable lessons to young children. And as with all sports, it’s an incredible way to make new friends and stay active. So next time you see cricket being played at a local field, go out there and watch your local friends play and cheer them on. Happy cricketing! n Indian Premier League: www.iplt20.com International Cricket Council: www.icc-cricket.com USA Cricket: www.usacricket.org Ramesh Donepudi, M.D., MRCP is a pulmonary, critical care and sleep physician and entrepreneur. He is a cricket lover and an avid cricketer.

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[ Q3 ] 2022

NEWS OF THE WEIRD

The Last Laugh Pull My Finger According to the Moscow Associated Press, a robot recently attempted to take a chess piece from its 7-year-old opponent during a Moscow Chess Open tournament, and grabbed his finger instead. “The robot broke the child’s finger,” Sergei Lazarev, President of the Moscow Chess Federation, told the Russian TASS agency. It took four adults to extricate the boy’s finger from the robot’s grip. While this particular robot has competed without any issues in several other events hosted by the chess federation, this was a first. Fortunately the boy returned to finish the tournament the next day—his finger in a cast. No word on a re-match.

An Old Fashioned—with a Side of Cocktail Sauce New Hampshire’s Tamworth Distilling is a bold producer of small batch craft spirits—from local grains and gardens to glass. According to the distillery, their “test kitchen serves as a hub for experiments and innovations that fuel our creativity.” That creative spirit now includes Crab Trapper Whiskey. The green crab is an insanely invasive species and their numbers are out of control. So in an effort to bring awareness to the issue as well as make something unique, this whiskey came to fruition. Will Robinson, Tamworth Distilling’s product developer, explains that after making a crab stock, they distill it using a vacuum still—a glass machine that allows for precise temperature control. “It preserves the flavor and aroma molecules that would get destroyed if we were to boil it,” says Robinson. The stock is mixed with spices, combined with a bourbon base and voila: whiskey.

VINICIUS AMANO

An appointment to get a tooth filled became much more than a routine dental visit. Earlier this year, Tom Jozsi was in the chair and at one moment he inhaled just prior to coughing. He was told he swallowed a tool, but in actuality he had inhaled the 1-inch bit, sending it deep into his lung. “I didn’t really even feel it going down. All I felt was a cough. When they did the CT scan they realized, you didn’t swallow it, you inhaled it,” Jozsi told WISN 12 News. Dr. Abdul Alraiyes and his team at the Aurora Medical Center in Kenosha, Wisconsin, came up with a creative way to get the drill bit out using a robotic bronchoscopy—a technique usually used to detect tiny lung cancer nodules. Foreign objects in the lung usually require surgery to remove part of the lung along with the stuck object. Luckily the small size of the catheter allowed them to navigate the narrow airways and remove the drill bit without damaging Jozsi’s lung.

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ARTREFERENCESOURCE/LEN

High-tech Tooth Fairy

Fembots Preferred And in other robot news: Even prior to COVID, the hospitality industry struggled with high staff turnover. A study by Washington State University researcher Soobin Seo surveyed approximately 170 people on hypothetical service robot scenarios. Findings showed that people are more comfortable interacting with female rather than male robots—particularly when the robots had more human features. According to participants, female robots are supposedly more effective in delivering comfort to patrons, perhaps due to the gender stereotyping typical in the service industry. Seo said that most hotels implemented robots for functions such as room cleaning and dishwashing, but further developments may also lead to customer service from robots in the near future. George Jetson may want to have Rosey do a reboot.

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