Seeking to match endometriosis patients with doctors most capable of treating the disease, Dr. Saeid Gholami founded iCareBetter. With a background in primary care, Saeid now works with AI to find better solutions to this issue and spread awareness of its importance.
Highlights:
Sal Daher Introduces Dr. Saeid Gholami
iCareBetter: Finding a Solution for Endometriosis
Peer Review: The Vetting Process for Endometriosis Surgeons
How Endometriosis Affects Patients' Daily Lives
How iCareBetter Started Out
“...When we nail the model for endometriosis, then we focus on complex diseases which need multidisciplinary highly specialized care, replicate the model for their diseases…”
How Saeid Gholami Came to the U.S.
The Immigrant Superman Effect
Advice to the Audience
ANGEL INVEST BOSTON IS SPONSORED BY:
Transcript of “iCareBetter”
Guest: Saeid Gholami
Sal Daher: I'm really proud to say that the Angel Invest Boston Podcast is sponsored by Purdue University Entrepreneurship and Peter Fasse pattent Attorney at Fish & Richardson. Purdue is exceptional in its support of its faculty, faculty of its top five engineering school in helping them get their technology from the lab out to the market, out to the industry, out to the clinic.
Peter Fasse is also a great support to entrepreneurs. He is a patent attorney, specializing in microfluidics, and has been tremendously helpful to some of the startups in which I'm involved, including a startup that came out of Purdue, Savran Technologies. I'm proud to have these two sponsors for my podcast. Welcome to Angel Invest Boston, conversations with Boston's most interesting founders and angels. Today, I'm delighted to have on the podcast, a faithful listener of this podcast, and a founder, and a tremendous guy, a physician, Saeid Gholami.
Sal Daher Introduces Dr. Saeid Gholami
Saeid Gholami: Hi, Sal. Hi, everyone. Thank you for having me. I'm a big fan of this podcast, and I'm so excited to be here and talking with you. I hope we can shed some light on this space that we are working in. It needs a lot of introduction.
Sal Daher: You know it's funny, we met each other just as COVID was getting off the ground. It was one of the last events that I can remember that we did in person. We corresponded, and everything. Then we reconnected via my sister, a surgeon here in Boston, and who had a use of your platform for someone that she was trying to help out, who has a problem that your platform addresses.
It was one of those, "Slap my forehead, why haven't I had Saeid on the podcast before? Ah." In Lebanon, they have this expression, "Majnun, majnun, crazy. Majnun. Why? Crazy guy, why you should have had this guy on?" Now, we're correcting a mistake. Saeid Gholami, welcome to Angel Invest Boston.
Saeid Gholami: Thank you very much. Yes, I remember the last podcast that you did in person before pandemic. A lot has changed since then for our company. We've almost went out of business during the pandemic as we recall it.
Sal Daher: Oh, my gosh.
Saeid Gholami: Yes, and that night, when I met your sister, it was an amazing conversation. I am so excited to be here now because of that conversation.
Sal Daher: Yes. Let's talk about iCareBetter. My listeners are very impatient. Not all of them are as patient as you are, Saeid. People are like, "It took 13 minutes to get to the startup. Get to the startup, Sal." [laughs] Saeid's startup is iCareBetter, and it is an online platform to help find the best specialist.
In this particular case, it's specialists who treat endometriosis, but I suspect you probably want to expand beyond that. Anyway, instead of my telling, why don't you tell this. Saeid is a physician. We're going to get into this later on. What possessed him to go against the advice of his wife, and start a company? Saeid, tell us what iCareBetter does.
iCareBetter: Finding a Solution for Endometriosis
Saeid Gholami: Sure. I think the best way to explain iCareBetter is the problem that I had as a physician. I saw patients had with endometriosis, I know many people it's their first time hearing the word, endometriosis. They think, "Oh, boring." It's not going to be boring. It's going to be a very enlightening--
Sal Daher: Okay. Half the population of United States are women. The other half are born from women, in addition to being women. Endometriosis is the abnormal growth of the lining of the uterus. When it gets out of hand, it is an extremely painful condition. It can afflict people who are young. It can afflict people who are older. It can cause infertility, and many, many problems. It is a very, very complicated thing to solve. Anyway, I just wanted to bring it down to the layman's level here. Please continue, Dr. Gholami.
Saeid Gholami: Sure. Yes. I'm going to put on my doctor hat for a few minutes. It's a growth of tissue similar to the lining of uterus. So, the uterus, it can grow in lungs, on diaphragm, on all organs in the body. The most common problem is a woman with endometriosis, men and trans people can have it, but 99.9% are women who have this disease.
The most common symptom is probably pain, which causes painful sex or infertility, or a lot of other issues. These people usually see up to 10 years of delay in diagnosis, and multiple years of delay in effective treatment. Going back to why we launched iCareBetter, as a physician, I was a primary care, I used to see people with endometriosis commonly coming back to our practice month after month, during their period, or somewhere around period with pain.
We send them to a gynecologist or a surgeon, and they come back next month, and the next month. We had an issue, we couldn't find the right doctor for them, and they couldn't find their own doctor. They'd come back for pain medication, for different issues to a point that we would blame the pain on them, on patients. Like, "Oh, you are seeking attention."
Sal Daher: Oh, yes. Munchausen or something, yes. [chuckles]
Saeid Gholami: Oh, exactly. I personally thought, all right, we need to listen to these people. I'm going to find them a doctor, and send all our patients to that doctor. Had such a hard time to find a doctor. I couldn't find a doctor. You call them, ask them, "Do you treat endometriosis?" They say, "Yes, we do." I ask a couple of more specific questions, they don't know what they are doing with endometriosis.
It's a complex disease. General OB-GYNs usually don't get as much training. What happens, that's the reason that people go 10 years without diagnosis, and then several years of multiple failed surgeries. A lot of women at the age of 25, 26, they are menopause now. They had surgery to take out, it's usually ovaries. Then you see these people coming back, and not being treated.
They have been castrated. They have been operated and they still have pain. You, as a physician, don't know what to do with these people. There are 10 million of these people in the US. It's as common as diabetes, and it's not like one or two exceptionally ill patient, no. Then you got to solve it. When there's a problem, there needs to be a solution. Someone needs to find a solution, but no one was finding a solution.
That's how we came with the idea. All right. We need to do better for these patients. We need to educate them and educate the public better. We need to help these patients to get to the right doctor, with the right expertise to help them. That's a surgeon, and a physical therapist, and fertility, and mental health, and pain management specialist. That's why we launched iCareBetter. To basically become a marketplace for those specialists, to be vetted and presented to patients with endometriosis.
Sal Daher: This is tremendous. I've had on my podcast, a physician from New York City, Jeremy Weigel, who is a urologist. The problems he deals with are problems of the pelvic floor. Multidisciplinary, it requires not just a physician, it's not just a surgeon, it's their therapist, and all kinds of people involved, and coordination of the care, and all of these.
He's created a platform which includes actually a connected device, accesses a nerve which can be accessed externally without intrusion of the body that helps people control the bladder. It's a parallel to this here. It's not necessarily incontinence that you're dealing with here. You're dealing with extreme pain, young people, young women mostly who are in just utter horrible pain. The pain in the abdomen is just unbelievably, unbelievably difficult to bear. Explain to us how it is that you're addressing the problem Saeid.
Saeid Gholami: Yes, I listened to part of that podcast, and a little bit of --
Sal Daher: Oh, yes. With Jeremy Weigel.
Saeid Gholami: Yes, it's amazing.
Sal Daher: That's bringing together the different disciplines to create a solution for patients. Anyway, so tell me what your platform does.
Saeid Gholami: Sure. Let's just start with surgery, which is basically the most important step in the treatment of endometriosis. With this, when we talk about endometriosis, is the growth of tissues similar to endometrium, which is the inner layer of the uterus, somewhere else. What you're going to do with that tissue? You're going to take it out. Otherwise, it keeps creating inflammation and pain.
You need to take that out. The problem is, not all OB-GYNs, which are the qualified surgeons to do this surgery, are trained enough to do these surgeries. They go to do the surgery, they miss a lot of lesions because the lesions don't have unique presentations. They can have 10 different ways of presenting.
Sal Daher: Ah. Horrible.
Saeid Gholami: Also, it could be around a nerve, or ureter, or a vessel, so they don't cut the whole thing. They just cut, burn the surface, or cut a little bit of it, makes it even more painful. Who can treat this disease? It's a surgeon who is trained to do this surgery, and he's doing 100 or 200 cases per year, and go in, and cut the whole thing. It's hard to find these surgeons. How a person not in OR can find these surgeons? We came up with a way to vet these surgeons. We asked them to submit three surgical videos, full surgeries.
Peer Review: The Vetting Process for Endometriosis Surgeons
Sal Daher: Three surgical what?
Saeid Gholami: Videos.
Sal Daher: Oh, videos. Okay. You're vetting the surgeons by having them submit three videos of the endometriosis surgery.
Saeid Gholami: Yes. We send those three videos to other surgeons who are top surgeons. It's a peer review video vetting. Then these surgeons, some don't pass, some pass. If they pass, we introduce them to patients that, this doctor has passed the betting of surgical skills for endometriosis, which is the most important step as I mentioned. The same concept we are replicating it for other specialties related to endometriosis.
Sal Daher: Ah, so basically having surgeons vet surgeons.
Saeid Gholami: Yes. Surgeons vet surgeons for their skills. There was this study in The New England Journal of Medicine in 2013, which showed they did this vetting data for bariatric surgery. They showed, there is a direct correlation between the skill of the surgeon and the rate of complications. If there is a higher skill based on the peer vetting, there's going to be a lower complication rate.
Sal Daher: There is no peer reviewed evidence of that. There's a connection between skills. You can't prove yet that vetting is going to have a lower rate of complication. Although you could end up with that data as well.
Saeid Gholami: Exactly.
Sal Daher: Keeping track of that in your platform, you could eventually have massive data set to show that.
Saeid Gholami: That's our next big thing to do. We want to compare our patient's data with the national average, which we're confident is going to be very different, but definitely that's the next most important step for us to take.
Sal Daher: Wow. Excellent. I'm just thinking, you say that one of the problems they have is finding the endometrial tissue. I'm invested in a company that comes out of Purdue and the technical founder is Philip Low, who's a very prominent professor at Purdue. He has put together a tumor targeting fluorescent agent for ovarian cancer. I'm just wondering if something like that couldn't be done for endometrial tissue so that when a surgeon is doing surgery for endometriosis, so they never miss it because it fluorescents. Has something like that, been tried to your knowledge, do you know?
Saeid Gholami: To acknowledge doesn't something very specific or endometriosis. I know some surgeons use fluorescent agents for endometriosis, mostly to figure out where is the vessel, so they don't cut into it or something like that. Actually, that's an opportunity for a founder or an entrepreneur and for investors to come in and support such a device or such a basically chemical material. That's a really good opportunity of basically innovation and investment, totally would be so important for a lot of surgeons.
Sal Daher: Saeid, when I talk to someone like you or particularly someone like Philip Low I have this feeling like, if I waste your time or his time, people might die because you could be saving lives right now by extending your platform to one more type of surgery or in the case of Philip Low, he has invented a treatment that basically clears patients of malaria in 48 hours.
He has malaria licked and the same guy has also invented this marker for ovarian cancer, which is a horrific cancer that is detected usually at stage three or stage four, because it could be confused for endometriosis, could be confused for a bunch of other things that cause abdominal pain. I feel like when I talk to him that, I might be causing deaths by wasting his time, so I shouldn't waste his time or yours. Anyway, I thought that would be interesting to at least mention this connection with Cytalux which has been FDA approved for basically illuminating ovarian cancer tissue.
Saeid Gholami: No, I really appreciate being present here. I think part of my excitement for being here is to tell people who are listening to your platform, our founders and investors and executives, we have an issue of a knowledge and basically awareness in the society. Investors don't get excited about endometriosis, or not many founders or executives are excited about endometriosis, because they don't know how big it is and they don't know how important this could be for a person's life. I think being here really, I believe is going to save a lot of people's lives in the future. Even if I have one person on your platform.
Sal Daher: Saeid, is there an endometriosis foundation? Is there something like that?
Saeid Gholami: In terms of like to--
Sal Daher: Like a cancer foundation?
Saeid Gholami: Yes. There is an Endometriosis Foundation of America they have this conference. There are other foundations like endometriosis research centers or other foundations that people can go donate to education or research if you're asking about that. Is that your question?
Sal Daher: Yes. I was just curious. Endometriosis, I think is genetically-- I don't know if it's determined, but there's a strong genetic component to it. I can just imagine a billionaire whose mother had endometriosis or whose wife has endometriosis, who would just solve this problem. It could happen and just be able to create around endometriosis a whole suite of the best surgeons and then the best imaging software, the best markers, whatever, procedures for nerve sparing surgery for this and that, because it can be anywhere, a very difficult enemy to be fighting.
Anyway, so the practical aspect of it is that you get surgeons who are interested in getting patients in sending three videos, and they get vetted by physicians who are independent presumably. Then if they're considered to be a good standing, they're included in your platform. Basically you're creating a list of highly capable surgeons who operate in the endometriosis space. Now, eventually you're going to map out all the capable surgeons, maybe there's 1300 of them in the country, something like that, 1500, once you map them all out, I'm a businessman, how do you make money doing this?
Saeid Gholami: Yes, I love this. The most difficult question for us has been making money, but what's happening now. We charge providers to be on our platform and on wall or for some of the monthly fee to be on the platform, because being on iCareBetter means they get a lot of patients with endometriosis.
We are basically the most important brand in the space of endometriosis now. Everyone knows us. Patients come to us for doctor. If someone gets on our platform, it means their practice is going to be like fully endometriosis. Endometriosis patients are very lucrative from business perspective. They're humans, they need to be helped.
How Endometriosis Affects Patients' Daily Lives
Sal Daher: It's a type of care that requires a lot of involvement, with good justification, because it's not like you're spending massive amounts of money on someone who's 85 years old. You're spending money on 25-year-old women who may not be able to have children, who are going to be with this pain their entire lives. You need to solve the problem. Now, if you're 85 years old, you can have ways to relieve the pain and all that stuff, but you're not worried about having family and being functional all that stuff. If you're 25, it's a different story.
Saeid Gholami: Exactly.
Sal Daher: Let me understand. Endometriosis is actually not necessarily a lethal condition.
Saeid Gholami: It's not lethal, but it gets people to a point that they can't work. They can't perform as a normal--
Sal Daher: It's debilitating, but not lethal. This perhaps is one of the reasons why, because it's not like cancer, because cancer kills in a horrible way, horribly painful way. Endometriosis is perhaps as painful as a horrible cancer, but it doesn't actually kill. It's a little bit like patients who have to be on antipsychotic medications. They're not psychotic anymore, but they're not fully functional either. It's a heartbreak.
I am a proud investor in a company called Karuna Therapeutics that has a new treatment. The only new treatment, I don't know, in decades for antipsychotic for treating conditions like schizophrenia, which actually works and allows people to be functional. I'm very hopeful about this company, public company, KRTX. They had a big pop recently because their therapy had a very strong phase three results, very strong numbers. It's similar to that.
Saeid Gholami: Actually, I compare it with diabetes. It impacts 10% of people in that age range, like 15 to 50 women. The same with diabetes. Diabetes is not going to kill people. It's going to make them sick and they are going to die earlier and endometriosis does the same. Endometriosis is an inflammatory disease, can lead to--
Sal Daher: It does shorten lifespan, not only health span but lifespan.
Saeid Gholami: Absolutely. Also it reduces a person's functionality and productivity in the society. The debilitating part that you mentioned, absolutely is just so like crushing for these people.
Sal Daher: Very good. Basically, your revenue model that you've developed so far is getting paid by the providers, by the physicians who are providing the service, surgeons to bring patients who are qualified for this. These are patients who the compensation will be very high because it is a very involved procedure. It is a very high value procedure, highly necessary. There's a lot of waste in our health insurance system treating a 25-year-old woman who has endometriosis is not one of them. I could not imagine something that's more effective in terms of costs if it's done correctly. Helping someone be able to have a family, to have children.
Saeid Gholami: Yes. Don't be menopause at age 26 and don't have osteoporosis, don't lose your life, don't lose your partner.
Sal Daher: Exactly. Also be able to have a life, and not be tortured with abdominal pain. If you've ever had abdominal pain, it is horrible. It is horrible.
Saeid Gholami: One thing that I want to say about the business model which you asked, we have been playing with a lot of models recently, not recently, since the beginning. We are a marketplace, the most lucrative business model for marketplace, which provides services is a lead fee, like we should charge per lead, but there are laws in this country that you can not charge per lead.
You cannot ask doctors to pay you a per-patient fee. They just need to pay you a subscription, which is a limiting factor for us, and for some doctors, because they might not want as many patients or they don't get as many patients compared to others. This is one of the challenges or complexes that we are dealing with, how we can customize the pay, so it's fair and also it's scalable. I'll say it doesn't worry that law. That's some interesting learning, I think for the audience here, which I think out the marketplace can escape, especially in the medical field.
Sal Daher: Let's talk a little bit about who else you have in a company with you. Did you have a co-founder, Saeid, or did you do this on your own?
How iCareBetter Started Out
Saeid Gholami: When we started the company I had a co-founder. If you remember, we started to be an education company focused on- -
Sal Daher: Oh, that's right. Right, I remember that you have videos explaining-- I think exactly.
Saeid Gholami: Yes. Explaining chronic diseases, specifically endometriosis. That's how we went through pandemic and we almost got crushed because when there is a pandemic, no one cares about education, people were looking for a mask and then gloves etc- -
Sal Daher: [laughs] I want an education on how to put on a mask.
Saeid Gholami: Yes. We went out of business almost. Then we needed to do a pivot. Yes. I had a founder, co-founder to start a company. Then things change. She still has some equity in the company as a great friend, but recently, the last couple of years, like two, two, and a half years, it has been me alone. We are a four persons team now. I've outsourced the take and the marketing to overseas and it's working perfectly fine. I have a lot of part-time, basically contract workers now. Just to keep the operation nimble and efficient. Yes. That's how we work now.
Sal Daher: Okay, so you pivoted. This is a great story, you had a COVID pivot, and you came up with the bone in your teeth, like the dog that goes into the pond and comes up with a bone in his teeth. Yes.
Saeid Gholami: Yes. We were one week away from closing the whole thing. I was looking for jobs, talking to some mentors, what type of job I should apply for. Then during our conversations with potential clients, we realized our clients were doctors, the endometriosis doctors, and they say, "No. We don't need your education, because we don't know if your education is going to help us. If you can help us have more patients because pandemic is hitting us so hard. We can't have patients anymore. That's a business that I'm willing to invest in." We were like, "Of course, we wanted to do it, but we didn't want to charge you for bringing the patients."
Sal Daher: Right. "You mean, you're going to pay me to bring you patients? You could have told me that before".
Saeid Gholami: Exactly, and patients, it's their diseases, it's their problem, they're looking for a solution. We realized, oh, it was so obvious right there. We were trying to charge them for education to bring them, patients, for free.
Sal Daher: This is typical. You think that they want something and they actually want something else and they're willing to pay for it. They want something else and they're willing to pay for it. You're like, "ah."
Saeid Gholami: I couldn't believe it. I would ask my mentor, like, "Why is this happening? This feeling that I'm having is suspicious. This is so easy now. I am not used to being this easy".
Sal Daher: Product-market fit. That's what it is. When a product is not a fit for the market, it's like pedaling uphill with a rusty bicycle with flat tires. You can't, they're really hard. They made you do it because you're a strong founder. Then when it's product-market fit, all of a sudden you can't stop that thing. You can't keep the product in the shelves, everybody's pulling it off the shelves and so forth. You know the difference between having a product-market fit and not having it is extremely obvious.
Saeid Gholami: Oh, there is no day, Sal, that goes by I don't receive an email from a patient that, "Can you find us a doctor in our region?" Or from a provider that, "How can I get on your platform?".
Sal Daher: What's your biggest challenge now? Is your biggest challenge finding providers in different regions?
Saeid Gholami: That's the biggest challenge, finding surgeons in different regions. You asked the question a couple of minutes ago, this ties to the challenge now. There are 100 experts, true experts in this country, not a 1000 or 2000. That's- -
Sal Daher: It's 100, it's not 1500?
Saeid Gholami: Yes. We need more. Part of it is we need more experts to be trained. There aren't enough trained experts. The other part of it is we need a multi-disciplinary chair. That goes back to-- when we max out the number of providers now, we need around 6000 to 7000 providers, including surgeons, physical therapists, mental health experts, and everything together to make these works. These providers aren't trained for pain or endometriosis. They are trained for general things. They know if someone has anxiety or if someone has pain.
Sal Daher: Oh, yes, they can deal with those things. The ones that have to be trained, the specialty in the endometriosis are the surgeons. What kind of therapists-- mental therapists?
Saeid Gholami: Yes, mental health therapy is big in our space. There's definitely room for innovation and we're moving in that direction.
Sal Daher: There's a lot being done of mental health online, providing mental health across state lines. This is something that developed a lot with COVID. You have a kind of a physical component of this, which is the actual surgery, which the digital-only helps in finding the right surgeon. On the other hand the therapy, it can be done with someone who's a good therapist, that person can be in Washington State, and you can be someplace in Florida. I don't know if it's allowed in Florida, I don't know if it's allowed in Washington State. It's just an example, a hypothetical example.
That's fascinating. That's really fascinating. Brings me back to Pelex and Jeremy Wiegel. He's creating a network in delivering care. He was helped a lot by the big leaps in digital health that happened with delivering care digitally, during COVID. It's like COVID takes away and COVID also gives. Very interesting. Is there anything else that you want to say about iCareBetter? What I like to do is I'd like to do a little brief promo for the podcast, and then I'd like to get into the founding story. We just sort of did already. I also want to get into your story. You're an immigrant to the United States. I want to get your immigrant story here.
“...When we nail the model for endometriosis, then we focus on complex diseases which need multidisciplinary highly specialized care, replicate the model for their diseases…”
Saeid Gholami: About iCareBetter, one thing that I want everyone to know and then you to know is working in this space in endometriosis is tough. People are not especially excited, it's not an AI or something. Patients are not understood well. We are not understood well. It's a really interesting space. There's a lot of opportunities and we are expanding. We have been self-sustainable, breaking even month over month now. That's our state of the company. We want to grow to all the states in the US. We are in 20 states and we want to go in all multidisciplinary care.
Sal Daher: You are hoping to expand all across the country in the endometriosis space, which you already have well-practiced procedures, and so forth. Are you thinking of expanding your model to other areas of care as well?
Saeid Gholami: Absolutely. When we nail the model for endometriosis, then we focus on complex diseases which need multidisciplinary highly specialized care, replicate the model for their diseases. I already have the disease we just need to nail this down, this model then replicate it for-- there are so many diseases out there.
Sal Daher: Outstanding. When you're at a point of getting into other areas I should put you in touch with Jeremy Wiegel so you guys can compare notes. Startups don't need to compete, they can collaborate and they can just share resources. If someone wanted to help, how could they help you?
Saeid Gholami: I'm not actively raising funding. All right, that's a great thing. I would love connections. If someone has a podcast or someone has an investor network or is an investor, I would love to introduce the idea to them so they know the space, they know us for the future.
Sal Daher: You want to meet more investors and you also want to meet more practitioners, more providers.
Saeid Gholami: More practitioners in all the spaces related to endometriosis OBGYN, mental health, physical therapy. That would be also really helpful to us. The more people we can see and introduce the concept to, the better for patients. Even if they don't join us, they know where to refer their patients to. Absolutely that would be something that we would love to see.
Sal Daher: Okay. icarebetter.com. That's pretty good branding. It's better than an Angel Invest Boston. I should have asked you for help on that Saeid, you're going to have an MD helping you with your branding.Your branding is so good, an MD could've improved it. You don't have a branding expert, that's how lousy it is, but I'm stuck with the name now. When I'm typing out I'm like, "Oh boy, is that long?"
[laughter]
Saeid Gholami: That's a very relevant name, I have to tell you.
Sal Daher: It does explain what it's about.
Saeid Gholami: Yes, absolutely.
Sal Daher: It certainly does. I optimize it for that. I could have maybe figured out a way to shorten the number of letters, it just tires me out. I'm getting arthritis in one finger from just typing so much.
[laughter]
Sal Daher: Anyway, let's do this. We already talk about how the company came about, but in the second half, I want to get you into your immigrant story, which is always fascinating. I'm an immigrant here. You're an immigrant to the US. Let's talk about that a little bit, but first I want to ask listeners who are psyched as I am at what Dr. Saeid Gholami is talking about. Very important problem that he and icarebetter.com is solving, namely the problem of providing better care for people suffering from endometriosis.
If you want to help, one way you can help is by going to the Apple podcast platform and leaving a review. It's so easy to do. Not just a rating, of course, leave a five-star rating. Come on. This man is helping humanity, that's the least you can do. Also, a written review because the algorithm seems to be able to distinguish when you just have a rating and you have a written review.
If you have a written review, doesn't have to be long. It tells the algorithm, this is an episode that's worth listening to. That particular episode gets upvoted so to speak. It helps other people find out about Angel Invest Boston, about what Dr. Gholami is doing at icarebetter.com. If you could do that a favor for us, that would be tremendous site. Saeid, tell me the story. You were born in Iran? When did you come to the US?
How Saeid Gholami Came to the U.S.
Saeid Gholami: I came to the US in 2012 after I finished medical school. I came to the US initially, I started studying for the board exams in the US. You have to take these board exams, US MLEs. Then I spent two and half years at University of Pennsylvania, department of Radiology, did hardcore research. I'm a published scientist. I have a publication.
Sal Daher: Oh, published scientist.
Saeid Gholami: Then I started a residency and during all this period when I came to the US to the research and the residency, I always had this in mind, for chronic patients, endometriosis is a chronic disease that, all right, we need to do something more than what we are doing, more than just this imaging or treating them with this pill and that pill.
I wanted to launch the education platform and help patients to find the right doctor for them, but I was on a visa. I had to do whatever my visa sponsor wanted me to do. I couldn't do things, but I kept reading, and studying, and learning about the culture of the business in the US and the infrastructure until I started my residency. A week before my residency, my green card came.
Sal Daher: Freedom. Green card for those who don't know it is the card-- it's sort of green. I don't even know where mine is because I'm a citizen now. It's evidence that you are a permanent resident in the US, that you're on path to become a citizen eventually. That you are allowed to work in the US permanently. You're a permanent resident. Then you have to stay in the US for a certain number of years, keep your nose clean. Don't do anything crazy.
Then you go and you take this exam to become a citizen in the United States where you prove that you know a whole lot more about civics than the average American citizen does about government. For example, most Americans don't know that there are 435 members in the house of representatives and that there are 100 senators only. There are 535 members of Congress, Senate, and the House together. That kind of information is indelibly impressed in my head. I remember the day I was very nervous. The citizenship test. You must have gone through the same thing.
Saeid Gholami: Yes, I went through the same. I was so nervous and I forgot the whole thing a week after the test. [laughs]
Sal Daher: That is part of your assimilation into being a normal American, knowing nothing about civics. That's only part of normality. You got your green card.
Saeid Gholami: I got my green card. Then that burning feeling that I had since I was a medical student in Iran, launched a platform that educates chronic patients and help them. I never could do that in Iran because of the infrastructure. Here, I couldn't do it because of visa sponsorship. Now I have that freedom. The first thing that I did was searching for a good name for the company.
[laughter]
Sal Daher: iCareBetter, it is a good name.
Saeid Gholami: I did so many brainstorming sessions, had so many names. I did some surveys with friends and everything to come up with this name. Then at that point, I launched the website, not the company, the website, and we were focused on chronic diseases, all chronic diseases. That point, I had the challenge with my mentors, which at that point, all my mentors were specialists in the field, and also with my wife. With the specialists in the field were like, "You need to become a specialist, you need to do everything here."
Sal Daher: Sorry. What is your wife's profession, if you don't mind?
Saeid Gholami: She's a radiologist now.
Sal Daher: She's a radiologist. By now she's a long-suffering radiologist being married to an MD who was crazy enough to found a startup.
Saeid Gholami: Oh my gosh. She has been through a lot. I would say, it was her support that's really helped me to go through so many things. Although she was anxious in many situations. Like I told you, we were almost going out of business during the pandemic. We lived several months with zero salary for me. Thankfully, she had a salary and everything is still-- not that now we still have some anxiety until you sell or you become public. You still have start-up anxiety.
Sal Daher: It's like the old Zen storytelling. One turn, you think you own the world, and the next turn you're back to zero, the story keeps turning and turning and turning. I have a very wise founder who was on the podcast. His name is Matt Singer. I invested in his company. He was bought by Squarespace, a company called Videolicious.
They started doing one thing and ended up doing an entirely different thing, kind of related, a pivot just like yours, but Matt said, "There is no magic carpet ride to happiness for a founder." Every turn you think that "Oh, I got to raise my seed round. When I raise my seed round, then I got it made." You raise your seed round and you're scrambling. Then you realize halfway through the year, "Oh man, I need to start raising my series A," and you're running around chasing your tail to raise a series A and to develop the business, to justify the series A at the same time.
Then you get your series A and that means the VCs are on your neck to scale that business. They want that business to go a 100X so they can make their 10X and exit. Then that's another level of pressure, go public. Oh man. Especially with the public markets as they've been recently, it is always very intense. Until you sell out and then after you sell out, you say, slap your forehead, "Oh, I sold it for just that, and now it's worth 10 times that. [laughter]
Sal Daher: That's the tragic nature of being a founder that I have observed. The person who pointed that out to me was Matt Singer. He's a very thoughtful founder. Very deep thinker.
Saeid Gholami: Every step of it has been a real struggle for me personally. Look, I'm not a typical founder in the US. I am not necessarily-- you see me, I am a Middle Eastern guy, look, face an accent, and come here, he is a doctor and he's not a typical tech founder who launches a platform and I'm not a typical doctor founder--
Sal Daher: Oh yes. You're a rare bird, and "avis rara". If you were a founder in technology, like in computer technology with a Middle Eastern accent, you fit right in, but you're a physician. [laughs] You're like, something is wrong. It's like a pebble in the shoe or doesn't quite fit the profile.
Saeid Gholami: Exactly. For a physician, you would expect them to call me the medication, a drug, or patent to device something, and that's not a device that I present.
Sal Daher: Not a digital platform.
Saeid Gholami: I have been having a hard time having people listen to me. No, the language barrier has been there at the beginning, now probably not there, hopefully, but the language and it's not just speaking. It's the culture. It's how we get the message through. It's not just the words that come, it's the understanding, the everything behind it. It has been a really tough run for me, but I came from a middle-class family and in our region, it was tough to survive, really. We didn't have gas. We didn't have anything. That resilience coming from that small town in Iran really helped me to survive this path of entrepreneurship.
The Immigrant Superman Effect
Sal Daher: I talk about on this podcast, a Superman effect from being an immigrant founder, men and women have this, that some of the most tenacious founders are people from overseas, people who come from countries where things aren't as easy. Most people who are born in the United States have no clue how easy it is to get things done in America compared to other countries. There are places in the world where you can do business more easily than Singapore? Singapore, you can actually-- I lived in Singapore. It's easier to do business there than it is here, but very few places. A country the size, it is a very welcoming environment and also very welcoming to people who are different. People with accents, people look different.
Americans are used to that, and so they get here, and they've come from a place where all kinds of restrictions, the institutions don't work well, everything is scarce, and they feel like they can jump over buildings in a single bound. It doesn't wear off. You have this need. I came here, I gave up all, I sacrificed all of that because being at home is also very wonderful, being close to family, and everything else.
I'm going to make my mark here. I'm going to jump over tall buildings. I'm not just going to have a job, 9:00 to 5:00, and then mail it in. I'm going to go full tilt. This is what I admire. I see it and I really admire it. Laura Indolfi; she's been on this podcast. She's the founder of a company called PanTher Therapeutics. Just recently, they got a $14.6 million grant from CPRIT, which is the entity of the governor of Texas to help develop their treatment for solid tumors, for pancreatic cancer.
Let me tell you, she was like a dynamo. Very, very hard to raise money throughout the whole-- Just really hard. VS's are not interested in-- they don't take pictures anymore. I think she now has enough money to prove out, and I think she has a very good chance of proving this out because it's like the material gets the cancer drug to the cancer site and it doesn't go anywhere else. I think she's got a good chance. People like that, just this tremendous tenacity.
She's from Italy. Her family are all lawyers and she had this idea to become a biomedical engineer, I think is her specialty. She's got a PhD and postdoc at MIT. The first one went to the sciences, everybody else in her family are lawyers. She could probably have been a very, very capable lawyer but she decided to do this very hard thing. Kudos to Laura Indolfi and her most recent accomplishment.
Saeid Gholami: I have to share something with you. It's a personal thing, you might see it in other immigrant founders. You get so many nos and so many rejections from normal people that would listen to other mediocre idea but they won't pay interest to your idea.
Sal Daher: Some tall blond guy with a 16-inch part with a lot of hair. It's just, "Hey, I played football for this state university. I got the plan for you." [laughs]
Sal Gholami: Then you get used to it. If you have the sense of reality and resilience, it's really helped me, those rejections. Now, looking back, if some of those people invested in me or invested our company, at that point, we might never be able to make the pivots or be so free to pivot and make this mark that we have made so far. We'd be focused on building a business, we'd be focused on generating revenue instead of go convince people to invest in us. At some point, I say, "All right, I don't want to convince people. I don't need people to--"
Sal Daher: This is a very important point, Saeid. My friend and mentor in Angel Investing, Michael Mark, has always pointed to it. He says, "Sal, at some point, the startup has to decide whether it's going to build a business or it's going to raise money. If raising the money gets really hard because the business isn't sufficiently developed get down to business. Develop the business and then when your business is really developed, you can't keep people from investing in you. They're going to chase you down. At that point, you don't need them anymore." See? That's the irony of the thing. Banks want to lend to people who don't need money. If you really, really need the money, banks don't want to know you. The irony of life.
Saeid Gholami: That's amazing. The same exact thing, Sal, happened to me. I have received emails from investors to invest in us. It wasn't the right fit. I said, "No." The great thing is we don't need money now. We said we're going to survive and we're going to grow. Money is going to help me to sleep better at night but you're not going to die without money and you're going to have a business that's growing.
Sal Daher: It's less complicated that way.
Saeid Gholami: We have had people who wanted to acquire our company. Again, it wasn't the right fit. We rejected. Why? Because we are in good shape from a financial perspective and we don't need that money, because we focused on business when I saw people have no interest in the company. It's really important to me. I really think going back it was such a blessing being rejected so many times.
[laughter]
Sal Daher: That is the sad reality of life is that whatever you're doing or selling, and selling is mostly about rejection because every conversation you have is not a sale, you have to steal yourself out of that rejection. Being an immigrant helps in that, having come from difficult circumstances. Saeid Gholami, this has been a tremendous interview. We talked about some really interesting things. I've loved the pivot story about how in the middle of COVID the doctors are telling you, "Ah, we'll pay you to bring patients to us," and you were like, "Oh, I'm too embarrassed to ask doctors to pay me."
[laughter]
Sal Daher: I love that story. Anyway, take a moment and think if there's anything else that you want to convey to this audience of founders and audience of angel investors, audience of people who are thinking of starting companies. Either in terms of asking for help for iCareBetter and also in terms of imparting lessons that might be of help to others.
Advice to the Audience
Saeid Gholami: I gave it a lot of thought before this podcast. I thought, "If Sal asks me this question, what I'm going to answer?" Everything that I thought through just goes through one path. There are 10 million people with endometriosis in this country. Every person who is listening to this podcast, male or female, if they don't have endometriosis there is going to be a person in the circle who has it.
Sal Daher: 100%. I have 1, 2, 3 people in my life who have endometriosis.
Saeid Gholami: The most important part, from a societal perspective, is validation of their pain and their disease. If someone tells you I have a pain or have had painful periods, ask them, "Do you have endometriosis?" That validation means a lot to them. Even if they don't have it, just the fact that you understand that pain is not something that they're making it up.
That 10 million with the disease means a huge business opportunity. The whole market opportunity, including healthcare and productivity loss, is over $100 billion. If there's founders out there looking for opportunities, come in this space, or if you're an investor, you want to go into spaces that have less interest for investors, endometriosis is a space that needs a lot of investments and great minds to help solve the problems. That's my message.
Sal Daher: Okay, entrepreneur, let's find a marker for endometrial tissue. [laughs].
Saeid Gholami: Yes.
Sal Daher: Here's a call, I can connect you with the right scientific co-founder who knows how to do this stuff. Of course, I don't want to distract him from curing malaria or cancers, and so forth because he has a platform. Philip Low has a platform. I want to have his brother because I'm invested in a company in which he's a founder and his brother is the CEO. I want to have them on to talk about that but a platform technology, which is really very powerful.
Phil has, I think this is a seventh company and the seventh company he's founded. Two of them have traded companies, billion-dollar-plus traded companies. A very successful founder. I just wonder if we couldn't use this similar technology for identifying endometrial tissue. Anyway, thanks a lot Saeid Gholami, MD, Founder of icarebetter.com which is helping people with endometriosis find the right providers to help them deal with this very painful condition. Thank you for being on Angel Invest Boston.
Saeid Gholami: Thank you very much for having me, it was such a pleasure.
Sal Daher: I thank my listeners for sticking it out with us and my bad sense of humor sometimes. I'm very glad that I could have such delightful guests as Dr. Gholami on. It felt like such interesting things, so it makes things easier. This is Angel Invest Boston. I'm Sal Daher.
[music]
Sal Daher: I'm glad you were able to join us. Our engineer is Raul Rosa. Our theme is composed by John McKusick. Our graphic design is by Katharine Woodman-Maynard. Our host is coached by Grace Daher.