Ashok Gowda developed a device for minimally-invasive laser neurosurgery to treat epileptic seizures. Having experienced the hand-to-hand combat of medical device creation and commercialization, he now helps other early-stage medical technology startups through Biotex.
Gina: Hi, I’m Gina Luna and this is HXTV, championing Houston’s innovators and entrepreneurs, brought to you by PKF Texas, the CPAs and advisors serving Houston’s innovators for over 15 years. My guest today is Ashok Gowda, Co-founder and CEO of Biotex. Welcome, Ashok. Glad to have you.
Ashok: Thanks for having me.
Gina: Thank you for being here. So, Ashok, let’s start by having you tell me about your background.
Ashok: Sure. I’ve got a background in biomedical engineering. My undergraduate degree was at Vanderbilt University. I did a master’s and Ph.D. at Texas A&M. Throughout that time, I got the chance in my master’s and Ph.D. work to work with a number of startups in the medical device space doing research, working in labs where they were doing research. By the time I was finishing my Ph.D. I sort of had the bug myself to develop new medical devices and medical technologies. We formed Biotex while I was still finishing my Ph.D. We got our first projects funded through SBIR grants and that kind of launched the company to start developing a number of different medical device ideas.
Gina: In those early days when you were thinking about device development, did you develop the ideas because you would see a need or a gap in the market, or how did you develop those ideas into becoming a product?
Ashok: In the early days, it was, we would use the stuff—people like to do what they know, right? So, you would use your background, and my background was in thermal therapies using lasers, so we did a lot of projects that involved lasers and thermal therapies. My late partner’s background was in MRI and control systems, so we did a lot of projects and sensing—biologic sensing, glucose sensing, we did a lot of projects in that area. You tend to gravitate toward areas that you know and have a little bit of background in. I would say often times we didn’t look at markets as close as we should have. We knew there was a big market, we didn’t always know whether our product would meet the needs. We went head forward in all these projects and some of them we should have never worked on and some of them turned out really well and we got to be involved with technologies that really transformed patient lives. That’s something that once you do that it’s very addictive and you want to do it again and again.
Gina: I can imagine that. Your first, maybe not your first invention but certainly your first big success was Visualase, and I think that led to the whole Biotex model. Would you talk about Visualase, kind of the journey through that?
Ashok: Visualase is a device for doing minimally invasive neurosurgery. The whole concept is to take a small, fiber optic probe about the size of pencil lead, stereotactically place it into the brain, into either a tumor or an area causing epilepsy, an epileptic foci, and to thermally ablate it. Thermal ablation means to raise the temperature to the point at which it’s no longer alive. Once you kill that tissue thermally, the body will come in and remove that dead area. That’s what it’s programmed to do. Thermal ablation has been used in the body, it’s been used in the liver and kidney routinely with other energy sources. It had not gained any traction in the brain and you can imagine why. In the brain you have to have extreme precision and control of that ablation process. You can be millimeters away from something that will determine whether or not—
Gina: That you’re going to need.
Ashok: That you’re going to need, whether you’re going to walk or talk or remember things. So, we developed a control system that interfaced with an MRI unit and that control system was a computer that had software running on it that took MRI data during the procedure and would transform that MRI data into thermal maps and estimates of thermal damage during the procedure. If you imagine, it was like, after the procedure of placing the probe, and the patient is in the MRI, it’s literally like almost playing a video game. Not to dumb it down that much, but it was very simple. People could see exactly where they were delivering the heat, they could make sure that critical structures weren’t overheated, they could look at the estimate of thermal damage and make sure they covered the area they wanted covered, and because you’re in an MRI, at the very end of the therapy you can run various scans that show you exactly what you did at the end. The most beautiful part of the entire procedure was that patients, rather than undergoing a crainiotomy, which is a larger 4-5-inch removal of skull, they actually, it was a 3.2 millimeter hole in the skull. A single stitch or suture could be placed to close the skin and most of them, honestly, within 24 hours they didn’t even know they had brain surgery.
Gina: And so the outcome of that is that people who, for example, were suffering from horrible seizures, they didn’t have the issue anymore. Is that right?
Ashok: When we got involved with the patients that had epilepsy and the doctors started pioneering this, there’s a huge subset of patients that suffer from seizures and they’re refractory to all the medications. There’s a lot of medications out there but they don’t work in many of the patients. There’s often an area in the brain, and if you can identify that area, and there’s various ways to do that today that are much more sophisticated, but if you go in and remove that tissue, the seizures will stop. These patients, some of them, some of the pediatric patients we treated went from having hundreds of seizures a day to being completely normal kids.
Gina: To your earlier point, life changing.
Ashok: Life changing, yeah. We did that right here at Texas Children’s Hospital. They helped us pioneer that procedure and they do many of them now.
Gina: That’s awesome. Congratulations to you. So, how many times do you think it’s been used?
Ashok: When we sold the company, we had done about a thousand cases. In the hands of Medtronic, it’s probably many more than that now. It’s in the, probably close to 10,000 by this time. The nice thing is that Medtronic has a global footprint, and so, putting this technology in their hands certainly will get to a lot more patients faster than it would if we had kept it in ours. That’s a nice thing.
Gina: Are you in the OR often?
Ashok: For the Visualase technology we were in the OR for every case. We were there for support. Obviously, we don’t touch the patient, we don’t touch the product, but it was a new technology and you can’t have anything go wrong and so you have to watch every step of the procedure, you have to make sure that nobody is doing something like mishandling the product or not using it properly. I think today, even still for this procedure, somebody is probably there supporting every case, and it’s an important part of the procedure.
Gina: Once you launched the product and it was being used in the OR, did you continue to iterate and make improvements based on what you saw?
Ashok: We did. We came out with different probes. We came out with different improvements to accessory devices that were used in the procedure. Certainly we made updates to the software based on physicians input and feedback, and so that’s always a process.
Gina: Continuous improvement.
Ashok: Yeah, you never get it right on the first time. You just have to expect that you’re going to have a second generation or an iteration.
Gina: You had this incredible device and it was adopted in practice, and what happened?
Ashok: It was a great learning lesson because it was a new technology. It was a market that didn’t exist, so it was a heavy lift, meaning we had to develop a market and we were very fortunate that we teamed up with a commercial team and a commercial executive that happened to be living here in Houston but he was commuting to the Bay Area for 10 plus years because there weren’t a lot of commercial opportunities here. We had just gotten our device on the market, we had no idea how to sell it, we had never sold a medical device and we recruited him to come on board. He saw the potential. He came on board for that spinout. We had spun the company out to a separate entity. We learned a ton because he helped us bring on the right people, helped us develop that commercial plan and helped us bring that to market successfully. We grew the revenue, grew the number of procedures. Every month it continued to evolve and then eventually we courted and secured an investment from a larger medical device company, Medtronic. A year and a half later, they saw that we had—it was the very moment where we had figured everything out, right?
Gina: They call that de-risking. You de-risked it.
Ashok: We were ready to scale this from 35 centers to 2,000 centers. We had plans, we knew exactly what to do, and then they made an offer we couldn’t turn down. We still existed throughout that entire tenure. We had actually, we were sort of the back end for the Visualase company. We did all the manufacturing, we did all the R&D, we developed all the quality systems, we did all the regulatory work and we had a really nice team of engineers, manufacturing, a fantastic team that we developed. After we sold the company, after we sold Visualase, we did some work for Medtronic for about a year. We helped them learn how to make the device. They eventually took that over, and we saw everything going on in this local ecosystem, this is about four years ago. We said, there’s a lot of really good ideas here. There’s a lot of really talented people. Not a lot of people have experience taking those ideas and turning them into products. We saw a gap in the market and we said, let’s try to help the ecosystem a bit, let’s leverage our team and help take these ideas and turn them into finished medical devices. That’s what we do today. We partner with various startups, physicians, some established companies helping them develop new technology.
Gina: You can help them either develop their commercialization plan or you can do parts of that commercialization like the manufacturing.
Ashok: That’s right. We do contract manufacturing for these companies that we incubate, or partner with. We also help them put in place the right teams, if they need that help commercially. Some of them have day jobs, they’re not looking to give those day jobs up. In that case, we’re trying more and more to help sort of drive and steer the technology, put in place the right commercial teams. I think we have a little bit of that background now to understand what it takes to commercialize these things and it’s not always just a pretty website and a billboard, that doesn’t do it. It’s hand to hand combat, that’s the way I describe it, every day, and so you have to bring in the right team at the right time.
Gina: The experience that you all bring and helping companies get through that process is invaluable. And helping us, frankly, build the ecosystem, because we need more and more of those successes in Houston with companies that stay here.
Ashok: Yeah, we do. Success breeds success, I think, and there’s so much going on here in the local ecosystem. It’s real exciting to see. I’ve been doing this for 15 years here now in Houston and in the last 3-4 years, I’ve seen a dramatic shift in just the number of new companies, the number of institutions or grassroot efforts that are promoting these companies, the startup innovation ecosystem. It’s really great to see.
Gina: Again, I think what you’re doing here is fantastic and I love sitting here in your development museum and see the evolution of these products. It’s exciting and, again, it’s great to know this is going on in Houston and that you’re bringing these life changing advances into reality.
Ashok: It’s a great, I tell people every day it’s a great place to operate because we get to work on products that potentially change lives, that improve patient’s lives, that make physician’s lives easier. And if you do it right, at the same time, there’s also a way to—we’re entrepreneurs, we’re capitalists, and you can make money if you do it the right way. We call it doing good while you do well, and so it’s a good place to be.
Gina: That’s right. What is it about Houston, as a community and as an innovation ecosystem that you most value or most appreciate?
Ashok: There’s an incredible pool of talent here, especially for us engineering wise. The people we hire, I’m just blown away because I was never that smart when I was that age. We’ve got a really great team here and it’s, I think, we find people that really want to make this happen. There’s a lot of people that are working really hard to try to make this Houston ecosystem evolve. I think being here is great right now and I feel like, I mean, we’ve been here for a long time but we’ve sort of been head down working on our own things. We’ve kind of come out and now we’re working with other people and doing more. I think we’re just seeing the beginning of something that’s going to be really special here.
Gina: I agree with you and we’re so thankful for what you are doing and you really are an important part and an influential part of this ecosystem. So, thank you for that.
Ashok: Thank you.
Gina: And that wraps up my discussion with Ashok Gowda, Co-founder and CEO of Biotex. I’m Gina Luna and this is HXTV.
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