Truly independent thinkers in medicine, who are, by definition, outside the mainstream of scientific dogma, are initially indistinguishable from quacks and charlatans and are often treated as such. The professional skepticism encountered by these first time founders of medical companies varies from unconvinced bemusement for an incremental advance to hostility and derision for a fundamentally game changing innovation. To endure requires a personality that is tenacious and independent, stubborn in the ability to ignore criticism and professional persecution and persevere.
A classic example of the reaction of the medical establishment to a game-changing innovation is the professional skepticism that greeted Australian physicians Barry Marshall and J. Robin Warren's 1984 publication in The Lancet that Heliobacter pylori caused gastric ulcers. It took a decade before a panel convened by the NIH 1994 finally accepted that the evidence supported H. pylori as the cause of peptic ulcer disease and the medical community discarded the diet, stress and lifestyle paradigm. Eventually they were awarded the 2005 Nobel Prize in Medicine.
But medical innovators do not always make it over that barrier of skepticism. Anticipating Marshall and Warren by almost three decades, a Greek physician, John Lykoudis, successfully treated his own gastroenteritis with antibiotics in 1958 and received a Greek patent in 1960. His attempts to publish his findings in JAMA were rejected and he was fined 4000 drachmas by the Athens Medical Association Disciplinary Committee in 1968 for treating his peptic ulcer disease patients with antibiotics, even though he cured an estimated 30,000 of them. He was completely shunned by the medical establishment of his time, or at best, considered an eccentric provincial physician, and died in 1980, just short of his vindication.
John Lykoudis was unable to attract the attention and support not only of the medical establishment but of the pharmaceutical companies as well, who stood to make a fortune with his therapy. First time medical founders often have similar difficulties getting attention from investors, companies and the medical establishment. Unfortunately the stubborn and independent personality which carried them to this point, can start to work against them in several ways.
Fallacy 1: Founders know best. No one knows this new technology or therapy as well as the founders do so they need to be in control to insure its success. What first time founders don’t appreciate is while they have the best understanding of the past, the things that need to be done in the future to translate a proof-of-principle to a product-on-the-market requires skills and experience they usually do not possess. The sooner a team of experts is engaged to help and lead this effort, the better. Unless founders have worked for years in medical device, biotech or pharmaceutical companies, they need a team in control who has.
Fallacy 2: Don’t Trust Anyone. When anyone experiences a lot of skepticism, criticism and resistance, it can become very difficult to trust others. After a while, first time founders can become braced for negative reactions every time they engage with others. When the reaction is not negative, the founders might be surprised and suspicious and look for a hidden agenda. In the development of medical products, as in most high tech projects, a high performance team is essential, and that requires trust to operate. If founders cannot trust anyone but themselves, the unintended message is they cannot trust their own judgement of other people, in which case they should not be managing something as important as the development of a new medical innovation.
Fallacy 3: Convince skeptics. Founders must believe there is a clear and logical argument for their idea or therapy and their evidence should be sufficient for a reasonable person to accept. However, despite this, skepticism will be frequently encountered. The focus needs to be on finding early adopters who are receptive to the ideas and willing to help, rather than wasting time trying to convert all skeptics. Finding support with investors, partners, or medical professionals is a selection process, i) are they receptive to new ideas? ii) does this innovation resonate? iii) does the evidence convince them? If they don’t make it through these hurdles, let them go and move on to the next.
Fallacy 4: Don’t listen to skeptics. The flip side of Fallacy 3 is ignoring all skeptics. There are at least two kinds of skeptics, 1) those that cannot accept a change to the status quo, perhaps from a deep professional investment in it or strong economic benefits from it and 2) those that find the innovation intriguing but parts of the proof or company deficient. Founders can learn a lot from the latter by carefully listening and considering the advice and criticisms. Sometimes founders dismiss everyone critical but embrace anyone positive regardless of how unqualified these supporters are. While emotionally reassuring to connect with an enthusiastic stranger at a party, their positive social reaction should not offset the constructive critical feedback from an experienced investor. There is always the risk of confirmation bias where the only feedback sought and embraced is that reinforcing the founders’ perspective. Company creation is a growth process and heeding constructive criticism can help.
Fallacy 5: We can’t afford mistakes. First off, the need to be perfect is a paralytic. It can stop founders from taking necessary actions. To get started, founders usually invest their own money and time and often get initial support from friends and family. The sense of responsibility can lead to a sense that founders need to be in control because people have invested in them and they can’t make any mistakes. Funders have invested in the team but expect them to use not only their innovation but their judgement about who to work with and how to let them help founders grow their company into something that will give funders a very nice return. The best way to insure success is let professionals with experience deploy that money and bring in more to develop the product(s) or service(s) to market or to an exit by acquisition from a strategic partner. Founders need to accept that mistakes will be made but move on from them quickly and don’t let them hold the company back by becoming the focus of attention and energy which are in very limited supply.
By no means are these all the challenges self-imposed on founders, nor are all founders guilty of these mistakes. However, the personality traits essential to endure the resistance encountered when new ideas are introduced are the same traits that can inhibit founders from taking growth steps necessary for their company to take off. Being honest and self-aware and having good help may be the best antidotes to entertaining these fallacies and flirting with failure.