Dec. 8, 2022
Josh Cohn, Chief Commercial Officer at EndoSound
Josh Cohn has 15 years of experience in the medical device field, rising to National Sales Director of PENTAX Medical, a major endoscope provider. He has a strong history of leading successful sales organizations, building winning strategies, and launching disruptive programs aimed at changing marketplace conventions. As product champion and strategist for all EUS sales, he has attended hundreds of procedures and has established relationships with key opinion leaders, hospital and ASC administrators, and device distributors. In his current role as CCO, Josh will be responsible for the pre-and post-commercialization Sales and Marketing strategy designed to ensure the integrated commercial success of the organization.
WEBVTT
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Welcome to the Latin MedTech Leaders podcast, a conversation with MedTech leaders who have succeeded or plan to succeed in Latin America.
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Please subscribe on your favorite podcasting platform.
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Apple Podcast, Spotify, Google Podcast.
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Amazon Music is teacher tuning.
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I heard radio, Pandora, or these are
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Welcome back to the Mex Leaders podcast, a conversation with leaders who have succeeded or plan to succeed in Latin America.
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Please subscribe on your favorite podcasting platform.
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Apple Podcast, Spotify, Google Podcast, Amazon Music, et cetera.
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Today our guest is Josh k He is the Chief Commercial Officer at Endo Sound, a company dedicated to expanding access to endoscopic ultrasound technology worldwide.
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So Josh, it's great to have you here today.
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Welcome to the
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Show.
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Thank you for having me.
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Glad to be here.
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Awesome, Josh.
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So let's get started with your journey to the region, to Latin America.
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Josh, how is it that you got involved?
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Well, I mean, my journey to Latin America started at birth, so I'm proud to, to be, um, a descendant of a Venezuelan.
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My mother migrated to the United States, uh, in college, and, um, she's been here ever since.
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So my affinity, uh, to Latin America started at birth and I've had the opportunity to be immersed into that culture from a very early age.
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Um, had the opportunity to visit Venezuela a dozen or more times over the years.
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And, um, my love for Venezuela and Latin America kind of started there.
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Um, from a, from a business perspective, uh, my journey started a little bit later, of course, um, had the opportunity to meet a number of KOLs and physicians, um, who visited the states for conventions.
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Um, I was the resident Spanish speaking person in the booth when my Latin American colleagues were at other meetings or hadn't arrived to the booth quite early enough.
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Um, so that helped me forge a relationship with those folks in the sense that I could, um, help communicate with their customers when they weren't there.
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Um, and that helped me forge a relationship with them that really, uh, was ongoing for a number of years.
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Um, so we, we kept in touch.
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We talked about strategy, et cetera, et cetera.
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And then, um, when I started at Endo Sound, my friends there really encouraged me to, and the organization to, to look at Latin America as an opportunity to do a lot of our early work and, and, and reach out to some KOLs down there.
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And, and we took their advice and it's been fantastic.
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Excellent.
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I'm so glad to hear that.
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Uh, Josh, so let's talk about, uh, trends in Latin America.
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What do you see happening in the region that is relevant to the discussion about, uh, clinical research or commercialization of medical technologies
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In Latin?
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Yeah, I mean, uh, historically med device would go to Europe.
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Um, that was the kinda feeding ground for early device work, first in man work.
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Um, and you know, at Pinax it was always a struggle to see all those devices being developed and sold in Europe first, and then it would come to the United States.
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And now, um, with what is perceived to be a much more difficult and arduous process with the mdr, um, medical device companies are looking for other areas to do some early, um, stage work, and I'm seeing a lot of, uh, companies like Endo sound, uh, look to Latin America where there's lots of opportunity, um, to work and, and learn.
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And the, the, the ground in Latin America is fertile with wonderful, um, physicians, KOLs that are very well respected here in the United States and around the world, and, um, are experience down there has been second to none.
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Um, so I see, I see a lot of companies starting to do what they did in Europe years ago, now going to Latin America and doing a lot of that early stage work.
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Excellent.
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Yes, I see that too.
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That's, that's, um, certainly, uh, a train that, uh, is been happening for probably five years now, where, um, in, in essence I see Latin America getting more mature.
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Um, and, and companies are looking more seriously at the region as a, as a, as a work class region for many, for many activities, uh, including clinical research and also commercialization.
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It's great for patient care, right?
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Because, um, especially in Latin America as well, right?
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The patients there are, are getting access to technologies that they may not have received previously, but quite frankly, it's really expediting these technologies to become available to people around the world, right?
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Um, just in the same manner as it was done in Europe.
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Now it's done in Latin America.
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And, um, you know, I think if companies take advantage of the opportunity down there, uh, they'll see some enormous benefits from a time to market perspective to building better products, being to market sooner, but also with a better product that that enhances patient care.
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Yeah.
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So now topic of trends.
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Um, what I have your take on what's happening in Europe for the audience to understand what is it that we're talking about here?
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Uh, what do you think is happening in Europe?
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What is it that is so difficult to commercialize or to do research in in that region?
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You know, the, the, I'm no expert right, in regards to the regulatory environment in, in Europe, however, um, some of the clinical requirements that are required as part of the MDR has really made it more difficult to, to go to Europe.
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Um, it's a much longer process.
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There are a lot more requirements that are required.
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Um, you know, then there's the, um, the process of, um, oh, I can't think of it now, my apologies.
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But there's, there's a number of policies that are in place that are making it a little bit more difficult, um, to go there.
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Yeah.
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And the number of notified bodies, uh, got produced dramatically.
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So there's a backlog.
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Yeah,
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That's correct.
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Yeah.
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That, that's another issue as well.
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Um, getting in with the notified bodies and now that they've reduced them is also a challenge.
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Yeah.
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Okay.
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So hopefully that means more business and newer technologies in Latin America.
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I think so.
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I, I, I really do.
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Um, you know, I've been, you know, working for a startup now, really in a consulting and full-time capacity for over three years now.
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I've had the opportunity to meet and talk to other leaders of startups and, um, this idea of going to Latin America is very intriguing.
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Um, and there are so many advantages to going down there.
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I think we're gonna continue to see the trend of folks going to Latin America and getting some work done.
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Beautiful.
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Beautiful.
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Alright, so let's talk about, um, what you're doing in Latin America today.
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Yeah.
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Um, so, you know, we started in Ecuador.
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We've done all of our first in man or all of our clinical work in, in Ecuador.
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And, and we've done a little over a dozen cases.
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Um, and it's been incredibly beneficial from not just a commercial perspective, but an engineering perspective and an r and d perspective.
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Uh, we went to Ecuador under strict clinical readiness reviews, um, to be sure that the, the product was ethical and safe for patients.
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Um, our physician partner, um, you know, received our protocol, looked at our protocol, accepted our protocol.
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After a number of changes and we were able to get a bunch of feedback, we've actually been able to iterate or quickly, uh, whereas if we would've, um, not gone to Latin America prior to commercialization, we might not have as good a product to market.
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So we've been able to, yeah, we, our engineering team has been able to take feedback from some of those early cases.
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And we've actually iterated we've changed the product to do a little bit different things and we thought it could do.
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Um, and, and it's been incredibly helpful.
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Um, the gentleman that we're partnering with is Dr.
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Carlos Robles.
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Um, he is a thought leader, not just in Latin America, but in the United States.
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He's on the circuit here in the us.
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He visits here quite, quite frequently.
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Um, and, and many of the things that he has learned down there has informed, um, informed our r and d group.
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And we believe that when we go to market in the next six months, we're gonna have a better pro better product, which is gonna give better patient care, um, et cetera, et cetera.
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Very good.
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Wow.
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And how is it that you found Dr.
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Rus, uh, in Ecuador?
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Yeah, so, um, having, uh, been at Pinax for 14 years and, and having developed relationships with the Latin American team, um, the, the US side used Carlos as well as a speaker, um, as someone who we could get early feedback on devices that Pentax may have gone to Latin America with first.
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So I had the opportunity to first meet him there.
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Um, and then one of my latinamerican mentors, Peter, who has run the Latin American market for a number of different companies, um, you know, really encouraged us to reach out to Carlos.
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Um, early on we did that, and, and Carlos actually did a lot of our early animal work as well.
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Nice.
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Okay.
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So he came over here and, um, helped us with that.
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So it's been, been an awesome partnership.
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It really has.
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And I believe he's going to be starting a, a study here in, in the next couple months, um, you know, in regards to our technology and how it compares to those that are already existing.
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Very
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Good, very good.
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The study in the United States led by Dr.
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Carlos.
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Well,
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He, yeah, he's gonna, he's gonna do the study in Ecuador and he will lead, he'll lead the study.
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Oh, ok.
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Ok.
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So, Josh, any, um, comments about the hospital infrastructure in Ecuador, about the skills of the investigators or the team, the research team and all that?
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Yeah, great question.
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Um, you know, the, the, the facility that we've done our, um, device work at is really second to none.
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Um, the folks are, um, always surprised when we, when we take'em down there with us, we take our folks down, look at it, and, you know, they have the latest and greatest equipment on the market, really is a benefit to an early stage company because that's what we're comparing ourselves to, right?
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When we come to the United States, they're gonna, they, they don't want you to compare yourself to a, to an older technology that might not be on market.
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So in our case, we actually compare ourselves to equipment that is the latest and greatest being sold across around the world.
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So from an equipment perspective, from a facility perspective, second to none.
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And then from a clinical expertise perspective, second to none.
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So the, the center that we use, um, is a training center, um, is endorsed by the world endoscopy organization and a number of other societies.
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Um, they, uh, train a number of, uh, advanced fellows every year.
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Um, I had the opportunity to meet, uh, a number of those fellows, uh, that have now gone back to Mexico, for example, in one that's gone back to Romania.
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And the benefit to them is that they're getting their hands on the latest and greatest of technologies.
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Um, and they've had the opportunity to see and, and use Endo sound as well, which is been a great benefit.
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Um, and they're, they're highly motivated to, to, to continue to work with Endo sound cause technology can bring benefits to their markets as well.
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So, um, the clinical, the, the clinical team there, the research team, again, second to none, we, we have no, uh, reservations in regards to, to doing our clinical research there and, and, and doing our early stage work
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There.
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Wow.
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I'm, I'm so happy to hear that.
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Uh, in, in Ecuador, it's not a country that I usually hear companies, uh, um, do research on.
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Uh, so, um, usually you hear Columbia, ua, other countries, Mexico, but it's the first time they hear Ecuador.
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So that's why I'm so curious about your, your experience.
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Yeah, you know, the staff is amazing.
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Um, you know, maybe it's endoscopy, maybe it's different specialties have their different areas in Latin America or whatnot.
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Um, you know, maybe it's, maybe it's a new and up and come in.
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And, and, and Carlos certainly is one of those folks that, uh, is highly respected and he, he did a lot of his training in Europe as well.
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Um, I think builds some credibility for him.
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And, um, in any event, there's a number of companies in the end actually and centers Ecuador.
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Um, so if we find Ecuador to be, again, just a wonderful place to work from a culture perspective and ease to work there.
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Um, you know, and, and in, in regards to this particular, it's five minutes from the airport to work every day.
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So it's convenient.
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The food's not bad.
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Uh, we like to have fun seafood, right?
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.
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Yeah.
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Excellent.
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Thank, glad, thank, glad.
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And, uh, do you have to go through at this committee review or Ministry of Health review, uh, what was experience, uh, in that area?
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So the account, um, handles it all right.
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So we provide them with a protocol, we provide them with our clinical readiness reviews, show that we've done certain tests to make sure it's safe and applicable.
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Um, and then they handle that through their IRB process mm-hmm.
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.
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So they kinda handle all of the ins and outs of what's required, um, for us to come there and do early stage work.
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Nice.
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Very good.
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So you do have to use the services of, uh, consultant, regulatory consultant or third party agency, uh, CRO or anything like
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That?
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Correct.
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It's, it's turn, it's turnkey, uh, which they make it very easy right.
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To work with.
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Um, now we do consult and we have consulted with our regulatory consultant to make sure that the things that we're doing down there, um, you know, are, are able to be done, et cetera.
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You know, one of the things that we also were allowed to do, uh, and this is just based on the fact that Carlos is a rockstar, um, he's, he's been invited, uh, to be on global, um, endoscopy courses, live endoscopy courses.
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So back in, um, I guess it was earlier part of this year, um, there's a program called Endoscopy on Air.
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And, um, Carlos and Endo Sound were, were asked to participate.
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So we were able, um, to do some cases with Carlos in preparation for that.
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And then we went live, so we had a live case done on, on a patient in Ecuador where thousands, thousands position we're able to see the technology.
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And again, because the facility is second to none, you know, uh, they're able to pipe in, you know, the, the recorders and, and video everything and streamed perfectly.
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And, uh, the responses that we received worldwide were almost too many that we could handle.
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Small team, absolutely small team.
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Um, but that was another huge advantage of going down there.
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We, we could have never done that in the United States, but cause Carlos was asked to participate, he thought highly enough of our technology to use it.
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And, um, it was just an awesome opportunity that we took advantage of.
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Beautiful.
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I'm so happy to hear that.
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And do you mind naming the city in Ecuador?
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Yeah, it's, sorry, it's
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Beautiful city, right by the water.
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Yes.
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Chance to the Galapagos, but that's, um, it's on my bucket.
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That's when I go down there again soon.
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Have you gone to keto?
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To keto?
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You know, we have not been to keto yet.
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Okay.
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Tito's in I city.
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Very historical.
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Yeah.
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So you fly directly from the US to gu,
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Miami, GU, four hours, five minutes to the hotel,
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Nice
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Hotel bar, and then
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.
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Great.
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Set up.
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Love it.
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I love it,.
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Alright.
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So Jeff, let's talk about your, your future plans in Latin America.
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What is it that you wanna continue doing in Latin America?
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Or you wanna do differently in Latin America?
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Yeah, I, I think our, um, our experience down there has been so good, um, that we plan to continue down there.
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Um, there are certain markets that are a little bit easier to navigate in regards to the regulatory environment, and we plan to take advantage of those opportunities.
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Um, we are in discussions with markets such as Venezuelan, uh, Venezuela, uh, Costa Rica, Brazil, um, Chile, um, and we, we intend on going down there very soon after our submission to the fda.
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So once, once we have all of our vnv work done, everything where we feel like, um, we're ready to pass the test here in the u in the US with our, uh, submission, we plan to be aggressive in Latin America.
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So we'll be attending a number of those countries.
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Um, certainly Columbia is also another country that we're interested in going down and, and working in because it'll be an opportunity to, to get a lot of more work done.
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So our goal is to, to get, you know, a hundred, 200 cases done down in Latin America prior to full commercialization in the United States.
00:16:57.081 --> 00:17:03.799
And as you can imagine, it gives us enormous advantages to our strategy to commercialize successfully.
00:17:04.599 --> 00:17:14.358
Um, and then once we get done with those, those cases in Latin America, we'll be a much more informed organization in regards to what this technology can do on a larger scale.
00:17:15.240 --> 00:17:26.640
Um, and then we plan to, to, to work on distributorships down in Latin America, because Latin America, um, for our technology in particular, um, could be really a game changer.
00:17:27.319 --> 00:17:38.009
Um, unfortunately the technology that we're looking to not necessarily replace, but to, um, to, to be a compliment to is very, very, very expensive.
00:17:38.108 --> 00:17:43.049
And unfortunately, uh, many countries have very little access to this technology.
00:17:43.930 --> 00:17:47.970
Uh, patients have to drive hundreds of miles to get to the main center.
00:17:48.730 --> 00:17:59.160
Um, and even then, it may be a long wait, um, to get in and we're able to provide the same technology at 10, 15% of the cost of traditional systems.
00:17:59.210 --> 00:18:04.358
So, um, you can imagine what kind of access that will provide to folks in Latin America.
00:18:04.839 --> 00:18:07.039
So we're really excited about the opportunity down there.
00:18:08.039 --> 00:18:11.640
Uh, we're exploring, uh, distributor ships down there that make the most sense for us.
00:18:12.319 --> 00:18:17.799
Uh, and when the time comes to, to fully launch in Latin America, hopefully we'll be prepared to take care of patients down there as well.
00:18:17.799 --> 00:18:18.880
Beautiful, beautiful.
00:18:18.881 --> 00:18:26.000
Have you had prior experience, uh, with regulatory approvals for commercial devices in Latin America, your prior company?
00:18:26.730 --> 00:18:38.799
So I do not, I do not have any of that experience, but again, one of my mentors in Latin America, um, has been, uh, very helpful and insightful in regards to kinda the regulatory environment.
00:18:39.160 --> 00:18:51.160
And he doesn't claim to be an expert either, but certainly having run Latin America for a couple decades now, he has folks that he relies on from a regulatory perspective that has given us a little bit of feedback here and there.
00:18:51.259 --> 00:19:00.799
And when I think when we're ready to, to launch down there and, and, and go through the process of each country's ministry of help, I think we'll be looking for experts like you, right.
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