Living to see the day (Part 1 of 2)
Consider this story from Numbers 20: 1-12: The people if Israel are wandering in the desert and dying of thirst. God asks Moses to speak to the rock so that it would produce water for the people. However, Moses was impatient and instead hit the rock twice with his staff. Water did flow, but Moses was instructed to talk to the rock. For this reason, he was barred by God from entering the promised land.
I will return to this.
One particularly nasty aspect of COVID19 is that it can destroy lungs, interfering with the infected person’s ability to breathe yet seemingly oblivious to a lack of oxygen. Since there is no cure for COVID-19, we are left with placing patients on ventilators to help them breathe. This sometimes helps save their lives, but all too often does not.
As the number of people with COVID-19 increased across the globe, the fear of running out of ventilators rose sharply. Panicked, the United States as well as other countries, drove many types of non-medical companies to design and build tens of thousands of “ventilators” while suspending the usual regulatory processes. Also, they suspended some common sense: ventilators are not stand alone devices. Each requires an extensive ‘infrastructure’ that includes high pressure oxygen and air outlets, patient monitors - lots of electrical power outlets – specialized drugs, intravenous pumps, expert around the clock one-on-one nursing, respiratory therapists, doctors and other health professionals. Intensive care units are a collection of rooms with this ‘infrastructure’. Using ventilators in other hospital space is problematic. One article recently published in the New England Journal of Medicine bemoaned: “The capacity of pressurized medical gas lines [i.e. oxygen and air] and power supplies were limiting factors. In one peri-operative area, for example, the power infrastructure was not sufficient to reliably run all the necessary critical care equipment.” This was a peri-operative area; one can imagine the unsuitability of an ordinary hospital room, much less conference centers, or countries that lack medical infrastructure.
The realization that both ventilators and their ‘infrastructure’ might not be available may be new to most of us, but it is old hat to the military. In 2004, Mr. Tommy Eagles, a former medic in the US Marines, approached a little known spin-off company from the University Health Network, Thornhill Medical Inc., on behalf of the USMC, to try to combine the ‘infrastructure’ and the ventilator in one rugged, portable package. After 6 difficult years the result was a 84 cm x 14 cm x 25 cm 17 kg complete life support system that runs on batteries and concentrates oxygen from the air rather than having it flow from a tank.
Early in the COVID-19 pandemic, the Canadian and Ontario governments quickly recognized the limitation of stand-alone ventilators and ordered more than 1060 of these military systems for Canadians. Here I address the current sudden opening of opportunities for Thornhill. This was a huge boost, but to be honest, we were not sure where we would land. In Part II I will address how I think we should turn Thornhill into one of the world’s leading disruptive companies, doing for medi-tech what Apple has done for electronics. But even at this point, there are some things about us and about what we did that merit comment. Perhaps I can now coin them as the three TMI principles:
1. Be audacious: If you take the ramp to the highway to Manchester, you end up in the same towns as everyone else on the highway. If you make the regular product you will be in a basket with the others making that product, clawing for “market share”. Even making an audacious product is not enough to lead to success. The audacious product sold by a company that is run “by the book” fails, because you can’t get even a market share for a product outside the basket. Getting away from running “by the book” is hard. Your own business consultants, the banks, investors, and the company execs brook no deviation. In the end they guarantee an impossibility of a break-out from mediocrity and the product fails.
To get a disruptive break-out company for your disruptive product, you need to have vision. Don’t take the ramp. Get out of your car. Get on a boat. Head west. If there is an America, its not on the highway to Manchester.
2. Have faith: some of the inconceivable is actually possible. I have been encumbered by society’s blindness much of my personal and professional life. My whole life the phrase I have heard most often is “Joe, Joe, face it: that will never work.” Moses was told by God himself to talk to the rock. Even so, Moses dismissed that approach and went with what seemed most effective. Me? I like the counter-intuitive and would probably have tried to “talk to the rock”.
I have done the inconceivable repeatedly. Its amazing what can spring forth. For a 100 years some of the smartest scientists in the world have battered their staffs and heads to find a practical treatment for carbon monoxide poisoning--the second commonest poisoning in the world. They basically battered the “rock” with their staffs and didn’t make a drop of progress. We took a gentle approach using a little mechanical device with some simple valves--that they too could have made 100 years go, by the way—and turned out a torrent of treatments for CO—first such HC and FDA approved treatment.
And how in the world would anyone think that controlling the carbon dioxide and oxygen in people’s blood is possible—much less be of ANY value? Well, it turns out this can be used to predict the vulnerability for a stroke and heart attack, to measure heart function, identify the urgency for heart transplant, and help measure brain oxygenation and blood flow in MRI scanners. Can’t believe it would ever work? Just watch us!
3. Persist. We make excellent, world unique products. For much of the world, “good enough” was good enough. We nevertheless believed in excellence and the great benefits these technically advanced products provide. And no, we were not going to get discouraged as they overlooked us again and again. We stood up to the advice of “consultants”, and to the demands of our own investors. We were not going to “dumb down” the products so they should blend in more with the mainstream. We were determined to hang on and go the full distance and if we have to close, we would do so with our best products and then only after the last penny is spent. And so , we struggled from year to year, and sometimes, from week to week in a neck-in-neck race between solvency and bankruptcy. Then it just happened.
Over about 2 weeks, in the midst of the COVID-19 epidemic, people suddenly saw the huge advantage of our life support system over ‘regular’ ventilators. We were deluged by massive opportunities. Bang. Just like that. And here we are, providing what no one else had hitherto even conceived that they would ever need.
A mind set I share with both my parents: Don’t give up. Insist on being defeated. And then don’t roll over and die. Fight to the death. “If you live just another day, you may live to see the day.”
