Monte Eaves’ a Kauffman Success Story

Monte Eaves is a professor of surgery at Emory University and Medical Director at Emory Aesthetic Center. He is also the man behind EMRGE, a company developing products that are revolutionizing the wound closure industry. EMRGE challenges the traditional needle and thread wound closure procedure with noninvasive and cost-effective technology that promotes healing and minimizes scarring. For this, Eaves was recently awarded the Office of Technology Transfer (OTT) award for 2017 Startup of The Year, one of many achievements. Shortly after, we got to talk with him about how he got there and the role OTT and Emory’s Kauffman Foundation FastTrac® TechVenture™ course for entrepreneurs played in helping him along the way.

Monte Eaves

Tell me a little about the origins of your startup company.

So I was a resident here at Emory in the ‘90s. I worked with one of the surgeons named Alan Lumsden and we were co-inventors of the first endoscopic vein harvesting system. Through the OTT we licensed that to Endosurgery Johnson & Johnson, and that product is still made today, more than 20 years later. It was eventually sold to Sorin, and it’s called ClearGlide®. That technology and its derivative products are now used in about 70 percent of heart bypasses. It’s really cool that one product could make such a difference, and that’s what gave me the bug.

Then I left Emory for about 15 years from 1997 to 2013. I had six additional patents that were licensed, but what I found was very frequently this intellectual property (IP) had a hard time actually getting significant and ultimately are just mothballed. I began developing the wound closure technology in 2010, but I was at a loss about how to move it forward until I came back to Emory where OTT really helped me get started and connected me to people in the community. They helped me sign up for the Kauffman course which was quite helpful, and got me into a southeast bio business plan competition. That’s what got me moving toward creating a company.

How did you realize there was this niche opportunity for you in the medical marketplace? What was your thinking process when first developing your products?

Our technology addresses a pretty well recognized need. I actually worked for two years with Johnson and Johnson in the field; I had an inventor’s agreement with them to try and develop new wound closure technology. They were always looking for things that would be faster, less invasive, and would improve scars. And yet, if you look at the majority of the way we close wounds it’s the same way we closed wounds 5,000 years ago; a needle and thread.

I’ve been aware that this was an area in need for a while now. As I was exploring the possibilities I probably tried 50 different technologies, trying to do it internally or trying to do it on the surface. Then one night I was thinking “Okay, I’ve really got to think outside the box. Well… what is the box?” I had to first figure out what box I had put myself in.

I started thinking, the box was that it had to be flat to the surface, or it had to be underneath. I kept examining, “If I can’t be underneath and I can’t be on top, what’s left?” Then I started thinking about Breathe Right® nasal strips and how they bend and flex. We took that concept but reversed it. This creates the forces that can push, turn, and twist tissues, but do it externally.

It’s a dynamic device that has two arcs of rotation, one opens it up and one pushes down this little footplate that’s like a strut, and between those two they create the right action to bring it all together. The process was, for me, a very interesting learning experience; when we’re trying to be creative and original we have to figure out what box we’ve put ourselves into.

Was there any other specific event or experience that got you thinking about creating your own startup?

After a certain point of getting IP mothballed and having projects that just don’t take off, you realize that sometimes you’re just going to have to do it yourself. I think the world has changed from 20 years ago when companies would frequently use internal product development and had the right researchers and engineers inside the company itself. Now, they want to go buy innovation. These days if you want to develop technology you might have to do it yourself.

The other thing that got me interested was being president of the American Society for Plastic Surgery. I think the experience of helping to run an organization made me realize how much I enjoy building teams, having projects, bringing people and concepts together, and figuring out how to pay for it. That’s exactly what you do with a startup.

Did the Kauffman course help you decide on a direction, or did you already know exactly what you wanted to do by the time you took the course?

Before I showed up here in 2013 I spent three years thinking through the technology, filing the original patent, and building what I could with models, but I didn’t have connections to any resources. When I came to Emory I knew I needed to move this forward, I just had no idea how. The Kauffman course was eye-opening in helping me know how to take the first steps.

Was there a specific moment in the course where you realized a startup was actually something you could do, or a particular session where something clicked?

Before the Kauffman course I knew I needed to do this, I just didn’t know how. Even just looking at the course material and its sections gave me an idea of what path to take. I went there knowing I was going to do this, I just needed guidance.

Were there any sessions that continue to provide guidance?

I think the most illuminating sessions were on regulatory processes. That, and understanding finances: what are your options, what are you going to do; that starts you thinking about what your best path is to get there.

Tell me about networking for your startup.

Networking isn’t just something that happens when you go to an event and walk around. That can certainly be helpful, but really what you have to do is just be hungry for it. And it’s amazing, when you start to cold call people asking if they know anyone who could help with a particular thing, if you do it enough you’ll eventually end up talking to the same people again. You get to know people, and then you become a resource for them as well. It’s a two-way street.

It’s amazing, one of my biggest lessons during this process was realizing how many people will help if you approach them with humility, and often after that it starts clicking. You just have to make that call or send that email.

Did any particular speakers from the Kauffman Course stand out to you?

Tom Calloway, he gave the talk on funding. There were a couple of things he said that stuck in my mind. Like, “Time is the enemy, money is the weapon.” I thought through that several different ways, and think it is a very important truism.

When you look back, do you see anything missing from the Kauffman course?

I think one thing that could be helpful is having someone who has gone through the process like me, talking about how to do this and still balance it with other responsibilities. It’s very much a learning curve, you can get so overwhelmed with clinical responsibilities or other research activities. You have to make decisions about priorities. That’s something that would be helpful: information on how to manage it, how to make connections and get the right contacts, how to be a good partner to your manufacturers, things like that.

The Kauffmann course tells you the steps, finances, regulatory, the legal details. It tells you what to do, but if I were teaching a course, I’d talk about how to do it.

Have your experiences in business given you insight into its relationship with medicine, and how the marketplace affects the evolution of the medical world?

Both fields are definitely mutually beneficial. Part of it for me was being the director of the Emory Aesthetic Center, which is a retail medical department, so it’s a business. You have a product, you have to manage people, you only have a certain amount of resources, there are barriers to overcome. There is a lot of beneficial crossover, particularly because I’m in a management position at the center.

What Does Mixing Math, Physics, Computers, and Imagination Give You? A Pioneer in Radiation Oncology.

Ian R. Crocker, MD, FACR, is a radiation oncologist specializing in brain and eye tumors, who worked at Winship Cancer Institute for over 30 years. Throughout his career, Crocker was an active member of multiple innovation and research teams that sought to develop new medical technologies and methods to improve treatment outcomes and patient care. Some of his most notable successes include his co-invention of the BetaCath system to prevent the re-narrowing of arteries after an angioplasty and his involvement in the Emory start-up, Velocity Medical Solutions, which produced new, widely used imaging software to improve cancer treatment. Now retired from Emory, Crocker continues to be involved in medical innovation by continuing his work for Velocity under the larger umbrella company of Varian Medical Systems.

What drew you to radiation oncology?

I always found the field of oncology to be very interesting because there was a lot to be done to improve it. When I was in the first year of the medical oncology program I was exposed to radiation oncology for the first time. I loved that it combined math and physics and computers, things that I was interested in and curious about. So rather than pursing medical oncology, I chose to transfer into radiation oncology.Ian Crocker

I finished my residency in radiation oncology and took a faculty position at Duke University for three years. In 1986, I came to Emory, which at that time only had a very small radiation oncology department. At first, when I started seeing and treating patients at Emory, I would see anyone that walked in the door including pediatric and adult patients, all with different types of ailments. There was not really an opportunity to specialize in any area. But over time, I restricted the types of patients that I saw to adult patients with certain conditions.

You worked both in a clinical and research setting, how did you balance the two and what were the challenges and rewards of working in both practices?

I loved patient care and I found it very rewarding. Patients by-and-large were very grateful and appreciative of everything that we did for them and what is not to love about that? In working with patients, I saw the need to improve and change things about existing treatment methods. I would say that my clinical work helped inform my research and vice versa. They were complementary of one another.

What has your involvement in commercialization been during your career?

In academic medicine, there is an underlying interest in research and teaching as well as clinical care. When I came to Emory, I initially became involved in an ophthalmology project that was looking at whether radiation could help fix retinal detachment. Our study indicated that the radiation seemed to work great. But I later found out that the study was only meant to be a lab experiment and it was never meant to be used as a patient treatment. I was disappointed because I was hoping that we were doing something that would help people.

Fast forward a couple years and a cardiology fellow from Israel named, Ron Waksman, asked me whether I though radiation could be used to prevent the re-narrowing of arteries after a coronary angioplasty. I told him that I thought radiation could help and I had in mind a system to combat the issue. But, I emphasized that if we found radiation to be effective, I wanted to see it translated into patient care. We did the animal experiments and radiation worked great. We decided to work with this small start-up company in Atlanta called Novoste to help further develop our product, with the goal of launching a clinical trial and receiving FDA approval for that product. In the end the product reduced the occurrence of re-narrowing from 80% to about 10-20% and really changed a lot of people’s lives.

After that I became involved in more attempts to develop and commercialize products to improve patient treatment and care. The next thing that I worked on was macular degeneration, the most common cause of blindness in adults after diabetes. I believed that applying radiation to the area where the blood vessels were proliferating, the cause of this type of macular degeneration, would reduce the incidence of blindness. I worked with two separate companies to develop radiation devices to be used in humans to halt macular degeneration. Although these showed efficacy, they never received U. S. Food and Drug Administration (FDA) commercial approval due to the development of a drug that was equally effective and easier to administer.

After this I embarked on research with Tim Fox, PhD, formerly with Emory, in automating the radiation planning process. We received funding from the Georgia Research Alliance (GRA) to create a company, Velocity Medical Solutions, to do this. We ended up not developing the automated radiation planning software, but instead developed a product which would allow physicians to use biologic information in the treatment planning and follow-up process. The product is FDA approved and is now installed in over half the top 50 cancer centers in the U.S. It was so successful that Varian Medical Systems, the biggest manufacturer of radiation treatment, came along and bought our company two years ago. I recently retired from Emory but have now resumed working with the Velocity group, helping them create new products for the market place.

What have you found most satisfying in being part of the innovation teams and being one of the first doctors to implement these new innovations?

I love having the opportunity to use my imagination. Medicine is in general very deductive. It is like being a detective and trying to uncover what the problem is so you can do something about it. Trying to imagine or invent a solution to a problem uses a whole different skill set. It allows you to think outside the box and I like that.

I am proud of being one of the first doctors to use the technologies and methods that I helped develop. But, I am probably prouder of having created the products and brought them to the market place, because when you do that anyone can use the product and even more patients can benefit.

You are a founding member of the Emory start-up, Velocity. What was your experience of getting that project off the ground l like?

It was hard. We had an idea for a product that we thought was needed. We had a bit of intellectual property around our ideas and GRA awarded us some funding to help commercialize those ideas. Unfortunately, it was not near enough money to finalize the product, get it FDA approved, start selling it and trying to develop a successful company around it. But, we believed enough in the company and the idea that we put in our own money. I still had a full-time job at Emory and when I finished work there, we would get together and work on company related issues. This was both stressful and rewarding. At the start, it was a month-to-month question of whether the business could stay operational. But, we managed to make the money last until we could turn a profit. We were lucky that many people saw the value of our product and purchased it as soon as we started selling it.

How has your work in the field of radiation oncology changed over your time in practice and how do you think it will change in the future?

The practice of radiation oncology today is completely dissimilar to what I learned as a radiation oncology resident. The roles of the personal computer, imaging, 3D visualization of the treatment plan, and the capacity of newer treatment machines to deliver precision radiation treatments are developments we could not have imagined when I was in residency. I feel very lucky to have been at an academic medical center where we were involved in implementing and practicing these new medical advances. I got to be part of so many firsts in my field like the first image guided radiosurgery.

Moving into the future, one of the projects that I am working on is using imaging to characterize the biology of a cancer much like people in genomics do to predict how a tumor might grow. There is this developing field of radionics which looks at the imaging characteristics of a tumor and trying to predict how it might grow and respond to treatment. I think this is going to be important moving forward.

Who has influenced you the most in your career and why?

The person that inspired me the most was the former head of Radiation Oncology at the Princess Margaret Hospital in Toronto, Dr. Bill Ryder. When I began training people did not know what you could and could not accomplish with radiation treatment. Unlike many people who just stick to established guidelines, Bill Ryder was someone who explored what you could do with radiation. He was on the forefront of multidisciplinary cancer care. He used to have a clinic for residents called the “odds and sods” clinic, where he would show you all these advanced cancers that he had taken on, treated and cured, when others had labeled them incurable. He made me believe in radiation and what it might accomplish.

What would your advice be to your younger self?

I would tell myself to balance my life a little bit better. It takes a lot of time away from family and friends to be at the forefront of new developments in any field. When I look back on it, maybe I tried to do too much.

Tell me something about yourself that many people do not know.

When I was growing up I raced sailboats competitively and at one time was a Canadian champion in sailing. I got invited to try out for the Canadian Olympic sailing team. The same day I got that invitation, I was also accepted to medical school. I showed my mother the letters and she took the Olympic sailing one and ripped it in half and said, “You’re going to medical school.” I think she made the right decision for me.

Lessons from Baseball: Applying Passion and Competitive Drive to Radiation Oncology

Tim Fox worked at Emory University as an Associate Professor & Director of Medical Physics from 1994 to 2014. In 2005 he and three of his Emory colleagues created the Emory start-up, Velocity Medical Solutions, which built and sold a multimodal medical imaging software. Velocity was later acquired by Varian Medical Systems and in 2014, Fox left Emory to accept a full-time position as the Associate Vice President of Imaging Informatics at Varian. Fox grew up playing baseball and now applies that same passion and drive to his entrepreneurial endeavors Just like the famous line from the baseball movie, Field of Dreams, Fox is living proof that “If you build it, they will come.”

What drew you to radiation oncology?

It was the combination of technology and medicine. It was the one area back in the 1990s where you saw computers being applied to the diagnoses and treatment of patients.

How did you move to software and cancer imaging informatics?

I always loved computers and started to become interested in them when I was 15 years old. When I got to college I majored in physics and minored in mathematics and computer science. I wanted to focus on the computational and software side of physics. I later found medical imaging and software projects in nuclear medicine and radiation therapy.

Then when I came to Emory I used my computer skills to build software programs like the radiosurgery treatment planning system, a computer oriented optimization program, and advanced molecular imaging software. Back in the 90s, computers were still evolving, so you often had to build these tools yourself, which is what I did. Over my career, I developed a philosophy about identifying problems and building products and solutions to fix those problems. Being part of a cancer care team in the clinic and immersing myself in daily challenges allowed me to observe an inefficiency in existing cancer imaging techniques and inspired me to build a solution to that problem.

Did you always know that you wanted to apply your computer skills in a medical setting?

Tim Fox, PhD

Tim Fox, PhD

No–my senior year as an undergraduate, I participated in a summer internship program at Oak Ridge National Labs in Tennessee where I was able to study nuclear physics doing particle simulations with computers. Working with PhD scientist, I learned about the field of medical physics, and I applied to a graduate research assistantship at Georgia Tech in 1990 to further pursue this field.

Who has influenced you in your career the most and why?

I think it would have to be my parents. They always said “Go get as much education as you can. No matter what you want to do, go and get all the education you can in that area.” They instilled in me the desire to attain the highest level of education possible. I always knew that I would do an undergraduate degree and then of course, graduate school.

Describe the development process for your software.

In 2005, we started Velocity Medical Solutions and approached some large companies with the idea of using PET imaging to improve cancer treatment planning. But, none of them were interested in working with us on solving the problem. Eventually, we approached the Georgia Research Alliance (GRA) and got a commercialization Phase 1 grant and decided to build the software ourselves, knowing that at the very least it could improve research and clinical care at Emory.

Our small team set up a series of smaller milestones. The first milestone was to build a solution to using PET imaging in treatment planning and create a business plan. The next milestone was to see if we could receive Federal Drug Administration (FDA) clearance, which would allow it to be sold on the market. This was probably the biggest hurdle we had to overcome. We got our first 510k FDA clearance in 2007 and our second in 2008. Our next milestone was to see if we could get a cancer center to purchase our software. We hired a team and started to commercialize our platform.

Your technology was licensed to an Emory start-up – what was that experience like?

There were both upsides and downsides to building our company; academics and industry do not always mix well, especially in the field of health care.

We did not think about everything at once, but set small milestones using the GRA Phase 1, 2 and 3 grant program. GRA was a game changer and a big supporter through the whole process. Without them we would have never made it. It allowed us, as university faculty members, to take the ideas and intellectual property we had and to actually build the technology. They helped us make the leap from having this great idea to having an actual technology.

A challenge that we encountered as faculty members at academic institutions was managing conflicts of interest between the university and entrepreneurial endeavors.  In the past, the word “commercialization” was typically viewed as a problem.  Today, the National Cancer Institute (NC) sponsors Academic-Industry Partnership grants since we realize that it does take a partnership to move ideas from the clinic to patients.  Being able to manage the conflicts of interest with the GRA Phase 1, 2 and 3 program presented obstacles along the way, but we worked through them with Emory and OTT.

Aside from the challenges, I love that this has been an opportunity for me to combine life sciences, computer technology, and medical healthcare. This startup and my transition to working for Varian Medical Systems has allowed me to continue to work on products in the field of cancer therapy. I think this type of innovation would be impossible without the growing relationship between academia and industry, which supports and expedites the innovative process.

What made you decide to follow your technology into the corporate world and how has that transition been?

After working at Emory for 20 years, I decided to leave to work for Varian because I recognized the need for partnerships between academics and industry. I knew that I could understand both sides of this partnership and hopefully facilitate and nurture it.

Additionally, I had worked with Varian over the years through Emory. Therefore, I was familiar with Varian’s team and technology development. I saw this job change as a new opportunity and new challenge that I wanted to explore. I definitely miss academic medicine, but I wanted to focus solely on building software.

What have you found most satisfying in seeing your work reach the marketplace and help patients?

It’s wonderful to go in and see people using the software. It is even better when users show us patient cases where they have used the software in ways that we did not anticipate. We built Velocity to address one initial problem, but people are applying it to other problems, which helps us figure out how to further improve and expand our software. From working in industry, I have come to appreciate that we provide physicians with tools and they get to use them in a multitude ways to help their patients.

Where do you see imaging in the oncology field going?

We like to say “seeing a patient is important, but seeing inside a patient is more important.” Medical imaging allows you to see inside the patient in a clear way, whether it is anatomical imaging like computed tomography (CT), which shows structural detail, or more advanced imaging like PET, which shows you molecular metabolic activity. It gives a more defined picture of a patient’s condition.

In September 2016, the NCI Blue Ribbon Panel announced their ten broad Cancer Moonshots. One of those 10 items was to develop new cancer technologies and treatments using new radiological imaging and deriving data from that imaging. That is exactly what we are doing, and we are partnering with academic centers around the nation. In the future, as new types of medical imaging are developed our software will be able to incorporate them and provide more comprehensive imaging package that will improve patient care.

Tell me something about yourself that many people do not know.

I think many people do not know that I played baseball through college and considered being a college baseball coach instead of a physicist. I did get to coach my son’s little league team though, which I enjoyed.

What advice would you give to your younger self?

“Work smart.” It is not just about working hard but being smart about what you are doing. Find what you like to do, but also find where you can add value to a company or a team.

I think it’s important to find a career path and then make it what you want it to be. Find ways to incorporate your passion into your occupation. For me it has been to use my love of teamwork and competitive drive, which I got from my passion for baseball, and use those skills in my chosen profession, and it has worked well.

Treating Anxiety Disorders: Balancing the Real World and the Virtual World

Barbara Olasov Rothbaum, PhD, is the Associate Vice Chair of Clinical Research in Emory School of Medicine’s Department of Psychiatry, a professor in the Department of Psychiatry and Behavioral Science, and director of Emory’s Veterans Program and Emory’s Trauma & Anxiety Recovery Program. Dr. Rothbaum specializes in treatment of anxiety disorders, with a focus on Post-Traumatic Stress Disorder (PTSD). With over 200 scientific publications, Rothbaum has changed the field of PTSD and was a forerunner in the use of virtual reality in treatment of anxiety disorders.

What initially drew you to the field of psychiatry?

I went to UNC-Chapel Hill as an undergrad. I actually went as a math major and that didn’t last long; My freshman year I decided to take a freshman seminar course, which meant there were only fifteen students, on how to design an experiment. It was a psychology course and I had no interest in psychology going in, but it sounded interesting. The course had the kind of teacher you always hope to have, or hope your kids have; the research bug bit me and I loved it. I kept taking more psychology classes and then got involved in research.

Who has influenced you the most in your career and why?

Barbara Rothbaum

Barbara Rothbaum

I learn every day. I learn every day from somebody, from every patient I see. When I think of real turning points; I think of my first professor my freshman year. He changed everything, I gave up all my math courses and went into psychology. When I was an undergraduate, I worked in a fetal alcohol lab under Carrie Randall, PhD, a professor at the Medical University of South Carolina, for a summer. I learned methodological control and precision from her. I also learned that I wanted to work with people after working with animals in Carrie’s lab. Working here at Emory with Michael Davis, PhD, Yerkes Researcher and Robert W. Woodruff Professor of Psychiatry, I started to get into translational research, asking questions of animals and then translating to humans and translating back to animals.

What was the process of integrating virtual reality and anxiety disorder work like?

In 1993, Larry Hodges, PhD, an Associate Professor in the College of Computing at Georgia Tech, contacted me about an Emory-Georgia Tech seed-grant program. Larry specialized in virtual reality and he found out that I was an exposure therapist, meaning that I help people confront their fears in a therapeutic manner. We originally wanted to do the research on fear of public speaking, but in the 1990s virtual reality was clunky. Virtual reality at the time worked more in angles, and people move in arcs. This made it difficult to do public speaking, so we decided to do fear of heights because of the angles and you can easily represent height in virtual reality. Our line at the time was, we “weren’t sure if we were on the cutting edge or the lunatic fringe.”

Could you describe the development process for the first virtual reality treatment incorporating computer scientists and clinical psychology?

Virtual Reality Therapy

Virtual Reality Therapy

I would go to Georgia Tech and I would explain exposure therapy to Larry’s brilliant computer science graduate students to help them understand why people get anxious. For example, we were working on the virtual airplane, there was just way too much room. About half the people who fear flying have a claustrophobia-focused fear that induces panic. Part of the trigger is feeling closed in so you need to remove the feeling of roominess. I would work with the programmers to help them understand the fear cues so they could go back and create them.

Your work has been brought to the marketplace through an Emory start-up Virtually Better – what was that experience like?

The first study was published in 1995, and the response was really amazing. Emory and Georgia Tech thought that there might be a marketable product, so they took us [as inventors] by the hand and drove us to a lawyer to incorporate, and that was Virtually Better. As soon as we incorporated, I received a letter saying that I had a conflict of interest since I was doing research in that area. That freaked me out, and I didn’t understand conflicts completely at the time. I ended up serving on the School of Medicine’s Conflict of Interest Committee for six years. It did limit my research for a while. Now we’ve learned how to manage conflicts; as a result I am able to do more research with virtual reality.

What types of challenges are there for the utilization and growth of virtual reality in psychiatry?

At Virtually Better, we often looked more like an academic department rather than a company trying to make money. This allowed us to get numerous grants, which supported more R&D. Every product we released had good data on efficacy. What scares me now is that people can be working on virtual reality in their garages. We have always had the input from clinical psychologists and computer scientists, we were cutting edge in both fields and releasing what we knew was a good product that a person can benefit from therapeutically. I worry now about quality control and efficacy.

Do you think virtual reality will be a game-changer in Post-Traumatic Stress Disorder (PTSD) treatment?

Well nothing works for everyone. One of the most important things we can have is alternatives and choices. Research has shown that if a patient with PTSD can choose their course of treatment they are more likely to respond positively. With this generation of veterans, which is a video generation, they tend to like virtual reality. It feels a little bit less like therapy to them and feels more “techie.” There was a study done with active duty military populations, that showed that people who feel less comfortable going to therapy would try virtual reality therapy.

What has been the personal satisfaction for you in seeing the progression in PTSD research and treatment?

It has been satisfying and challenging. When I started working in PTSD, there were no indicated treatments, it was just a diagnosis. Psychologists were extrapolating from other treatments for other anxiety disorders. It’s really nice to see that evidence-based treatments for PTSD exist now, but what’s still challenging is that none of them work for everyone. Also, I think some of it is the nature of the beast [with PTSD]. People with PTSD are avoidant; they don’t want to talk about it or go in for treatment. We need to not only develop effective treatments, but also acceptable treatments.

Many who work with PTSD, and other psychological disorders, experience burnout; how do you avoid burnout or compassion fatigue?

I exercise; I do yoga, I ride my bike. We talk about experiences at work in a group setting with supervision as part of the Emory Veterans program. There are some cases that we are talking about that bring tears to our eyes. It’s important that we are able to support each other, it’s not something you can go home and talk about over the dinner table. We hear the worst of the worst. So it’s about work-life balance.

What advice would you give to your younger self?

Problems and roadblocks used to really upset me. I now have the attitude that problems will occur daily, some large, some more manageable, and my job is to navigate them, so I can approach them with more equanimity, wisdom and creativity. I have also had to learn to not take things so personally, for example not receiving a grant or a paper rejection, and to bounce back and start working on the next one. I do give myself a little time (not more than a day) to “wallow” (I wouldn’t use that word for anyone else) following big disappointments. We are only human.

To learn more about Virtual Reality Therapy view our success story. To learn more about Virtually Better go to their website.

Inventor Becomes Patient: My Tool Was Like a Trusted Friend Telling Me What Was Wrong

Ernest V. Garcia, PhD, or better known as Ernie, is an endowed professor in cardiac imaging and the director of Emory’s Nuclear Cardiology R&D Laboratory. He specializes in medical imaging and bioinformatics, particularly quantitative analysis of cardiac images. Ernie has received numerous awards and honors but to highlight a few he was named a Medical Imaging Industry Top 10 Nuclear Medicine Researcher by the Medical Imaging Magazine and was named to the Council of Distinguished Investigators of the Academy of Radiology Research.

What lead you to pursue cardiac imaging as part of your profession?

I was trained as a scientist, a physicist. And I had a great deal of experience with computers and computer software, which was unusual for a scientist working in the 1960s. Back then, cardiology was the most quantitative modality that existed and it probably still is today. Meaning that the cardiologists were and are interested in numbers and quantitative data. So, I thought that I would apply my scientific background to the art of image interpretation.

Who has impacted you the most in your career and why?

That’s a tough question, there is the physicist part of me. So, I am definitely motivated by the life of Einstein and the many things he did. But, I think a lot of my inspiration and motivation comes from the patients themselves. This is where I can see the impact and need for my work.

Ernie Garcia photo

Ernest Garcia, PhD

Medicine has evolved substantially but there is an element that is still a bit of “art.” Many physicians are proud of that component. But, in today’s world from a patient’s point of view, it should be a science. They want medicine and doctors to be more objective in answering questions like: “Why give this medicine versus that medicine? Why give this surgery versus that treatment?” There are more demands for doctors to know exactly what they are doing.

Did your relationship with patients change after you had experienced your own cardiac event?

Obviously, the answer is yes. Your life always changes with an event like that. Beyond that when I was in college I would volunteer for studies and they would inject me with some imaging agent, I was a guinea pig. The thing that changed me more than anything else, was seeing the images of my heart analyzed by our software. It was like “WOW!” Most people did not think that I had heart disease, but it was very obvious from the images. That was a big event.

How did your own cardiac event impact your perception of your work with the cardiac toolbox?

First again, when I saw my images analyzed by the toolbox, to me it was like my son was diagnosing me. This meant I really believed what it said, regardless of what anyone else said. I knew what the problem was right then and there. To be honest, when I fill out a doctor’s sheet and see the question “Do you have heart disease,“ my initial reaction is still to say “no.” I don’t know why that is, because I definitely have heart disease, so I have to say yes. And over time I came to the realization that maybe I’m going to be one of those guys who goes into heart failure. So, it would be nice if there were tools to help treat that. Just like we have tools to help people with coronary disease, now we have tools to help people with heart failure. Maybe the toolbox, one of these days will knock on my door and say “Let me help you.”

Is it scary to see your own heart and know the medical implications and meaning of those images?

Emory Cardiac Toolbox Screen Shot

Emory Cardiac Toolbox Screen Shot

Actually, it is probably the opposite. In my case, I was concerned that my test would come out equivocal. Then, I would have had to choose, “should I have bypass surgery or not, should I go through all that?” But it was so obvious, there was no question what was going on with me. So, in fact that was a relief. Even though maybe I would have rather seen a totally normal heart, my imaging explained my symptoms. Patients look for answers to what is going on with them, and there is nothing more frustrating than unexplainable symptoms.

Did you feel like a pioneer at the time, as an academic, taking on the task of creating a start-up?

You know what they say about pioneers, they’re the ones that get the arrows in their rear ends.

The biggest issue was computers. Think of the computers in ’68 and ’69. They were expensive and inefficient. So a huge machine only had a little power and it would cost like $100,000. With those high costs computers came with software, or all the software they had at the time.

This is before Microsoft and Apple and people were not used to paying for software. So, as a so called pioneer, I had to point our that if a person wanted more software to have as a tool, they had to pay for it. And this was an idea that did not exist at the time so it was not easy.

Then when we started producing this software we reached another obstacle, because technology transfer is not what it is now. People used to say “why would a scientist want to develop a commercial tool? Scientists are supposed to be above that. They are supposed to write papers and then the companies develop the tools.” But, if I had followed that route, my software and the toolbox would have died. So, I took on the responsibility of seeing it all the way through and that got me a few more arrows in my back side.

Now over time and fortunately at Emory, we are seeing more of a positive view. That not only are scientists developing tools to help patients, but we are also generating funds to help run research labs and help the university fund further research. However, there are still people who say “Why is this guy so interested in money and commercial tools?”

What types of challenges are there currently in continuing the development of the cardiac toolbox?

We have been working on this for a long, long time. At Emory alone over 30 years. The idea of calling it a toolbox, is because it is exactly that. When we develop a new tool, we do not have to say “Oh, this is a different device.” It is like when you go to Sears and buy a toolbox with a lot of tools. You hope to have everything you need at the time in one box. So, as new needs evolve in cardiac treatment and diagnosis, we develop new tools to meet those needs.

The toolbox was originally developed to look at the blood flow and function of the left ventricle of the heart, which is the one that pumps blood and the one that gets in trouble when a patient has a heart attack. But, overtime other needs have evolved. Cardiology treatment has vastly improved and there are many great drugs and treatments available. That means that patients with heart disease live longer and move past their original cardiac problems and often into heart failure. With more heart failure and people living with heart disease to an older age there is a need for new treatments. There are pacemakers, which help input electronic waves into the left ventricle and try to synchronize the electronic stimulation. This was a recent addition to the toolbox. So, instead of helping the interventional cardiologists in the catheterization lab, this new tool helps the electrophysiologists.

Currently, many cases of undiagnosed or misdiagnosed cardiac symptoms are being seen in women, because women experience different symptoms than men. A lot of women come in with heart symptoms and are told “That’s not really your heart.” They are told this because their heart disease manifests in a different way than men’s disease does.

In men, it is usually the large vessel causing a heart attack. In women, very often, it is the small vessels that are affected. And it turns out that the smaller vessels cause more pain than the large one, but no one can see them using traditional imaging. So, often these women are sent to psychologists because they are complaining of a symptom that doctors cannot explain. But, now we are developing tools to detect more disease in women.

Additionally, the question always comes up as to whether an Indian patient’s heart looks similar to an American patient’s heart. We have to wonder if we can use the same normal databases, which we developed here at Emory by scanning normal peoples’ hearts. In the old days I used to gather my neighbors, asking them if they would like to be part of a normal database. I would then have my neighbors come to Emory and be imaged. So, the toolbox and computer compare a prospective cardiac patient to these normal distributions. But because we used Americans to develop our normal distribution, we have had to do a lot of work to try to reproduce and compare patient populations so that our observations demonstrate problems with a patients’ health and not just their genetic predispositions. We are finding that not only are there differences between men and women’s hearts, but also possibly between Chinese people, Indian people, Korean people.

What has been the most satisfying part of seeing the cardiac toolbox hit the market?

The first time that it really hit me, I was on vacation in Florence, Italy and there was a bookstore next to the place where I was staying. Browsing in the bookstore I found a book, which was in Italian, while looking through it I found our work. I thought “what an interesting thing to see.”

In visiting clinics all over the world and seeing that they are using the toolbox – that is very satisfying. The toolbox is not only in Italy, but also in places like Peru, Colombia, and even in places like Algeria and Iran. The toolbox is helping distribute the knowledge that we have, but with that comes responsibility to release new tools that are validated. There comes a time when you have to ask “when does this tool really start helping versus hurting people.”

Tell me something about yourself that many people do not know?

I think something people usually find particularly interesting is that I play in a rock band called The Thallium Stallions. Thallium is the pharmaceutical that we use for perfusion imaging. Our band plays at meetings for nuclear cardiology and nuclear medicine. I mostly play the alto sax.

There is also a video that accompanies this interview; you can find the video here.

It Started in My Basement, Now it Improves Patients Lives

Charles M. Epstein, MD, or “Chip” as he’s been known since childhood, is a professor of neurology specializing in epilepsy and the founder of  the Laboratory for Transcranial Magnetic Stimulation (TMS). He is also a co-inventor for the technology that is utilized by Emory partner Neuronetics, Inc in their NeuroStar TMS Therapy® for treating depression. Neuronetics has safely administered more than 10,000 NeuroStar TMS Therapy® treatments with clinically significant results: among patients studied, 54 percent responded to the therapy and 33 percent found their depression in remission.

Neurostar wasn’t the first technology you were involved with. Could you tell us about some of your previous technologies?

Charles Epstein, MD

Charles Epstein, MD

NeoControl was actually the first magnetic technology that went on the market thanks to Neotonus. This company was the first to develop TMS to treat urinary incontinence in women.

World wide, women have been more prone to urinary incontinence than men. This was especially true after childbirth and before modern obstetrics. Using electromagnetics, treatment is much more comfortable than prior methods. The magnets work right through clothing and are essentially painless. This was the foundation of Neotonus’ technology, NeoControl. Unlike brain stimulation, TMS in the pelvic area takes even more power and without our technology, would have been impractical. The company was moderately successful with sales primarily in Asia, but ultimately went out of business during the recent recession.

Does TMS have a role in your current research?

I continue to use TMS in several kinds of brain research, and am beginning a preliminary collaboration to explore its potential for experimental stroke treatment. My “day job” is epilepsy. TMS hasn’t been used as much in the epilepsy field, though, and the reason for this is a bit complicated.

In simple terms, we don’t use TMS for epilepsy as much because epileptic seizures often come from too deep in the brain and are difficult for us to reach. Often times we don’t even know precisely where the seizures are coming from, so we wouldn’t know where to aim with the stimulatoror be able to guarantee that we could cover a big area.

Do you think TMS could be used to treat other medical conditions?

With other conditions, the data is promising but too limited to know exactly how effective it is. Far more conditions have been reported to respond to TMS than I think are likely to hold up, but there’ll need to be more studies to determine that.

How did your work with magnets come about and progress?

The funny thing is, the basis of this technology is something I put together in my basement. The coil is the key; it’s what makes NeuroStar so much more reliable and cheaper to build.

To give you a sense of the power requirement for TMS, think about this: A standard light bulb uses 100 watts of electrical power. 100 watts gives you a fair amount of light. TMS comes in pulses, usually 10 pulses over and over. For other systems, a single pulse requires up to 5 million watts. That’s 50,000 standard light bulbs going off all at once for a tiny fraction of a second, a ten-thousandth of a second, to be exact. Now, to do that takes a lot of power and generates a lot of heat. What we’ve invented takes a quarter of the power, and produces eight times less heat on a person’s head. We no longer need to keep air and water running around the coil to cool it.

What is it like to work on a project and meet a patient whose life has been changed by your technology?

TMS Prototype Photograph

First Magnet Prototype for TMS

What’s it like to work on a project and meet a patient? It’s fantastic! To have built something in the basement that is out there treating thousands of people and making them better and changing their lives is amazing. And, even by extension, making it possible for other magnetic stimulators to make lives better – because likely none of them would have been cleared for sale if it weren’t for NeuroStar – is positive.

In general what was the process of creating NeuroStar like?

Well, science and medicine are a lot more chaotic and random than they appear from outside. And what you see in pictures is older scientists frowning in white coats. What people don’t see often enough is that science is actually fun, along with hard work. That fun and playfulness are fundamental to a lot of new things, and were fundamental to NeuroStar. I was essentially playing in a lab and in my basement with a different goal, and with no idea what this coil would lead to. Alexander Fleming is famous for the fact that he was playing with bacteria when he created penicillin. A big part of discovery is play. This has been fun from beginning to end, and hopefully we’re not at the end.

What has been the most satisfying part of seeing NeuroStar hit the market?

My job is to make people better and it’s very gratifying that NeuroStar has multiplied the number of people I can make better by hundreds and thousands. That’s a great feeling that I don’t think I would have experienced otherwise.

There are six videos on the Emory’s TMS technology listed below:

This piece is one in a series of four blogs related to Emory’s TMS technology. They look at the development and management of the technology, its impact, and this project from several points of view.

From Academic Researcher to Startup Scientist: Leaving the Lab to Pursue Your Innovation

Each year OTT helps launch a number of startup companies based around discoveries made by Emory faculty or staff.  In most of those cases the faculty member remains at the university as a researcher or clinician while he or she simultaneously serves in some type of advisory role for the company. In some instances however faculty leave the university environment to strike out into the exciting world of startups. In this piece we talk to former Emory professor Harriet Robinson, PhD, who is now the Chief Science Officer at GeoVax, an Emory startup developing HIV vaccines based on previous work from her lab.

Before you created the HIV vaccine technology, had you ever given much thought to the commercialization of university discoveries?

Yes, I had previously wanted to commercialize a different vaccine technology that I discovered while at another university. At that time it was not possible due to state restrictions that limited the ability of faculty to license their own findings from the university. Those limitations stemmed from legislation created to curb legislators from awarding contracts to themselves or relatives.

What made you decide to follow the technology to a startup company rather than stay in academic research at Emory?

Harriett Robinson, PhD Photo

Harriett Robinson, PhD

At a certain point, the vaccine technology needed expertise that was not present at Emory, for example, manufacturing, formulation, and regulatory expertise. It also needed full-time effort which was not compatible with being a full-time professor.

What has been the biggest challenge in moving out of the academic lab and into industry?

Maintaining funding focused on the commercial development of a product. For HIV vaccines in the developed world, funding is primarily from the NIH. This means that one has to steer a course that meets study section approvals as well as company objectives.

What is the biggest difference (or multiple differences) between an academic lab and an industry lab setting?

The biggest difference is that in industry, one is part of a team that has set out to achieve a goal. If something doesn’t work, the team figures out how to make it work rather than just going on to some other project that is interesting at the moment.

What advice would you give younger faculty interested in technology commercialization?

The small biotech world is very different from the university. Make sure you are really interested in working towards specific products and willing to give up the freedom (and resources) one has in the university to explore multiple different areas of research.

Many Thanks to Dr. Robinson for agreeing to participate! For more information on OTT’s efforts to support faculty entrepreneurship & startups check out our website: http://ott.emory.edu/startups/formation/index.html and http://ott.emory.edu/inventors/education.html. For additional information about GeoVax and their clinical stage HIV vaccine please see their website www.geovax.com.