BoneChat #60 - Unplugged - Open discussion.

Foreign.

Topic this week. So I thought we just open it up. We did do a poll, so a lot of thank you for everybody participating in the poll. And I can show you, I can show you the results if I'm any good at all. Let's see. Okay, here's the results. Because I'm always trying to bring value to everybody. And so the way to do that is to find out what everybody's needs are. Okay, start share. Did that work? Can you guys see my screen? Yes. Okay, so we had. It's, it's. Sorry if it's small text. So we had a bunch of questions. We had 32 questions and a lot of this was brought by Maloney. He had some great questions. So the top votes were how do you navigate 1099s and A versus A direct sales force? That's really important to a lot of people. Another one was angel precede early seed funding. And I think Colleen Gray is going to speak on that later on, which is going to be good startup marketing practices. So your company's getting acquired. What do you do next? Leadership strategies for managing 1099s. There it is again. Sales versus marketing. Where to allocate your focus. You know, that's a good topic. Early stage grants and then cost effective marketing. So it seems like it's all marketing and sales and finance for the most part. And then, then we get into the things that got very little votes and then nothing. Anybody want to, anybody want to venture into one of these numbers here? We'll get a, the goal is to get a speaker that can speak to, you know, this topic, but we can talk about it now. Guys are awfully quiet.

Early stage grants. Anyone on the call had to, to write grants or get, get grants written.

Well, I know Alyssa's done a lot of that in, in Missouri and she's, she's spoken about that. It's the, the. I think the good news is it's free money. And especially at the state level. The bad news is, you know, it's, it's not a lot of money. You know, it's usually, it's usually six figures, you know.

Yeah.

But it's real free money with no strings attached.

Usually you get somebody who knows how to write it properly and whatnot. Yeah. And I, I would, I think that the money is not as available or there's not as much available as there as there used to be. But it might be a good place for, for a small startup to, to, to begin. I mean, once they've exhausted friends and.

Family you know who's pretty good, you know who's pretty good at getting grants was Leah Winter.

We had to get her on bum chat. I've reached out to her over and over. I know she presented at mnvc. She's got a, she's got a new suture technique called Easy Whip. Mark talked about her last week, and I don't know how much traction. Mark, give us an update. How much traction is Easy Whip getting and are they selling?

So if you show it to somebody that does a lot of graft wraps, you know, like maybe quad tendon users or Achilles tendon people that use Krakow stitching and so forth, I would say the ACL quad wrap is probably the. One of the biggest candidates because you have to really wrap those kind of tubularize them, I think is the word they use. And it takes a lot of time on the back table. And if you don't have a pa, the surgeon has to step back and do it. It takes at least five minutes. And so her technique is really fast and easy, and easy always sells. And I guess the only downside is that it's got a, you know, it's got a price point of like 350 bucks for, for suture and. But that's not. The doctor doesn't care. I've only shown it a couple of times about. My people have. And both of the doctors said, yeah, we'd love to use it. They say it would save me time. And then, of course, we, you know, they ran right into the buzzsaw of, you know, red light, green light, product.

Approval, squid games of.

That's right. Squid game committee.

Squid game. They shoot you. Oh, man.

Yeah, but, yeah, but Leah's. Leah made a. When I first talked to her, was telling me that in her early stages she was pretty successful at getting grants. And so I, you know, I think she'd be a good guest speaker on that if it's, if it's a big enough subject. I don't know if it's a big enough subject.

Well, I mean, what is. You know, I'd just love to hear about what she's done and how she did it with very little resources and, you know, what her challenges are. Can you make that introduction, Mark?

Yeah, I'll ask her because, you know, she, she wants us to work for her. So she probably would be, you know, favorably inclined. I mean, I, I can. The people, the kind of people that do grant granting are the kind of people that after like five minutes, I want to shoot. So she probably has a good personality for it. She's a very patient person.

It seems it's usually the academic types that like to rent, write grants. Yeah. Because they understand how universities think.

Excuse me, Tiger, did you see Alyssa's text?

I did not.

She texted both of us saying, asking to be let in.

Oh, sorry about that. Let me try this.

Oh, you know, guys, on the grants, I got contacted by a company called Alien. I just had the call this morning from a lady named Sasha.

They do.

NIH grants and so she's going to be sending me some of the materials. And so I'll be happy to share that with everybody once I get some of those.

That's a good idea. And I also this morning happened to talk to Adam Hochek and he is doing some integration with Los Alamos Labs and they do grants and that's why he's jumping in there.

Wow.

All right, Tiger. This is very near and dear to my heart because I spent a lot of time and my surgeons even helped me early on. So there's a lot of rules to navigate if you're pre revenue or any type or close even FDA clearance, NSF all the way. And that's what Leah had mentioned that she got. They're more friendly to startups, but you can get too far along with your startup for NSF to, for it to be viable. And then the NIH, 95% of that money is reserved for researchers that have actual labs. So the likelihood of getting funded as a manufacturer is very low. And it's a, it's a. We got 33 points in the first one that I personally wrote with, with our KOLs. And 30. You want the lower points the better. So 33 points was actually right in the cusp of getting cleared. But it always seemed like there was a reason we were. We just always had one reviewer that would, that would offset everybody else's. It's in. And then there's the writers. You have to pay for the writers. Your state can give grants for the writers for a portion of it sometimes. And. But the writers don't understand orthopedics and spine. And so it's, it's almost like a waste of time and energy and a lot of capacities. Like, unless you really know. It's like getting a product in the, in the, in the hospital. If you don't know that pathway, you're in trouble.

Hire a writer who knows spine and ortho.

Yeah, well, it's. The key is understanding what means most to that individual product and tailoring it with the scientific approach that the NIH likes. So unless you've done 50 submissions, you know, like it's. You don't. I mean it is complex to say the least.

We're approaching it through our biomechanics lab. Ty Lee is part of our co founders, part of the co founding group. And so we're going to approach those things through, through his lab at Congress Medical. So he's. That's. That's the approach we're going to take. Not from a, not from a company perspective.

I don't know.

Have you had experience?

Oh, yeah, we had. Yeah. Colorado State was going to be our. They're the largest animal study university in the, in the U.S. but because there's a manufacturing and commercialization viability, it puts you down to the bottom.

Right, right.

That we would, we would pitch it.

In a different way probably.

We'll.

We'll find out.

I'll keep you guys up to speed and share that information with you.

Yeah, I think we've submitted ours three years ago. Before we were way free revenue, way pre. It was just really for data. Trying to do a sheep study to understand drawing in bone marrow and how it affects the bone surrounding the hardware. I mean it was true research, but the. Yeah, it was interesting. And we had Duke, Wash, ucsf, Colorado State all behind it. The names so interesting.

There's also a lot of defense money. I remember Norian got Department of Defense money because they had any. Anything that helps treat people in the battlefield is fair game, usually a lot of trauma.

I would be more. I think that that's probably the most viable approach for us, for the people in this room that are trying to raise money is Department of Defense money. I would love to understand that pathway.

Well, that's another topic. Maybe we can get a. Somebody that's been through that before. Yeah, good. Because the military's got tons of money, obviously.

I think embody was really successful at getting a lot of DoD funding. So maybe one of those guys.

Yeah, I will definitely reach out to them. Interesting.

DoD is a good idea.

Yeah.

All right.

What other topics? What else is going on? Where's everybody's pain this year? Is it other than f. We don't. We don't need to talk about fundraising.

Because.

VCs are still sitting on their wallets and I mean it's just family money and any, Anything you can get.

I guess I'm, I'm finding VAT committees are dragging as if it's 2020 all over again.

Wow.

And I don't mean. I don't mean rejections. I Just mean dragging the process systematically.

I am finding that they're supposed to be monthly meetings and they'll skip two months.

That's, that's what I'm encountering across the country.

Yeah, yeah. And they, and, and, and I'm getting like so ghosted on emails. Unless they're like old friends and my old friends that I've had to call to say, will you go kick this guy to answer me, you know, they can only do that once or twice before they sort of get in, you know.

Well, the, the trickle down effect that I'm seeing though is that the 1099s are less willing to even go down the back process for bigger facilities. And so what I'm, what I'm promising them is we're going to do it ourselves. We're going to do it for you. We just need somebody on the ground to reference.

There you go. Mark, Mark Copeland.

Can I weigh, can I weigh in on this, please? Okay, you guys know me pretty decently. We just got a $2 million deal in a big west Texas health system. Beaumont, a $700,000 advocate did a $200,000 airway management and I'm about to get something much smaller. It'll be a 50, $60,000 thing in at MedStar. And I got another thing in Lehigh Valley that I did. I'm actually doing one in Lehigh Valley that I got to. Customer. I had two client calls today, earlier today and I was going over this with him. I, I, I seriously, this is not, this is not a setup. Like I literally had this here for two of my clients today that have been stuff is getting approved and it's being approved through value analysis committees at big health systems. And our industry's approach is wrong. And it was interesting to see Joseph's comment or hearing Joseph's comment about 1099s. They're getting less and less likely to do anything on it. It's not there. We, we have to have methodologies to get these things approved. And we're all on the same bone chat group. I'll be glad to help any of you guys. I mean, Maloney, I've talked and I have talked 100 times. I will help any of you guys as much as I can for free because we're all in the same group here. The Tigers put us all together and we all try to help each other, but we, we have to change our approach because these value analysis committees right now are meeting, it seems like less commonly, but so it's getting harder. And if we're not Handing in, like, pro formas and executive business summaries. We have no chance. We have no chance.

And there's no. What's the oversight on these things?

Of what?

I mean, don't they have to meet regularly? Who's, who's.

It's third party. They're just a bunch of people that the surgeon may or may not know.

Yeah. A lot of times it's volunteers.

Yeah.

Yep. So that's one of the issues is they're. They're asking their employed doctors to come in and do value analysis once a month for no money while seeing more patients, while being more productive more. Like they're, they're in many cases, that's.

What we're hearing at 5am Yeah. 5am Meetings. They want, they, they want the physician to come into the hospital at 5am before clinic. And, and these are physicians that aren't even in the field.

Yep, yep, yep.

So, yeah, we, we have to. And somebody saw somebody put a note across there and tiger, I'll do one of these. I'll do another one. Like, I think there's a misconception partly that value analysis committees, like, I want the VP of the service line approving my product, because then they say, oh, they're at all the meetings anyway, and they're like, I'll get this approved. I got it all taken care of. You've given me everything I need. Be prepared to start. When is it? January 20th. Okay. We're going to start our evaluation probably early April because our meeting is until February. We get it done. We got to go through due diligence, but, but, like, they're the ones that are getting it approved. Counting on my doctor at 5am on a Wednesday where they're in the OR to make a meeting. I mean, it's, it's just not, it's just not sustainable. And ambulatory surgery centers are never going to be as bad, but they're not going to get easier because I've interviewed five ASC administrators across the country, and they're saying the same thing. We want performance. We want, we don't. Like. You can't just come in here and say, I want to do that thing next week. It's just, it's not going to work. And I'll help anybody here. And it doesn't. Not here. I'll call me up and let's get on it, and I'll. And I'll tell you some of the simple things that I think we need to be doing that work. It, it, it still might be four months instead of 12. But yeah, it's, it's, it's frustrating to everybody. I understand it. And in the meantime, I'm talking to these. I, I literally now on LinkedIn have people sending me messages who do value analysis for. And they're saying, please keep saying all the stuff you're saying. Like, like, I'll keep saying what I'm saying. Could you do us a favor? Could you tell us what the hell your process is? Because nobody knows it. You know, I mean, you guys would laugh if you saw some of my direct messages that I sent back to him. Like, yeah, you know what would really be helpful? If you actually put it, like on a piece of paper and handed it to somebody that might be. All of our doctors know what the process is. No, they don't. I'm like, no, they don't. No, they do not. And Joseph and I and Mark will go out and talk and Alyssa will go out and talk to 10,000 doctors, and 10,000 out of 10,000 will say, I have no idea what the process is.

And some of them, yeah, different institutions have different. If they're a nursing pat driving institution, that's very, very different. And they're much more reliant upon data and information and so on and so forth. You just have to know what you're getting into. And there's only certain people that actually know the pathway.

Yeah, yeah, yep.

So I will help anybody here.

Mark.

Mark.

We will be in touch. So, Alyssa, I saw your comment on beating Goliath.

Yeah.

So, yeah, this is an interesting1. About six months ago, I got together with Christy Blakely from Geislick and we, we essentially said, you know, it's kind of funny, all of these companies in the sports medicine segment, all these small startups are essentially trying to take on Goliath. We're all chasing the same 1099s. And we pulled together, I don't know, everybody we could find at AOSSM and just got in a conference room and talked openly about the challenges we were facing. And when I say everybody, CEOs, heads of sales and marketing at about a dozen sports med companies, and we decided to form a little group, not, not a legal entity, no confidentiality agreements, but essentially just a group of people who can talk and be opportunistic about marketing and sales collaborations. And so what's come out of that is a number of us get together one on one and share 1099 distributors and just compare maps and say, who's been effective for us, who hasn't, you know, where Can I help make introductions for you? And vice versa. If one of us is doing an event in a city, then we put it out to the rest of the group. See if people want to share a cadaver lab or share renting out a room at the brewery to do a marketing event. And then, you know, we're not participating in it, but nine or ten of them are getting together and doing a really nice event at AAOS this year. And, you know, you think about the power of the group. You're pulling together nine innovative technologies, probably more innovative than anything the big companies are launching in that segment. And you're putting them all in one room. It's pretty attractive.

And you could go one step further with this. This is what we're doing, figuring out what technologies fit with each other. And so, and then, so I'm on the NASS committee getting societies to endorse a new GPO for innovation.

Oh, very cool.

And so this is, this is an, part of my agenda is because science, not just our side, but the, the physicians are tired of commoditized implants. So if physicians, the societies are gathering together to teach surgeons how to bring their ideas to market, how beautiful would it be to marry that with a micro fund and a GPO that has the seal of NASS and CNS or like the societies, and say, we recognize this is innovation that might be deemed beneficial for the patient and has a disclaimer, maybe like scales in there that demonstrate the strengths and weaknesses. So it doesn't just say, yes, we believe in this. And then it puts liability on NASS and on the societies. It's more of a, it's a support system and a roadmap to bring that and give those value analysis retina surgeons that are looking at orthopedic products, give them some, some credence to go. Okay, you know, this makes sense why your surgeons want it.

Yeah.

And I think, I think most of us, the biggest battle that we're facing is awareness. And my frustration with the big meetings in societies, which is why we're not going to most of them anymore, is that they cater to the big companies who give them the most money. And I think the only way that we have to combat that is by teaming up and forming this segment of the innovative young companies. And so it's not marrow access or a bands or any one of us trying to get the same footing as an Arthrex.

And that's exactly what I pitched to the, to the team, the committee over at nass, and I said, listen, surgeons Medtronic brings everything to them. Now they don't have to show up at a conference to see the new stuff from the big companies. It gets there in an RV with a cadaver lab in tow and they just leave clinic for an hour and go play around with instruments and get fed. You know, if they attend this conference, they're there to see new stuff and the new stuff can't get in because it's 4 grand just for that 10 by 10 booth space that's over sitting in a corner. And so I presented the concept of navigating it from two perspectives. Revenue. How much revenue does the company get? And then also mapping out the floor map like they do with grocery stores. What are they interested in most? What gets them in the door. And then on a third note, creating an innovation throughput machine to where surgeons can literally go to one area, have a LLC created, start a patent search with like Andrea Davis and then talk to an Engineer, have a 3D printer at the event with a reliable manufacturer because they, these all have to be vetted. These contractors have to be vetted. Instead of doing what I did and searching for that pie in this, that one person that could bring product to market and one engineer that could do the impossible. These are reliable, trusted sources. And so that we protect those surgeons from their time and their money and walk away at the end of the week with something in their hand.

Well, that's awesome.

I love the idea of the small companies combining together. I mean we're doing that at the grassroots level. Scheduled dinner at the end of the month with two different companies there. And at the middle of next month, Abanza Arcuro. And it'll be the first meeting that I was also going to show Joseph's product.

Well, it's about time.

Yeah, it takes time. The. But you know, these small sports medicine products are really a natural for that kind of combinative effort because by themselves sometimes they're not really. It's hard to get like six or eight docs together, you know, to see a fixation device come on. But you know, if you got three or four of those, or two or three of those things in a nice place and you get somebody to give a talk, it makes sense and it's entertaining, I think. And they like.

And that's my pitch to some of the 1099s is if, if you want to be seen as the rep who's bringing in the new technology, I'll plug a couple of the other startups that are really complementary to ours. Orkiro is usually one of them.

Yeah, yeah. Well, you know, Jamal was supposed to come in, but I moved the date from the 11th to the 12th because I've got that webinar on AI and medical practices on February 11th with, you know, Ron Navarro and Scale Healthcare, Roy Bajarno and a couple of other docs, plus a couple AI scientists. And he was going to Israel on the 12th, so I kind of screwed, screwed him up there. But I think his, one of his sidekicks is going to come in. We'll still get it done. And servos, I've got them at the end of the month with another small company for the same thing. And just for the record, I'll say that for 10 years I've been telling people that corporate medicine, corporate medical device world dropped the ball hugely on product approval from day one by not officially giving it to marketing as a marketing function because the dealer doesn't have the bandwidth or the margin to work for free for 6 to 12 months to get a product approval. They think they kind of do because they had to, but it really wasn't in the, it wasn't in the cards.

So the sales process has been extended, effectively.

Sales cycle has been more so in.

Some areas than in others. You know, I signed at outstanding distributor in the New York City area.

Couldn't agree more.

Yeah, Q1 of last year and it's, we're just starting to sell now. We're just getting the, you know, the bigger facilities approvals. But until then, you know, especially when you're dealing with 1099s, how do you keep them excited about your product line when they have no revenue coming in?

Yeah, yeah, they'll sell the, they'll sell the thing they have in their hand. That's the highest margin today. Yeah. So what do you call this consortium of like a pack of Chihuahuas?

Of this, this particular pack of Chihuahuas is called the Orthopedic Innovation Consort Consortium.

I think ours is called Megatron.

That's way better.

I like Megatron. Alyssa wins on branding.

And, you know, I, what I, what I hope it becomes is, is one where, you know, new startups come in, you know, other startups are going to graduate out of it one way or the other in that it becomes, you know, something with longevity to give the smaller companies a little bit more leverage and give surgeons a little bit more visibility to innovative products. I mean, right now we're counting on them. For those of us who don't have full distribution throughout the US we're counting on them finding us.

Man.

Interesting.

Hey, Matthias.

Good to see you.

How are you? Good to see you. I talked to Sam the other day.

Excellent.

And that's fascinating stuff. Here's another idea that I just heard recently. I don't know if it's been done before, but I have two friends that said what. There's lots of surgeons that want to invest in new technology. They don't really know how. Why don't we get 500 orthopedic surgeons together in a consortium and create a fund and we'll vet. We'll vet the innovation for the surgeons and it'll be like, you know, I don't know. Has anybody ever tried that before?

I mean, yes, I don't know about. They might be trying to do 500, but there are a handful of groups of surgeons that have gotten together and they, you know, one in particular that's invested in us is Shelter Island Ventures, primarily HSS surgeons, but they welcome surgeons throughout the country and they haven't promoted it. It's kind of been a word of.

Mouth.

But they act. It's technically a family office. I would say they act more like an angel group. You know, they. They write individual checks rather than having a fund, and they form an SPV when they invest. But they have a pretty savvy business office to help manage that and protect surgeons who aren't as experienced with investments.

Interesting. As pre revenue, the investments usually.

It seems to be a mix.

A mix?

Yep.

How many people are in that Shelter island group supporting family office?

I think informally, they probably got a network of 20 to 40. From what I gather. It could be a little bigger than.

That.

But again of that, it's not that all of them consistently write checks necessarily, but that's how many are in their network.

Interesting.

What I found with those groups is very rarely is there anybody with orthopedic or spine or biologic expertise. So it can be challenging. Is this specific to orthopedics?

Yeah, they're trying to do an ortho spine play.

They do both, but yeah, they. Or, I mean, they. They do venture outside of orthopedics, but their main surgeons are HSS orthos.

Has anybody encountered any challenges with surgeon investors and conflict of interest at the time of the exit? I remember when we went through this with Arthur Surface, there was a big initiative to pay out surgeons before the exit. Is that something that others have experienced?

Apologies, will you repeat that?

Yeah, I was.

I was gonna ask if anybody had experience with conflict of interest of surgeon investors and technologies and they're using it themselves and invest money into it. Does that impact the exit at the time of the acquisition? If anybody had any experience with that, it definitely does.

And it affects getting on contract and getting utilization in hospitals. That's why you have to have that spv. And so is that what you guys are seeing as well?

Yeah, I only had my experience with arthrosurface and there was a big initiative to pay out surgeons before actually the exit because they ran into difficulties there.

So is it a problem for the acquirer or is it a Department of justice compliance kind of thing?

I think it was a combination of things.

Yeah.

So, you know, when I was on the medtronic side of things looking at acquisitions, you certainly would discount certain users revenue if they had enough of a financial stake. And especially with, you know, interbody devices, spinal implants, one. One user can generate a lot of revenue. So you would certainly come in and want to discount that. On the other hand, you know, conversations that I've had with, when we explored this topic was with strategics was it kind of depends. And you know, for instance, we've taken some individual surgeon investments and those surgeons, all of them were using the product before they invested. Their usage didn't change after they invested. You know, I don't think that would be discounted. And it probably just depends on which company was looking at us and what their policy is. But at the end of the day, they invested in us because they used the product and saw that it worked really well from an approval standpoint. The only time that that's become an issue for us was with HCA facilities.

Where.

We were rejected by a facility for having any surgeons on our cap table. And I've been told by somebody who's more of an expert in back approvals that there is a way around that with hca, but it wasn't. That particular facility wasn't important enough for us to go back and fight it. You know, for instance, we had a spine surgeon on our cap table who's not, not a user of our product at all. And that's, that's what prevented approval at, at a surgery center.

I've heard that they're even getting somehow, and this might be wrong, but I've heard that they've even gotten to the point where they're looking at the SPV to see who invested in the spv. But those are typically really close to where nobody's supposed to know. So I don't know. Have you seen that as well?

I, I haven't.

You know, the cap table should be private and, and the preferences of the people in the cap table should be private until the acquirer sees it. Right?

No, no. Hospital gpos are requiring a view of the, of the startups. I know a company, they advised us very early on because they had to buy out their surgeons to get on to hca.

Wow.

I know, that sucks.

That's just a presumed conflict of interest before if you're guilty before you're. You've proved innocent. That's amazing.

Yeah. That's what I was talking about the other week was unless you know these pitfalls, you're really setting yourself up because when you get, when you get it to the opportunity to get to HCA and on contract, that's a huge national contract and you really only have one good shot at it. Your best, your first shot is your best shot. Right. And if you have to go back and you. And you completely get roadblocked and all of a sudden you have to have all of this money to buy out the. For the surgeons that you don't necessarily have and you need revenue. It affects everything down the line.

Interesting. So can you put. Can. Is there any way you can put the special purpose vehicle off to the side at arm's length and have the surgeons, you know, through some third party or is it just. You're. You're doomed.

We have. The only time we've raised money so far with physicians are one, if they are completely outside of the scope and it's a smaller amount and two, if they are private ASCs like they own their own surgery center. But I didn't take any physician money for that purpose until we understand this spv. How, how close that SPV can get.

Really. That's really interesting. That's a great topic for the future.

I, I think it'd be a really interesting topic. What I, what I know about it is it's not a showstopper. I mean Arnalon, you know, several surgeons that I know were invested in that one way or another and, and they clearly had a successful exit despite that. But I do think it'd be really interesting for somebody to lift the veil and show us what those challenges are.

So Ardalan, I was part of the commercialization for them through a national distributor and they really touted that none of their KOLs were paid and none of them had interest in the company. So it might have been side handshake deals.

And what. And Artolon has been around forever. I mean they. 25 years. So you gotta imagine their surgeons surgeon ownership there.

Wow.

Sarah. Their competition was actually the, the guidance that told me that they were the ones that had to buy their surgeons out.

I've got some surgeon investors in my Venops company but all of them are under their, an llc. That's not their name. So really it would take a pretty good bit of digging to figure out that they were there.

I honestly think that that's the pathway that they're doing on the spv. That's what we were thinking of doing. So I hope this isn't being recorded.

I can, I'll certainly not record.

Is.

Yeah, okay, no problem.

This one, this one will go dark but it's a lot of good stuff here though.

Wow. You know you're. In the beginning you, you talked about how marketing is. So was such a big part of the voting and to me part of marketing is informing the market of who you are and lead generation. What's everybody doing or any if anything from a company standpoint for lead generation as part of their kind of growth branding, marketing campaign. Is it LinkedIn? Is it email? Is it. If we're not going to meetings like Joseph was talking about, that's on the downside, you know, how are you making a splash? How are you making noise? How are you getting leads?

We did, speaking of Artalon, we sent, we had Artalon print us out 250 samples and we literally wrote letters to the physicians and they opened it up and they had a sample with. And so it's like going back to the 1980s making it more personal. It is more expensive but you get more viability in, in the awareness you're not going to get them to call immediately but that one initial impression right from the get go and being different, they remember it. And then we also. I do a lot of LinkedIn I to push an agenda where to teach people. So I will republish studies. People love to be informed. Right. Betsy Grunch has made her entire career out of informing the public. So people are interested in being informed. They don't want to be sold, they want to be informed. And so resharing research that's clinically relevant and addresses the agenda that you're hoping to achieve. There's a lot of interest in that and commenting on these crosstalk X rays that post surgeons will post X rays and they'll communicate with each other and showing that you know what you're talking about by, by resharing an article or whatever and chiming in on your $0.02 about viability of certain products. I try not to make it illuminate product, but I try to make it something to where we're recognized. It gives recognition. They need 11 or 13 points of seeing something before it actually registers now.

Yeah, I couldn't agree more. We've had a steady stream of both surgeon and distributor leads just by posting consistently on LinkedIn. And it's, I mean, you can argue that it's free, but every now and then we'll boost it in certain cities. And what I love about LinkedIn is how inexpensive the targeted marketing is. So we had a couple of really big approvals in Miami, for instance, started pushing our LinkedIn posts to those cities for just a few hundred dollars to second what Alyssa was saying, though we tried email blasts to surgeons, we found that the open rate was shockingly low. We just don't think. And I, I spot checked my own surgeon consultants and they said, yeah, know I'm sitting on 1200 unread or whatever. Like they're just not opening them. But I've been with surgeons as they walk in their office and get that mailer and you know, paper mail still works. That's, that's our next plan marketing initiative is to do something like that.

Interesting. What about text? I mean it's, it's a, it's a ticky subject. Nobody wants to see text from somebody selling them something. But there are, if surgeons opt in, there are some great tools where you can do marketing campaigns by text.

If they opt in and they're aware of it, that's, that's one thing. But if you're taking these surgeon lists and just doing a mass text, you're, you're creating a, a standoff, you know, like, like almost like a car wreck in a way where they're putting their hand on the dashboard to, and you don't want to have that initial impression, especially as an innovative product. That's just my personal opinion. There's nothing more that annoys me than 50 million messages on LinkedIn from solicitations to enhance my AI throughput or something that's not relevant or that I've already spent the last five years finding the exact right person to do that one job. So that's why I like the passive. I think it's an elegant approach to send a sample to because you could 3D print a sample for, for pennies on the dollar and, and then they have something to touch, feel, hold, and it's four dimensional then.

Yeah, I've heard of companies that sell or they, they, they mail a FedEx package with a real product and maybe a saw, bones, or something and you open it up, you can feel how the thing fits together or what it does and then you put it right back in the box and you mail it back. And it's just a, it's a sample cost, but it's not that expensive. Welcome back, Mark.

Well, thanks.

Oh.

Wrong Mark.

Oh, wrong Mark.

Yeah, I was gonna say there's a bunch of ways to beat the. The topic was partnering together to beat Goliath. Would say one of the ways you beat. By the way, I'm six, seven. I'm technically Goliath sometimes. But as an aside, that notwithstanding the way, the way smaller, faster people beat Goliath, a lot is to be different, smaller and faster. And I think like you just described something, Tiger, but I think like doing things differently. Everything from those video books you send to people to video messaging, to founder based marketing on LinkedIn. I, I know a couple weeks ago I heard some people saying that they thought LinkedIn was sort of rung dry and I, I disagree, but it doesn't, it doesn't really matter. I would say you, you'd be surprised at the things that you can do on some of these platforms where your audience is. If your messaging is different and changes and is not the sort of same thing that Medtronic does or same thing Arthrex does. So. And here my phone's ringing again, so. And I may find somebody for us to talk about that too, Tiger as well.

I agree with that, Mark. I think that they've changed up the algorithm because I'm getting a lot more interest in likes and comments on very old posts. So they're doing, they're always revising their algorithms.

But yeah, something changed in the last three months. My, my engagement has become not less, but just different. I'm just getting like you said, a lot of likes on our older posts.

I think if you have. And what's cool though is there's people that I never even thought would know who we are that, I mean, like the president of the scoliosis society said that we were killing it and asked if we had instruments, you know, that's really, really powerful. You don't just get awareness from them to the point where they see something different. If you are clinically differentiated and they see that you can benefit patients and they have the passive opportunity to listen to a pitch or something like that. It's really powerful to have. And Tiger, you do a great job of bringing old articles. Re mentioning old articles.

Yeah, I just try to regurgitate things that have a lot of had Legs in the past. Yeah, you're right. I mean, LinkedIn's got a billion users now. It's hard to, hard to even wrap your head around that. There's a billion users and there's so much noise. But if you can find a little niche and you can communicate differently, you know, then you can, you can reach. I think what Alyssa said, what is fascinating, there's the push versus pull marketing. You, you want the, you know, you want people to find, you want the surgeon to contact you, tell me more about your product. I mean, how good is that versus trying to hound dog somebody at a trade show or send a message? That's what you want. Push versus pull is like, it's everything.

If you want to look behind the curtain at LinkedIn, I got a friend of mine, Josh Zuckerman, and Josh's machine can push out 30 to 40, 000 LinkedIn messages a month. And he does, he, how he does that is pretty clever. And it's all organic, it's not automated. And we could bring him on and you could say, how does LinkedIn really work? Like, like they changed their algorithm in November to greatly decrease the amount of inmails that were going out because they didn't want LinkedIn to turn in. You know, they're always, they're always fighting machine. Okay. And, but you know, you can still send out huge amounts of connection requests and get a message and a dialogue going that way. And of course, you know, you know, I'm, I, I'm working on that AI initiative called Provinces, and I'm using it right now for outbound calls, to invite surgeons to a dinner or to an event or to listen to a webinar. And, you know, I'm, I don't know how that's going to develop, but I can tell you this. If I'm, if, if I am using text, I don't send a text without mentioning another physician that I know, this doctor knows, saying, Dr. Smith asked me to ask you. And then we get really good response on that. The AI is so new and we're doing that webinar on the 11th, but, and that's going to be fun. I got Dr. Navarro from Kaiser Permanente and three or four other docs on there, and I don't know where it's going. I just know that I'm on the wave. It's a lot of fun.

That's, you gotta, you have to experiment now. I mean, that's the thing. You have to do trial and error all the time, see what sticks and it and it's a moving target. Send, send everybody those that invite in in Slack. So we'll, we'll show up on February 11th. That'll be interesting.

Thanks.

You don't know the early traction yet from that where you.

Is it just, I mean it's, it's going into orthopedics this week. This, I think this week I got a bunch of registrants people signed up for it. I don't know yet. I mean I've got two AI scientists, you know, three, three surgeons, a couple of CEOs. I don't think anybody knows anything more than this is big. And you know, just this week, of course, you know the government and a couple of tycoons are announcing a 500 billion dollar investment. So who knows if it blows up it's going to be a big disaster. But I mean I think it's going to change everything.

AI is going to change everything. It's. I'm, I'm trying to, I read a lot about it. Try to talk to people, try to figure out. Yeah, I believe, I personally believe every single person will have an AI and it'll, it'll be. You'll have inbound where it'll, it'll look at your emails and text and calls and it'll be. And you'll have an outbound and it'll communicate out and then every business will have an AI for inbound and outbound. I just don't know what they look like yet.

I don't either. I mean on their website it's probably going to go live within a week, you know, preventsis.com and if you, when you click on that, you'll be able to click on an AI agent that can be a receptionist to do inbound, that could be a sales rep to do outbound. You know, that can just be an information agent. We'll find out together what works because I don't know what it's going to, I don't know what's going to work yet. But it's going to be fun.

Going to be fun. It's. And it's going to be what it looks like today in 6 months is. I mean it gets 10x better every few months. So it's just, you can't even wrap your, your brain around. Humans are not built for exponential change. We're built for linear change. I don't know if you ever heard the example like you know, we grew up as farmers and stuff and so if you need twice as much corn, you have to have twice as much Land, everybody understands that. But now the world is exponential and we can't wrap our heads around it. So the example is if you take 30 steps, you go 30, 30 yards. But if you take 30 doubling steps, you end up going to the moon and back and then a little farther. And we just can't, we can't get our heads around doubling of technology all the time. It's, it's gonna outrun regulatory agencies, it's going to outrun everybody. And a few smart people are going to have to figure out how to use this stuff.

That's the problem. Oh, go ahead, Mark.

I was gonna say that's why we're doing the webinar, which is basically said using AI in your medical practice because they see it coming, they're smart people. But the question is, how do I, how do I use it and not get swept away by this tsunami and do something stupid? Or, or how do I use it without risk would be a good question too. Sorry, Alyssa, go ahead.

No, no, and that's the problem is in a kind of segues into what I just posted in the comments. There's so much 50% of the available capital in the world is being invested into AI. Only a handful of those companies are going to make it. So now we become the value analysis people, where we have 2,000 companies coming at us saying use our AI product and in six months time there's a new one that's twice as better because of the amount of information. It's whoever gets the most people the most market share because the AI gets better, right, as it gets fed more information. So it's going to be like the cloud. The cloud used to be free and you would get a certain amount of data available. But now everybody, including grandparents, are paying because they don't want to lose photos and stuff like that. And whereas nobody 10 years ago would have paid except for maybe a business for cloud. But that's 10 years away, you know. And so I just, I think that using the Warren Buffett theory of getting in while everyone's getting out and investing in AI, I think that that would be a really powerful segment and not make it company specific. Just a discussion amongst us at thought leaders within the community of why you should consider investing in outside of AI. Because bone is always going to need to be healed in our lifetime. We're always going to need biomechanical stability and what we can do to enhance that message could be looked at and watched many times. And as companies and orthopedics and spine and bio and Sports and trauma are raising money. They can actually put that into their marketing towards these family offices and bcs and, and be seen. I don't know.

Well, the theory's worked pretty well for Warren Buffett.

He doesn't make a lot of mistakes. But let me counter what Alyssa said. So there are going to be a few winners and they're going to dominate. But if you have a big enough data set, you can create a private AI that works for you that's disconnected from the Internet. And Nvidia just announced a new chip that is insane that runs by itself, you know, on a desktop. So if you, the, the question is not the AI tool. I think it's how you train it. And if you have, you have to have a ton of data and where are you going to get the data? Is it publicly available? Is it privately available? Can you boost the data, you know, synthetically? I think those are the. I, I don't know. There's be private AIs all over the place. I shared this a few weeks ago. I created this thing called Delphi, which is my clone. And I just trained it with YouTube videos and blog articles. And every day somebody goes and asks the, my clone a question. Yesterday they asked what who are the zombie companies in orthopedics? And it, it answered in the middle of night. I didn't even know about it, you know, so. But it's the training data. Always think, when you think AI always, you have to always ask the question, what data is training it and who owns that data?

Well, and, and never before in history have people been available 24 hours a day. Like you used to have to pick up a phone and you wouldn't call anybody before 8am There used to be rules about how accessible people were and now even like confirmations that messages were read. You know, like it is very invasive. So we as a species are learning how to navigate this new accessibility 100% of the time. And I think AI is going to be very powerful in that, in helping bring back a better lifestyle, more balanced life lifestyle. And for physicians especially, I think they, they, they've gotten brutalized over the last decade.

They do more work for less money. Right.

Every year and higher risk. Risk is the scariest part.

Good point. It's a really good point. Well, we're, we're on the, we've hit the top of the hour. We can keep going, but I mean, heck, we talked about grants, VAT committees, managing 1099 SPVs, AI. I mean we've, we've covered broad topics. They're all interesting.

Well, let me, let me know if you want me to invite Josh to talk about LinkedIn.

He's a pro. I think everybody would love to see behind the scenes how to use LinkedIn, how. How the algorithm works, at least today. And then how we can better.

I mean, his company does lead generation and marketing and they use LinkedIn.

Oh, perfect. So, yeah, sign them up. You know, any Thursday at three, Mark.

Okay, I'll send you the date. Okay, perfect.

All right, thanks. We'll sign off.

Thank you very much.