Salvatore Viscomi, MD founded his own startup and is now with GoodCell which isolates and stores cells of healthy patients who may need them for future cell therapies. The startup is founded by David Scadden, MD of the Harvard Stem Cell Institute. A truly informative interview.
Click here for full episode transcript.
Highlights:
Sal Daher, CFA Introduces Salvatore Viscomi, MD, Physician, Founder & Investor
“...to isolate and store cells that you may utilize for future therapy.”
“The ability to not only isolate and store the cells but to be able to say, "These cells are of good quality for future therapy...”
“One of the unique capabilities we have is looking at what are the genetic changes that happen in our lives that cause risk.”
“...two years from now, and we can always reference your biobank material to see what your baseline levels were.”
GoodCell Co-Founders: David Scadden, MD, Trevor Perry, CEO, Brad Hamilton, CSO
Salvatore Viscomi Was Vetting GoodCell for a Friend but Ended Up Investing and Coming Aboard as Chief Medical Officer
Raised $30 million Series Seed, Looking for Strategic Collaborations
GoodCell Has Expanded on the Intellectual Property Licensed from the Broad Institute
“The second filing was around the ability to determine the quality of cells that go through a manufacturing process.”
Owned Patents Also Cover Matters Related to Autoimmune Disease
How GoodCell Tests for CHIP (proliferation of unhealthy cells) Works
Possibility that a Therapy for CHIP Will Be Developed
A Plug for Purdue University Entrepreneurship & Peter Fasse, Patent Attorney
“Purdue is in the middle of the country in West Lafayette, Indiana and so they're really making a big effort to reach out to angel investors in both coasts.”
Salvatore Viscomi’s Father was a Stone Mason from Italy Who Moved to US via Argentina
How Salvatore Viscomi, MD Got the Entrepreneurial Urge
The Resistance of Certain Academic Institutions to Entrepreneurial Ventures
“...taking that idea and making a business out of it, which is probably what was really the most fun for me...”
How Being an Immigrant Makes People More Prone to Entrepreneurship
“No matter how smart you are, no matter how smart your idea is, it's very difficult to do it alone.”
ANGEL INVEST BOSTON IS SPONSORED BY:
Purdue University entrepreneurship
Peter Fasse, patent attorney at Fish & Richardson
Transcript of, “GoodCell”
Guest: Salvatore Viscomi, M.D.
Sal Daher: This podcast is brought to you by Purdue University entrepreneurship and by Peter Fasse, patent attorney at Fish & Richardson.
Sal Daher, CFA Introduces Salvatore Viscomi, MD, Physician, Founder & Investor
Welcome to Angel Invest Boston conversations with Boston's most interesting founders and angels. Today, I have with me Salvatore Viscomi, MD. He's a physician and also professor at Harvard Medical School and has been involved in starting companies. He's involved with starting a company right now, but today we want to really focus on GoodCell technologies which is a company that he got involved with because he was an investor. Welcome, Salvatore.
Salvatore Viscomi: Thanks, Sal. We share some of the same first name.
Sal Daher: Yes, Sal.
Salvatore Viscomi: Sal, it's pleasure being on your show.
Sal Daher: Mine is to make it easy. Salvatore is a mouthful for Americans and Saleh is also a mouthful.
Salvatore Viscomi: That's right.
Sal Daher: Sal is often easier. Tell me, what does GoodCell do? What problem is it addressing?
“...to isolate and store cells that you may utilize for future therapy.”
Salvatore Viscomi: GoodCell is a platform that's multiple channels. The core channel is the ability to isolate and store cells that you may utilize for future therapy. These are there are therapies for treating cancer, CAR T therapies, and there are many trials underway for Parkinson's, Alzheimer's, blindness. The ability to store your cells at their best date, at the youngest date, as soon as you can, and also to identify the quality of those cells on a genetic basis because the cells circulating our blood are accumulating damage through stressors in our life and through age.
“The ability to not only isolate and store the cells but to be able to say, "These cells are of good quality for future therapy...”
The ability to not only isolate and store the cells but to be able to say, "These cells are of good quality for future therapy, that's the first channel and that's more of like, "How do I help myself in the future?"
The additional channels are genetics. The first aspect of genetics that most people are aware of is inherited genetics. What did I get from my parents that is going to predispose me to an illness in the future, and many companies do that. One of the unique capabilities we have is looking at what are the genetic changes that happen in our lives that cause risk.
“One of the unique capabilities we have is looking at what are the genetic changes that happen in our lives that cause risk.”
We have products that look at the risks based on those accumulated non-inherited genetic changes, and we'll talk more about that. That's pretty exciting. It's one of the reasons why I ultimately joined GoodCell full-time.
The final channel is biomarkers. As you know and you probably have had many people on your show that talk about specific biomarkers they developed. We have the ability, in blood is to look at the plasma and what circulates there and what we can tell about someone's health today and the future of their health.
“...two years from now, and we can always reference your biobank material to see what your baseline levels were.”
What's nice about the platform is that we track these changes over time. It's not a static once and done. It's, this is where you are today. This is where you are a year from now, two years from now, and we can always reference your biobank material to see what your baseline levels were. That's it in a nutshell. It's a very comprehensive type of product.
Sal Daher: Excellent. How did the company come about? You're not a founder. You were an investor and now you are an officer of the company. Tell me the founding story of the company.
GoodCell Co-Founders: David Scadden, MD, Trevor Perry, CEO, Brad Hamilton, CSO
Salvatore Viscomi: The co-founders are David Scadden who's also a founder of the Harvard Stem Cell Institute, Trevor Perry, a co-founder and president of the company, and Brad Hamilton, chief science officer, and founder of the company. The idea when these gentlemen met was it is, well, there's all these cell therapy trials that are happening and how do you enable that? The idea is, "Well, we have the ability to isolate and store these cells for everyone who chooses to and they can be used for future therapy," but what assets do you need to be able to do that?
One is the storage of cells, was the asset that was acquired through a license through the Broad is the ability to tell you about the quality of those cells on a genetic basis, because not all the cells are the same. They may look the same, but genetically they're different and they may carry risk with them. That was the core of why the company GoodCell was founded.
I was vetting the GoodCell for another investor in 2018. I spent some time. I didn't have a genetics background, learning some of the genetic IP that was available and understanding the cellular therapy world. It was very interesting to me. I actually invested myself as the first investor, I believe, and joined as an advisor just because I had been a serial entrepreneur.
Salvatore Viscomi Was Vetting GoodCell for a Friend but Ended Up Investing and Coming Aboard as Chief Medical Officer
I found myself working more and more for the company and providing some medical advisory capabilities. I think it was probably right just around pre-COVID, where I got more and more engaged on expanding the IP profile of the company. There was opportunities to build upon the license from the Broad. I learned, felt like I got a PhD in the last two years on genetics. I ended up joining full-time to really support the science and medical team.
Brad Hamilton is on Chief Science Officer, really, to look are what are the clinical utilities we have for looking for some genetic diagnostics that would be novel? That's how I came about from investor to Chief Medical Officer. It was not a planned expectation when I made that first investment.
Sal Daher: Let's talk about what is the revenue model for GoodCell?
Salvatore Viscomi: Sure, multiple channels are available to us. There's the direct-to-consumer channel, where we target members from the population. There's the physician channel where we approach a physician and say, "We have this offering for your patients who may benefit from it." There are components of what we do that are reimbursable. We're FSA, HSA approved for the genetic testing and the biomarker testing. The model is reimbursement from the payers.
There's the additional to upsell additional products. Whereas you have the core genetics and biomarker products, but we build additional, specific, more intense profiles based on someone's needs, for example. It could be an expanded cardiovascular panel for someone with that history, could be an expanded oncology panel. Then there may be targeted panels for Alzheimer's, for example. The initial core member would get the storage of cells, genetics, and a general health panel.
Sal Daher: Interesting. Is there a pricing scale that you have already for the service?
Salvatore Viscomi: Yes. We're in the VIP mode now. We're about to launch to the FSA and HSA customers through certain channels that we have. The price point will be 848, which people could use their accounts to pay for.
Sal Daher: Okay. This is for storage of cells and also checking the amount of insults that their genetics have endured from the environment and so forth. Is that what it entails?
Salvatore Viscomi: Yes. It's the storage of cells like you suggested. You can use them whenever in the future or someone, maybe a family member could use them. The inherited genetics, it's something called the ACMG 59. It's actually a B73. These are genetic tests that the American College of Medical Genomics and Genetics has deemed actionable. Meaning that if you get a predisposition of something, there's things you can do about it.
It's really important for us to be a medically actionable company, that we're not just giving people information that's going to cause anxiety about things they can't change or do anything about. Then we have blood testing that can tell you about your vitamin D levels, your high sensitivity CRP, if you're at risk for cardiovascular disease. Things that you can track over time.
Sal Daher: Very good. Has the company raised money?
Raised $30 million Series Seed, Looking for Strategic Collaborations
Salvatore Viscomi: We have. We've done a Series Seed round. I believe we're up around 30 million from a loyal group of investors. I believe we are planning a Series A at some point next year. We're just starting to think about that.
Sal Daher: Okay. What type of investors came in?
Salvatore Viscomi: The very early stage were myself and your angel investors, some friends and family, and soon after it was family offices who have invested multiple times at this point to support the company. The next stage is going to be looking for more strategic investors. Our current investors, they're fantastic. They continually want to support the company. In addition to that, we're looking for strategic investors.
Sal Daher: Are you considering having a strategic collaboration with one of the big players to help you get your products to the patient faster? Someone that already has patients, is already doing genetic testing and so forth, or?
Salvatore Viscomi: Yes. We like the idea of partnerships, especially partnerships that are aligned with our vision and mission. For example, I'm not sure if you're aware of Community Labs in Texas, was an organization that was formed by Grant Weston who's the co-founder of Rackspace. This organization was founded to offer COVID testing in the community because the traditional testing organizations were not meeting expectations.
These guys that come from the tech world with no healthcare experience were able to scale testing. I believe now they're doing about 100,000 test a week. We were working on a partnership with them. What's interesting about that organization is they have a large footprint in their community and they're a do-good organization, but they want to expand beyond COVID testing. They look at GoodCell as the right partner to offer their community, which is a high risk for cardiovascular and diabetes.
What are some of the products that we have that can help identify risks in that community to be more precise and preventative. In addition, it offers that community ability to store their cells for future therapy. We don't believe that the cell therapy storage should be only for the elite or VIPs, but everyone should have access to their own cells for future therapy. That's why we like that partnership.
We're also talking to other corporations. We're talking to academic medical centers, who are all also interested in some of the technology we have for looking at some of these genetic changes that happen not from an inherited basis, but on an accumulated basis. The idea is that partnerships ultimately with potentially organizations that pride fitness. The Pelotons, the world, the Equinox that are all looking to improve the health of their members.
Sal Daher: That's intriguing. Somebody like Peloton, they have a very large base of people who believe in their product already, and could be interested. Someone who's very concerned with fitness and so forth and pretty young population. If I were in their shoes, I'd look at something like this very closely.
Salvatore Viscomi: We believe that's a captive audience that as particularly, in the COVID era that we're living in, there's definitely a lot more concern about what predisposes you to different things, and what can you do to maximize your ability to mitigate those risks.
Sal Daher: You say that you've licensed intellectual property from the Broad Institute, and have you built your own patents in GoodCell?
GoodCell Has Expanded on the Intellectual Property Licensed from the Broad Institute
Salvatore Viscomi: We have. We filed several that expand upon the basic IP that was there. The first IP that I filed with my colleagues here was around the ability to look at these accumulated genetic changes to predict who may be a risk for severe COVID disease. We're running a clinical study with New York Blood Center right now, but the preliminary results are that particularly young people who have had severe disease defined by hospitalization or ICU that a large percentage of them tend to have these accumulated genetic changes, which are pretty rare in younger people who are healthy. There's IP based on that.
“The second filing was around the ability to determine the quality of cells that go through a manufacturing process.”
The second filing was around the ability to determine the quality of cells that go through a manufacturing process. All these cell therapy companies have to start with the material. We have the ability to look at the quality of that material on a genetic basis to see how that quality changes through the various manufacturing steps. Then there's a final product that can be analyzed for genetic quality, because the concern is that those cells that are created to treat cancer, for example, are also being introduced and can cause other problems. They're complicated in the blood system. Our second filing is really to look at cell quality and manufacturing, whether those cells are T cells or HSC, or if they're induced pluripotent stem cells.
Owned Patents Also Cover Matters Related to Autoimmune Disease
Then finally, the last filing is around autoimmune diseases. These genetic changes that we can measure in people, can they tell you about what therapies may be a better target treatment for them. For example, in rheumatoid arthritis, not every patient's the same, not every patient responds to therapy the same. What are the differences between the patients that may make some candidates for one therapy versus another.
Sal Daher: Interesting. You mentioned the quality of cells that are used in doing cell therapies, would that have helped, for example, Allogene in the event that happened with their CAR T trial, which they suspended? Because they set up dosing patients and patients started showing abnormal mitochondrial function from their off-the-shelf CAR T treatment that they had.
Salvatore Viscomi: I think the idea is that this will help any cell type regardless of whether it's autologous, meaning from the same patient, or allogenic, coming from somewhere else, is that, it's important to understand the starting material. Is it problematic? Are there clones that are better than others to start with? During the manufacturing process, are there certain steps that are high risk where you need to identify?
Ultimately, before you introduce a therapy to a patient, is there a concern that you're introducing something you might not want? Currently, it's not part of the process, it's not a required part of the process. We'd like to make that a standardized process for a patient to know that the cell therapy that is going to be introduced is not only going to treat their cancer or whatever other disease they may have, but it's not going to also create a new problem for them.
Sal Daher: How does your test work? What is it looking for?
How GoodCell Tests for CHIP (proliferation of unhealthy cells) Works
Salvatore Viscomi: In your blood, there are circulating progenitor cells. These are cells that are able to make other cells in your blood. Every once in a while, they can mutate, and we know mutations happen all the time. Some of these mutations are meaningless, they have no issues and sometimes they're meaningful. If certain cells in our blood that are progenitor cells, they give off other cells, develop one of a several set of mutations, it allows those cells to have a self-renewal advantage in the blood.
What this means is that they replicate more quickly, and they can become clones. When they become clones of a certain percentage of your total cells, the cell fraction that's significant, they have been shown to cause things like cardiovascular disease up to a 4x fold increase.
Sal Daher: Oh, wow.
Salvatore Viscomi: They have shown to increase blood cancer risks of 13x, and overall mortality increases by 40%. These were very large studies published in the New England Journal of Medicine. Understanding those mutations and how much of your blood contains them is important. This process is something that the longer it goes on, they tend to propagate, and with age, it also increases. That's why one of the messages for us is that you want to store yourselves as early as possible, less likely to have damaged cells.
This process is called clonal hematopoiesis of indeterminate potential. The extending phenomenon and it's the reason why I joined GoodCell is because I believe it's going to replace cholesterol in terms of cardiovascular disease risk, because right now, everyone relies on cholesterol testing and taking statins to decrease that. A lot of cardiovascular disease is inflammatory and the inflammatory process can be predicted in part to people that have this phenomenon in their blood.
Sal Daher: Let's break down that name. Clonal means replication.
Salvatore Viscomi: Yes.
Sal Daher: Hematopoiesis is making up of precursor cells of blood? What are the other terms?
Salvatore Viscomi: Indeterminate potential.
Sal Daher: Indeterminate potential, kind of just like multiplying like crazy.
[laughter]
Salvatore Viscomi: Yes, but not cancer, right?
Sal Daher: Not cancer. For example, like in the case of T cell competition, where T cells for combating cancer, I was reading something in the Koch Institute, that that's one of the things that they're studying a lot now, is just the fact that your body can be programmed to produce certain types of T cells, and they take over, but the T cells that you have to produce to react to the cancer, don't happen to be the ones that become the “popular kids”, so to speak.
They're thinking about creating cancer vaccines that trigger your body to start producing the correct T cells to attack the cancer that may be present. It sounds like a similar process going on in your body where a certain population of naturally occurring cells take off for a variety reasons. What is it that you can do to control this process? Is there anything you can do to stop that?
Salvatore Viscomi: That's a great question. There's no direct treatment for clonal hematopoiesis of indeterminate potential, people call it CHIP. For me, the way I think about it is, it's an identification of abnormal inflammation in your body that predisposes you to cardiovascular disease, perhaps COVID, severe disease, autoimmune disease, but it identifies a significant risk. If you potentially have no family history, you're not a smoker, and your cholesterol is normal, you still may have another really important risk that puts you at a 4x risk, particularly, the studies have shown that that risk is highest in your 40s and 50s.
If you're at a higher risk, and you were identified, and otherwise you would not have been identified, you mitigate the possibility that you would have had an early EMI as your first event. If you're identified early, if you're identified as somebody that is trending towards CHIP in your 30s or 40s, then you should see a cardiologist sooner. You're probably going to get screened, maybe an echo, a stress test, but I believe that one day there will be a therapy for CHIP. Anti-inflammatory states in animals have shown that it slows down CHIP. If you take cells that are clones or have the self-renewal advantage, you put them in an inflammatory environment, they're going to replicate even more so.
Then they're going to produce inflammation and response to that. There's positive feedback cycle. If you can interrupt that inflammation with an anti-inflammatory, can you decrease the escalation of CHIP? I've heard of some experiments being done where people that are on high dose anti-inflammatories, people with rheumatoid arthritis, for example, that it has slowed down the progression of CHIP. Those studies are going to be very interesting in the future. I'll give you one more example that there is one stage--
Sal Daher: I'm just curious to know, are there known factors that set off CHIP, or is that just a randomly occurring thing?
Dr. Viscomi Salvatore: That's a bit of both. It's random. There are inherited genetic predispositions to getting it. Then there are stressors in the environment. If you are a smoker, you're more likely to have it. If you have undergone chemotherapy, you're more likely to get it. The environment plays a role, random events play a role. Then your inherited genetics may play a role. For some people, maybe none of those. It may just be the random event, having an unlucky event. That and stuff.
What's interesting to me, I think, early on is that you don't need to have a lot of this process. Even if 2% of your cells have this, the cell fraction of a 4%, let's say, you're at high risk. It doesn't mean that your cells have it, it overtakes your whole blood supply. These, in a small amount, can cause a lot of damage or risks.
Sal Daher: What was the other example that you were going to mention?
Possibility that a Therapy for CHIP Will Be Developed
Dr. Viscomi Salvatore: The other example is a study that was done with the UK Biobank. They confirmed that people that have CHIP, these genetic changes, are at risk for cardiovascular disease. This has been known. They also looked at that same population and looked to see who had an inherited genetic variation in the IL-6 receptor. IL-6 is a cytokine. You've heard of it during COVID for cytokine storm.
People that had a variant that's pretty common in 30%, 40% of the Caucasian population, for example, that had this variant, which downregulates IL-6, if they happen to have CHIP they were protected. If you have CHIP and you don't have this variant, high risk of cardiovascular disease. If you had CHIP but also are lucky enough to inherit something from your parents that downgrades IL-6, you're protected. It abrogates the risk. To me, that's important because it tells you a lot about future therapy, because not everybody is going to have their variant of IL-6, but there are drugs that block IL-6.
To me, the future is going to be if you take a population with CHIP, you identify them and target them with anti-inflammatory therapies to protect them from the downstream effects of having CHIP.
Sal Daher: Are there any large-scale studies going on right now?
Dr. Viscomi Salvatore: I believe so. I believe people are really looking at how do you mitigate the risks of CHIP? Certainly, people are looking at the conventional means in terms of take people with CHIP and you put them on statins, for example, or what does that do to them. I think there are really interesting studies are going to be if you target inflammation to people that have this abnormal inflammatory process, can you protect them from cardiovascular disease in the future?
Sal Daher: Fascinating. Dr. Viscomi Salvatore, Sal, let's switch gears here a little bit. Let's talk about your journey as an entrepreneur, from being a physician and academic to entrepreneurship.
A Plug for Purdue University Entrepreneurship & Peter Fasse, Patent Attorney
First, I want to put in a plug for the sponsors of this podcast. This podcast is sponsored by Purdue Entrepreneurship, and also by Peter Fasse, patent attorney at Fish & Richardson. Purdue University is, I understand, number three in turning out startup companies. I don't know if you've heard that.
Number one is MIT, number two is Columbia University, according to this particular study, and Purdue's number three. They have top five school of engineering, and they turn out very interesting companies. As a matter of fact, I'm an investor in an enumeration of cells, rare cell company that came out of Purdue, their labs, which is called Savran Technologies. I'm on the board of that company. I became a sponsor of Purdue. I'm not connected to Purdue in any way. I'm an MIT alum. I came to admire Purdue because of my connection with Savran. To see how much they support the faculty in getting technology out to the market, it's really remarkable. They do a great job in that. Had you run across Purdue at all?
Salvatore Viscomi: Certainly, I have. I've seen that name quite a bit and it's one that probably gets the least amount of credit. I do have to the bigger shout-out to Columbia because I'm a Columbia alum.
Sal Daher: Exactly.
Salvatore Viscomi: I'm happy to see Columbia on that list.
Sal Daher: Columbia, look over your shoulder. Purdue is gunning for you.
Salvatore Viscomi: Exactly.
“Purdue is in the middle of the country in West Lafayette, Indiana and so they're really making a big effort to reach out to angel investors in both coasts.”
Sal Daher: Columbia has a big advantage. They are located in New York City. There's a lot of resources. Purdue is in the middle of the country in West Lafayette, Indiana and so they're really making a big effort to reach out to angel investors in both coasts. I'm involved in some efforts to get them more connected here. It's amazing. The professors in the School of Engineering are actually evaluated on how many patents they get approved. In addition to many papers they publish, how many citations, and also, how many startups they found.
They have somebody who comes and will sit down in their office and help them start their company if they want to take a technology to market. They'll provide support. I have not seen any school be so supportive of entrepreneurship as Purdue is.
Salvatore Viscomi: That's fascinating. Columbia may have the advantage of being in New York City, but there are also a lot of distractions there.
Sal Daher: That's true.
Salvatore Viscomi: You wonder where the advantages truly lie. Mayo Clinic, for example, is really a hub of innovation. I think in part, is because of where their location is.
Sal Daher: That's very true. Great. Let's get back to your entrepreneurial journey. By the way, were you born in the US?
Salvatore Viscomi: I was born in Italy. I immigrated here with my parents.
Sal Daher: How old were you when you came over?
Salvatore Viscomi’s Father was a Stone Mason from Italy Who Moved to US via Argentina
Salvatore Viscomi: I think it was five the first time. Then we went back and forth a bit, deciding where we're going to spend our future. My parents did move here for opportunities for me and my sister. That was the reason for my dad, who's a mason, to transfer here.
Sal Daher: He's a stone mason?
Salvatore Viscomi: That's right.
Sal Daher: He was looking for opportunities in the US and he came to New York City?
Salvatore Viscomi: He came to New Jersey.
Sal Daher: Oh, New Jersey?
Salvatore Viscomi: Yes. His travels were Argentina, Italy. Started off in Italy then Argentina.
Sal Daher: Where in Italy? I'm curious.
Salvatore Viscomi: We're from Calabria.
Sal Daher: Oh, the south?
Salvatore Viscomi: The south, yes.
Sal Daher: It's interesting because, usually people from the north end up in Argentina. Then the US, people from the south, from Calabria, from Sicily, that region.
Salvatore Viscomi: That's right.
Sal Daher: I don't know why that is, but it's--
Salvatore Viscomi: He took the wrong turn and then he ended up in the US. He's very happy. I think he liked his time in Argentina, but he's very pleased that we ended up here.
Sal Daher: Wonderful place. I've lived in Argentina as well. I enjoy the place, but it's so chaotic. The people are so delightful, but the place is so much chaos.
Salvatore Viscomi: It's gotten worse too.
Sal Daher: It's gotten worse. You think it can't get worse, and then it gets worse. Look, I'm Brazilian by birth. Brazil's more organized than Argentina is. It's bigger scale. It can't be as chaotic as Argentina, but still there's so many problems. I came here when I was 11, to the United States. English is a second language for me as well. You grew up in New Jersey and you went to Columbia?
Salvatore Viscomi: I went to Columbia. Yes.
Sal Daher: Then you studied medicine?
How Salvatore Viscomi, MD Got the Entrepreneurial Urge
Salvatore Viscomi: Yes, I did my medical training, MD at UMDNJ, which is now Rutgers Medical School. Then I ended up in Boston to do my residency at Harvard, which was centered at the Brigham/Dana-Farber, Mass Eye and Ear in radiology. It's actually in my third-year of radiology where myself and two other co-residents thought, this is how my entrepreneur started, about an idea about, "What if you can outsource imaging?" Meaning that, what if people sent images from another hospital to us to read?
We pitched that idea to our mentors at the Brigham and it was rejected multiple times. The answer would be, "People are never going to outsource imaging. You have the opportunity to get in private practice, academic job, a great job market. Why would you waste your time doing this?" We ultimately convinced them at high-risk to us to launch the first academic teleradiology practice in the world. It was successful because people were very interested in outsourcing. People didn't want to be on call overnight reading CAT scans and MRIs, and then having the next day off or having to work being tired.
Fortunate timing as well. It was a very beginning of where imaging started expanding, where the ER doctors were ordering more CAT scans and so people couldn't really be on call and work the next day. That was a great experience in terms of, we did everything. We had to do all the marketing, we had to do every aspect of creating a business, so there's a lot of learning there.
The Resistance of Certain Academic Institutions to Entrepreneurial Ventures
You also learned that if you do a joint venture with an academic institution versus on the outside how difficult it is because there are a lot of challenges in the Harvard system to scale a business because you need to credential doctors to scale. That was limited for us. The learning experience is if you're going to create a business, you have a great idea, potentially don't discount. We looked at outside funding and we thought, "Well, that seemed pretty predatory. They're into 80% of our business." Looking back, that would've allowed us to scale in a different way at the right timing.
The most important part of that experience was how much I enjoyed that early phase, the phase of not knowing whether you're going to be successful or not. Once we were successful and we have business and we were able to hire more people, it was still interesting because scaling is important and growing is important but it's less interesting. For me is that initial taking that idea and making a business out of it, which is probably what was really the most fun for me and what made me want to repeat it. That's how my career since then has been.
“...taking that idea and making a business out of it, which is probably what was really the most fun for me...”
It's about if I see an idea that I like, build the right team around me, that's the other learning part is like it's about people and have to be smart, right personality and the right chemistry. That's what I've done is really taken ideas, mine or other people's ideas and build teams around them and then try to go out there and see what happens.
Sal Daher: Tremendous. That's, as Peter Thiel calls it, zero to one and one to n. You like the zero to one phase. You're not into the one to n phase, which is understandable. Very, very interesting.
What drove you to this idea of creating a business? That's foreign to what doctors do is they see patients or they do research. Why would you think about [chuckles] creating a business?
Salvatore Viscomi: Yes, I think it's in the DNA. I think some people have that need to explore that. I would say I agree with you, most doctors, most of my colleagues feel like they've invested all their education, time, energy into learning their specialty, that they're not going to take the risk of taking an idea and try to experiment with it. For me, it's the opposite. For me, I do enjoy clinical medicine. I still practice to a very part-time basis these days. For me, the excitement is really around these ventures and the challenges around them.
How Being an Immigrant Makes People More Prone to Entrepreneurship
Sal Daher: That's very interesting. It's very true. I noticed that there is a remarkable incidence of this kind of thinking among immigrants or children of immigrants. They have the attitude like, if my family or if I was willing to change countries, come to a completely different place, why not explore this thing or create my own thing. I think it's programmed. It's in people who've made a new home here away from the old place. Very interesting, very interesting.
Also, Howard Stevenson, I've interviewed him and he had a situation where he was offered a chair professorship at the Harvard Business School. He got out of that because he was afraid of getting into what he called the velvet covered rut of being in very prestigious position and doing certain kinds of work, but you're like pigeonholed and that's what you do. He quit the Harvard Business School, went off and founded a hedge fund. One of the most successful hedge funds historically, Baupost, along with some colleagues and did a bunch of other things and then came back to the Harvard Business School and started entrepreneurship study there and grew it and so forth.
It pays off, so I think the risks that you're taking will eventually pay off in a very, very big way. They have to certainly extent already, but I think you're going to see even more remarkable payoffs.
Salvatore Viscomi: Yes. I started this entrepreneurship late for-- I started as a late resident, but I feel like it's in the second phase of a career for me, where it's certainly much more important than my clinical medicine career. It's a priority. The skills you learn as a doctor are important, in some ways, in terms of the discipline and the funding knowledge background. It limits your creative side. If you have a creative angle, you to need to be in the startup world to really maximize that.
Sal Daher: Medicine is very much an in the box kind of profession because you can't fool around with patients' health and so forth. Salvatore Viscomi, a physician, founder, and investor. Are there any parting thoughts that you would like to leave our audience of founders, investors, and people who are thinking of founding companies that you you'd like to impart?
“No matter how smart you are, no matter how smart your idea is, it's very difficult to do it alone.”
Salvatore Viscomi: Yes. I think it's talk to as many people who have founded companies before because there's a lot of lessons or mistakes that you can make early on, that you could potentially avoid, and then some mistakes you want to make because they're really important. You learn from them. To me, I think, in the 15, 20 years that I've been an entrepreneur, I would say that the importance of the team is critical. No matter how smart you are, no matter how smart your idea is, it's very difficult to do it alone.
It's very difficult to do it with other smart people that are not aligned with you on multiple levels. Identifying people that you have great chemistry with, that different expertise to you that are going to challenge you is probably as important, if not more important, than the idea itself.
Sal Daher: Dr. Viscomi, you probably know this already, but what you're saying is one of the most deeply supported findings in the study of entrepreneurship, that more founders, better. Founders that are complementary in terms of skills, but also on the same wavelength in terms of values and motivation. I think you're spot on. With your experience, you've observed something which is extremely true.
I thank you very much for making time for this really fun and interesting interview. I'll be following your work with a great deal of interest.
Salvatore Viscomi: Thank you, Sal. It's been a pleasure talking to you.
Sal Daher: For myself as well as interest in academic or as an investor but just for my health as well. I'm going to contact GoodCell and be your customer.
Salvatore Viscomi: You are automatic. We are making you a VIP member as of today. Stay tuned for an email.
Sal Daher: Thank you. Thanks again, Dr. Salvatore Viscomi, MD, for being on Angel Invest Boston.
Salvatore Viscomi: Thank you, Sal.
Sal Daher: I'm Sal Daher.
I'm glad you were able to join us. Our engineer is Raul Rosa. Our theme was composed by John McKusick. Our graphic design is by Katharine Woodman-Maynard. Our host is coached by Grace Daher.