If you’re not following Dr. Tom Oxley on LinkedIn, you may have missed his 8 part post over the weekend, fresh on the heels of announcing his company Synchron’s expansion into Parkinson’s and Epilepsy. I’ve reproduced and consolidated his words into one post below for easy reference moving forward.
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1/ Synchron’s thesis on Interventional Neurotechnology:
Massive unmet need – neurological disease biggest cause of disability globally.
Only proven procedural solution shown to scale is interventional.
Opportunity to positively impact millions of lives and for a $100B company to emerge (ie $10 billion revenue from 200,000 devices delivered annually)
(our thesis hasn’t changed from first patent in 2011. Brain Computer Interface is just the beachhead)
2/ There is a massive unmet need with 10s of millions of people with neurological disability in the USA alone.
A range of conditions can cause us to lose our ability to live independently. We can suddenly lose the ability to walk, talk, see and hear. Some of us live with a fear of unexpected convulsions. Some of us have trouble manipulating simple objects. Some of us simply cannot express ourselves. Despite being the largest cause of disability, Neurology has been considered the field where nothing can be done. This is the largest unmet need in Medicine.
3/ The history of interventional cardiology teaches how to deliver technology to patients at scale.
Delivering technology into the heart previously required open heart surgery. Over several decades, it became standard of care to access the heart using an interventional approach - with a catheter. Balloons, stents, pacemakers, ablation, valves – all delivered at scale in the cath lab. This enabled the field to scale from thousands of procedures, to now millions of lives treated every year.
4/ In neuro, no technology delivered using open brain surgery has scaled beyond fringe (~tens of thousands of implants per year).
Deep Brain Stimulation (DBS), despite being very effective, has not been able to grow more than ~ 10,000 procedures per year. The same fate has occurred for every technology requiring open brain surgery to be delivered into the brain. The technology can be very effective, but it cannot help enough of the people in need. Part of this is due to the scarcity of ORs dedicated to open brain surgery. Part of this is economics: the surgery is too expensive and is a money-loser for hospitals. Perhaps the most successful example is Cochlear, who despite addressing a massive unmet need, still have had trouble growing beyond ~30,000 procedures per year and decades on market.
5/ The only solution capable of scaling to meet the unmet need in neurotechnology is interventional: transcatheter.
The arrival of catheter-based stroke therapy in 2015 has been the biggest breakthrough in Stroke. Ever. It has led to an explosion of cath labs with neurointerventional physicians ready 24/7 to mechanically pull a blood clot causing a stroke, often urgently in the middle of the night. These facilities are now available at secondary level, community hospitals. The facilities are open during the day - hungry for elective procedures. There are almost as many neuro cath labs as cardiac cath labs now.
6/ Introducing: Functional Neurointervention.
This field will comprise three additional major technology domains: read / write / restore (monitoring / stimulation / prosthetics).
There are 12 million people in the USA affected by the top condition alone in each functional domains of neurotechnology. 3 million with epilepsy, 1 million with Parkinson’s and 8 million with paralysis. Active implantable neurotechnology products will use the blood vessels as the natural highways to reach all corners of the brain, and then engage with the neurons to help us live better.
7/ Opportunity to positively impact millions of lives and for a $100B company to emerge ($10 billion revenue from 200,000 devices delivered annually).
The opportunity emerges from the size of the unmet need, and the potential to scale into the hundreds of thousands of procedures. Interventional enables breaking through the ceiling of open brain surgery economics (tens of thousands of procedures).
8/ Interventional neurotechnology will grow to a larger field than cardiology eventually.
The heart is a mechanical pump with a simple pacing circuit. The brain is the most complex electrical organ on earth. We are at the beginning of a renaissance in treating brain disease and preserving human autonomy.
What questions, reactions, or thoughts do you have about this market outlook?
What do you want to learn more about related to Synchron or implanted BCI?