188 - A Revolutionary Device: Improving Men's Health Through Objective Data on Sexual Activity with FirmTech's Elliot Justin, MD

Welcome to Listening with Leaders. I'm Doug Noll, lawyer turned peacemaker. I teach executive leaders how to listen to emotions rather than words so that they can become the leaders everyone wants to follow. And I teach those same leaders how to be authentically present, available, and connected to their families despite being insanely busy. I have learned that we are 98% emotional and only 2% rational. Learning how to listen to emotions is, in my experience, the foundational skill of life. Stick around to the end of the show and I'll reveal how you can be on our next guest in 15 to 20 minutes. So let's get started.

Eli Justin, welcome to Listening with Leaders. You are a really interesting guy, a medical doctor, emergency medical doctor by profession, but you are also the CEO and founder of a company called FirmTech, which can be found at myfirmtech.com. And what I think is so fascinating is that you developed a device that measures men's sexual activity. I guess we'll learn more about that if we talk, but why don't we start off and just tell us a little bit about your backstory?

The backstory? Well, I— How far back do I go?

A Reader's Digest version of— I mean, you're 70, I'm 73, we've been around for a long time. Give me the Reader's digest for you from the East Coast. You're living in Montana. So how did all this occur?

Well, I was blessed with, uh, because my, in terms of my intellectual development, my mental development, and my emotional development, right, having parents who are different, different sides of the political spectrum. So the, the chasm is rather wide today, but it was pretty wide in the 1960s. My father was, uh, career army originally. My mother was a red diaper baby. My father was a, what's good for business is good for America. And my mother was interested in redistributing wealth. My father's message to me was, don't be envious, go out and get your own. And my mother felt everything, things needed to be leveled in the planet. People just to start at the same point. And the war in Vietnam, I mean, I don't think they made love after the war in Vietnam, but it's during or after, drove them deeply apart. On the other hand, both my parents were readers and argued continually. So for better or for worse, I got to see that, whereas my mother was more articulate, won most of the fights, historically she was wrong about most of the things that she predicted happening would happen. And then in the late 1970s, she switched and just kind of And it takes a long time for people to change if they're wrong and to hold themselves accountable. In 1969, I hitchhiked out west, disappeared, because that was something to do at that time. It was a lot of fun. And always felt after that trip, when I spent about 4 months hitchhiking out west, that as I said to you earlier, the west is best, the east is least. I always wanted to live out west and live closer to nature. I always felt that my father, my father to some degree was my hero. He was a forward artillery observer in World War II. He won Silver Star, Bronze Star, and I felt that I kind of grew up in the shadow of his heroism. And that he— I had a pivotal event. I went— anyway, I had a pivotal event in 1972. I went to Harvard and my father came up to visit me the middle of sophomore year and said he lost his job. He was a salesman and that this is gonna be the last year of college he's gonna pay for and I would have to pay for things going forward. And he then proceeded to lay out to me what, from his perspective with the choices in life. I said, well, you could become a lawyer. I know, Doug, you're a lawyer. He said, you could become a lawyer, but then you kind of got to suck up to people who you want, the firm you want to become partners. You got to become part of the social senior community. You got to worry about the judges. You're not going to like it. So you could become, go into government the way your mother wants you to go to the State Department, but then you're kind of a parasite. You could become a teacher, I was majoring in Slavic language and literature. He said, but eventually you'll get tired of sleeping with undergraduates and you'll probably end up in someplace like Kansas. You could become a businessman, but you see, my father had made money and lost money twice in my life. So I had experienced being upper middle class and being lower middle class a couple of times. And, you know, business is risky. And you could— at that time I thought I was supposed to become a spy. So you could join the CIA, but you're not gonna like it. And I did later on take the test of CIA and went down to Langley and didn't like the people. So you could join the Army, but you can't follow orders. You might wanna consider becoming a doctor because that way you'll have a profession you could take anywhere and you'll always have the respect that comes, self-respect that comes from helping people. I can't say that was pivotal. My motivation going to medical school was more, Well, I liked school, it was really easy for me. And what's the longest postgraduate program there is, longer than being a lawyer or accountant?

Medicine, right?

It's medicine. And that was a big part of motivation. And then, but I have to say, medicine made a man of me. It made me take seriously my obligations to other people. And it was— and I enjoyed it. It did take some growing up because I had to go from rather— there's a Russian character named Oblomov. He's really— so not written by Goncharov. And so Oblomov is a character who is talented but spends his life on the sofa because he has enough money just to, you know, he has a maid and he has a maid who he sleeps with. And people come to him and say, well, you need to get up, you need to do something. I had, I had an open-minded tendency because, because school was really easy, it was really easy for me. Anyway, I went to, I went to emergency medicine partially because it was probably as close to combat as I imagined things could be. It was a relatively new specialty, uh, and I think I probably took care of 175,000 people across my medical career. Wow. Um, and had the satisfaction that came with that. I would say 99.5% of people come to emergency department, you can make them better. You can solve their problem in about an hour and a half. And medicine trained me to think algorithmically and with differential diagnosis. So here's a problem. What are the range of possibilities? What's the most economic way of approaching a solution? And that type of dialectic thinking has— I still make my— I live it. I have my opinions. I have my, you know, we all have our go-tos. This is what I think. But I always try to run in my mind, what's the other possibility? For every thesis, there's an antithesis. And you need to try to run both those things before you come to a conclusion. Anyway, emergency medicine turned out to be not that interesting after a couple years, or at least not that interesting in the sense that there are about 15 problems that occur 85 to 90% of the time. And the challenge then is to— most doctors don't master this, unfortunately, but the challenge is to come up with an algorithmic approach to those problems. So this is like being a chef. I would actually compare what I was doing to being a chef in a really good restaurant. Here are 35 things I have to— I need to know how to cook. And so in medicine, it's like, here are these problems. I know how to cook them. So I early on became— I want to go into a leadership position. I want to run departments, I want to run them efficiently. And initially my, my focus in medicine was on, uh, was on how do you maintain quality while being efficient. I became very interested in, uh, in pre-hospital healthcare, empowered medicine, uh, and in, in taking skills that were the doctor level or the paramedic level and delivering them to EMTs, because EMTs, people who initially provide healthcare So, um, I always want to run a really progressive department. Uh, so we all— so we had the first department in the United States to train EMTs to do defibrillation. It's everywhere now, these automatic defibrillators everywhere. But that time it was, you know, it was revolutionary. We trained— I was the first people in the world, in the United States, to train paramedics and EMTs too to use something called a laryngeal mask airway. Because the most difficult skill as an emergency room doctor is to intubate someone who's had a respiratory distress or respiratory arrest. And this is a device that can be— I could train you, Doug, to do with anyone, to do this in about 3 minutes, uh, this, this LMA. Um, and, um, and that was when I did research in that area. So that's— and but how did I get into what I'm currently doing? It kind of relates to emergency medicine because I, I, um, well, here's the backstory for that. I've always been really interested in sex. So the first day of medical school, I learned two important lessons. And I think every man is going to relate to one of them. There's always some girl in college you're too intimidated to pick up or speak to because she's just so beautiful. And it's then you just kind of get tongue-tied or tongue-tied around her. And there was a girl at Radcliffe that doesn't exist anymore, it's not part of Harvard, who I felt that way about. She also made the Slovak Language and Literature. I didn't know that She also had qualified for medical school like me. And I was really scared of her. And then lo and behold, I get— I'm in Cambridge, I'm taking the trolley over to Boston University School of Medicine. She's there and she's going to the same medical school that I am. Well, I matured somewhat over the years of college and have the nerve now to talk to her. I sat down next to her and by the time we got the bridge over the Charles River, I was utterly bored. It was such a— and by the time I got to medical school, I wanted nothing to do with this person. So it's one of those profound lessons for guys, like, oh, uh, beauty is not necessarily the most important thing, and a lot of these people are really boring. You don't have anything to do with them. So I got to medical school and looked around and felt, these are not my people. So I went off— I went off to the medical school library 'cause going to library was always part of my habits. Now, what was I interested in? Well, I'm 22 years old, aphrodisiacs. So there's something then called the Index Medicus. Today it's all online, but Index Medicus was a yearly compendium, came in a book form like this, of medical articles. I looked up aphrodisiacs and there was stuff in there. Um, yohimbe, bunch of other, you know, types of thing people talk about today, you know, orals and topicals and, I tried most of them. None of them worked. Anyway, skipping ahead years, in 2015, I started a company called Pegasus Emergency Group. We were very successful. I exited that company and I was riding a horse recklessly and hit a tree and broke 6 ribs and 6 vertebrae. And as I was lying on the ground, this is important for all of you, for, for your listeners to pay attention to this, because any man who skis the way, the way you do, or rides motorcycles, or does anything that, that's at high risk— the high— what's the worst thing that happens to you? You break your spinal cord, ends up being a paraplegic or a quadriplegic. Got knocked off this, this, off the horse. Um, I quickly assessed that I'm not gonna, I'm not gonna die, but I'm in a lot of pain. I have a lot of broken bones. The cock up sign. I've been trying to teach this since 1982. If you, if you think your spinal cord is injured, injured, but you can cock up your big toe, you can urinate, defecate, and fornicate. The big three.

You're okay.

Are you okay? Exactly. My wife came over here, she was there and says, are you going to die? I said, no, but I'm going to be a lot of pain. Everything's going to go okay. Anyway, that got me interested. I just sold the company, I had money. I was interested in rehabilitation of men with spinal cord injury. And the most promising technique was neuromodulation. Most men know, most people know about neuromodulation because you know about cardiac pacemaking. It's basically implanting a nerve in the heart and with it you have a battery, essentially you have a generator pack and you send various amplitudes and frequencies of electricity and you can control the heart. And these, there were papers by doctors saying that they had done this with men with spinal cord injuries. And multiple sclerosis. First, I tested out on two rams, male sheep. I called it ram charging. And we got urination, defecation. We also got erection and ejaculation, but it wasn't exactly bedroom friendly. And maybe in some small communities in San Francisco or London or Provincetown it might be, but not bedroom friendly. Now, the usual thing would've been to go to Silicon Valley and raise some, raise $15, $20 million, and conduct experiments on more than 2 rams and then take this down to— this is the way the game works— Mexico, Colombia, or Brazil and conduct an under-the-radar experiment on people you're paying to be experimented on, basically. And I felt, no, I tried it on me. It didn't work. And I, but a few years later, a urologist at the University of Utah heard about what I was doing and said, gee, you're now in medical technology. I have an idea and I wanna count the number of nocturnal erections that men have because they're a leading indicator of men's cardiovascular health. Well, leading indicators are really powerful thing to say in, in medicine. It's not an association, it means it's predictive. Now I had no idea that, that, about that, that if a man goes from 5 nocturnal erections per night down to 2, that man will have a heart attack or a stroke in a few years. That's so— this becomes like a sixth vital sign.

This is not age-related.

It's not? Well, it— well, that's really interesting.

I know on my blood work I have like this tiny little bit of testosterone.

Well, it is age. If, if your testosterone is low, it is, it is age-related. 'Cause testosterone goes, goes down with age. And that's a reason actually to take testosterone. So I believe, I'm confident, I'll say that 3 years from now, what we, what we are doing now with FirmTech, we call it an erectile fitness score, will become the standard for care and for research.

Huh.

For all men over the age of 45 and for younger men who are diabetic or hypertensive or obese or have, or have, who have risk factors.

And you've invented a device that fits over a penis.

Correct.

And it sends data somewhere.

It's a wearable, so it's Bluetooth enabled. We have an app. If— and I'm the— to objective, you know, basically the phrase goes, if you can track it, you can hack it. Right now, If you and I, and we're the same age, if we went to a cardiologist and said, gee, you know, I feel a little short of breath walking down the driveway, maybe I might get a little twinge of pain in my left arm, and the cardiologist just said, hey Doug, you look good, listen to the stethoscope and said, your ticker's okay, you're okay, we would think WTF, is this 1880? We would expect the CT angiogram, electrocardiogram, stress test, blood work, Well, that's where we are with urology or sexology when it comes to erectile dysfunction. They, they, the urologists and sexologists have pretty much nothing other than opinion, and those opinions are based upon, uh, subjective studies that use a subjective scoring system as opposed to an objective scoring system. So that's what we're doing is, is revolutionary. And since cardio— since your sexual health, it's not just about your sexual health, it's a reflection of cardiovascular health and your medication side effects. I mean, Men our age, more than half the men our age are taking either antihypertensive or antidepressant, and about 35-40% also diabetic. All those things are erection killers, but they also are a reflection of our cardiovascular health. So I'll share with you that the next gen— the device we're doing, we're doing right now is like a flip phone. We're now working on the equivalent of, of a smartphone for the device because we're going to We're going to be adding radar, probably. We're testing it right now. But with radar sensors, we can see through your pelvic bones and into your pelvic floor muscles and see how strong they are. We can look for calcifications in your arterioles and your venules in your pelvis. So this is what's going to happen with this device. Just, we've already sold 11,000 devices. What happened with the next generation devices a year, year and a quarter from now, it'll be like a painless catheterization, only through looking at your pain, looking at your pain, just looking at your sexual health.

This is amazing.

Yeah, I'm happy to say that I'm on no medication whatsoever.

That's good.

I'm really in good shape, but I work hard at it.

Well, I'll give just— and I'm certain you are in good shape, but we've had We've had men get our device who are really fit, who did discover that they had something wrong. There's something wrong. So what it's, it's the predict— I mean, it's the predict— so the point being that before a man manifests clinical erectile dysfunction, can't get it up, can't, or either can't attain erection, that's really bad, or more commonly has trouble sustaining erection, the data shows problems. So that's— this becomes a screening test.

Wow. So we see a time in the future, in the not too distant future, where this becomes a commonplace device for men for getting diagnostic health in their whole pelvic region, in their necks, and—

And as a reflexor of cardiovascular health. Right. And women too. And we have— we've tested device on 38 women, and I hope to bring that out to 2025. I don't— I don't have the money. You know, this business is largely done with my money that I've made in other ventures. Right. And I will— I will— I will do the female device anyway in time, but I'd rather fund it from revenue than fund it from, you know, personal assets.

And that's what you're doing. You're, you're pretty self-funding the whole project.

I've self-funded almost every business I've done. Matter of fact, I have self-funded every business. I've never worked with VCs.

It's the right way to go if you can, if you can do it. So what is it that gets you up in the morning, gets you excited about everything that you do?

This is the most exciting thing I've ever done because one, it's a legacy. I, you know, I don't have to do this business. I could, I could be knocking around a golf ball and skiing and just riding horses and reading books. But that's not who I am. I would need to be doing something. And, but, but this is, this is, we're delivering potentially life-changing, potentially life-saving data to people. And I would, and 3 to 4 days a week I get emails from men of all ages, uh, with two themes. One is, I'm not having— my wife and I— but the most common one is, my wife and I are not— are now having the sex of our lives, thank you. And they could be men recovering from prostate cancer, they could be men who have— who, who, uh, are taking too many medicines. I mean, you know, there are people our age who are taking three medicines, and I make recommendations to them. I always tell them, of course, Don't change your medications without consulting a doctor. But I know these people doing their own 'cause people don't trust doctors. And these, so if you're, you know, the oldest person is 82 years old, his wife is 65. He was taking 5 medications that could have an impact upon his sexual performance. And I recommend to him that they stop 3 of them. And he did. I don't know if he talked to his doctor or not, but he and his wife emailed me and said, well, we're really, they're really happy now. So to restore people's sexual function, is to change the quality of their lives and to extend their lifespan. And people who are sexually active live longer.

What are urologists saying about this?

They love it. So, I mean, it's— there's a Dr. John Mohal. He's the head of andrology at Memorial Sloan Kettering in New York. He heard about what we're doing. He asked to join our scientific at the large board, this is about 6 weeks ago. He wants to do a study involving, you know, using this device before and after prostate surgery with the goal of one, eliminating malpractice because people claim that they're potent before and end up being impotent after this. But this device makes it objective. But more importantly, getting men to comply with the rehab from prostate surgery. You and I are probably blessed. We know my prostate's normal, your prostate's normal, but a lot of men have problems. And as a consequence, the incidence of impotence after surgery is between 30% and 70%. Well, that's game over for a lot of people. There's suicide, depression associated with it. And men, the therapy is demanding. Men have to do pelvic floor exercises, they have to use pumps, they take medications. And a lot of men quit 'cause they don't see any significant benefits. But if people see data, they're more likely to comply. I mean, even myself, I've weighed the same thing forever, and I'm fit. My wife has a digital scale. I still get on it every day. I don't need to. It's the same thing every day. But if there's that type of response, and people develop positive relationships with, you know, with their wearables for health. And it's my hope that with this type of technology, people will enjoy better cardiovascular health, less medication side effects, and also the benefits of having a happier sex life.

Wow, that's quite a legacy.

Yeah, so it's fun. So what gets me up in the morning, it's that, uh, it's great to be in business with my wife. I mean, I've started other businesses, my wife's never been engaged, uh, we've married, close to our 36th year. Uh, in the past, I'm certain her attitude would have been, no effing way I want to be in business with my husband, because, uh, that you and I discussed before the call, I can be impatient. I tend to work at a gallop. I'm always sort of triangulating in my mind and coming to decisions faster than other people. And I need to often— In my own defense though, I do want to say something appropriate for this conversation. I've always said, And I'm going to use a word that's fallen utterly out of fashion, but when I started running emergency departments and, and I would invite everyone to our monthly quality meetings— everyone meaning people who clean the toilets, security, um, technicians, nurses, etc. And a lot of people did— doctors didn't like that. People didn't like airing their dirty— their problems, like the cases they misdiagnosed in public. But my, my point to the team was, even the dumbest person here could come up with a better idea than me every day of the week. And if I'm not listening, if they're not here and we're not listening, we're not going to realize that one of the problems we have here is actually the toilets aren't being turned over faster, or the waiting room is not being cleaned up, or the parking situation is really bad. And also, I was always often impressed with how people lower down or people without college education could come up with really practical solutions. So it is imperative to listen, but I would say probably in my marriage, there was always going to be some problem about it. But this business has been great. It's really been great working together. That gets me up as well too, because where we're working together. And I guess the third thing would be, and you understand because you live in natural beauty, I love where I live. I didn't feel this way when I lived in, in New Jersey. I wanted to get out.

Yeah, I'm with you. I couldn't live in the city. Living in the mountains is really a blessing. Really is. Yeah. I tell people I live in the California that nobody hears about and it's gonna stay that way, I hope. Yeah.

I get up, I get up in the morning, I feed the chickens. I, I, I give carrots to my horses. Yeah. Feed them. And then, you know, it's not, it's not riding season, but it's, it's always beautiful. And I, and I get, I, I try to, I try to see dawn every day.

Good for, good for you.

And that's what I love about living out west. I live in, I want to live in a place where I can see the sunrise and the sunset. Probably like you, we've never, since we moved to Bozeman, we've never locked our doors. No, we don't even know where the keys to the house are. And I don't— Bozeman has changed because of California.

You had a lot of people moving during the pandemic.

They call it Boz Angeles now. And, uh, it used to be, we moved here and I— the city had like 28,000 people, has over 60,000 people right now. It used to be that you could, that, you know, if you and I passed each other on Main Street and we didn't say hello, we think the other person was an asshole.

Right.

And that's changed. People actually don't like being spoken to in the street. People come here from Los Angeles or San Francisco or Seattle that they're not used to that type of civility. I miss it. And I would, I would actually move further out, but we have, but my wife loves our social life here and she makes her happy. So We'll stay. The town has come to us though.

Yeah.

Yeah. I know. I know how that is. Well, it's going to take a while for the town to grow out here, but we're 30 miles from town, so it's a good 35-minute drive in. But I, you're right. It's the lifestyle is unbelievable. Well, one more question. I've learned it's been, there's so many interesting things about you, Elliot. One question that I'm really curious about, what is one thing about yourself that we would never know about unless you revealed it to us?

Annie?

Yeah.

You mind if I have my wife join this?

Have her come on in.

Yeah, this gentleman has a question. Come on. I'm coming, I'm coming.

Uh-oh.

This, this—

he's asked me—

go ahead.

So, hi Annie, I'm Doug.

Hi, hi Doug.

So I asked Elliot, it's always the last question I ask on my podcast, and the question is, so Elliot, what's one thing about yourself that we would never know about unless you revealed it to us?

God. Go ahead. I have no idea.

Okay, I will reveal it.

I—

what would people know about me?

How kind you are. Because Elliot's got a lot of opinions and he, you know, expresses them vociferously. But ultimately he's, you know, he's an emergency room doctor. You have to really be kind to do that work. You know, he's open to anybody that comes in.

So yeah, I think by my qualifications people might think that I'm a snob. And I'm not. I really, I do listen and I am a caretaker of people. And that's good for you.

Well, if you were to ask me that question, I'd tell you I'm a jazz violinist.

Oh, well, wow.

How fun is that?

Well, it's been a great, a great conversation, Ali. Thank you so much. I really appreciate it.

Thank you. It's a pleasure. Thanks. It was fun.

Doug Noll here. Thank you so much for listening to Listening with Leaders. If you are a successful executive leader who would like to be on this program, please visit podcast.dougnull.com/podcast. If you got something out of this interview, would you please share this episode on social media? Just do a quick screenshot with your phone and text it to a friend or post it on the socials. If you know someone that would be a great guest, tag them on the social media to let them know about the show and include the hashtag #ListeningWithLeaders. I love seeing your posts and guest suggestions. We are regularly putting out new episodes and content. To make sure you don't miss any episodes. Go ahead and subscribe. Your thumbs up ratings and reviews go a long way to help promote the show and mean a lot to me and my team. Want to know more?

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