I'm a really firm believer in sort of this principle that it's the engineer's job to solve all the hard problems for the user. And you've got to design products that are both easy to use and also really difficult to misuse. And so we did spend a lot of time with patients and human factors types of studies to really understand what it was that was going to make this product really simple for patients to use and ultimately effective. And then we also worked with some early physicians in the space to understand exactly how physicians are performing these actions so that we could better sort of mimic exactly what's happening in a dermatologist's office, you know, directly in the device in the hands of a patient.

Welcome to Medsider, where you can learn from the brightest founders and CEOs in medical devices and health technology. Join tens of thousands of ambitious doers as we unpack the insights, tactics and secrets behind the most successful life science startups in the world. Now here's your host, Scott Nelson.

Hey everyone, in this episode of Medsider, I sat down with Rick Bente, co founder and CEO of Indomo, a therapeutics company developing at home prescription dermatology treatments. Rick brings more than twenty years of experience as an engineer and operator across medtech, pharma, and diagnostics, and has held leadership roles at Medtronic, Insulet, UniLife, and Your BioHealth with a focus on drug delivery and combination products. He's an inventor on more than 50 patents and has helped raise over $150,000,000. Here are a few topics we explored in this conversation. First, how do you translate an in office procedure out of the clinic? Second, how do you build consumer facing medical technology that works without user training or supervision? Third, what needs to be proven before a company is ready to develop a public narrative? And last, what proof points need to be reached before you're ready to raise your next round?

Before we dive into the full episode, I think you'll wanna check out Medsider courses. These new eight-week courses are designed to help you learn winning formulas from world class CEOs. Medsider courses cover topics like fundraising, device design and development, clinical and regulatory strategy, commercialization, and M&A. Each course covers hard earned lessons shared by the medtech founders and CEOs who join our program. Medsider courses can be purchased individually or they're included at no additional cost with the Medsider All Access Pass. You can explore Medsider courses at medsider.com/courses. Again, that's medsider.com/courses. Alright. Without further ado, let's dive into the interview.

Alright, Rick, welcome to Medsider Radio. Appreciate you coming on.

Yeah, thanks so much, Scott. Thanks for having me.

Now that our voices are fully recovered, the last interview kind of summary that I recorded for the most recent podcast that we released, my voice was still very much recovering. And I'm like, now's the time to like start doing some, looking at some of these AI voice tools because like if I, my voice is gone for like a week or two weeks, it's like, it's hard to, and everything else is is delayed. But but anyway, you sound good. Long way for sure. You sound good. Sounds like it was a semi decent week coming out of JPM. So I'm looking forward to Yeah. Learning a little bit more.

Mostly recovered now by Tuesday here.

Yeah, well cool. So I recorded a very abbreviated bio at the outset of this episode, but let's start there. Mean, you've got like a two decade plus career now kind of spanning med tech, biotech, etcetera before Endomo. So give us like a one to two minute overview of kind of your background from your perspective.

I'm an engineer by training and background. I started in the diabetes space at Medtronic working on some of their first and now existing still insulin pump platforms, figuring out ways to improve the way people with diabetes were able to get access to insulin and overall just improve their care, find ways to connect with sensors better, and ultimately with the vision of unlocking kind of an artificial pancreas. And so that was the place where I kind of put my teeth in the med tech space and learned a lot about the systems and what's required. And then I spent another six years after that in the more startup drug delivery space, building frontal drug delivery solutions for large volume monoclonal antibodies for large cap pharma and learned a lot about what it takes to deal with pharma, to be a pharma company, combination products, all of the things that go into that process. Then spent a little bit of time back in diabetes, but got the entrepreneurial bug here almost a decade ago now, and then spent a couple of years running a company here in Boston that's called Your BioHealth.

Shout out to that team. They just got acquired by Hims and Hers about a month and a half ago or so now. So it's amazing to see that technology live on and move really into a business that is very consumer focused and thinking really hard about how to open up access. And from there, started Indomo with my co founder, Jack Abraham, who was also a co founder at Hims and Hers. And that was really focused again on finding ways to bring therapies out of the office into patients' homes, into patients' hands, and really empower them to take more control over their own treatments.

And that's probably been the biggest theme in my medtech pharma diagnostics journey is really just finding ways to use technology to unlock access for patients and really find ways to empower them to kind of take more control over their own health.

Very cool. Yeah. And now that you say that, now that you mentioned that your bio was acquired by Hims and Hers, I do remember seeing that headline. I'm like, yeah, that's right. I kind of forgot about that.

It's gonna be fascinating to see, you know, which diagnostics they start to launch with. And, yeah, it's it's very, very cool to see see technology that you developed, you know, just continue to grow and expand in its applications.

We'll we'll get on to Indomo here in in a second. But do you recall, I think it was when HIMS first launched, it was like, guess, like '18 or '19, 2018, 19 timeframe. And they just like their their revenue numbers out of the gate were just wild, wild.

Unbelievable growth in a space that, I think if you were to ask people at the time, there was not a lot of confidence that people were going to be willing to work with telehealth providers, cash pay for pharmaceuticals that presumably they could get from their physician. And I think there's no question HIM's flipped the model on its head and convinced the world that people are demanding. better access, simpler access, cheaper access in a lot of cases to the types of therapies that they know they can get and telehealth is gonna be a major piece of that going forward.

Yeah, I mean, you see all the players now and right, everyone sees like the commercials for Roe and obviously Hims and Hers, etcetera. It feels like they'd, oh yeah, of course, this has been around for a while. Right? But back in that time period, Yeah. You're I mean, it's like tons of skepticism.

It was interesting. That point in time, hadn't started Fastwave yet. I was still working on Joovv. And we had seen it firsthand where we had commercialized this class two device in a brand new category. Obviously did not hit the same revenue numbers as HIMS did.

Mean, it's hard to match that. I thought we did pretty well, but they, I think, blew almost everyone out of the water. But I saw it firsthand, Like this burgeoning trend from patients, well, let's just say consumers, patients, however you want to describe them, and the same, that they are absolutely willing to pay cash, right? And not $50 cash, right? I mean, we're talking hundreds, if not I mean, AOV at Juve for gosh, I think over the course of like two or three years, at least was like $1,314,100 dollars So people were like absolutely willing to pay cash if they had right, that something would work, a therapy.

It's a real solution to a real problem. People absolutely will do what it takes to get access. I mean, look at how GLP-1s have flipped the pharma model on its head, and they're now going direct to consumer themselves and finding a whole bunch of new ways to distribute. I think it's changed fundamentally how you can start to think about pricing and for really consumer facing devices. There are a lot of new opportunities and business models to explore.

100%. Yeah. So let me use that as a transition point to the Clear Pen, right? Tell us a little bit more for those that haven't jumped on the site and know nothing about what you're building. What's the Clear Pen? What meaningful clinical solution are you solving for?

So Indomo developed Clear Pen really to provide patients with an opportunity to access the same treatment that they get in a dermatologist's office at home. And our first indication is for inflammatory acne. So if you go to a dermatologist today with inflammatory acne, dermatologists will make small micro injections of corticosteroid sort of directly into that acne lesion or pimple. And because corticosteroids do an amazing job at reducing inflammation, it can reduce the symptoms of those lesions very, very quickly, sometimes sub twenty four hours. So it's a really unbelievable treatment.

The challenge is it's really only accessible in dermatologists' offices. And in addition to that, it's something that you need right away. So it's not something you can schedule months in advance. If you call your derm today, you're standing in line for a month to three plus months or more, depending on where you're located in the country. And so what Clear Pen does is it basically allows a patient to self inject a very controlled dose of corticosteroid directly into that intradermal space. And it controls very carefully the depth of that injection, the volume of that injection and the rate of that injection.

Okay, got it. I love these business models where something that is proven, right, but hard to access, right, in a situation you've got to schedule an appointment that's usually, you know, what, sixty, ninety, one hundred and twenty days out and for something that's much, much more urgent, much more immediate, right? So I love these business models. And if you're listening to this and don't get to the full write up on Medsider, the website is indomotx.com.

So indomotx.com, We'll link to it, of course, in the full write up on Medsider, but just wanted to get that out there now in case you don't happen to get if listening is the only way that you kinda consume this type of content. So with that said, give us a sense for kind of where the company is at. We're recording this in very early twenty twenty six. Are you full on commercialization? Like where are you at from a life cycle perspective?

We're clinical stage. So we'll be going into our phase two trials this year, delivering that interim data sort of at the tail end of this calendar year. And based on that data, we'll then move into our pivotal trials prior to NDA submission. So we're still pre clearance, we're in development, but we have built the clear pen, we've developed the drug and we're just now in the process of rolling out the clinical trial itself.

Got it. And phase two and phase three trials for a product like this, what are they, in terms of like participants or subjects

Phase like two is typically in an application like this somewhere between one hundred and two hundred patients or Phase three tends to be more like 500 to 1,000, often split across two different pivotal trials. So sort of a phase three A and B or one and two, depending on what you want to call it.

Got it. Got it.

And that's really just based on FDA's guidance and the feedback that we've had from them as well as what they provide in sort of guidance documents.

Okay. And I would assume for something like acne enrolling in a trial though, even though it may be 500 patients in a phase three, like seems like a lot of patients relatively speaking, but you could probably enroll quite quickly, would imagine, for something like this?

Yeah, that's one of the things we're really excited about. You have twenty million patients in The US who have inflammatory acne and a million of them or so are regularly getting these types of injections in dermatologists' offices. And based on that, yes, we have not struggled to recruit patients. We've run a preclinical feasibility study in the past and the recruitment process was actually quite smooth. One of the nice things about dealing with indications where the patient population is large, it's much simpler to recruit larger numbers of patients pretty quickly.

Yeah, got it. Cool, all of that makes sense. I think that's a helpful backdrop kind of for the next kind of twenty, thirty minutes of this conversation. We'll go back in time and learn a little bit more about your journey building into Elmo over the past, gosh, it's what? We're going on five years now, I think, right?

Four years.

Yeah, yeah. So and you're at obviously a pretty, pretty crucial point. Right? I mean, it's, it's, it's difficult for any startup, right. To get to this, to get in your case to a phase two trial, you know, or maybe pure play device to get to a, even a, even a feasibility study.

So there's not a lot of, lot of, lot of folks that make it this far. So curious to get your learnings, right? Built the company over the past handful of years now. So with that said, let's circle back around to kind of those early days, right? Call it 2021, 2022 timeframe, still pretty far off from getting it into patients, trying to move quickly with a fairly limited amount of capital.

When you think about kind of that early stage development work, what are a few things that either you've learned personally or that you maybe often recommend to other entrepreneurs around how to best deal with that constant balance of trying to get to the next inflection point from a development standpoint, but oftentimes with not a lot of capital?

Yeah, I think there are really sort of two key points that kind of guided us in those early days. One was fail fast. So we wanted to prove out the hardest, most challenging technical problems, first generate as much data as we could to support those so that we knew what the overall scope of what we had to do was going to look like. And the other piece was working with advisors and investors and other entrepreneurs to really identify where those value inflections are in that sort of commercialization journey so that you can map out pretty carefully what capital you need to achieve, what milestones. And then based on that, you can go out and sell to investors.

This is what we're going to do. This is what we're going to achieve. And by achieving that, we've generated real value inflection points for the business. And in a venture backed company, you're raising additional capital on the basis of each of those milestones and creating an opportunity for people to to gain value throughout that entire process.

Yeah. On that note, and we'll maybe talk a little bit later on the in the conversation about fundraising specifically, but that framing, right, of this is the amount of money that I'm going to raise to achieve these milestones, and that's going to lead to, you know, a two x or a three x or a four x in value. Even though that sounds relatively simple, us talking about it, it's not like to communicate that in a very succinct way, right? It makes so much difference, you know, when you're in those early stages, right? And I don't know, it's something that I think is worthy of emphasizing, right?

That just the ability to kind of nail that messaging and have that kind of very thoughtful talk track speaks volumes of those earliest points in the company.

Yeah, it makes a really big difference in your ability to raise capital throughout the process.

Especially as you're thinking about not just maybe a seed round or a series a, but what does then the series B look like. Right? Because every investor that's coming into those early rounds are gonna be thinking about their investment and what that looks like in those later rounds. Right. How much are they going to be diluted, you know, etcetera, to eventually see a return on their capital.

So with that said, let's talk a little bit about some of the design decisions that went into the clear pan, especially considering kind of the the consumer aspect of this. Right? And I think I think even though this question is maybe a little bit more consumer centric, it applies, in my opinion, even if you're selling a device or something that that's used by a physician. Right? Thinking putting yourself basically in the shoes of the end user and how they're how they're thinking through workflow and how they do something.

Give us a sense for kind of how your team thought through that in those early years, kind of eventually leading up to getting it into clinical studies.

I'm a really firm believer in sort of this principle that it's the engineer's job to solve all the hard problems for the user. And you've got to design products that are both easy to use and also really difficult to misuse. And so we did spend a lot of time with patients and human factors types of studies to really understand what it was that was going to make this product really simple for patients to use and ultimately effective. And then we also worked with some early physicians in the space to understand exactly how physicians are performing these actions so that we could better sort of mimic exactly what's happening in a dermatologist's office directly in the device in the hands of a patient. Having sort of both of those inputs early and then just saying, even though it might be simpler from a technical standpoint to offload a step to the user or rely on the user to perform something, check something, I think one of the key sort of guiding principles in this product was let's take as many of those things off the table.

I would rather make sure we understand from an engineering standpoint how to solve for that complexity in a controlled environment, you know, manufacturing, in the design space, you know, as opposed to trying to say, let's put this in the hands of an inexperienced user and hope that they can do this correctly. Hope's not a great strategy when it comes to usability.

Yeah. No doubt. That comment you made about designing something so it's not misused. Right? I don't wanna gloss over that because I think it's so critical because I think all of us when we're thinking about a new design or a new device, new product, etcetera.

Like how do we want to improve upon a legacy product or legacy something and what new features or what improvements do we wanna make. But we're thinking about it within that context and not necessarily okay what if someone uses it the wrong way, right? Or how could they potentially use this the wrong way? Because it's not just, oh, that may lead to adoption friction. It literally could lead to efficacy issues too, right?

I mean, if you're like literally not using the product the right way, you could end up in funding a clinical study that has poor outcomes. Not because Clear Pen didn't work as an example, but literally people were not using it the right way or incorrectly. So I think it's hugely important. So talk to us a little bit. Do those, I got to think that probably came up a little bit, right?

Because you're going from in-office use to home use. So it's critically important point to nail.

Yeah, no question. And I think one of the other pieces there that's really important is also your ability to recover. So if you make a mistake designing products so that they can go back and you can fix that mistake. So for example, our product has the ability to sort of lock out the activation until it's on the face in the right position. And based on that fact, it means that a patient can't accidentally activate the device too early.

They have to have it fully pressed up against the face in the proper orientation in order for the device to work. And so I think that's an example of the kind of design trade off where you might say, well, it's okay if you just have a button you can push anytime, we'll just tell patients to put it on first before they push it. But if you pick it up accidentally and push that button, now you've wasted a dose, maybe you have to go back to your physician, get another one, this will be a prescription product. So that's gonna be one of your uses. So those were the kinds of sort of decision matrix trade offs that the engineering team sat and said, okay, let's find another way to make sure that that doesn't happen.

So if you think about those misuse scenarios, how do you keep that from happening and how do you also make it so that if they did push the button, in our case, it doesn't work, so they can recover by just stopping pushing the button.

They can still continue to use the product.

Yeah. I'm sure I'm sure you've heard this. I don't I'm not sure the best way to describe it as analogy or maybe a framework of like, is this a glass door decision or is this a decision that we can kind of like the door's open and we can kind of go back the other way. You know what I mean? And that comment that you made about like, is this something that could eventually be fixed?

Because if it is, let's just move forward with what we think is going to work now, knowing that we can kind of walk it back later. But if it's a glass door and the glass is shattered, that's gonna be a little bit more difficult. So kind of thinking through some of those decisions with that frame of mind, I think is helpful for anyone that's building a startup in those early days.

Yeah. Get it into the hands of users as early as you can, as often as you can, because patients and consumers will teach you a lot about how they think about things, what makes sense to them, how they would use a product like this. And the details matter. It's almost as much as what they don't say as what they do say in a lot of those situations.

Yeah, I couldn't agree with you more. It just speaks to the importance of just being as close to your customers, your end users as possible. And I think it's sometimes it's easy to be like, well, we've got this usability study that's planned for three months down the road or four months down the road. But there's oftentimes these periods leading up to that that are very iterative, right? And if you're close to physicians, if you're close to patients or consumers, you're largely gonna be able to prevent some major issues coming up as a part of that usability study.

You're gonna be able to solve for those well in advance.

These informal types of, we sometimes call them friends and family types of studies, they're certainly not the validation method that you're gonna use in a submission, but they can be incredibly helpful in making some of those trade offs early and avoiding going down a pathway that ultimately doesn't pan out.

Yep. It reminds me of, there's this conference that we discussed going on a year and a half ago and we were getting feedback on a device handle. And one of the physicians who I would argue is, I mean, was a KOL, I mean, high volume user as well. So kind of a unique blend where he still does a lot of procedure volume and talks on podium, etcetera, etcetera. He picked up the handle and not in way of which we expected, right, of someone to kinda control it with one hand.

He picked it up like a it was like a gaming console, like a gaming controller for a console. And I was like, oh, that's so interesting. And he was younger. I mean, tended to be younger. So that's probably, I mean, that's sort of maybe the natural kind of a natural way to kind of pick up a design like that. And I was like, oh, that's so interesting. But it wouldn't have been something that we would have picked up on, right? If we didn't, weren't going through kind of some of those informal sort of feedback sessions. So yeah, so just can't reiterate.

It saved you some time in thinking about the next phase.

Well, at the very least that's in your head, right, as you kind of think through, even though that's maybe not the way most people are going to naturally pick up a handle that's designed in that way. Absolutely, you're thinking about, okay, someone misuse this or would this cause somebody to use this in the wrong way? It's just helpful to have of those outlier or that outlier type feedback. So with that said, let's talk a little bit about stealth period that you kind of recently emerged from. You obviously made the decision to stay stealth for a while and then kind of come out of that period.

Give us a sense for why you guys made that decision versus trying to more, I would say, build more in public, if you will. What's your typical advice for other entrepreneurs that are trying to make that decision? Do we stay quiet? How long do we stay quiet? When do we come out and tell the world about what we're doing?

Hey everyone, let's take a quick break to talk about Fastwave Medical, the company I co founded and lead as CEO. We're developing next generation intravascular lithotripsy, or IVL, systems to tackle complex calcific disease. Over the last few years, we've closed a series of oversubscribed funding rounds, bringing the total investment into Fastwave to over $50,000,000 Corporate interest in the IVL space is growing too, the $900,000,000 acquisition of Bolt Medical by Boston Scientific in 2025, and Johnson and Johnson's $13,000,000,000 acquisition of Shockwave Medical signal a lot of attention on emerging IVL startups like Fastwave. And we're making serious progress. In addition to recently receiving our ninth patent, we've successfully completed peripheral and coronary feasibility studies and are gearing up for pivotal trials. If you're interested in investing in the fast growing IVL market, head over to fastwavemedical.com/invest. Again, that's fastwavemedical.com/invest. Now let's get back to the conversation.

There are definitely pros and cons, you know, to to each style of building, and I think a lot of it does depend on, you know, we're we're fortunate to have, you know, a really strong group of early investors, you know, who had conviction and believed in what we were doing. And so we didn't need as much public validation in order to gain access to that capital. Sometimes that's not the case, and you just simply don't have a choice. You've got to get out there and tell a bigger story and be more public. I think for us in particular, too, it was really about starting to establish some of the IP portfolio, thinking through some of that early clinical data, and really establishing a strong position before we went out and started talking to both the investing public, I would say, but also consumers.

Because as a business who ultimately our end users are your next door neighbor, the random stranger you meet on the bus, those are the people who are going to be using the product. And it was really important to us that before we started to communicate with them, we really had a strong position of data that supported where we were headed, because it's critical in businesses like this to maintain that trust throughout the whole process. And absent that data, you're just making a statement with receipts. So having the receipts is an important piece to having the ability to speak candidly to your actual target patients.

Yeah, that's just such a smart way to think about, think through that. And I couldn't agree more with your thought process early on. Like you had institutional investors, right, that were willing to support a company through kind of a stealth period of time. Right. If you're in that boat, there's largely not a compelling need to be very front and center and be operating sort of in public domain.

Other startups may not, right? You may be kind of scratching and fighting for that next phase of capital. So it may be more urgent, right, for you to tell your story in the public and reach a wider audience. But your other kind of the latter part of your answer though, I think is spot on. I remember having the founders of Saba come on and they have that, I'm not sure if you're familiar with SAVA but they built a pretty novel like, wearable sensor, I think, to eventually compete in the in the CGM space.

But Yeah. I asked them the same question because they they they were stealth for quite some time and and they a little bit more consumer biased. And they they answered, I would say, somewhat similarly to you in that. They wanted to wait until the major technical questions, and I'm paraphrasing a little bit, but the major technical questions had been So in essence, to your point, to steal your phrase, they had receipts. They weren't guessing at that point once they came out in public.

They were able to answer. The most technical risk had been burned down. They had data to prove it, etcetera. And so they were there's more of a compelling reason to kind of like surface and begin to kind of tell their story in the public domain. Yeah.

Yeah. So I think that those good approaches if you're in that boat kind of a couple of things

Particularly in businesses that are going to be communicating to consumers. And for us, the rationale to come out of stealth was we are starting clinical trials. We want to start to engage with that target audience. We want to be available and accessible so that they can see and understand what it is that we're building. And frankly, there's also just a lot of excitement from those patients and from the providers and the physicians that we're talking to. And so sooner or later, we needed to get out there and be able to start talking about it in a bigger way.

Yeah, no doubt. On that note, let's chat through your recent fundraise, right? Because I think you announced it late last year, the $25,000,000 round. Congrats on that. As we were chatting about before we hit the record button, it's just even though there's signs and signals that this year hopefully should be some positive activity, fundraising, M and A, etcetera.

It's just always hard to raise. It's always hard to raise. But Always for the life sciences. And so when you think about getting this round closed, are there a few things that like you know now, right, after closing a pretty big round that maybe you wished you do ten years ago, right? Or like, what do think would be most helpful for others that are kind of new to the fundraising game to really understand as the approach for capital raise?

Yeah, I think it really came back to what we were talking about early on in the conversation about trying to carefully map out what data do we need by when to really justify value inflections in the business. And for us, we'd finished our investigator led trials, we'd really demonstrated equivalence between an in office procedure and a patient performed procedure. And that was a critical unlock fundamentally for the concept. And that was data that frankly didn't really exist anywhere else. And so by collecting that ourselves, being able to synthesize it, and then emerging from that sort of the next phase of clinical device product and design, that was the real critical unlock to say, okay, with additional capital, we can now go run phase two, develop additional commercial hardware and product so that ultimately, we can get this thing to market as quickly as possible.

And when you can start to outline what those use of proceeds will be for exactly how those are going to leverage into the next step of value, I think that's the critical part to ultimately having investors gain conviction. And that's the name of the game. At the end of the day, they've got to believe in what you're doing, that you have the team that can do it, that you've got the data that backs it up. And when you combine those things together, then it's about finding sort of founder funder fit and also funder market fit. And those are really two critical variables that are sometimes difficult to tease out early on in a process.

There are a lot of investors out there. Every size, shape, flavor of investor pretty much exists today. And the key is finding investors who really sort of are aligned in the same North Star you are as a business.

And so for us, we're really lucky. Atomic, Foresight, Polaris all see that intersection of science and consumer and the opportunity to build products that resonate with real people and identify that the market is shifting in that direction. So for us, we see huge opportunity in that space. I think GLP-1s before that, auto injectors in the monoclonal space, insulin pens have all been shifting this at home injection as a common practice. And I think what almost ten percent of Americans have now been on a GLP-one and until hopefully soon, right, with pill versions of GLP-one, but they were all injectable. So that means one in ten people have self injected for a treatment at home now. And ten years ago, that was not true.

Yeah. Yep. Your syndicate I mean, that's an impressive syndicate. Right? I mean, we talked about Hims and Hers, but I think Atomic was maybe the original investor in Hims and Hers.

Yeah. So Yeah. Jack started hims and or started Atomic, excuse me, as a, you know, a venture studio to help commercialize, you know, concepts that emerge from that that space. And so, you know, we're we're hoping to be another another hims and hers coming out of that process.

Yeah. Certainly, you've got some solid investors around the table, which again, congrats on that. I mean, that's just, you've been able to build out a collective of some impressive folks, no doubt. And we touched on earlier on just the importance, of being able to clearly communicate in essence what you're funding, right, with this capital and what that's ultimately gonna lead to in terms of evaluation. And I can't remember the interview that we published.

It was probably within the past couple months, but I'd be drawing blanks here in terms of the name. But anyway, we talked about that point of like, there's all kinds of different aspects, right, that go into a pitch, right? Know, communicating the market size, how your technology is differentiated, etcetera. But the single most important point by far is return on capital. You've got to be able to communicate what's being funded with this money and what is that going to lead to in terms of valuation. And if you don't nail that, everything else is kind of secondary. And it sounds like you've been effectively able to do that. Guess one more follow-up question on fundraising, kind of just focusing on the syndicate that you've built. Really impressive group. Any other thoughts around how to because sometimes it can be intimidating, right?

When you're approaching quite literally some of the best of the in terms of VCs in certain category. Any other thoughts around how you've been able to successfully do that or what, you know, in terms of kind of, you know, going from initial pitch to follow-up meetings, etcetera? Like, what's been helpful?

Personally, for me at least, one of the things that's always helped me in these situations is just making sure that there's such a deep set of knowledge, data, and facts behind what it is that we're saying so that while we may distill it down to a very simple concept or a market size or a TAM or a revenue opportunity, each of those has enough backup that we can sit there and say, ask as deep as you want to go, and we're going to be ready with really validated answers to those questions. And at least for me personally, that's always helped from a confidence standpoint in being able to shrink things down to sort of bite sized pieces by knowing that underneath of that is a stack of receipts that makes sure that that statement is going to hold up. They won't always agree with you, but knowing that at least allows you to say with confidence that, yep, that's the size of this market and we have confidence in that answer and we think you should too.

Yeah. It's interesting that you bring this up because we've all seen the pitch decks of like Airbnb's series A pitch deck or whatever. Name your like hot company whether it's in the life sciences or the technology space, consumer, whatever. And it's like, oh, the slide deck looks so simple. But the complex part of that is distilling all of the work that laddered up to that one point.

And knowing that like the back of your hand, yes, the slide may look simple but certainly the background information that was collected and reviewed and analyzed wasn't simple. And you forget about like, yeah, it's a simple deck but all of the questions that came as a part of that pitch in multiple pitches around that deck, I'm glad you brought that up. I mean, goal is to communicate with simplicity in sort of a straightforward approach. Right?

And that's hard. I'm not perfect at it. There's no question. There's always room for improvement in those areas. But, yeah, I think that is the key at the end of the day when you look at those really simple decks. They're only simple because there are probably a thousand pages of appendix behind each of those points that investors are gonna dig into. Once they dig into it, then they can come back and say, Yep, totally buy exactly what you're saying at the top here. But until you have that, if you don't have that backup, it's really challenging to defend those points.

No doubt. No doubt. I've got a couple of questions left before we get to the rapid fire portion of this interview. And I'm gonna skip to the last one and then circle back around to the second one. But let's talk a little bit about hiring, right? Because you've scaled teams multiple times now, right? Especially over the past decade, right? At several startups. And so what are maybe a couple non obvious things or maybe they are obvious, but you just think they need to be emphasized, right? Around how you go about not only identifying and recruiting, but also convincing folks to join your team.

So one of the key things I've always looked for, in addition to technical skill set, for whatever the role it is that we're hiring is really just an inherent curiosity. I think if you aren't getting good questions back, if people aren't questioning fundamentally the why behind what they're doing, why they're doing it, that's key, especially in these early stage startups, because we don't know the answer to everything. We don't have a 10,000 person organization that's just a big machine where you're turning the crank. You need people to pick up their heads and say, why are we doing this? Or why are we doing this this way?

This seems like we're not answering the fundamental question or we're missing a major chunk. And I think especially in scaling startup teams, you have to have people who are really talented and skilled at whatever it is that they're going to do. So period, full stop. That's sort of the starting point. But beyond that, I think trying to identify people who just have this innate curiosity and are willing to kind of question the why in the world, at least for me and the way I like to think about engineering teams and technical development, think that's a really critical skill set that ultimately helps unlock a lot more value and allows you potentially to skip a lot of operational steps that might otherwise be built into workflows that they inherited from either other companies or experiences that they 've had.

Yeah. It's something that I look for as well. It usually stands out. I'm not sure if you would agree on It usually surfaces throughout the interview process, have you ever made the decision to sort of where your intuition says this person that isn't surfacing, right? They're not asking enough questions or they don't seem to be as interested, but you've maybe made the hire because of their experience or their pedigree. And it ultimately has not worked out as you expected.

Certainly have been in the situation where, yes, either by skill set or especially in sort of niche skill sets where the number of people who have those are limited. I think there are sort of two approaches that I've taken. One is for a very specific given skill set, sometimes you to coach the players that you have. And so you find ways to instill that curiosity or enforce that curiosity by kind of first principles thinking and just overall planning. And sometimes you just simply identify that from a cultural standpoint, that person's not gonna be a fit and it's always better to, I think, trust your gut in those situations and say, Hey, this is not the right person for the role. Let's go find that. I think especially in small, nimble teams, Those first, don't know, call it 10 to 20 hires are so key in establishing the culture, the expectations. And if you let your team down by bringing in talent that's not up to par, they notice.

They'll make their own decisions, you know, with their feet at some point if you can't be consistent in that.

Yeah. No doubt. And if you you you if you hire the right folks, that sort of that that that culture almost becomes almost organic. Right? Like, it's kind of In other words, A players want to be around A players in that sense.

And so I think that's kind of what you mentioned if I'm kind of reading between the lines. But the reason I ask about kind of trusting your intuition is I found more often than not that good entrepreneurs, they do have good intuition, typically. And not that they aren't averse to risk or willing to take kind of uncalculated risk, but typically they know where to lean in. And I guess maybe my words of encouragement was like, I'm a huge believer in curiosity too. And if you're a big believer in curiosity or something else for that matter, trust your instincts as you kind of go through that process because usually it's right.

I'll always take a technical person with curiosity over just pedigree. I you know, I think there I've I've been at a few places where pedigree was a a really important factor, and I'm unconvinced that that is the best signal for selection these days.

Oh, 100%. And the reality is like, these are long journeys. And so if you're not, usually curiosity is like, it's either part of, or it's aligned with like just a willingness to kind of lean in. And there's so many hurdles and challenges across the years, maybe decades of a startup. Need people that really enjoy kind of the area space and they're unafraid of challenges.

Day to day problem solving in a startup environment. There's no question you have to be ready to just think differently and really tackle problems from a bunch of different angles to find solutions because resources are constrained. We are not big pharma.

A 100%. With that said, I've got a couple of rapid fire questions, but just real quick, kind of circling back around to kind of the early days of Indomo. Did you know that you were gonna mean, you have from day one that you were gonna develop the Clear Pen? The reason I'm curious is like, I mentioned earlier this, like I love these ideas, right? Where it's like this sticky kind of friction around something that has been proven to work. It just needs to be access needs to be opened up in essence right and I don't want to appreciate all of the steps that ladder up to developing something that can effectively be used at home in your case, but nonetheless it's reasonably straightforward. When you when you think about these types of plays, were there other things that you considered or how did you go about kind of landing on the Clear Pen?

Really since the beginning that he bring a derm procedure into the home, solve the sort of technique dependence of that procedure with device technology was kind of the core guiding principle for Indomo. The pathway to commercialization, regulatory, sort of how much of that full stack therapeutic process wasn't Domo going to own? What might you partner? How might you think about other ways to get that access to patients? But we're pretty fortunate, I think, in talking to a lot of entrepreneurs, were very few pivots on the product.

When I talked to the very earliest sort of seed investors, We're still making the same thing. We're still solving the same problem based on the same core thesis of this large market of people with inflammatory acne does not have access to the best in class treatment that they can get in the office. And they should. There's no technical reason. There's no laws of physics that we're trying to break with what we're doing. You just simply have to find innovative ways sort of within that overall standard to make it happen.

Good way to kind of wrap up this portion of the interview. We'll get to the rapid fire questions here in a second. But again, for everyone listening, indomotx.com is the website, indomotx.com. We'll link to it in the full write up on Medsider. But if you don't happen to get to that write up, definitely encourage you to check out the website. Very well done website for sure. Communicates a lot of science in a pretty easy to understand fashion. And if you know anyone that's been challenged with Acme, it's probably a product or technology that you wanna follow.

So definitely encourage everyone to check out the site in more detail. Of course, again, we'll link to the website as well as Rick's LinkedIn profile in the full write up on Medsider. So with that said, Rick, let's give the last three rapid fire questions. Feel free to answer those in rapid fire fashion if you want to expand a little bit, that's totally fine.

Since cofounding the company back in, you know, I guess you were what? You you said four plus years

Make 2021. So we're gonna have four years four years in here. Late late twenty one, twenty twenty two.

Four four plus years. So almost almost five years now. What's the most surprising or unexpected thing that you've that you've learned?

For me, the most surprising thing was understanding how little data is available on old drugs. So just having now reviewed what these submission packages looked like twenty, thirty, forty, fifty years ago compared to the FDA's expectations today, they're wildly divergent. And so it's always fascinating to me to just see how much both industry and regulators have really improved their ability to assess safety and efficacy for the products that we're launching.

Got it. All right. If you had a room full of, say, we're on the East Coast, maybe in your neck of the woods, you got a room full of med tech or biotech entrepreneurs. What's the one lesson that you would really want them to kind of understand and fully take home?

Make sure you're solving real problems for patients, providers or payers, and cool technology is not enough.

So problem matters a lot. No, it does.

Does tremendously.

All right. Let's take us back to maybe late twenties, early thirties. Your career probably is beginning to kind of really take off at that point. What's, anything, one particular thing might you tell the younger version of yourself at that point in time?

I think early in my career, I always thought there would be a perfect moment to start a company when I finally knew enough about whatever industry space, the process, and everything would feel just super confident. And I think that never happens, at least it's never happened for me and I've been doing it a long time now. So my advice to my former self would be just go for it. There's never a perfect time and perfection is the enemy of good enough in a lot of cases. And so just rip off the band aid and take a shot.

And take a swing, take a rep. Reps are important for sure. Yeah, great answer. So with that said, Rick, can't thank you enough for coming on the program. This a lot of Yeah, thanks so much, It'd be fun to watch your progress too.

You've got a really cool product, a great team, and it could really solid set of investors around the table. It'd be fun to watch what's ahead for Endomo.

Yeah, we're excited. 2026 is big year for us and we're really excited about what's in store here.

Thanks again for having me on the podcast. I love what you're doing and the sort of depth and detail you get to with folks like me who are maybe outside of the general media space gives us a window and some insight into what it takes. Really does take a village to build businesses in this space. And so this is a great way for entrepreneurs and investors and other people to really understand how it works.

Oh, yeah. Yeah. I love being able to shine a light on what others are building. Right? Because I use this phrase probably arguably too much, but like startups are always hard, but especially in the life sciences space, whether it's med tech or biotech, it's like playing the game on hard mode, you know?

It's so important. So important for the world. Oh, no doubt. This is where innovation that that changes people's lives, you know, comes to light, and it is hard, but it's it's hard for a reason. If it was easy, everyone else would do it already.

A 100%. Yeah. So I'll have you hold on the line real quick, but again, thanks everyone for your listening attention. Endomotx.com is a website, indomotx.com. Definitely check it out and appreciate your interest in Medsider as always until the episode of Medsider goes live. Everyone take care.

Hey. It's Scott again. One quick thing before you go. You see, I love bringing you insightful conversations with the best founders and CEOs of medical device and health technology startups. But here's the thing.

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