- What is it like to build
a world-changing healthcare company?
Today we're sitting down
with my colleague and YC Group partner, Surbhi Sarna,
as we hear about her journey
into building Envision Medical into a startup acquired
by Boston Scientific for over $275 million
and having a big impact on women's health in the process.
Let's get started.
(upbeat music)
(upbeat music continues)
(gentle music)
Many startup founders started by seeing something
other people just didn't experience.
Surbhi's story is one
of the most intense ones I've heard in startup land,
and it starts with a sharp pain in her side
in high school.
- I was writing a paper on Emerson
in my bedroom when all of a sudden I felt such a sharp pain
in my side that I could barely make it to my mom
and say "my side hurts" before blacking out.
And the next thing I remember is waking up in the hospital.
Of course, I didn't know it then,
but it was gonna be the first of many trips.
Eventually I found out
that I was suffering from repeat complex ovarian cysts,
but it took months and months more before they could tell me
whether or not those cysts were cancerous.
So from the lack of therapeutic options
to the despicable state that the initial diagnostics was in,
I realized that women's health isn't where it should be,
and sort of this dream form that maybe one day I
would be able to start a company dedicated to women's health
and specifically the early detection of ovarian cancer.
- That was the experience that set her on a path
to figuring out how to solve something
truly important to her.
- I remember in high school writing my personal statement
to the UCs saying that I wanted to start a company
dedicated to women's health.
So at that point on, everything that I did,
every decision I made, I thought,
how does this decision that I'm making now
bring me one step closer to starting that company?
Early on in my career,
I knew I needed to kind of reach into every functional area
of what it takes to run a healthcare company
to understanding sort of not only the innovation itself,
but the regulatory climate to reimbursement
and everything else.
- That's one of the most important lessons
for future founders.
Once you know you want to solve a real problem,
you need to start orienting the steps
in your life to be able to create the thing that you want,
how to build it, how to sell it,
how to work with regulatory bodies,
and how to bring it to reality.
(gentle music)
When Surbhi finally did get started on her own startup,
one of the first things she ran headlong into was
how to get in touch with customers.
In the healthcare field,
this was doubly difficult
because you need access to both healthcare providers
and patients eventually to even understand what to build.
- So after doing a lot of reading
in the women's health arena and really trying
to focus on early detection of ovarian cancer,
an idea in that specific space and that clinical indication
of ovarian cancer still hadn't clicked for me.
But what I uncovered as I was reading these journals
on women's health is that there was another unmet need,
which was the detection of blockages in the fallopian tube,
which is the leading cause of infertility in women.
And so I had this concept and I thought, wow,
instead of injecting dye during an x-ray procedure
to see if the fallopian tube is blocked,
what if we put a microcatheter
through the fallopian tube to look at these blockages?
- Steve Jobs said "creativity is just connecting things.
When you ask creative people how they did something,
they feel a little guilty because they didn't really do it,
they just saw something.
It seemed obvious to them after a while."
(gentle music)
Surbhi found what she thought was a eureka moment,
a connection to something that had never been done before
but she still needed to get in front
of customers and the medical establishment to even begin.
While she had connections from years working in cardiology,
she still needed to build up her connections
in women's health.
It turns out the first connection wasn't far away.
- I realized that I do
in fact know one gynecologist, my own.
At first, I called her office and I just said
"hey, I'd love to talk to Dr. Cook
about this new innovation", click.
They thought that I was someone
trying to sell them something yet again.
So I thought about it for a little bit.
I called back feigning a little bit of
a stomach ache, and asked if I could see Dr. Cook.
And in the middle of my examination I said
"hey, I have this new catheter concept
I'd love to run by you".
I'm not sure she's ever been in that situation
where a patient was then pitching a new concept.
And she did not agree to speak to me,
at least in that moment.
But she did say that
"hey, if you wanna meet me at this cafe
in downtown Saratoga,
I would be happy to meet with you and talk to you then".
And so I'm glad that I made the effort to talk to her,
the only potential customer I knew
because she then introduced me
to dozens more physicians.
And each one of them introduced me to somebody else.
And even when they disliked the idea
or thought it wasn't feasible, I learned something.
And the ones that did like it were
more than happy to introduce me
to more and more prestigious institutions,
until the head of women's health
at Stanford was willing to join our advisory board.
- The journey of a thousand miles starts
with a single step,
and I love this story of how Surbhi just got started.
Figure out something that could be a real problem,
then become a heat-seeking missile
for people who can help you validate that idea
and move it forward.
(gentle music)
When you're trying to do something hard
like Envision was doing,
it really requires a real scientific breakthrough.
- The fallopian tube is only
a millimeter in inner diameter,
which means you can't actually put too much in it.
So we use a balloon to capture these cells,
but no one knew if cells adhere
to the outer surface of a balloon.
No one had ever navigated the fallopian tube before
and no one had used this balloon technology
to capture cells anywhere in the body.
- It was years of trial and error to achieve this feat.
Surbhi and her team walked through thick and thin
to figure out how to do
what no other scientist had been able to do before.
- I remembered driving up to a sheep farm
in Northern California
for two hours to get some sheep fallopian tubes
that they discard after they slaughter the animal for meat.
And then driving back in my car
with this stinking up my back seat
so that we could then do studies to see, well,
are we able to navigate sheep fallopian tubes?
Are we able to collect cells from them?
And then we were, and so those little wins mean something.
But you know as a scientist
what works on the bench doesn't necessarily translate
to what's gonna happen clinically.
I still remember our very first case
where we saw our device after years of
going from something that we drew on the back
of a napkin to actually seeing the first prototype
to working on the bench.
I remember that first clinical study
where the balloon was deployed and
we saw it navigate the full length of the fallopian tube.
I remember the physician finishing the case
and then my whole team turning to look at me
and just having a shocked look on my face
to the point where my VP of R&D thought
that something was wrong,
but in my mind I was so happy,
but also already thinking, so what does this mean?
What's next?
- Being able to turn an idea into reality
was itself a huge accomplishment,
but Surbhi still had to go raise $12 million
to complete the studies to go all the way.
- Finally nailed a terms sheet
after many, many, many rejections,
and in the middle of those negotiations
around the terms sheet,
not that it was anything too horrible that happened,
but I did with one of my earliest investors
who led my A round,
I did actually start crying on the phone,
which was immensely embarrassing to be honest,
because I mean this is just a terms sheet
negotiating what was going on.
I was really confused about that moment.
And eventually we got it signed and everything.
But a couple of weeks later,
I noticed that my appetite was shifting
and that my body was shifting.
So I got a pregnancy test
and realized that without knowing it,
I had been pregnant in my first trimester.
I'd been pregnant while trying to fundraise for this money.
- Between that moment and a year later
at Surbhi's son's first birthday,
they signed the deal to sell Envision for $275 million.
- Now my dream, the reason I started the company
was to get this to patients.
The first study that we did all five times
that cancer was present in the fallopian tube,
our device was picking it up.
And ovarian cancer until this day is one
of the most lethal forms of cancer impacting women.
- Envision continues to be in development and on a path
to being brought to market
to make a big impact on cancer and women's health.
Today, I get to work with Surbhi
day-to-day at Y Combinator,
where she's a group partner working
with many kinds of companies,
including the ones focused on bio and healthcare.
She's a wealth of knowledge,
and her experience is incredible at bringing this idea,
any kind of idea, especially hard ones to reality.
- When you know without a doubt
that you're building something people want
or something people need,
and that the product you're building,
especially in healthcare
is going to change the landscape for patients
and you have that almost anger behind it,
that good indignation,
you don't let others externally validate your company.
The only people you do let in are the potential customers
and all of the research you've done
and the pain that you have felt personally
or seen other people feel.
And that's what kind of keeps you focused
and keeps you going in the moment,
which is another reason why folks
should never try to be an entrepreneur
for the sake of being an entrepreneur
because there are so many setbacks and so many hurdles.
The other thing that kept me going outside
of my good indignation were the couple of people
who did believe in me.
On this journey of entrepreneurship,
you don't need everyone to believe in you,
and you don't need everybody to get to a yes.
You just need a couple of people to get behind you.
And if you empower those people adequately
and they empower you, you can move mountains with just that.
- Surbhi has new book coming out called
"without a Doubt: How To Go From Underrated to Unbeatable"
in bookstores and Amazon now.
You can follow her on Twitter @SurbhiSarnaSF,
and she also runs Y Combinator's bio program.
If you are inspired by this story,
please go buy Surbhi's book and know
that YC is here to help you build your dreams.
I'll see you next week.
(upbeat music)
(upbeat music continues)