Aditya Rajagopal: 00:03

One is the clinical paradigm as it exists today. Even if it's the best widget in the world, if it creates friction by eliminating jobs that are necessary, eliminating nurses, it's not going to get adopted. You're going against the grain. Even if it saves costs, there is a human capital cost to that new device, and it's going to result in a lot of friction.

Narrator: 00:30

Welcome to Medsider, where you can learn from the brightest founders and CEOs in medical devices and health technology. Join tens of thousands of ambitious doers as we unpack the insights, tactics, and secrets behind the most successful life science startups in the world. Now here's your host, Scott Nelson.

Scott Nelson: 00:50

Hey, everyone. In this episode of Medsider, we sat down with Aditya Rajagopal, co founder and CEO of Esperto Medical. Esperto is a Caltech spinout utilizing compressed sensing technology with ultrasound to continuously and noninvasively measure blood pressure. Before Esperto, Aditya cofounded ChromaCode, a molecular diagnostics company, was a researcher at Google X, where he worked on novel medical imaging methods. Aditya also serves as part time faculty at Caltech and USC and holds BSMS and PhD degrees in electrical engineering from Caltech.

Scott Nelson: 01:20

Here are a few topics we explored in this conversation. First, what does it take to win as a fast follower in medtech? Second, three reasons why even a clinically superior technology can struggle to gain adoption. Third, how do you avoid spreading yourself too thin when building a platform technology? And last, what do first time founders often misunderstand about how VCs make decisions?

Scott Nelson: 01:40

Before we dive into the full episode, if you're a Medtech founder or CEO preparing to raise capital, you should check out the Medsider fundraising cohort. This four week live workshop combines small group sessions with real time feedback to help you sharpen your investor story, build a targeted investor pipeline, and run a focused fundraising sprint instead of a never ending slog. Over the month, you'll walk away with an investor ready narrative and deck, outreach scripts that actually get responses, a refreshed LinkedIn profile, a simple content plan that keeps you on investors' radar, and a repeatable system for running your raise. You can join the waitlist at medsider.com/fundraisingcohort. Again, that's medsider.com/fundraisingcohort. Alright. Let's get to the interview.

Scott Nelson: 02:25

Aditya, welcome to Medsider Radio. Appreciate you coming on.

Aditya Rajagopal: 02:28

Thank you for having me, Scott.

Scott Nelson: 02:29

Yeah. Very much looking forward to this conversation for sure. I think it'll be a fun one. I recorded a very abbreviated bio at the outset of this episode, but let's start there. Give us kind of like the one to two minute pitch on your journey from undergrad and graduate work at Caltech to Google to starting ChromaCode and now Esperto.

Aditya Rajagopal: 02:44

I grew up in Southern California. So staying close to home for school was definitely my parents' dream and wasn't mine. But somehow life happened and I stayed close. It was the right home for me because it gave me a lot of confidence to build things with my hands when I was there. So as an engineer, it was kind of a playground. And the class of problems I started to work on because of exposure to people like my advisor and other classmates was using engineering tools for biology. And the time I'd spent at Caltech was just at the cusp of when people were starting to invest a lot of research dollars into understanding neurons and brain functions. I spent a lot of time building tools to understand the behaving brain. And as part of that work in biology, like a bunch of ideas around startups kind of came to mind. Caltech is a very friendly place for starting companies when you're at school and or even as a faculty member.

Aditya Rajagopal: 03:40

So some of those ideas got turned into companies in the disease diagnostics segment. And then along the way, because of some of my, neuroscience work, I got introduced to a guy named Andy Conrad, who was the chief science officer of a company called LabCorp. He got recruited into Google to work on life science projects. So Andy recruited me up to Google to work alongside him in a few of those projects, and I ended up working in the ultrasound segment. And that's kind of where my interest in ultrasound measurement started.

Aditya Rajagopal: 04:08

This idea of measuring blood pressure with ultrasound was like, is this even possible? kind of germinated at that juncture. After my stint at Google, I'd raised capital for one of my ideas out of Caltech and then the rest is history. I became more of a business person than an engineer, if you will. That's when I first really started running companies. We're going to spend most of the time talking about, I think the company you're most focused on as of right now, is Esperto. So I'm on the website right now. Esperto.health is the URL. We'll link to it in the full write up on Medsider. But for those that have never heard of what you're doing at Esperto, give us pretend I'm a middle school student and frame this up in a way that would help me best understand it.

Aditya Rajagopal: 04:48

If you hold your finger up to your wrist, you can tell your heart rate with your pulse, right, that your heart's beating faster and faster. You can feel that thumping by putting your finger right on your your artery. But heart rate and it's very related metric, blood pressure, are great indications of how healthy we are and how sick we might become. But blood pressure, unlike heart rate, is extremely difficult to measure without being invasive, without puncturing the the artery itself. So blood pressure cuffs are a great example of a noninvasive tool, but they're not able to measure blood pressure continuously; just once in a while. You squeeze the balloon till you stop your heart rate, and they say, okay, record that number, and then you let the air out of the the bladder from the blood pressure cuff till that pulse starts again. You say, okay. Okay. I'm gonna record these two numbers. I'm gonna call the first one the systolic, the higher blood pressure number, the second one, the diastolic, the lower blood pressure number. But that's how that's how they do it in the doctor's office.

Aditya Rajagopal: 05:46

When you're really ill, you need to know second by second, beat by beat, how your blood pressure is changing. And the only way you can currently measure that is with a invasive tool. It's an it's an arterial catheter. It's a little invasive. They basically stick like a straw into your artery, draw out a little bit of blood, and they put a sensor right against that blood that measures the pressure. People for about fifty years have tried to take that measurement that's kind of gruesome and make it much simpler, just like putting a finger on your pulse. The problem is that from a physical perspective, it's an incredibly challenging problem to measure blood pressure without contacting the blood. So Esperto Medical, we spent about eight years at Caltech developing the only method.

Aditya Rajagopal: 06:31

We can prove this actually. Provable from physics. The only method you can use to measure blood pressure non invasively and continuously. That scientific concept has a lot of clinical utility. My co founder and wife, also fellow faculty member Alaina, is a physician by training as well. And so her initial insight was, hey, we can use this method to replace this invasive procedure for measuring blood pressure. And so Esperto Medical was built to take that technique and and bring it into the hospital where continuous blood pressure is needed and then to extend that forward and take the platform to measure blood pressure and put it just into the strap of your favorite smartwatch. So you can have continuous blood pressure monitoring even on the go.

Scott Nelson: 07:17

Okay. Got it. I was just gonna ask you kind of what does this actually look like from a patient's perspective? Is it a wearable? Is it something like a Whoop or Fitbit? Is that how you envision this being utilized?

Aditya Rajagopal: 07:27

The second product definitely, it'll be just the strap. Okay. It's just the strap. And having it interfaced to a smartwatch is helpful because you can use the smartwatch's display to deliver the data to the patient. For the hospital device, it's gonna be slightly larger, but it's gonna be a brachial cuff.

Aditya Rajagopal: 07:44

So you get that familiar 120 over 80 blood pressure measurement. And it'll have a battery pack, you can have the patient walk around, use the restroom, something they can't do with existing invasive tools and other tools that other companies have brought to market. It'll be wearable in the sense that the patient can walk around with the Esperto device even in the hospital.

Scott Nelson: 08:05

Got it. That's super helpful. Is your team pursuing kind of both sort of applications in parallel, right? The more medical application as well as the more consumer style?

Aditya Rajagopal: 08:14

Yes. Yes, we are. So our view really is both of those opportunities represent different ways to impact patient care. In the hospital, patients that need to be measured continuously with blood pressure sometimes don't have the right tools used because it takes so much time to set up these invasive catheters and there's danger to the patients, especially like pediatric patients, where there's a high probability that there's going to be a complication in putting in a device like that. So for those types of patients, it's necessary to have a tool that's noninvasive, but accurate and continuous.

Aditya Rajagopal: 08:51

And so we feel like we can hit all those three things with the platform we've built. And the impact in the hospital itself is an extremely interesting company. Dan kind of put it into perspective. The market opportunity is like 20,000,000,000 in recurring revenue a year. And if we went and hit that, we would cleanly be the most valuable medtech company in history.

Aditya Rajagopal: 09:11

It's like cleanly, right? It only works because in the last one hundred years, people have developed the clinical utility for measuring blood pressure. It's ubiquitous. Everyone who goes through surgery and their critically ill patients and ICs, they all get this invasive measurement. So only thing we're doing is making the invasive measurement noninvasive.

Aditya Rajagopal: 09:28

It's hard technically, but the market had already been built. So it's a very easy market to make an impact on commercially. The second one, putting the device into the the wrist, technically challenging because you have to miniaturize a whole bunch of components. But that's something that myself and other teammates have done before. In fact, a lot of the work we had done, you know, about fifteen years ago was in reading and writing neurons in fruit flies. We were remote controlling them at that point in time. And so a lot of the skill sets we learned in making electronics really small translate into building a blood pressure device that fits right into the wrist.

Aditya Rajagopal: 10:05

The interesting thing about that device is it's actually the world's highest speed ultrasound camera. So our device takes pictures 3,000 times a second, and the amount of compute that's required to pull that off, let alone the the ultrasound aspect of it is, it was a astoundingly hard engineering problem. But now that we've kind of done that work already, putting it into the band of the smartwatch, just the band of the smartwatch, it's a pretty tractable problem. Takes time and money, but that's that's something that we're, I think, well equipped to address. And the the interest in that second market is that like Whoop or Oura that are trying to provide metrics to, you you and I, humans outside of the hospital, we'll be able to provide that data directly to patients.

Aditya Rajagopal: 10:49

We wanna start with hypertensive patients that are on medications to manage their blood pressure. But more importantly, you can get hospital grade accuracy on everybody's wrist. And on top of it, you'll have a wonderful camera that can look at other metrics that are just not possible with that classes of devices.

Aditya Rajagopal: 11:06

You'll get the blood flow itself. And why is that important? As you go through different stages of cardiac disease progression, things like calcification on your arteries really matters. And it matters on how you dose yourself with medication. It matters on the lifestyle choices you make. And having that information, high quality information, not just in the physician's hands, but in the patient's hands, I think that's gonna be the biggest triage for making sure we live longer and live, more importantly, more healthier.

Aditya Rajagopal: 11:35

And there's this whole whole slew of new things to look at, you know, things that we as Esperto as a small company probably won't do. But what we can do is provide that microscope back to the people so they can look at their own data with those images. And things that we think are interesting as an example are, can we predict strokes before they happen? Probably with this camera system, can because you can look at blood flow. As clots begin to form, you can actually see that with our device. Looking at other things like preeclampsia prediction or fall detection, all of those things are within the scope of possibility with this type of a device. And longer term, that has us pretty pretty excited.

Scott Nelson: 12:15

Not to get too sidetracked. Right? But the wrist specifically, is that is that a function of, look, most people find it easier to wear something like a watch, or is it is there something particular about the wrist that allows for, like, your technology, the the camera, right, to see certain things that you otherwise wouldn't if it was in a different anatomical area?

Aditya Rajagopal: 12:33

That's a great question. So the technology itself works on any artery. In fact, it works on the veins. You can measure venous pressure the same way. There's no machine learning or training or anything like that. It's a first principles method that works on non humans too. You can take it to your favorite animal and the same principle, same device will work.

Aditya Rajagopal: 12:50

There's nothing special about the risk, but patient compliance is really important. A friend of mine ran a company called OMRON Healthcare for a long time. Great human, guy named Ranndy Kellogg. If you haven't met him, I should make the introduction. Love talking to this dude. He's just a great human being. So OMRON is probably the most prolific provider of at home blood pressure monitoring devices. They, amongst other companies, but they were the first to build a bespoke smartwatch that has a bladder on the wrist.

Aditya Rajagopal: 13:18

And so their idea was, okay, it's easy for people to wear. It's got a watch on it and the bladder will inflate and deflate, you can measure blood pressure. And they found that over time, people just stopped wearing it. A month or two, they just stopped wearing the device. So even though they put it into a form factor that was they thought was convenient, the measurements just didn't get done.

Aditya Rajagopal: 13:38

On the other hand, at this point in time, everyone wears smartwatches, mainly for the text messages. I think that the notifications are probably more important than any other feature. So our view was, let's learn the lessons that Randy had to go through a decade ago and what can drive people to wear the device. And that led us to wanting to put the device just into the strap of the smartwatch itself, where there's no friction. As a consequence, though, we can do some cool things.

Aditya Rajagopal: 14:07

The reimbursement for a company like Esperto Medical in providing these devices to people like you and I at home is sufficient. It's pre established. We didn't do any of that work. So we could, as an example, provide a new smartwatch to the patient every year. So it'd be like, we can make whatever platform they prefer. And I happen to be a Google guy. The Google in me dies hard. So I love Google's electronics, but my wife loves Apple's. And so you can pick your favorite platform to incorporate this type of device into.

Scott Nelson: 14:38

That makes a ton of sense. It'll be fun to see where you go kind of with both arcs, right, of the Esperto story, right? The consumer arc as well as the pure play medical route. Before we kind of jump into the more sort of substantive part of the discussion, give us a sense for where the company is at right now. Are you still very much in the throes of development? Are you studying this in patients yet? Where is Esperto as of, call it, mid twenty twenty six here?

Aditya Rajagopal: 15:00

We've collected a fair number of patient datasets at this point in time. So we'll gear up to do the rest of this year and to early next is completing our pivotal study. So we'll do some, you know, industrial design work streams that we'll complete at the end of this year, leading into a pivotal study early next year. And the intent is with that pivotal study for regulatory clearance, we should be in a position to sell to hospitals at the end of next year. As we start to transition into commercial entity for the hospital markets, we will divert our engineering resources into ramping up product development for the remote patient monitoring and consumer markets. So start to shift technical focus internally. That's how we're thinking through the company.

Scott Nelson: 15:47

Okay. Got it. That's that's very helpful. So kinda maybe by the end of 2027 that's the goal that you you can potentially be, you know, be staring down some early commercial efforts. I think that's very helpful for anyone kind of listening to this after the fact.

Aditya Rajagopal: 15:58

That's right. Yeah, exactly. That's exactly right.

Scott Nelson: 16:01

Very good. Well, that's cool. That's very helpful overview. You've got such an interesting background kind of from technology heavy science now to running multiple companies. Excited to kind of dig into these, a few topics in particular. But one of the things I wanted to start with was your experience in startups. You've got quite a few years now under your belt. And I know ChromaCode and Esperto are largely related to kind of this area of biological signaling. And so let's start maybe there. Like when you think about kind of like some of the key lessons learned from ChromaCode that you're now pulling into Esperto over the past, call it seven, eight years now, are there a few that kind of stand out?

Aditya Rajagopal: 16:36

Absolutely. Maybe hard lessons learned. Mistakes that people were fortunate enough to let me work through at the the previous company. ChromaCode was a technology seeking a problem when we started it. It was myself and another Caltech colleague, a guy named Emil Kartalov, a brilliant scientist, had developed a mathematical strategy for increasing the amount of information in biological signals. So so it's a biological signal. So as an example, like, if you're looking at fluorescent signature from, like, a PCR test, like, from a COVID test as an example, instead of looking at just one thing, we developed a method where you can get 10 things out of that fluorescent signal. So it was actually it's fundamental mathematics that it solved a problem that had been proposed about a hundred years ago called the problem of unique sums. I think it was NRL.

Aditya Rajagopal: 17:23

The Navy had proposed that problem because they were trying to increase information in ship to ship communications with antennas. But the solution to that problem, when applied to biology, is that you get this beautiful increase in the number of things you can measure. Or said another way, if you can measure 10 things in the same effort it takes to measure one thing, you can make things 10 times as cheap as well. So that technology really predated the need for it. So we started that company in 2012, and we started to build products and get them into the market closer to 2020, just when the pandemic was hitting. And so it's interesting that the the COVID pandemic really increased the the market need for a solution like ChromaCode.

Aditya Rajagopal: 18:11

But for the first eight years, it was a technology seeking a problem and now ChromaCode's doing well. It has historically has had a new direction about 100,000,000 in cumulative revenue, and it's very laser focused on cancer diagnostics right now. If you've heard of some of these cancer companies like Guardant Health is one that has a lot of blood based cancer tests or GRAIL, which was started by a friend of mine from Google, a guy named Jeff Huber, who might be a great guest actually. He's a great dude.

Aditya Rajagopal: 18:40

But companies like that use next generation sequencing, often made by companies like Illumina, to look at a genomic record and translate that into either a prediction, in the case of Grail, like you might have cancer that's developing, or a diagnostic in the case of Guardant Healthtech, Hey, you have cancer. We think you're eligible for these types of drugs. And that type of testing is really useful, but it's expensive. And so the ChromaCode strategy now lets you take that same result and get it at a much cheaper price point. So it's beneficial to patients. It's beneficial to providers because they get the information much faster. And ultimately, it saves everyone a lot of money.

Aditya Rajagopal: 19:20

That utility though, wasn't present when we started the business. And this was kind of maybe, in essence, a very important lesson I learned is great science doesn't necessarily make for great companies. You have to have to time the markets well. And to give you a sense in developing the blood pressure technology for Esperto, as an engineer, I'm I was woefully ignorant of the clinical applications. I was like, oh, it's gonna be super cool. I'm gonna make do this blood pressure measurement non invasively. It's all gonna work out.

Aditya Rajagopal: 19:50

But I was very, very fortunate that my cofounder Alaina was the physician and knew exactly what the market need was in the hospitals. And we were fortunate that in the hospitals, people had established the need for continuous blood pressure monitoring over fifty years. So companies like Edwards Lifesciences or GE or Philips really built the clinical utility. So everyone was using these types of devices already. All we had to do was kind of take it forward for this last mile of making it noninvasive.

Aditya Rajagopal: 20:21

On the other hand, companies like OMRON Healthcare, run by Ranndy for many years, and companies like Whoop and Oura, and now maybe Google, what they're thinking about there, they're starting to really build out the market need for measuring people at home in a very convenient form factor. So we are kind of riding the coattails of others in going into the market as a fast follower. But our trick is, hey, we're a best in class device. You won't be able to beat the underlying physics that gets you the right information for blood pressure. So that, for us, is a pretty exciting journey.

Aditya Rajagopal: 20:56

But that clinical need and the market need had been established. And so focusing on solving a problem that needed to be solved rather than trying to bring the technology to market before the need, I think was one of the fundamental lessons learned in Esperto versus Chromacode. And it directly translated into how efficient we can be with the requirements of the company and the capital we need, and also kind of the step function for the market that we can achieve.

Aditya Rajagopal: 21:26

Because once we bring this to market, in essence, we're going to build a monopoly. And so the ability to do that really comes into play when the market is already established, when there's, like, a single thing, small small one small step, but critical step. If you solve that one, then you can flip the market. Lot of these lining up these advantages only came about because of painful lessons learned on another company where I had to make mistakes and learn how to approach markets a different way.

Scott Nelson: 21:57

Yeah. But it's it's so so crucial because in the early days of like idea iteration, right, it's really hard to sometimes let go, right, of an idea that's really promising. You find yourself, you know, thinking about it, right, maybe there's sleepless nights because you're thinking about this idea, but it simply may not line up, right? With a clear market need, a market opportunity. Timing oftentimes is the piece that often that doesn't fit into the equation.

Scott Nelson: 22:22

So I'm glad you brought that up. And actually that was one of the next questions I had for you is because I, and it reminded me when we were drafting kind of notes for this particular interview, reminded me that the conversation I had with Anthony Odell, he runs a startup called EchoPoint, somewhat loosely related field, guess. But he's got a fair amount of experience kind of taking IP out of academia and kind of like trying to figure out if these ideas could be viable. He said, one of the things he often looks for is has this academic at whether it's Caltech or Stanford or name your academic institution, if they're working on something, have they, one of the things he looks for always, have they actually talked to a clinician? Have they talked to a clinician and actually figured out like, does this even work in a traditional workflow? Is there really, is there a need here? And so that's that's kind of the thing he looks for. So when you when you think about because I imagine you still to this day probably see a lot of ideas, probably have a lot of ideas yourself. Right? When you think about whether or not to pursue or go all in on a on a particular project, are there other things that kind of come to mind, you know, from your perspective?

Aditya Rajagopal: 23:20

There are, and I can can sort of give you my perspective on it. But I think the the most important thing for me to keep in mind is my own perspective on anything is quite limited. It it is a product of my experience and a product of my training. So learning from people like you, who are experienced operators in the medtech space, learning from people like Alaina that are experienced clinicians, that's requisite. And every time I haven't been humble about that, I've made mistakes. And so I think continuing to take a good perspective from others is necessary for orienting my companies for success and certainly necessary for my own growth.

Aditya Rajagopal: 24:02

But with that said, I do think in the case of medical devices, there's a few perspectives for new technology that should be taken into account. One is the clinical paradigm as it exists today, even if it's the best widget in the world. If it creates friction by eliminating jobs that are necessary, like eliminating nurses, it's not gonna get adopted. You're going against the grain. Even if it saves costs, there is a human capital cost to that new device, and it's going to result in a lot of friction.

Scott Nelson: 24:36

Hey everyone, let's take a quick break to talk about Fastwave Medical, the company I co founded and lead as CEO. We're developing next generation intravascular lithotripsy, or IVL, systems to tackle complex calcific disease. Over the last few years, we've closed a series of oversubscribed funding rounds, bringing the total investment into Fastwave to over $50,000,000 Corporate interest in the IVL space is growing too, the $900,000,000 acquisition of Bolt Medical by Boston Scientific in 2025, and Johnson and Johnson's $13,000,000,000 acquisition of Shockwave Medical signal a lot of attention on emerging IVL startups like Fastwave, and we're making serious progress. In addition to recently receiving our ninth patent, we've successfully completed peripheral and coronary feasibility studies and are gearing for pivotal trials. If you're interested in investing in the fast growing IVL market, head over to fastwavemedical.com/invest. Again, that's fastwavemedical.com/invest. Now let's get back to the conversation.

Aditya Rajagopal: 25:33

The second is a real alignment of interest between doctors who are always wanting to do the best for their patients and payers that have to look at how to triage resources across their entire network, because every patient's lives matters, so you can't over index on resourcing for a particular patient. I think payers sometimes get a bad bad rap, but without insurance, we individually wouldn't be able to afford these acute medical events that that spike costs in a in a very major way for each of us individually. So so aligning interests from a reimbursement perspective and from a regulatory perspective is really important. And on that latter element, I used to think that the FDA was this horrible entity that was a gatekeeper. Prevents people from getting things out to the market.

Aditya Rajagopal: 26:18

But after now fifteen years working in the segment, I realized how important their perspective is in making sure that you do no harm when you bring new devices into the marketplace, and that requires a great deal of rigor. And if we were building, let's say, like a video game, it may be there. Even there, you need to have a lot of careful thought into this is gonna create harm. But ultimately, the ramifications of doing something poorly are a lot less than when you're building things in the healthcare segment, whether they're therapeutics or medical devices. Because cutting corners results in patient lives lost, and that's not an acceptable risk to take. So being mindful of all of these requirements to bring things to market, I think is necessary. It's certainly not a perspective I had the first time I spun something out of Caltech.

Scott Nelson: 27:07

Yeah. Spoken from experience. I can tell for sure. Even the first point that you mentioned, not to diminish the kind of the latter point, but understanding kind of the stakeholders that are impacted right by your technology. Because it's, again, it's so easy to get kind of laser focused on the direct end user, but understanding like how this may impact referral patterns or various economics inside a hospital versus maybe an outpatient care center of some type. I'm just kind of throwing out examples, but that's so, so important to understand some of those dynamics as early as possible because they're likely going to impact whether or not maybe you work on the project, maybe certain design decisions early on, etcetera. So really, really good points.

Scott Nelson: 27:44

On that note, I want to talk to you a little bit about early stage development because obviously you're an engineer by background. You've got a lot of experience taking very sophisticated technology and actually turning it into a viable product. And I think the early stage development, it's so hard because there's oftentimes very little capital that you have to work with. Maybe some non dilutive, maybe some early angels, etcetera, that are willing to take a bet, but you just don't have a lot to work with. So you've got to make, you've got to like ruthlessly prioritize decisions. And so when you think about, and maybe frame this up for another technologist, another physician that feels really bullish about this idea and they want to maybe take a swing. How do they, like, what what's most crucial to get right in those very early early years of of development?

Aditya Rajagopal: 28:26

That's a good question. Yeah. I was fortunate to have had two PhD advisers. One of them was an old school physicist named Tom Tombrello. He used to always say, I don't think there's a there there for certain things. And it's a phrase that for me rings true here. For technical solutions, and it's challenging to build the right intuition, sometimes you can get incrementally close to the right answer, but never have the capability of getting to the right answer. There's no there there. Blood pressure is one of those problems where I myself have tried many things that have gotten incrementally close, but never could have gotten to true blood pressure. So having a good pulse on, is this actually a tractable problem is probably the most important insight to have because that directly translates into how you spend money and the time scales at which that money needs to be spent.

Aditya Rajagopal: 29:17

So in the case of blood pressure, as an example, every other technique out there that's not the invasive arterial catheter is looking at proxies for blood pressure, things like blood flow, as an example. There's a way variety of ways to do it. You can do them with capacitive sensors on your skin. You can do that with PPG sensors looking at blood oxygenation, But none of those methods actually get to blood pressure. They get close and sometimes it's close in some cases where you're either using machine learning models to fit the data or you're calibrating against a known blood pressure standard over time for that patient. But the ability to get to true blood pressure, doesn't matter how much money you throw at the problem, it's not going to be there.

Aditya Rajagopal: 29:55

So having an insight that if you want to solve a problem properly, there needs to be a there there is really, really important. And again, in the case of blood pressure, doing that in a safe environment like Caltech was an advantage because for us as academics, discovering a whole bunch of ways to not do something is just as valuable in terms of scientific productivity as discovering the solution to to doing something. You know, the goal being a faculty member at a school is to help students launch their careers. That's, like, the primary objective. So the student will still be just fine.

Aditya Rajagopal: 30:32

I might not get as nice grant dollars, but the student's going to be fine. That's the primary objective will be achieved. So doing this in a safe environment at Caltech and the example of blood pressure is really important. So we'd probably had about four or five technical strategies that we don't talk about that were actually incrementally close to pressure. We almost got there one time. We got to, like, change in blood pressure over time.

Aditya Rajagopal: 30:50

We could tell delta pressure. But we couldn't tell absolute pressure. And so we're like, oh, this is almost a company. And the reason we we left it at Caltech and not didn't move forward is when we looked at what it would take to bring an almost solution to market. It's just as expensive as the almost solutions that were already on the market. So it didn't make sense to start a business. So having that discipline to say, okay, this is a tractable problem. Now it's time and money, but now we need to capitalize the stages of that engineering project carefully and align expectations, which was really important to take that to the next phase. It was really, really a crucial insight. Does that kind of give you a perspective?

Scott Nelson: 31:30

It does. And it allows maybe just to segue into clinical validation too. And it may be a little bit easier in your shoes, right? Because your wife is Alaina. When you think about a technology like you're developing at Esperto, it's obviously talk to any physician in the world and they're familiar with like how to take blood pressure, of course, but this is a fundamentally different sort of mechanism and a way to do that.

Scott Nelson: 31:53

So when you were kind of navigating or putting together your clinical roadmap, obviously there's the regulatory requirements that are needed and then the clinical data that ladders up to that. Were there other aspects that you thought about when putting together the clinical trial design that you felt were needed to convince physicians that, no, look, this is different, but it's the same. They can feel confident to trust this new tool.

Aditya Rajagopal: 32:15

So rigor around data sets is really important. And in its essence, the best advantage I had is that my most rigorous critic was also my co founder. So the evidence generation was part and parcel of the development process. Even at Caltech, we measured like 300 patients and work we'd done there. So there was a lot of confidence we had that it would work and conveying that to physicians with the data, enhancing all the proof points we have, was I think easier because of that bolus of evidence.

Aditya Rajagopal: 32:50

But you do bring up a great point in medical device development, in particular, having that evidence to not fool yourself that there's a vector that there's a there there, I think is really, really essential. The other thing is to communicate it to clinical customers who are ultimately the practitioners using the tool, I think is essential. In the case of blood pressure on that latter aspect, we had a convenience that a lot of people had already tried to solve this problem in a variety of ways. So many of the physicians that are our natural customers, folks like cardiologists or surgeons or anesthesiologists or ICU docs and ER docs, they already were aware of a number of the other methods and their pitfalls. So for us, there was less effort needed to convince them that there was a problem worth solving and a lot of effort needed in convincing them that we had solved.

Scott Nelson: 33:44

There's a couple of different topics I want to touch on before we get to the rapid fire portion of this interview. But one is fundraising because I know you have experience too in this arena generating or attracting capital to fund these companies. But let's tackle kind of this topic of platform technology. I imagine you probably went through this at ChromaCode too right, with this very novel underlying kind of technology. But where do you basically the question becomes where do you start? How do you prevent yourself spreading too thin and where do you focus kind of those early efforts? Not terribly dissimilar to probably Esperto. Right? It sounds like you've got a pretty, pretty good idea of how to sequence this from the medical to the consumer side. Even like with a medical focus, you could focus on a lot of different areas of medicine, right? When you think about like all of your experiences kind of on this topic, whether it's ChromaCode, whether it's at Esperto or any other startups for that matter, what's your advice for other other folks that are working on kind of a platform technology? How do they how do they best focus?

Aditya Rajagopal: 34:42

Maybe the advice for myself, I hope I'll listen to this and remind my advice to myself, and then perhaps for others, but I'm sure they've already figured this out, is if you do one thing well, doing the next thing well is much easier to do. But trying to do two things well at the same time, you might succeed at neither. So laser focus on accomplishing the first task is needed. In the case of Esperto, that was displacing tools that are continuous blood pressure monitors. So clinical utility is established.

Aditya Rajagopal: 35:18

They're already used in the standard of care. Only thing we're doing is being noninvasive. So that was the initial goal is let's go replace the markets that have already been built. And once that's done, there's other use cases in the hospital that tools like the arterial catheter haven't been able to address. So measuring patients as they go from ward to ward or measuring patients in the emergency department where invasive tools, because of workflow reasons, are just infeasible.

Aditya Rajagopal: 35:45

You don't have an hour of time to spend with each patient to put in a blood pressure monitor. You need to triage the patients and deliver care immediately because everyone's acutely ill when they're when they're coming in. So those future markets are ones that work better when you've already established the business in that preexisting market. So that laser focus on doing the first thing well, I think will continue to pay dividends for us in the future. To learn from Chromacode, in its essence, back to being lucky, better to be lucky than good.

Aditya Rajagopal: 36:17

And we definitely were very lucky. We had a global pandemic of unheard of proportions that took place that made ChromaCodes product very valuable. And so it enabled like $85,000,000 in sales, like super quickly with very little effort. And that type of a market need was the reason why we were successful early days. Outside of that, we would have had to triage our own resources very carefully into solving the problem.

Aditya Rajagopal: 36:46

Couldn't have boiled the ocean and gone from measuring drug resistance for septic patients all the way into cancer. It would have probably taken us ten years longer to get there. But there was this wonderful chance to establish ourselves that was because of this pandemic that enabled all these other things downstream. So Esperto, I don't think has that type of a once in a lifetime opportunity, but it can be smarter about how it addresses markets. And this is kind of the reason why we're focusing on hospital markets that are already there and then focusing on expanding in RPM and consumer markets later later days.

Scott Nelson: 37:24

I always like this topic because you said it's advice to yourself. Right? You can go back and then listen to this interview and make sure make sure you follow your own advice. Same thing for me. Right? I always like to hear it's it's it's good to to kinda continuously hear, like, focus is so so crucial because it's it's I think all of us that are entrepreneurs are probably inherently optimistic, and we think we can maybe take on more than we truly can. And so if you have to default into focusing, that's usually the best approach.

Scott Nelson: 37:51

But with that said, let's end the discussion before the rapid fire portion talking a little bit about fundraising. And I think might not show that you guys closed, Esperto closed an oversubscribed Series A back in early 'twenty five. When you think about everything that led up to closing this Series A, I'm sure there's so many things that you've learned over the past ten plus years raising capital. Were there a few things that really came to mind that allowed you to close this oversubscribe around that kind of key lessons learned based on a decade of building companies?

Aditya Rajagopal: 38:22

I think so. It applies for bringing investors on board. It applies for bringing co founders, employees. Every time you add people to the team, you have to make sure everyone is aligned and rolling in the same direction. That discipline making sure that people are aligned is necessary across the team, but ultimately it's the responsibility of the CEO to do that. So in the case of fundraising, it means that we talk to a lot of groups to find the right participants in building out the team at the structure. We got some phenomenal investors for the series A. It was Catalyst Health Ventures and Bold Capital in particular. I'd love to shout out to Josh Phillips, who started Catalyst in London.

Aditya Rajagopal: 39:07

He's been a phenomenal partner and friend in the process and longtime friend from Caltech and mentor from Caltech, Helen McBride, who who led the round from the Bold Cap side, along with her colleague, Neal Bhadkamkar. Those three individuals were exceptional at providing the resources and helping align everyone to this broader mission. And along the way, when we talked to about 200 groups, we had three term sheets we processed and picked the one that mattered in probably the most challenging venture financing landscape in the last twenty five years. Being in a position to choose only happened because we had exceptional discipline in raising money at a time where we had a lot of runway to do so, and making sure that we were careful in accepting investment from the right groups, which I think is one of the more important principal components in situating for success.

Scott Nelson: 40:09

There's two things that stand out hearing you answer that question. One is you said you spoke to about 200 groups or roughly about 200 groups. A lot of times I'll talk to founders or CEOs that raise capital. They're like, I just can't. I'm struggling raising etcetera. I think it's hard for everyone even if you're proven, even if you're quite proven. But when I asked them that question, roughly how many firms, groups, etcetera have you talked to? It's like 20 or 30. I'm like, woah, you need to like 10x that. I mean, like, is this it's like you need to talk to a lot more people.

Scott Nelson: 40:37

Yeah. You know? But but but secondarily, that point around being disciplined about who you take capital from. Right? I mean, we've I I think most people that are listening to this are probably familiar with like my my story with FastWave. And I, like, ask me that five years ago, and I would have said Yeah. How big of a deal is that really? I mean, it is but, is it that important? And it's like, wow. I mean, it's like you are getting married to a group of people in most cases. Right? I mean, I think that's I hate to sound cliche, but it's very much like that. And it's it's good to hear you say that, right? Because you've raised from a lot of different groups, right? And kind of understand that that's pretty critical, right? To only take money from the right partners.

Aditya Rajagopal: 41:13

Yeah. Is ultra important and a lot of things oriented for success to enable that. I had an exceptional set of angel investors of three executives from from Google. Jeff Huber, whom I mentioned had started Grail at a earlier juncture, and a guy named Michael Frumkin who who wrote AdWords, kinda made Google's economic engine work. And third guy, Phil Nelson, who's been a senior exec there for a number of years.

Aditya Rajagopal: 41:39

And having those three longtime friends and friends and mentors as as part of our angel syndicate was really important. They're very involved in making sure that we could say no to things. And along the way, there was really a phenomenal guy named Mark Stevenson. He was chief operating officer at Thermo Fisher Scientific for a number of years, and he's seen every everything happen for startups and big companies, everything good, everything bad. And having him as a a strong strong investor and support on the company put us in a position where we could be very highly selective.

Aditya Rajagopal: 42:16

So the leading into the right series A for the business really started with who we included in that initial company formation stage. And in addition to that, we had an advantage that there's two folks, a guy named Vern Norviel, who's his longtime life science attorney at Wilson Sonsini. He's a he's a phenomenal guy. Again, maybe a great host. Had he had started a company called Affymetrix, and he took that public.

Aditya Rajagopal: 42:40

It was a $10,000,000,000 public company, kind of financially retired and then built Wilson Sonsini's IP practice over like thirty years. And so having him as a wise advisor and a seed investor and his partner on the corporate side at Wilson, Ben and Marty Waters, having their wisdom in helping select the right groups, I think made things highly effective in putting together that route. Yeah. Yeah. Those early angels, it sounds like they were pretty, pretty crucial, to putting it in the best position possible along with obviously execution and a lot of cool technology with the big market.

Scott Nelson: 43:18

One other kind of follow-up question related to fundraising, when you think about other whether it's academics, physicians, technologists, right, that are raising capital for the first time, what do you think they underappreciate most, right, if they've never done it before?

Aditya Rajagopal: 43:30

I don't think I understood how venture capital worked when I started. And sometimes you get no's from groups, and the reason is okay. It's a no. The reason is X. But really, the reason isn't X: Looking at the fund dynamics, that particular partner's interest, the other types of investment sector, specific investments they've made, their LP base, where they are in raising their next fund, how this current fund they're investing into has returned. All of those dynamics lead into a decision on whether or not they're gonna make a financial bet, but it's like a hidden markupo model. You you have none of that information as an operator saying, okay. I pitched this venture capital company, and they said, yes. Great. I must have done everything right.

Aditya Rajagopal: 44:14

If they said no, then it's probably not my fault. They just didn't get it, or it's their fault, and I don't but you don't know why things work or don't. And spending a little time in understanding the perspective and incentive structure for the folks investing into the company, I think, may help others overcome this hurdle that I had when I started raising capital for businesses earlier on. But at this point in time, keeping that framework in mind, I think, makes me much more effective in raising the the money we need for the company.

Scott Nelson: 44:46

Yeah. It's a a totally underappreciated aspect. Right? I think even if you've been around fundraising for a while, right? It's oftentimes easy to forget how important those fund dynamics are. And just doing a little bit of research in advance and making sure that that's one of the first things like you and the folks on the other side of the table understand together because it's like the worst thing is you get two or three meetings in and it's like this isn't this wasn't ever a fit anyway. Right?

Aditya Rajagopal: 45:10

Yes. Yeah.

Scott Nelson: 45:11

You know? So so with that said, I know we only have few minutes left. Want to get to the rapid fire portion of this interview. Again, for everyone listening, esperto.health is the website. We'll link to it in the full write up, but E S P E R T O, Esperto, just as it sounds, .health is the website. Really interesting technology and huge markets that the company is going after both on the medical and consumer side. It'd be fun to watch what you and your team accomplish over the next couple of years. But first question on the list, when you think about the next twelve months, take us out to kind of mid 2027. What's the most exciting milestone for Esperto?

Aditya Rajagopal: 45:42

I think if things track, we'll have submitted everything we need to the FDA. So we'll be sitting tight and waiting, and then we'll be doing more more of the fun stuff, which is to start onto the RPM side of the the project where we get to miniaturize everything into a single piece of silicon. And so it's gonna be a exciting time of growth for the company. And, hopefully, we'll have lots of published data, pub publications that we'll have in the public domains for people to look at in the in the interim.

Scott Nelson: 46:09

Very good stuff. Alright. What's the one key lesson that every medtech entrepreneur should really understand?

Aditya Rajagopal: 46:15

Spend less than you have. That's I think the most important most important thing.

Scott Nelson: 46:21

Very pragmatic. Yes. But but but so so important. You're right. Alright.

Scott Nelson: 46:25

Last question. One piece of professional advice that you'd give the younger version of yourself?

Aditya Rajagopal: 46:31

Have confidence that you can learn from other people and become a better version of yourself.

Scott Nelson: 46:36

Good stuff. Aditya, can't thank you enough for carving out some time to do this.

Aditya Rajagopal: 46:39

Thank you, Scott.

Scott Nelson: 46:40

A fun discussion you've built around a lot of cool technology over the years. So definitely appreciate you lending your wisdom right to the to the folks listening to this this podcast.

Aditya Rajagopal: 46:50

Thank you so much for having me, Scott. It's been a pleasure.

Scott Nelson: 46:52

I'll have you holding the line here. But for everyone listening, appreciate your attention as always until the next episode of Medsider Goes Live. Everyone, take care.

Scott Nelson: 47:00

Hey. It's Scott again. One quick thing before you go. You see, I love bringing you insightful conversations with the best founders and CEOs of medical device and health technology startups. But here's the thing, I'd be super grateful if you could help me reach even more ambitious doers who share our passion. So if you found value in this podcast, if you found yourself nodding your head while listening, or if you simply enjoy what we're doing with Medsider, please take a moment to leave us a review. It's super easy. Just open your Apple Podcasts app or the podcast app of your choice, search for our show, and scroll down to the ratings and review section. Leave your honest thoughts and hit that five star rating if you think we're worthy.

Scott Nelson: 47:31

Your feedback is incredibly important, and it's the best way to ensure we keep bringing you awesome discussions with leading founders and CEOs. So take a moment to be a good friend and leave that review today. As always, thanks for being a part of our journey and for helping Medsider continue to grow and evolve. Your support is greatly appreciated. Alright. Enough talk about reviews. Stay tuned for another informative episode coming at you soon.