BoneChat #28 UNPLUGGED - Ossio, how we did it and where we are going with Brennan Marillo.

We are live with Brennan Marilla. He's the COO of osseo. Osseo's cracked the code on non metal orthopedic fixation. Incredible growing private company. I want to say one thing is that Brennan and the CEO Brian Verrier came from the cardio space. They didn't know much about orthopedics. And this to me is another checkpoint that the management team is the only thing that matters. They will figure out. So hand the mic over to Brennan.

Thank you. Well, I would say you have to hire orthopedic people and put them around you or else you're going to be in trouble. That's what we tried to do, but it's, it's great. It's. I appreciate Tiger asking me to, you know, share Asia with the team and I'm looking forward to just sharing our company with you. We're proud of it. But we also could, I'm sure could greatly benefit from the expertise of the people on this call. So I, I don't know, I don't know what everyone's backgrounds are, if you've even heard of our company, but going to take a few minutes and just share with you guys our technology and, and kind of our strategies and where we've been and where we're going and welcome, welcome any feedback that you guys have or questions at the end. So I'm gonna tiger you. Let me go ahead and get going. Share my screen.

Yeah, yeah, yeah. Share your, share your slides.

Okay, fantastic. So, so what's, I'm sorry, I'm moving my stuff around the screen so I can see my slides and you guys too. So. The orthopedic industry right now is fascinating, especially from someone coming from a, from a different space. And what I, what I hear mostly about these days are, you know, robotics and additive manufacturing, 3D printing, smart knees, regenerative medicine. So there's a lot of fantastic innovation, orthopedics and some of you may be involved with some of these technologies. But what is really interesting is that there's not a lot of innovation happening in fixation material technology. We're still using metal implants, primarily metal implants, you know, 150 years after they first were used. And so why is, so why does that matter? Who cares? Well, I, I think you guys would agree if you had the choice between an implant that is permanent or an implant that was, would go away quietly and turn into your own bone and be non permanent, that's probably what you would choose. At least. I, I haven't met A that when offered the choices and they understand both choices, that they would pick metal. So the interesting thing about metal fixation implants, they certainly work, but they are problematic. I like to say that for fixation implants metal is a permanent solution to a temporary problem. You only have to have your bone held together six, seven, eight weeks and after that the metal implant that you have in your body is nothing more than a souvenir and oftentimes it gets you in trouble. So there's, you know, obviously there's irritation, there's, there's a metal sensitivities which are seemingly growing, growing in the country. There's a lot of new data on that, there's secondary surgeries, a lot of reasons why you don't want metal if you have the choice. And we're realizing more and more that patients are talking about us online, which is really cool. And so there's growing patient awareness and we're fueling some of that and I'll show you how in a minute. The other reason why it's an issue is because it's of cost. First of all, nobody wants a second surgery if they don't have to have a second surgery. Patients don't enjoy it. Surgeons don't look sexy taking out metal hardware. It's really difficult to do. Often there are complications involved with hardware removal surgery and it cost the US healthcare system one and a half billion dollars a year. So the, so the, the me that the unmet need is there and we didn't invent the unmet need. Matter of fact, I almost spend zero time talking about the unmet need. Every, it's pretty intuitive and pretty much every large strategic orthopedic company in our space has tried to come out with non permanent implants over the last few decades. And the only ones that have ever been successful are kind of bio composite anchors that really go in your shoulder that are not weight bearing. So that's the reason why we exist. We have a technology called OSSEO fiber intelligent bone regeneration. It's a material technology platform for fixation implants which is a 15 billion dollar market. It's a shoots a massive market. And the idea with our technology is that it is, is a natural biomaterial, it acts differently and I'll explain in a minute how it does acts differently than non permanent implant attempts of the past. This is really strong. This is stronger than cortical bone and it's very, very biocompatible. The most biocompatible non permanent implant that's been out there, our mission really is to transform the orthopedic experience for patients and for everybody that deals with patients to really transform the experience so that they walk away feeling like I'm being returned to my natural self. I don't have to have hardware in my body, I don't have metal in my body, I don't have anything that's going to irritate me down the road. I'm returned to my natural self. And that's kind of our mission. You can see some of the milestones here. We did start the company in the US in 2017 up in Boston and our, our founder, who's an American that lives in Israel and a few other engineers, we're already kind of starting animal studies and we didn't even have a product yet. We just had some animal studies around the technology and the little pin that we, that we made for the animal study in Israel. So in 2017 we really kind of got it off the ground and started marching towards FDA. FDA clearance. We went commercial in the middle of 2019 with one size hammertoe implant. That's all we had. And then we got our larger approval for the full hammer toe complement and the nails the week before the United States shut down in March of 2020. So that was like the, the best and worst week of my life because we finally got FDA clearance about, about a year late and we launched into the abyss of no elective surgeries. So we had to survive that. And that's a whole nother call. That's a whole nother story. But since then we've exceeded 40,000 implantations. So this technology is proven now. We've had over 1500 surgeons use the product and we've been growing greater than 80% year over year over year since the very beginning. We have over 120 employees now between the US and Israel and we sell through 1099 distributor reps. And our first, the first market we entered was foot and ankle and for a lot of reasons that you probably could figure out. And then now we're venturing into sports medicine and we'll enter some other spaces as well. So the idea here is that we have created a new category in fixation materials. And we don't use the word bioresorbable because that's a bad word because bioresorbables carry a lot of baggage. They have traditionally been very brittle and weak. So they're not good on implantation or they're not weight bearing or if you're able to implant them. And they do their job Then oftentimes you'll have late inflammation two, three, four years down the road as the, all the polymer is breaking down rapidly and creating cysts and late inflammation. So what we've tried to do is create a material, a natural biomaterial that is in kind of that upper right hand corner, the sweet spot of fixation material. So it's very, very strong. It's twice as strong as peak 5, times as strong as a biocomposite, about two thirds as strong as titanium. But it doesn't have to be as strong as titanium because it needs to be a better match for bone and then it's more biocompatible and basically invites natural bone regeneration into the implant. So we think that upper right corner is kind of the holy grail of orthopedic fusation materials. So basically what happens is you, you, you, you implant it. Bone starts growing into the implant and then eventually it's gone. And in two years you won't even see it on histology, which I'll show you in a second. So this is the secret sauce, this is the material here. This is bone minerals found in bone, just basically like bone void filler. So we didn't invite, we didn't invent any new chemistry here. These are known materials, been around for 30 years. But Iran, our founder, basically took bone minerals and he was able to engineer them into these solid continuous mineral fibers like fiber optic cable. And then we weave those into different, in different directions or layer them in different directions, which creates this infrastructure, this matrix infrastructure that is incredibly strong. But also bone cells love, and they love to grow into and infiltrate the implant. There is a little PLDLA polymer and that acts not as the body of the implant like bioreservals. It really just acts as a glue that holds the fibers together. So at one year it's completely eliminated by the body. There's not, there's no polymer hanging around to create issues. Very easily eliminated by the body. And so again what you'll see in our animal studies, so this is kind of the, the, the ISO study you have to do for the FDA when it comes to new fixation materials. This is a rabbit femur study. And along the top is the control that was a PL DLA pin that's been on the market a long time. And then at the bottom is osseofiber. And this is histology from these rabbit femurs. What you can see with, with osseofiber is bone cells attached to, if you look at the far left, bone cells Attach to the implant. In as early as two weeks, you see bone attaching to the implant. And then in early six weeks you see bone cells infiltrating the the fibers. And then if you kind of move from left to right, you see with the staining, you see the biological activity with the blue staining. And then across the bottom, you see at 78 weeks, there's nothing left other than some fibers that are still mineralizing into bone. And then at two years down to the marrow, it's gone. There's no trace that there was ever an implant there. Along the top you'll see, you'll notice that when the bioreservable polymer based implant was implanted, the body walled it off, it saw it as a foreign body and it took a long, long time for it to break down. And when it finally broke down, it happened all at once and created issues. So that's kind of some of the biology I thought I would share. This is also another interesting study. I'll show you real quick. We know what happens in bone with our implant. It actually completely turns into bone over time. But we wanted to see what would happen if we made a plate out of this material. So we did a sheep study. We have sheep out to two and a half years, actually several. And when you put the plate on bone, what you'll see from, if you move left from right in these micro CTs, as we've harvested different sheep, you can see that it basically remodels all the way back down to the cortical surface, which is phenomenal. And that's how we got our staples approved with the fda. And this was the feasibility study we did before we started on a plate project, which we are actively pursuing at the moment. Some of the clinical studies. This is our first in human study. We did a hammer toe study because that was the first product we had, was actually a great study because the hammer toe implant takes up a lot of that intramedullary space. There's not a lot of blood flow in your toes. So this was almost like a worst case scenario type of study when you're looking at biocompatibility. So this is the first in human study. It was a hammertoe study done in Europe. And you can see that on the imaging. You can't see the implant on the left you can see that's a fused hammertoe at 2 years on X ray. And on the right you can see that's an MRI and it's completely gone. And it's really nice because the visibility of your fusion site is there. It's not blocked by metal. There's no MRI issues or any CAT scan, you know, any, any sort of artifact that you have to worry about. But the most important thing is we had 100 patient satisfaction. We did measure that as an endpoint. We had zero adverse biological reactions. We had excellent biointegration at two years. We've since done 22 to. I think we have 24 posters and publications now. These are some of the more recent ones. On the left we did a pediatric study. We now have pediatric label actually for children as young as 2 years old. You can think about the value proposition of pediatrics. These kids all need hardware removal surgery. You could avoid second surgery for your child on the left. This is a big group in New Jersey that's 100% focused on PEDs in the foot and ankle space. We did a head to head study. It's a small study, but we did a head to head study and we had less complication rates. We had no, no reoperation rates. And we had actually a cost savings over metal implants. So that was an important study for us. We also did a study at Mass General looking at metal versus osteofiber. And Liz Frank, which is a complex surgery that has a very high hardware removal rate. And that was a non inferiority study. And we actually did really well, really well in that study. And then we looked at, we have a suture anchor and we compared our suture anchor to the market leader and you could probably guess who that is. And we looked at in a sheep study and we looked at the strength on implantation. We broke none of ours on implantation and sheep tibias, tough, tough bone on those. We, we, we broke about 40% of the implants. Brian Cole, who's you guys may know, Brian Cole, big sports surgeon, Chicago, is a PI. This is again, this is a sheep study. And we looked at also at two years at biointegration at two years. Ours is basically gone in two years. And the other biocomposite anchor really hasn't even begun to break down and to integrate any way. And then we had higher degree of cellularity around the graft anchor interface which was really cool. We had better biologic attachment and infiltration of the tendon and the anchor than the, than the control. And so that was a really cool finding that we weren't necessarily expecting. So we continue to invest in a lot of clinical studies. We also have one that I'm not showing right now, which is basically for subchondral insufficiency, putting kind of our nails into that subchondral space where there's edema. And we're seeing some remarkable results from that. So it's a little early for me to talk about it. We do have a multi center study that we're doing. It's kind of the who's who of sports medicine surgeons, but that's really going after OA and maybe prolonging, you know, it's basically joint preservation. So if you guys have heard of Moxi Med and companies like that that are going after it, this is a very elegant solution. You just put two, two or three nails in to that subchondral space in the knee and we are seeing unbelievable bone regeneration and reduction in pain and edema. We're a little bit stealth right now on this until we get more clinical data, but that could be a whole separate company alone. That opportunity is so big. So bottom line is this is a platform technology and we can make products across a number of different sectors. We also can take the mineral fibers and we can weave them in different ways to make different types of implants. You can see an example of, you know, the way we make a screw is different than the way we make maybe a staple or a hammer to implant. So we can really customize all the different, you know, mechanical properties that you need in these implants. This is our foot and ankle portfolio. Again, this is the space where we, where we began and this is our core business. And so we have, you know, we have five product families. We're launching an Aiken staple next week. We'll have our first cases next week. That'll be again the first ever non permanent small staple in the world. And, and we have a pretty robust pipeline of products coming in the next couple years. This is our knee portfolio. Again, we, we're also working on ACL screws. I mentioned knee bar already. And we have, you know, applications for shoulder as well. It's interesting. We entered the sports medicine market last year with suture anchors for rotator cuff. And these sports surgeons are like, wow, I've never seen like this material. It's so strong. Do you make screws? Because I'd love to do ttos or latter days or other applications with these really strong materials that go, go away because it gives you a virgin landscape. If you have to go and do revision surgery, which is very high in sports medicine, there isn't anything in your way, there's no peak in your way, there's no biocomposite gooey biocomposite in your way or metal in your way? It's virgin landscape. And that's a huge value proposition for them. So that's been an important space for us to enter. And I have just a couple more slides on the commercial side. You know, some of our key initiatives are first and foremost, we. We try to encourage our team to be creative, to show up differently, to not look like orthopedic marketing. As a matter of fact, to not even look like medical device marketing, even though you have to maintain the clinical relevance of your marketing and your claims. But we try to do things a little differently to stand out. We feel like the product is innovative and disruptive, and the marketing should follow that. So if you follow us on LinkedIn, maybe you've seen all kinds of fun things that we do. But we have some new product launches coming this year. Like I mentioned, we have a threaded nail, which is basically a fully threaded screw. And what's cool about this is you can trim it, you can cut it, and then we have a pencil sharpener apparatus that comes in a disposable kit, and you can recut the tip so you don't need a thousand sizes. You can customize right there on the table. So that's a game changer for us because inventory management's a nightmare, as you guys know. But that's a really important product for us and may be the foundation for our screws in the future. But the other, the other, again, big initiatives are entering sports medicine. We've done a really nice job of that so far. Just surgeon engagement. We have a lot, we're investing a lot in medical education, and we try to have a more relaxed atmosphere with our medical education. We have fiberfest events and surgeons really enjoy that. We just had one in Naples last weekend. And then direct to patient marketing is kind of how we wrap all of this, how we kind of wrap our strategy around this technology. And so what does that look like? So we, again, because we're primarily in foot and ankle, we looked at a couple of elective procedures that are searched often on Google. So bunions and hammertoes. These are typically elective surgeries where patients are on the sidelines for years. They're afraid of surgery, they don't want to take time off, they're worried about recovery. And when that line crosses between pain and worry, that's when they finally get treated. So we're really going after that market and educating patients that this exists. And maybe this is another reason to go ahead and get treated, because you don't have to worry about metal. And so we have ads on Facebook and Instagram. We are advertising a lot of the social channels now, kind of across the board. And we're talking about the metal free bunion, the all natural hammertoe. And, and we are seeing unbelievable traffic to our landing pages. And so we see patients will, interested patients will see those ads about, you know, you don't have to have metal hardware and you can get your bunion treated, etc, and you can return to your natural self. They go to our landing page and then they go to surgeon locator, which we didn't invent the surgeon locator, obviously, but it really works very well. So we are, we're getting unbelievable direct to consumer results right now. And we are driving patients to surgeons. A matter of fact, I have surgeons that once a week we have surgeons reach out to us and say, I've had enough patients ask me about this now that I need to have a rep come see me. Which is, I call that forced adoption, which is one of our strategies, not unlike what Treece did so successfully. So that's kind of our direct consumer effort and we have spent a lot of money to get this off the ground and to, and to do it very professionally. And it's really paid a lot of, paid a lot of dividends for us. It's really interesting because patients are now in these Facebook resource groups and they're talking about osseofiber and they're doing that organically. I mean, you know, we, we just monitor those, those sites and people in there talking about it, which is really cool. The, the next phase, I would just show you this ad in the middle. Our next phase is, this is a preview of an, of an early ad concept. But our next phase is to market to pediatric parents that, that this exists, which is a little bit of a different, a different tactic than the elective procedures. Some of these are elected, but it's just good to have parents know that, you know, if your kid, if your kid breaks up in a soccer game, this exists, you know, maybe ask for it finally. What I would just say is I like to leave people with these, with these pictures, these X rays. On the left is, you know, I'm going to show you some images. The same procedure. On the left is kind of your traditional metal. On the right is osteofiber. And you can see here's the tree of Andrew, which is the orthopedic symbol. And this is our take on the tree of Andrew. So on the left you can see, you know, the question I always ask is, you know, as we go through these images, which one do you want? You want, you want your foot to look like the one on the left or the one on the right. And that's, that's our mantra and that's how we recruit and that's how we, that's how we attract money, that's how we attract talent, that's, we attract customers and that's how we attract patients. Because ultimately this is what you would want if you had the choice. So anyway, that's great, great stuff and thank you so much for your time.

Well done. Elizabeth up first and then Ted.

Yeah, so as you were talking about.

Marketing to the parents of children, I.

Thought about, I'm here in New Orleans.

And there's a very popular magazine just called.

It used to be NOLA Baby and Kids, now it's NOLA Family, widely read and all over town at, you know, Ochsner, a major medical facility. And so that's one idea. I feel sure that in each city there's, if not a hard copy magazine.

We're a little behind the times here in New Orleans.

We like to keep things, you know, we, we have the last daily for print newspaper in the country, I believe. In any event, Philadelphia has Philadelphia Family Magazine. You could sort of check that out for different locale. Great ideas. Thank you. We've been using Facebook. We, we haven't started the pediatric ads yet. We're just doing the hammertoe on the bunion ads. But we've been using Facebook primarily. You know, it's a good, our target, our target audience is on Facebook primarily. And it doesn't take a lot of money on Facebook to reach your, reach your audience because you can dial in the demographic, the zip codes, all the keywords that you need, and you can, you can have a very targeted effort for not a ton of money running these ads. So that's been our number one way of doing it. But we've, we've done some other things like you're referring to some opportunistic TV shows or things like that to get the word out. So that's a cool idea. Look into it.

But Ted.

Yeah. Hey, Brennan, first of all, congratulations from the product director at JJ Orthopedics over 25 years ago for trauma and sports medicine who was struggling to go against the grain in Orthopedics to introduce. We, we made the mistake of calling it bio absorbable, biorabsorbable.

But you know, I entered a work could have been a good Term. Right.

No, absolutely. I should, I should have, you know, found your, your team then. But, but we, you know, so I, I was, I was, I was carrying this flag 26 years ago, introduced Orthozorb, you know, got introduced to the podiatry. Podiatry community with bunions. So I'm really pleased to, and I've been following your success as a company to see it finally come to fruition. One sort of technical question. When you, when you cover the design of the, the material and the way it's put together, what. How do you form, like the screw threads, you know, the fine tune aspects. Is that molded or how do you do that with that material?

Yeah, that's a great question, Ted. I failed to mention that. Thank you. So we could, we. These have to be compression molded. The. You can't 3D print them. You, you can't machine them. You have to create a mold. And so what we do is we have a raw material. The, the mineral fibers are a raw material that, that we work on. And then we layer them into these molds. You know, these metal molds that have a shape. The screws. You know, we, you know, one thing we do with the screws to reinforce the strength of the screw and the threads is we actually wind. You know what, we actually wind the, the, the mineral fibers around the screws to give the threads more strength. And we also wind in the middle around the mandrel so that the cannulation is strong. You know, like on, on our, our, our staples, you know, we actually, as when we make our mold, we actually reinforce the shoulders of the staples with more fibers so that you get the strength that you, the compression strength you need. So I tell you, these guys, our core competency is in making the implants. And that's what our team does really, really well. You know, you know, the instrumentation part of it has been a little bit more challenging. You know, that's not in our wheelhouse. We, we outsource all the instrumentation like most companies do. There are very few companies that do instrumentation well and can deliver it on time with good quality. And you know, I would have launched half of our portfolio six months ago if I had him, if I had the instrumentation ready.

Yeah, no, that's a big, big struggle in orthopedics in general.

Yeah, we don't have trays. We. I should have mentioned, everything we sell comes with disposable instrumentation.

Perfect. Yeah, no, it's great for today's environment and your marketing efforts and congratulations on that. Some great hires, Alexandria. Such Is a champion. She shot some videos, some corporate videos for me in the past. So you're bringing some great talent on board.

You don't mention her name. I don't anybody in this call hiring her?

Yeah, yeah, no, forget.

Forget that name. But yeah, we tried to do that or we did that well at titan spine when we were going against peak, you know, back to titanium with. We came up with all kinds of marketing campaigns that broke the mold. So keep. Keep doing what you're doing. You guys are doing fantastic. I just want to figure out how I can invest and when you're going to do your ipo so I can become a share owner.

I'll let you know. I don't know. Okay, I'll let you know. We'll see how things go this year. Great. These are always options, for sure.

Yeah.

We don't have a round open right now, but you know that you. You know, you know, this is a startup. You can never say you're not going to have another round. Sure. But thank you, ted. Appreciate it. Yeah.

Okay, Patrick's up and then adam and then mark copeland.

Brennan.

This.

This topic came up on a previous meeting, but as you guys expand into other sub segments of orthopedics, particularly with using a third party salesforce, how do you think about. You know, my guess is most of your distributors now are your distributors because they had existing foot and ankle relationships, Existing foot and ankle business. And how do you think about sort of transitioning, training, adding to or, you know, like, you know, moving a third party salesforce across subspecialties? It's not an easy task.

Yeah. Awesome question, Patrick. Where are you located? Who's. What's your company?

I'm the president of the u. S. Subsidiary of epicer medical. I'm in dallas.

Okay. Is this something you're dealing with right now? You. You have like a technology going. Two different spaces will be in the future.

Not. Not today.

But.

But in.

In.

Not too long.

Okay, well, maybe I can be your canary in the coal mine here.

I asked for a reason.

Yeah. They're not getting squashed, so it's not easy. So we have pure play foot and ankle. We. We have foot and ankle distributors. That's where we started. These are. These are people that are focused in foot and ankle. Now, some of them have hand and wrists. Some of them say they have sports medicine products, and maybe they do, and maybe they don't have so much.

And that's the tricky part is, like, they know a guy. They have relationships with, like one surgeon or something. So you get, you can get sucked into thinking, oh, great, we've got our sports distributor here also. And it' like it's, it's not as easy as, as that.

So a couple things. So in anticipation of entering other sectors, at the very beginning of our journey, in our distributor contracts, I was very specific that it was foot and ankle only. So I said, here's your territory. Yeah, definitely foot and ankle only. And I was very clear with them about it. So that was one. But even when you're clear, it still doesn't address the emotion of it all when it comes to fruition. So what we, we've actually had pretty good success in the fact that we've gone into certain markets and we've said, look, you're just not a sports distributor and I'm going to keep you. I'm gonna, I'm gonna protect your people. And we're gonna, and we're gonna have somebody else coming in, but they're going to be calling on sports medicine. You're calling on foot and ankle. And we have, I should mention, we have W2 sales managers that manage Tiger helped me hire some of, some of the ones that we have on our team. And so they've had to kind of maneuver those, those, those situations in each different. Some markets are super easy. Like we went and say, hey, look, I just wanted to give you a heads up. We're going to hire a sports medicine distributor. Fine. No big deal. So we make sure that they understand their territories. We've had some foot and ankle distributors that, that have sports medicine products. And so we went with them in those markets. That was the easier decision. In others, we had foot and ankle distributors that were not happy about this and we just had to pry it out of their, you know, their grip and, or maybe say, look, I'll give you one Sports surgeon. I'll give you one. If you do a good job with that sports surgeon, I'll give you another one. But I'm not giving you the whole. I'm not giving you New York City, every sport in New York City. So I, what I would tell you is that there isn't one solution. It's like you go into each market, you handle them each individually, but you try to have focused distributors that can deliver what you need because most of them will tell you that they can handle the broader portfolio and they won't deliver. Having said that, I'm finding that in the sports medicine world, there's just less 1099s that aren't already for sure. But the big orthos. So it's a little bit, you know, foot and ankle. There's lots of 1099s because there's a. Lots of startups and it's just a very fragmented sector in sports. There's, you know, it's dominated by a few players and there's just less of a need for 1099. So that's been a little more challenging for us. So. So we've actually, we're. We're kind of. We're kind of playing around with. We've got a few direct. We've got some direct accounts and we've got some hybrid people that are kind of managing both. But there are a few markets where we're not able to find 1099s that we like. And. And so I've put a direct person there to see what they can do. Isn't kind of on a experimental basis so far it's worked out okay. Hand and wrist might be a little easier for us because about 60% of our foot and ankle distributors also carry extremities. Otherwise we're gon to have the same conversation about hand and wrist. Also pediatrics, we have pediatric distributors.

Whole.

Yeah. And those pediatric distributors, we just signed one that has the entire western United States their big orthopedia distributor. And we. That was easy to sell to most of our distributors because we just carved out children's hospitals and that was it. And then there were a few that felt like maybe they'd made a few calls in a children's hospital before and therefore we were, you know, taking something away. And that was a tougher conversation.

Is, are all of your sports products different skus than the foot and ankle products?

Well, no, they're not. Only we have a rotator cuff. We have an arthroscopic version of our. Of our anchor. So that's the only skew that's a good delineation.

Otherwise that's an easy way to separate it.

But if you.

Yeah. So when the billing form comes in, we look at who. The rep's name on the billing form and that's who gets credit. Yeah, yeah. Internally I had to. We've tried a few different things and internally I. I had. I had foot and ankle and sports kind of together and then we separated them and now we're kind of moving a little bit back more towards generalist managers that kind of handle both because we created some turf battles even in. Within our company.

Great, great question.

I mean.

Yeah, totally.

Thank you. I'm still kind of figuring this out too. So we'll stay close on this one.

Okay. Adam's up next.

Hey, Brennan. Salute your good progress in the space.

I.

You may have shared this. I guess I'm not following.

Maybe.

What.

What caused you to jump into the foot and ankle segment with your technology? What. What kind of caused you to kind of steer that direction opposed to sports medic? Other areas kind of at the onset.

Of your company's foundation? Yeah, awesome question. So we. So we looked at the foot and ankle space and we saw it was the fastest growing sector in orthopedics. It. It didn't have a. A good non permanent weight bearing implant. The hardware removal rates are very high in foot and ankle. Patients are more irritated by foot and ankle hardware than maybe other parts of their body. Because you're walking on it, you can. You can feel it under your skin. And we also felt like there was a readily available distribution network that we could tap into fairly quickly. Those are kind of all the reasons why we went into foot and ankle first. It certainly wasn't because there was little competition. It's a red sea, that's for sure. But we thought we could differentiate ourselves. I mean, we entered the market with a hammertoe implant. There's 25 different hammertoe implants in foot and ankle. So you look at that and you go, are you crazy? It's like a suicide mission. But there's a reason why there's 25 foot, 25 hammertone plants, because no one likes any of them enough to have any reasonable amount of market share. If there. If there was an awesome leader in that, there wouldn't be 25, there'd be like five. Right. So we thought that that may be an opportunity to differentiate ourselves in a sea of metal widgets. So looking back, would you.

Would you.

Would you lead out within foot and ankle again, would you.

Would you do it differently?

Or do you feel like, are you.

Happy with your choice?

And, you know, some of that's going to be arbitrary.

But I think about this a lot. What I'll tell you is that on the sports medicine side, we've seen faster uptake with the surgeons and higher retention rates, and they get things through vac. If they want it, they get it. On the foot and ankle side, it's a little tougher. Right or wrong, the podiatrist oftentimes don't have as much cloud as the MDs do. I don't make the rules. That's just a fact. Or the foot and ankle MDs are highly specialized and they're just less of them that are willing to go to fight to battle for you. So I'm just finding so oftentimes I'll tell my team like, damn, if we'd gone to sports medicine first, I would have gotten a way more, you know, way more penetration into the IDNs and GPOs. But at the same time it was harder to find distributors in that market. We didn't have a lot of the products ready to go there. More fixation implant opportunities in foot and ankle to differentiate. So, you know, right or wrong, we decided to go to foot and ankle first. Benefits of sports medicine. I mean I'm definitely seeing some real benefits of sports medicine over foot and ankle, but it probably wouldn't change the direction we took because we probably didn't want to come out first with a more complex suture anchor configuration versus like a little pin. It was kind of an easy kind of, you know, what's the worst thing could happen putting a pin in someone's toe? I mean, what's the worst thing that could happen? So I guess that would be my.

Last question is just, you know, leading.

With the Hammer toe product, you feel like that was the right call? Not necessarily. I think it was the right call from a regulatory perspective and a risk perspective, but in terms of. So I had a surgeon one time tell me, Brennan, you have a Tesla. Why are you going to come out with a moped as your first model? That's, that's how they thought about hammertoe implants. So there's some truth to that. There were probably some sexier things we could come out with. But the, the hammertoe implant market was pretty hot. Yes, pricing's really good. There's a, there's an unmet need with non permanent implants and Hammer toe. No one wants a wire sticking out of their toe or no one wants a nitinol implant that's going to break. So if we probably would have done that first.

We launched with the Hammertone product out of the gate.

Right.

And so I think that was, it's.

Just fascinating hearing you come out as a new startup company within the hammerto product market. So it's just we have a little bit in common there. I would say you have a superior.

Material arguably in many ways. So, you know. Yeah, we salute everything you've done, man.

Thanks for your time today. I appreciate it.

Yeah, thanks. Thanks for the question.

All right, Copeland's up next and then Mark Maloney and then Kyle.

Well, these guys asked most of the questions I was going to ask, but I Will tell you, Brendan, a couple things. On behalf of everyone here who has a skeleton, I think we, we appreciate the advancement you guys have come up with and thank you for not being boring with your marketing. It's, it's like, it's nice to. I was looking at some marketing for a couple different companies, and it was so 1999, I almost fell asleep over it. I love that. Medals for trophies, not for kids.

Yeah.

Kudos to you. And did I read that right? 40,000 procedures and 1500 surgeon users in these past. Is that five years, four years? Is that what you said? Yeah, I mean, I guess, you know, we got full approval in mid 20 or in March of 20. So we've been really out of four years. Before that, we just had like a little medium hammerto implant, you know, but we, we, we've been out four years.

We'll.

We'll probably, we'll probably do around 30 million this year in revenue. Well, it's astounding. Congratulations. Thank you. I didn't have any good questions. These guys took all the ones. You know, it's funny, on the, on the marketing piece, I mean, this is what kind of fun about being a startup. I mean, I was at Medtronic for 12 years and Covidian for four years. Everything I wanted to do that was creative. I just had to fight city hall every time. And the first thing I did when, when Brian Very asked me, join this company, I said, don't hire a general counsel and I'll come and I'll join you. I know the rules. I know how to keep us out of trouble. I'm just kidding. I hope there's no lawyers in the phone. I'm just, I'm just kidding. Of course, you know, you gotta. If you're not compliant and you're not, you know, you're not doing what you learned at big companies, you're gonna set up your startup for failure if you're not. If you're not doing things the right way.

Right.

But, you know, we, we kind of know the law and we know, we know where the edge is and we don't go over the edge. But I just thought that this, I just thought this product was this technology. Even though I didn't have an orthopedic background, I thought it would be so much fun to market. I said, God, this, you could have so much fun with this. And I knew we wanted to do direct to consumer, but knew it would probably take us about three years before you had enough critical mass of customers and products to actually have that view worth the money. Otherwise, the mantra was, no, we don't want. Our marketing cannot be boring. You cannot do what everybody else is doing. We are different. We have to look different. Let everybody else look like metal. Like the sea of metal you walk through aos, there's a lot of wonderful marketers there and a lot of great stuff, but it, it kind of looks like every, it's. Everything kind of looks the same. And we wanted to stand out. We went to a meeting, we went to AOFAs and the booth was going to cost a fortune and it was just going to be like one of these 10 by 20s, you know, and, and we said, okay, the meeting's in Charlotte. I said, okay. I looked at somebody in my team, I said, what if we just rolled in a, a NASCAR instead of a booth? How much would that cost? And so for $10,000, we rented a NASCAR and had a skin made for it. And instead of having a booth, we rolled that thing in and parked it on our 10 by 20 footprint. We could fit it in the footprint. We were nervous about fitting the footprint. And then we made a video, a 90 second hype video. And we, we had the video playing in the car. So the surgeons had to get in and either look in the car or get in the car to watch the video. So I, wow. It looked, look, I made a lot of, I've made a lot of mistakes, but this is one little one that I thought was kind of fun that actually worked out okay. So I looked around the room. There were Stryker and Paragon and all the huge companies with their beautiful giant million dollar footprint booths. And here we were with the $10,000, the cheapest booth in the whole place. And I had the longest line of surgeons at our, at our booth. I just think there's things like that we can do that it's compliant, it's not, you know, it's not overly edgy, but God, it just stands out. And I think, I think you got to have fun. And I think that's how we've been able to attract and retain marketing talent. Because they know if they, they know that they can, they can fail if they want to. You know, they can fail, they can try things, we can experiment, we can try to be different. But we, we often sit around and just kind of think about what is the wildest, what, what can we do next? And I mean, we, this is not, this is not that creative. But a couple weeks ago, Alexandria, since, I think Ted, you brought her up, she's brilliant. We said, hey, why don't we just osseo on the street? Why don't you just go out and start interviewing people on the street and show them. Show them our screw and a metal screw. Because we really need to get through that. Surgeons and 1099s and hospitals and IDNs, there's so much conflict of interest that you have to just be able to cut through that and get to the patient. You know, the patient's got to ask for it when there's all these barriers to, you know, barriers to entry and competition. So we just went out. It cost us nothing but parking in downtown Austin. She went around and interviewed a bunch of people. Every single person she interviewed said they'd rather have our product. When we were in Naples last weekend, when our met. When our med ed program was over, we ran downtown Naples. Target rich environment, man for bunions. And we asked a bunch of people. And you wait. Wait till you see that one. You know, so we're gonna probably once a month or every couple weeks, you're going to see an osteo on the street. And I just think it re. It costs. It's cost zero dollars to do this. And it just gets people. It reminds our. Our reps, it reminds the industry players. It reminds people that are thinking about investing in us. It reminds surgeons like, guys, this is what the patients want. They don't want the hardware. They don't want the permanent hardware. This is what they want. And it gets attention. And every time we do it, we get 10,000 views like that on LinkedIn, which is free. Yeah.

Guerilla marketing.

Love it.

Okay. Mark Maloney. Oh, Mark.

Like everybody else, I'm really impressed with what you've done. My first thought when I hopped on board was, how'd you get an Irish first name? But I'll leave that to another time.

I had confused parents. I have an Irish mother and Italian father. That's why my name is screwed up.

That's great. My question was, what are you doing in trauma? But before that, I run a compliance company but have an orthopedic background. We actually still have a small, kind of a boutique ortho dealership here, and we do sports medicine and foot and ankle.

Oh, do you? Okay.

And they are. They are two different worlds. And then when they're. It's in a sports medicine case, they're in there with the direct arthritx rep or Stryker Smith and Nephew rep, Giant big group. But if it's a foot and ankle case, It's a small 1099 group. It's a whole different world. And I really haven't had anybody heard anybody talk so creatively since I sat down. And we became one of the first trees dealers.

Oh, really?

Wow.

Yeah. Yeah. Where are you, Mark?

Where are you located?

Atlanta. And we invested, we invested in that B2C right from the very get go Facebook. It was hugely successful. And we also invested. We didn't go to the podiatrist. Instead we went to the ortho foot and ankle because the volume is so much higher. And they dragged the podiatrist market kicking and screaming to the lapiplasty product because it was just the right way to go. Anyway, great energy, great topics. What are you doing in trauma? Because that would be an interesting market.

Well, you know, we, I mean within the spaces we're in, you know, like the foot and ankle space, a little trauma and the pediatric, we see a little trauma, but we just don't have a full complement of screws and plates yet.

Okay.

We've got a couple of, we've got, you know, we've got a few screws again, we're also rolling out these threaded nails and we do have these trimmable nails that we use are kind of like orthopedic rebar. You can use them for all sorts of things. They hold compression, they're really for stability. A lot of different applications, but we, we just need a broader portfolio to really go after the trauma surgeons in a major way. Yep.

Thanks.

Go ahead, Kyle. Thank you.

All right.

We've had enough sales and marketing talk. I got some technical questions for you.

Oh, no.

So you mentioned 2/3 of the strength of titanium, but you also talked about manufacturing wise, that you guys have some, some special tricks and that's one of your specialties, is there, when you say 2/3 of titanium strength, is that in just bending or like are there certain ways that you're having to work around that?

It's just bending. I mean, you know, again, we're, we're, we're, we're twice as strong as cortical bone. And so we're, we're plenty strong. We just, we, you know, we run into technical challenges if we want to make a 25 cannulated screw. And so we, we, we have some raw material innovation that needs to happen to get into smaller fibers to get into the really small cannulated stuff. But anyway, that's.

I can help a little bit. So I actually interviewed the PhD founder and they're aerospace engineers and so they, they, they know how to lay carbon fiber down to make A aircraft wing, you know, and so they can do, they can lay carbon fiber down in any orientation to make any strength they want. Torsion, bending, tensile. And so they do, they basically are doing the same thing with, with the bio glass material. It's incredible.

These little 10 micron fibers, when you put thousands of them, if you, when you overlap thousands of them, they just are incre. Strong. It's like, it's, yeah, it's like the carbon fiber wing on an airplane like Tiger said or you know, the Golden Gate Bridge. Those big pole, you know those big wires, those are actually hundreds or thousands of little wires inside that are weaved that give it that strength. And that's kind of the same idea.

Yeah, so I, I love the answer and the reason I asked that is because when you were talking about the man on the street type of interviews, if everybody's going to pick one versus the other when you're given metal versus not metal, the, the negative response to that would be if their post op protocol has to change because you're trying to work around and if, if the strength isn't a concern, then it doesn't. So that's great. Thank you.

You know, it's a great comment. If it changed, we'd be dead right now. We, no, no one would use, no one would adopt this product. Maybe a few, you know, people that are all in, but we wouldn't so we, we don't have, there's no difference in post op protocol with our, with our products.

So you have no problem with using metal for a predicate device?

Well, we use, we, well the FDA wanted us to use non permanent implants as a predicate but in terms of comparing ourselves to metal implants, that wasn't necessary. I mean all the, all the mechanical testing, everything we did was, was more than adequate for fda. Matter of fact, this is the strongest non permanent material that's ever come to market in the, in the United States. So they, they were, they were fine with it, but it didn't need to be as strong as metal. Sometimes metal is too strong. It's not a good match for the elastic modulus of bone. Our, our founder could geek out about this for an hour. I, I, I'll get over my skis real fast on this conversation, but it's a really, really strong material. Matter of fact, on the, on this, on the soft tissue products, one of the reasons why we're picking up market share in sports is like I said earlier, there they are not breaking our anchors. I'm not saying you could Never, ever break one. But they are not breaking our anchors. And they break big ortho anchors more than, you know, all day long, they break them. So we're amazed at how strong these anchors are. But, you know, again, there's certain constructs in foot and ankle that are going to require more than just a screw or nail, might require an osseo plate. And until we get there, there might be some procedures that certain surgeons just aren't willing to do.

Good questions. Patrick.

Brennan, a little bit more of.

A, I guess a personal question, but given that most of your professional background has been outside of orthopedics in the last handful of years, what have you learned or what has surprised you, either positive or negative, about this therapeutic area?

Yeah, so I, so I like, I like orthopedic surgeons. I mean, these are, you know, I've, I've called on almost every specialty, even outside of cardio. Orthopedic surgeons are probably one of the, one of the, one of the better groups to have dinner with. These are, these are cool people. They're, you know, get good personalities and they're fun. So I like orthopedic surgeons and podiatrists as a group. One thing that struck me when I, when I came to orthopedics is that there's an incredible lack of data. Clinical data. Yeah, I mean, look, there's clinical data, but compared to cardio, it's, I mean. Yeah, yeah, yeah. I mean, cardio, clinical data is everything. And it's probably one of the reasons why startups get taken out oftentimes pre revenue, because these are PMA paths and they take a long time to get this, this technology to market. And when it gets adopted fast, because you come out with level one evidence or, or just below level one evidence. Yeah. And you can flip. I mean, you can, you can pick up 10, 15 points of market share in six months.

Yeah, they unapologetically just move and then two years later move in another direction.

I think it moves. So I think the market moves slower. I, I've, I've seen, I think orthopedics move slower.

The.

The vacs have been kind of a surprise for me, but I'm not necessarily sure that's because of orthopedics. I think that's just because I'm at a startup and I haven't been at a startup in a while. And when I was a startup before big company, you know, vax didn't exist. It was the good old days. So I don't know. I think, I think the clinical Data. I think the fact that it's 510k is a pro and a conversation. So the fact that it's 510k is great because I'm not waiting 6 years to get the next generation product out like I've lived with in cardiovascular before. That's great news because you can get products out fairly quickly. So there's a lot of great, it invites a lot of great iterative stuff. But the problem is the barriers to entry are so low. Like in foot and Ankle, there's 30, I think there's 30 companies that sell hardware. It's just so noisy and so crowded. It's just hard to get, you know, share of, share of noise I guess if that's a term. And so I think the 510k environment is a pro and a con that we're, that I've had to adjust to. I know I'm going to think of something after I jump off this call. I know I've had way more thoughts than this, but those are.

Maybe I spent most of my career in orthopedics, but one year in cardiovascular and the clinical difference is an enormous, like they, you're sort of generic surgeon at a generic facility. They'll know the studies by name. They all have these acronyms for them. They like, they, they cite them, they know the data like the back of their hands and, and they will move, you know, in mass to a product and then two years later, unapologetically, when a new, you know, a new data set comes out, move to a, you know, move to a different thing. It's a lot, you know, I guess they're measuring outcomes in shorter intervals too. It's not what are your, you know, it's what are your, you know, they're measuring what's your outcomes in 30 days, 90 days, one year. Not like what's your 15 year studies.

Yeah, I mean look, the other, bigger, the biggest difference that I kind of forgot was the fact that in car, in cardiovascular there's just almost no 1099s. It's almost all direct, it's all, it's all direct sales forces. And again I think it's because you spend that much money coming to market, it takes a lot of money to bring a product to market in cardio cardiovascular, especially a PMA product. And so when it does you expect pretty rapid uptake and there's, and you got to put your own channel on. Yeah, you can't have part time channel. You have a very well trained 100 focused on you channel and so that's. I've, I've, I've worked with distributors before in different spaces, but this is a definitely a new world that I've been in. It's just. Yeah, again, they're great, they're fantastic. I mean, they're wonderful. You can just, you can go into markets and find folks like Mark immediately, but you're going to deal with the fact they're going to have 10, 10 different product lines and you're just gonna have to fight your way up the food chain and you know, you just gotta be, you know, you gotta earn your way up the, up the food chain and in that distributor bag. So that was just something new that for me because I was always a direct sales, sales leader. Yeah.

Interesting insights, Brennan. Is there anything you want to ask the group?

Anyway, how do I get into Ascension? Anybody know Ascension? Anyone? Bueller? Bueller with tears in your eyes. Yeah, that's one. You know, I was just curious if anyone has had any, maybe. Has anyone used any software or any technology to address the dreaded inventory management trunk stock world we all live in where you have expiring inventory, lost inventory, you have the right amount of inventory, but it's never in the right hands, you know. Yeah, I don't know if there's any really great. I know that there's stuff out there, but has anyone had any success in trying to, you know, cut your costs, avoid waste and get the right amount of product to your distributors on the right in just in time?

Martin Maloney.

Well, I can say that inventory control is in orthopedics. The monster in the attic and in the basement. Every company, every company has a secret horror story of they don't even. Very few companies know where everything is. We're, I'm on a couple of boards and one of them is a, a software company that accelerates the time that a doctor uses his emr. And I'm adapt, I'm adapting. I'm actually, we're adapting that so that a rep. Without having to go through the local emr, any local kind of system can at the time of surgery. Exactly. Track usage, inventory, billing, all, you know. And I know there are programs out there, but this will be non proprietary and agnostic, which is good. So. Yeah, I feel, I don't, I don't have an easy solution for you today, but I feel your problem.

Yeah. Have you ever, have you ever had any experience with those little. There's a, there's a company out now that's raising money called Edgex, but there's These little stickers you put on the package that can read temperature and it can also. It's like find my iPhone on your, on your, on your packages. So if you want to do cycle counts, you can just see where everything else is in the country. If we have, we have a problem with a product getting too hot and we have a little black sticker that will go off and then it's toast. And, you know, reps going to Chick fil A for five minute lunch, and they come out in their car 150 degrees on a hot day, and all of a sudden all my inventory is cooked. So this will tell, this apparently will tell you, like, okay, it's getting hot. You get a text message that says, inventory is getting hot. You know, I, I don't know if you have any experience with that.

That was a problem back with the early. That was a problem back with the early rollouts of the lactic acid products, probably glycolic acid products, all of that. If you left them in a hot car or, or a lot of synthetic bone void fillers and bone screws that I've been associated with for like 15 years.

Yeah.

And you left them in a hot car. They cook fast. So I can see how that's a big problem. I don't have any experience with, with any alarm systems for that other than just tell your rep not to leave them.

Yeah, Interesting. Yeah.

Question.

Something, Something to say here.

Alyssa's. Alyssa's got a question. And then Asher.

So distributor for many years. And I can tell you the easiest, the fastest and the most cost effective way of maintaining your inventory is, number one, not having back orders. Number two is providing a picture to the distributor or the. Whoever the logistics team is and the rep of what was sent and then forcing them to provide a picture of what is returned. It always. It saved me thousands upon thousands of dollars when it. Because I would. I would take a photo of everything I received and I would take a photo of everything that was shipped back and messages three months later, hey, you have, you still have X, Y and Z product. I was able to say no, this is exactly what was shipped back. Every single shipment.

Good idea. Thank you. Are you still a distributor?

No, I'm not. I'm the CEO of Illuminate. We're bringing to market some porous therapeutic hardware.

Oh, cool.

Yeah. Great presentation. Oh, and I also looked online. I looked on Research Gate. I only saw three papers and so do you have any long term data yet?

Well, we have two year. We have two years. We have the two Year first in human study. That should be on there. I don't know where the rest of it is. I bet we better do a better job of getting a research gate, but I'll have to check with my clinical team on that. A lot of them are in process. A lot more posters that have been accepted that are in process and a lot in process. But we sh. We have more than three. We have more than three published papers, so we'll have to look into that. Thanks for the heads up.

Google Scholar had several, but I didn't see any on ResearchGate. But all I could find was two year data.

Well, it's because the product's gone in two years.

That's awesome.

There's nothing to study after that. I mean we have investors sometimes say, well show me your 10 year data. I'm like, there's nothing to, there's nothing to see. That's gone. It's still a bone. It's on histology, it's gone at two years and, and once it's gone there's nothing left to cause problems. So that's the reason. And we have all of our animal studies and in our first human study are two, two years or two and a half years.

I mean, I would probably give a little bit of pushback on that considering, you know, you drink out of a water bottle and they're showing calcifications just from drinking out of water bottles on the hearts and, and I worry about that in sylnovial fluids and so on so forth. So it's got to go somewhere. So I mean just I would, me personally, if it were my company, which it's not, I would want to know what is still in the body five years later.

Okay, good question. Good. It's good. So far. So far all of our. Obviously we can't do histology on humans, but all the animals, every single alma. 2, 2 years histology looked like the slide I showed you and it's gone. It's bone. There's nothing left. It's bone. And, and all the, all the mineral fibers mineralized into bone and the polymer's gone. It one year. All of the Palmers gone in one year. So otherwise we, I mean again, we've been commercial for five years like I said, and we haven't had any late adverse events reported, adverse biological reaction stuff reported.

That's awesome. Congratulations.

Your point? I take your point. Thank you.

Congratulations. That's phenomenal. And a very, very extraordinarily rare for bioresorbable. So very, very good job.

Don't use that word. Yeah, biointegrative. We. I spent a lot of money on that phrase.

Bio integrative.

Everybody say a lot of money to come up with that one, so that's funny.

Ours is integrate porous pedicle screws. So. And we spent a lot of money on that one too, so I can appreciate it.

You're both integrating. I like it. All right, Asher's up and then we'll. This will be the last question because we're a little over the time.

So this is actually just in regards to the inventory traceability question that got asked. And just kind of expand on Alyssa's comments. I worked at small and big companies all in spine, where the inventory is, you know, $50,000 a set or more sometimes.

Right.

And the, the best solutions I found are not actually software based. They're more your process and like Alyssa said, like little tools and taking pictures here and there. So like, you know, take a picture of every single level on your tray. Take a picture of your implant kit so you've got visibility on the barcodes and lot numbers. Use OCR to convert that picture to the actual data and then cross reference that to your shipping kit. You know, put a air tag like a. One of those Apple tags inside the shipper kits. They have auto cleanable GPS trackers now. Or you can put them in your instrument sets. You guys should be doing like quarterly audits.

We don't have sets. We're all disposable. We're 100 single use.

Okay.

I mean, even better than. Yeah, like in the kit that it comes in, then you should have you know, like the GPS air tags on the little kits and whatever and you know, it's 50 bucks a pop, so you either eat the cost or you build it into your asp. But quarterly audits, like, you know, and you know, reconciliations, outlawing field transfers, where it has to come from the distributor to your warehouse and then back up to another. It's more about the process stuff than the actual underlying software that traces it. Because we're using third party logistics software that was sort of like custom built. But even then, like at the end of the day, like, it's more about the underlying protocols and adhering your distributors and your operations team to those protocols and you know, whatever software solution you plug in there, love it.

What's. What, what was the tag you were using? Do you remember the manufacturer?

Yeah, it's. We were literally using Apple Air tags or Android Air tags. And then we were using the company's called smaio I think it is. Mayo.

Yeah, we need some Apple air tags. We've done something.

Yeah, smeo. I think they're a subset or a spin off on, I think Intech Medical, which is like a French contract manufacturer, but it's basically just an autoclavable air tag, effectively. But they sell them for like, the trucking industry that aren't necessarily medical grade, but they're. They're not medical qualified. But they are so medical grade where you can throw them in an autoclave and they'll be fine.

What is your policy with distributors when they, when inventory is lost or damaged?

Bill them. No exceptions. I mean, if, if, if you have pictures of them, of you shipping it out to them, and you give them a predefined time to, you know, inspect it, receive it, you know, look through it, make sure there's no mismatch, and they either don't get you that confirmation or they get you that confirmation late and then suddenly the inventory is gone. I mean, you should have all the evidence at that point that you shipped it out to them. They should have received it. And if they don't get you that info, then you just take it out of their commissions check and you give them, you know, ample time to review and inspect it. You give them the tools they need to cross reference it on your shipping, your. Your pack slip, your. Whatever you want to call it. But at the end of the day, it's the distributor's responsibility, especially if you're going to pay them, you know, competitive commission rate.

Thank you. Appreciate that.

Good stuff, Asher. All right, that's a wrap. Brennan's a Bone Chat member. You can reach him on Slack, you know, talk to him, email him, whatever you want to do. Thanks. Great presentation. Yeah, super innovative, obviously, and growing like a weed.

Thanks.