Master of Innovation

In this episode, Malik Kahook, MD, provides Gary Wörtz, MD, with details about his pursuit of innovation in ophthalmology. Listen as Dr. Kahook discusses how he finds time to explore many different paths and shares what inspires and motivates him when setting out to turn an idea into a reality.

Gary: Open, outspoken. It's Ophthalmology off the Grid, an honest look at controversial topics in the field. I'm Gary Wörtz. A full time practice, 30 plus patients, numerous inventions, prolific research activities, a prominent teaching role, and a productive start up, it would be an understatement to call Dr. Malik Kahook an active contributor to the field of ophthalmology. In this episode of Ophthalmology off the Grid we'll hear from Malik on the time it takes to balance these commitments, why he sees himself as a so-called match maker, and how he goes about turning an idea into a reality.

Speaker 2: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.

Gary: Today on Ophthalmology off the Grid I have really the distinct honor and privilege to interview a friend of mine and a mentor both in one. This is Malik Kahook. Malik, if you don't know, is quite the inventor. He's got over 30 patents filed. At the same time of being an entrepreneur and an inventor he is clinically very active. He's actually the director of clinical and translational research at the University of Colorado. He's a professor of ophthalmology, and the Slater Family Endowed Chair, and also in his spare time the director of the Glaucoma Service and fellowship, and beyond all that helps run a basically kind of an incubator and start up, and has actually gotten a couple of products to market.

Malik, I don't know where you find the time. I really have no idea how you've got time to talk to me today, but I'm really happy to have the opportunity to interview you and learn from you. Thanks for coming on the show.

Malik: Gary, thank you very much. I'm just thinking as you're doing the introduction that I could ask you the same question about how you could do everything that you're doing, including this podcast, which has been really a treat to listen to. I've been passing around some of the links, and the most recent episode on outreach and mission work was fantastic. It's a real treat for me to be on with you today.

Gary: Well, I appreciate that, Malik. It's sort of easy to say, "Oh, well. I just fit it in here and there," but time is really one of those resources that everyone gets the exact same quantity, and it's what you do with it and how you schedule your day. You know, actually just before we started the interview we were talking about time. That may be an area we should just jump right into. Previous to about a year ago I was going five days a week clinically, doing surgeries, seeing patients, and then trying to do my extra activities with Omega and other consulting activities really after hours and on the weekends. I found myself being stretched too thin. I've actually have some dedicated time now to work on other projects. It sounds like you may have a similar situation. Walk us through the decision in your career when you said, "You know what? I have to back off a little bit clinically to engage more in this other area."

Malik: This is a huge topic for people who have a foot in the clinic and also trying to do some things on the side with inventions, start ups, and similar to the work you're doing with the podcast as well. How do you find the time? The time commitment is enormous for every single thing that we do, whether it's patient care in the clinic, or surgery, or any of the invention work, or the research done in the laboratory. I have a full time practice, as you said, at the University of Colorado. I have a glaucoma fellow every year. I also have administrative duties that go along with the vice chair position for translational research.

It really wasn't until recently that I started thinking about balancing things a little bit more and cutting back. I'll just give you an idea of how a day usually works for me. I typically wake up at 4:00 in the morning. I do work from 4:00 to 7:00 at home on the research work. I actually have a wet lab in my basement that we set up for convenience so that I could get some work done.

Gary: Not surprising. That's a mad scientist laboratory, I'm fully convinced, but go on.

Malik: That's right. Yeah. There's a Phaco machine that goes in and out of there for some of the work that we do as well. I then go to clinic. Usually my clinic runs from 7:30 until 12:00. I also am married to an academic physician. My wife is in family medicine. We have a three and a half year old son, so you can imagine there's a lot of juggling that goes on. We're tag teaming care as well, so we usually high five in the garage when she goes to her clinic. Then I usually end up going back into the office and into the laboratory for evenings, and I work until midnight almost every day before going to bed and doing it all over again.

You get to a point where you start looking at how to get time efficient. I think that's something that a lot of people in our circles are very good at. I started looking at my schedule and balancing things a little bit better. Recently I went to a 50/50 split where I'm doing clinic and surgery half the time and then focusing on research and some of the company work that I'm doing the other 50% of the time. That has worked out really well. I can tell you just like you I milk every minute out of the day.

I'm rarely just sitting down and just staring at the TV or doing some of the work that might be seen as taking time off. I usually have a phone in my hand, just like I'm sure you do. I try and fill every minute with some activity that will at the end of the day make me look back and say, "Okay. I got done what I wanted to get done." That's the challenge every day.

Gary: It is. It's the old Pink Floyd analogy of, "All and all, it's another brick in the wall." Whatever career we build, whatever thing we do, I really hate idle time. I hate doing things where I'm mistaking activity for productivity. I really try to look at impact and making sure that the activities I fill my day with are impactful. Whether that's business impact or whether that's medicine impact, or whether it's personal impact, meaning trying to spend time with my family and friends and being a good friend to people who need that from time to time, I try to judge my day in sort of an impact score. It sounds like you are doing the very same thing.

Malik: Yeah. The other thing that comes to mind just as your were talking, I was thinking about the truth is we're surrounded by so many people. It becomes extremely important, extremely clear very quickly that, whether it's me, you, or any of the clinicians who are working in different inventions and trying to get different products to market, you have to surround yourself with people who can help you fulfill that obligation to the technology, but also people to learn from, so you can see people who have done it before and how they manage their time. I've certainly been the beneficiary of some of that advice in the ecosystem around translational research.

Gary: That actually brings up a next point I wanted to get into. That's we are physicians trying to solve our own problems. As a physician inventor or a physician entrepreneur we fall into the user innovator category when you look at innovation from a top down approach. You have companies out there who employ engineers and employ people to think about new inventions that they can make. Then you have physicians out there thinking about problems that they want to solve. Sometimes those two groups don't interface or don't connect well, because their priorities may be different or what you want to achieve may not be something that would impact someone else's quarterly earnings. Sometimes we don't see eye to eye with industry all the time.

I think our industry may be a little bit of an aberration where I do feel like a lot of the companies really do ask and do listen. I don't want this to sound like an indictment at all, but just in the world of innovation user innovators typically come up with some of the best ideas, because they're deeply connected to the problem they're trying to solve, but typically they fall short in connecting that idea or that solution to the resources necessary to take it all the way through development and to market.

You're talking about connecting yourself or surrounding yourself by people who are able to maybe fill those gaps. Walk me through what it looks like in your world. How have you been able to find the right partners to surround yourself with to take an idea and not just let it die on the back of a napkin, actually moving through a step-wise process and all the way to market? I'm very curious to know what that looks like in your life.

Malik: Yeah. I'll give you an idea. I used the word ecosystem, and I think that truly is an important thing when it comes to making sure that your ideas can grow and that they don't die after the initial light-bulb goes off. I've been very lucky to be in the right place I think at the right time. Nothing will happen without passion. I know that you would second that, that the passion for the idea's really what starts [inaudible 00:09:19] and the concept of never giving up when you really believe in something.

I can give you countless examples of people in our field who went through years, decades even, of development to get a product to market, whether it's Dr. Ahmed from the Ahmed valve, Dr. Baerveldt from the Baerveldt valve, and then some of the companies that are in the news lately, like Transcend, Glaukos, Aquacis, Ivantis, these are companies that have been around for a considerable amount of time before even getting any attention. From my standpoint I feel lucky to be in an environment that can really take care of me and foster that passion.

I have support from my academic center. I think that might be something that's a little bit unique with my circumstance compared to yours. I'm in an academic center. I have an endowed chair that really covers a chunk of my time to give me the freedom to take a step away from clinic without feeling that burden of needing to see another 30 patients or 40 patients in a half day. I have a very supportive chair, dean, and chancellor. They understand the innovation process, the mandate to enhance patient care. That's something that I can feel when I talk to them, that that support is there.

I also have been able to get great contacts and mentors from my training, training with Joel Shuman, who was one of the original inventors of OCT, and my chairman, who's also very inventive, who have made several introductions. I think I'm a good project leader. I have the skills to keep pushing things forward. When I meet people that I think would be interested in some of the ideas I'm always taking a list. I don't know if you're a list taker, but I'm a list taker.

Gary: Yes. Absolutely.

Malik: If you pick up my iPhone and you look at the notes section, I have lists that go over many things. One of those is if I meet somebody, if it's a student, or a resident, or a fellow, or somebody more senior to me, I keep a list, and I go back to it often. The other thing I think that I've also been lucky with is getting introduced to certain venture capital firms. NEA has been instrumental in some of the stuff that I've done recently. That is a venture group that initially funded ClarVista Medical. ClarVista Medical then brought in great leadership. Paul [McClain 00:11:36] is the CEO from Boston Scientific, Glenn Sussman, head of R&D from Alcon.

I have all of these resources around me, people who I'm learning from who take the time to teach me. I make the effort to as much as possible foster those relationships. I'm constantly texting, emailing, calling, meeting with people at meetings, and I make an effort to connect with people and to as much as possible figure out not only how they can help me, but how I can help them. I think we're lucky to be in an environment with translational research where that is common in our field that people are helping people. You probably feel the same about that.

Gary: Yeah. That is interesting. I think as physicians we probably all share a common bond of wanting to help people, but then you mentioned something. You said rather than spending another half day in clinic, seeing 30 additional patients," your time needs to be spent, at least a portion of it, actually thinking about driving the field forward. For me that's the hook. That's the thing I think about. In many ways as physicians, doing surgery or seeing patients, we're skilled laborers. We don't ever think of ourselves that way. We think of it as physicians somehow we are magically different, but when you break it down we have a skill, and we apply that skill one patient at a time to impact that patient's life. That's fantastic, and I love that, and I hope that's always a part of my life, but the thing I love is I love thinking bigger.

I love thinking about driving change. What problems are here today that when I look back over my career I can maybe say I had a hand in moving our profession forward? We have such a great profession in ophthalmology. This is nothing against any other specialty or other field, but ophthalmology, it's like the crown jewel where we really get to help people protect and enhance their most favorite sense I should say. Also you've said you focus more on contribution than you do trying to get other people to fall in line or to give you something. I just think that is the ultimate quality of a leader.

If you are a leader that's always just trying to take from people, it just doesn't end up working out as well, but if you're someone who's always trying to add value to a situation and assembling the right people that you can give to and then what you give them multiplies exponentially, because you're trying to find their talents and the things that they can do in a project to make contributions and extend themselves, that's really team building. That's how I find a lot of fulfillment in this is seeing people contribute beyond maybe what I even thought they could, giving little bits of information or little pearls to people and letting them run with it. I totally agree. I think it's a lot more about giving than getting. I totally agree with what you're saying. You have any thoughts on that?

Malik: Yeah. I think one of the most important things that I do in any given day is I act as a match maker for a lot of things. I remember reading Malcolm Gladwell, The Tipping Point, about match making and how important that can be for certain ideas to grow. Through the past 10 years of practice, since I've been in Colorado after fellowship, you get these Rolodexes, these lists of people who do specific things.

We're in an environment, because we are practicing in clinic, and in surgery, and also interfacing with technology innovators, where we can start mixing and matching with people and making these introductions that end up growing. I feel like it always comes back to benefit some of the stuff that I'm doing in some way. You might not see it today, but the fact that we have a foot in both places I think gives us a very unique opportunity to bring people together. That's another thing that we can all do I think.

Gary: Yeah. I totally agree. I think one thing that I'd love to pick your brain on a little bit, it really surrounds the physician entrepreneur that may be out there and has an idea today or comes up with an idea some time in the near future. What kind of advice would you give someone? I kind of have my own opinions, and so I'll be willing and happy to share with you my opinions on that. What pearls would you give to a physician that feels like they've solved a really important problem and they just don't know what to do with it?

They don't know if they should file a patent, or call up Alcon, or call up another major player in the space. There's always this tension of protecting your idea, but also the tension of getting enough supporters and cheerleaders around it to make it happen. What does your experience tell you is maybe the right first step, if you have a good idea, to help prevent it from just dying on the vine?

Malik: Yeah. This is a great question. It's something that we all think about. We get asked these questions. It's not unusual for me to get a phone call, or a text, or an email from somebody just saying, "Hey. I have this idea. What do you think the next steps might be?" It's really difficult for me not to talk a mile a minute here and just share all of my experiences. I've tried to boil things down to a basic list. At the top of that list is the time commitment.

Everybody who comes up with an idea, whether you're in surgery or in the clinic, and you think, "You know what? I think I have something here," the first thing you should think about is the time commitment, because I don't think we do that enough in some of our daily practices. Like we were talking about earlier, from conception to market it's not unusual for something to take eight to 12 years. This is a very serious commitment, and something that should be the first step that you take.

After that you have certain things that you can think about in sequence that will make a lot of sense. The first thing is is this truly an unmet need? The best way to do that, rather than calling a major company or an industry member, as helpful as they can be, I think the most important thing is to call somebody like me and you, colleagues, people that you interact with, talking to even patients and talking about, "Hey. If you had something like this ...," and just be very basic about it. That gives you an idea of is this a true unmet need, or is it just a cool idea that maybe isn't a product or a company?

Gary: Yeah. I think that is such a key that you hit on is finding a solution to an unmet need that's real. I'm studying some of this right now, design thinking and innovation. I'm taking a course online, which has been very fun. One of the very first almost cornerstones of innovation is not that light bulb moment. Most people think about innovation as having an idea or having that light bulb go off in your mind. That's actually two or three steps beyond where innovation starts.

Innovation starts by defining an unmet need or seeing something that no one else sees as a problem and finding a solution to it. I think you're exactly right. You can talk to people about the problem without revealing the solution to gauge your appropriate judgement about whether this unmet need is maybe a minor headache in someone's life or whether this is a migraine. If you have the solution, you really want to know how big of a deal it is. I totally agree with you about finding unmet needs. If you don't have a big unmet need, there's probably not a huge motivation to go forward, because you're right, whatever solution you develop will likely take about the same amount of time. You want to make sure that at the end of all that you've met an unmet need that is significant.

Malik: Let's say you have that now and we've figured out that we do have an unmet need and the next steps become a little bit more vague, especially to people who are trained primarily as physicians. You have to start thinking more on the business side. What's the competition? Start looking at different patents, and textbooks, and internet searches about different things that might be out there that we might not be familiar with. What's the true business opportunities? Is this just a good idea, like I said earlier, or is it something that's financially viable for a company to drive forward or an industry partner to think about from a business standpoint?

Then I would start basic builds and basic concepts. That's probably a whole podcast in itself. How do you find the right contract manufacturer, maybe a university partner? Do you do it with or without a confidentiality agreement? Do you start thinking about filing a provisional application? What does that mean? The whole patent field is completely foreign to most physicians, but I think these are things that we have to start thinking about from that point where we have an unmet need, what's the competition, what are the next steps, when do you file the patent? I'm sure you've gone through this before, and that's something that we can share with others as far as when do you take that next step, who do you talk to, and how do you go through with it?

Gary: Right. You know, I have the same experience. Not infrequently I'll be at a meeting, or I'll get an email, somebody'll come up to me and say, "Hey. I've got this idea." I've had some conversations with some folks in the industry who experience this same thing. They call it the DWI, doctor with an idea. It's almost like something they dread, which I think is really unfortunate. I guess I'm biased, because I guess I'm a DWI. I'm a doctor with an idea. A lot of the things that you've said I've been trying to figure out a good frame work.

The frame work I've been studying and really resonates with me is something called the Real Win Worth It Frame Work. There's basically three categories. If someone comes up to you and says, "Hey. I got this idea," first of all, as we mentioned, does it really solve a problem that is out there? Does it meet a real unmet need. That's that first hurdle for an idea to make sense to pursue. The second one is win. Do you have the skills, or the people, or the funding to actually create a winning solution? Are there technological challenges that are going to prevent this idea from going forward because they haven't been invented yet? Is there a competitor out there in the landscape that maybe you can come up with a solution, but they're going to eat your lunch? You have to decide can you and your team create a winning solution for this?

Then the third thing is is it worth it? At the end of the day if part one and part two go well, you develop a winning solution, is there a market that's large enough out there to recoup your investment and make it attractive for people to invest in your idea? This is sort of the business logic that I think is missing a lot of times. We're not trained this way. We're trained to think do whatever we can do to save a patient or to save an eye. A lot of times we don't even think about the worth it category, because we're so trained in medicine to do everything necessary, but that's a frame work that I have found to be very, very helpful. It boils down a lot of the things that intuitively we know, but it puts them into hurdles that we can walk people through. That's been a helpful thing I thought I would share.

Malik: Yeah. One thing that I've been thinking about over the past few weeks is something that I think would be very helpful to people like me, you, and others who are listening that have ideas. It's not just what has made you successful when you're talking to mentors or to people who have done it, but what was your worst failure? Why did that happen? I'm going to name drop for you, but here's something that I think would be a perfect learning tool for a lot of people.

If you put Bill Link, Jean Luong, Emmett Cunningham, Andy Corley, and let's say Dick Lindstrom all in one room and you say, "Each one of you sequentially tell me what your worst failure was, and some of the steps that led to that failure, and how you're avoiding them today," because obviously we have a lot of great innovators from Venture, to Industry, to clinical practice who've done tremendous things, and they must have learned from their mistakes. How can we take that and really internalize it? I would love to see a piece by one of our journals just covering the biggest failures and how to learn and avoid them in the future.

Gary: Man, that would be like collecting the Mount Rushmore of innovators, so no small task there, but those are all such gracious and great people. I think they would probably be willing to do something like that. I definitely will take note of that. I think that'd be a tremendous thing. You know, for me I've had plenty of failures. I've had people tell me my whole life that, "This won't work," or, "You will not be able to achieve that," and sometimes they were right. That's the reality. Sometimes you do fail.

When people talk about their failures I think that the lesson I've learned is understanding that as sure of an idea as you are you have to be a skeptic of yourself. When you fail you recognize that maybe you had an idea and maybe it wasn't as good as you thought it was going to be. It builds a healthy dose of internal skepticism so that when you have that next idea ...I don't want to say skepticism to the point of you don't feel like you're capable of doing anything and you don't have a good self-esteem, but a healthy dose of skepticism helps prevent you from drinking your own Kool-Aid and allows you to maybe navigate or see some of the obstacles where before you may just see everything through rose colored glasses and really think about the idea. Then you fast forward the eight to 10 years to the solution. You have this euphoria of I'm going to change the world. It just doesn't work like that.

Malik: Yeah. It's the idea of being honest with yourself about the go, no go decision. That is extremely difficult for every inventor. It's not something that's unique to ophthalmology. It's something I think that needs to be addressed. I'll tell you the way that I deal with that. It's something that I'm constantly learning and going back and bouncing off of colleagues. This is one where my wife is extremely helpful, because I can do an elevator pitch where I just say, "Here's the biggest benefit," and she's pretty good at saying, "Hey. I get it. I understand it. I think that this is a good idea."

Also, it's very helpful to get people who might be outside of ophthalmology. My wife is in family medicine where she might say, "You know what? I just don't understand exactly what the major benefit is going to be." Then you go and refine the elevator pitch. If you can nail the elevator pitch where people understand intuitively what the benefit is going to be, I think your go, no go decision is going to be very well informed by that. At the end of the day I think you always ... I do mean at the end of every day you should look back and say, "Okay. Did I add value? Where are we with the unmet need? Where are we with the proof of concept? Is this going where I think it's going?"

I'll tell you, if you're ever able to come and visit here in Denver, I can take you into my office, and open one of my cabinets, and show you all of the ideas that never made it beyond proof of concept or never made it into the clinic. There are many more of those if you compare them to those that have made it into the clinic, like the Harmony Lens or the Dual Blade device, so we have to constantly look and be honest with ourselves. I would suggest using the elevator pitch to make yourself honest. Is this something that's sounding good or not?

Gary: Right. When people don't get it, don't just write that off as, "Well, they're not creative enough," or, "They don't get the vision." The diffusion of innovation curve shows that you have to get into that early majority for your idea to tip. If your elevator pitch isn't going so well, that may be a sign that you're going to have problems bridging that gap from your innovators to your early adapters into that early majority. You're dead on. You're going to have to convince more than just the wild thinkers out there that this is a good idea. Just for the record, my wife is also just my best internal review board for any idea. If I can get it past her, I know there's some legs to it. She's actually helped me, I think prevented me from going down some rabbit trails before, because she's wise beyond her years. Even though she's not in medicine, she understands people. I think there's a big benefit to that.

Malik: Just imagine if you're doing the elevator pitch to your wife, and she doesn't get it, and you say, "You know what? You just don't have the vision to understand it." It doesn't work out that way. Go back to the drawing board and get a new elevator pitch.

Gary: Just shred that idea., Just don't worry about it. It's not worth pursuing. Well, Malik, we could probably talk for hours and hours, and we have before, and we will in the future. I look forward to that. Any parting thoughts before we wrap this up?

Malik: One thing I will say is for any of the listeners who have ideas and are really seeking more input, we can share a lot more than what you can in a podcast, as you're aware of. I think a lot of us who have been through this process are mostly happy and willing to share as much as possible. For anybody out there, if you want to reach out to me, pretty easy to find me on the internet and get in touch. I'm always happy to share some of these learning lessons that I've had and to learn from those who reach out. I would keep the door open for any of that for those of the listeners to the podcast.

Gary: Yeah. I'll offer the same exact thing. When you have an idea it's important to talk to people who may have been there and can give you a little bit of perspective and point you in the right direction. Malik, always a pleasure. Thank you so much. Look forward to many more conversations, and I look forward to seeing your continued success. Thanks, man.

Malik: Thank you, Gary.

Gary: As evidenced by Malik, the pursuit of inventions requires time, energy, honesty, resilience, perseverance, and perhaps most importantly, passion. If it inspires you, it will drive you, as many physician innovators have found. We'll hear from more of these individuals coming soon in part two. This has been Ophthalmology off the Grid with Gary Wörtz. For more episodes like this visit eyetube.net/podcasts. Thanks for listening. Until next time.

Speaker 2: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.