#386 Podfather

September 25, 2020Scott Benner

The Pod Father

John Brooks is the father of a type 1 diabetic and the guy who developed the Omnipod.

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Scott Benner 0:08
Hello friends and welcome to Episode 386 of the Juicebox Podcast. Today, I bring to you a conversation with john Brooks, one of the men who sitting on an airplane over 20 years ago, conceived of and dreamt about, for the very first time, a tubeless insulin pump. Eventually that pump became the Omni pot. And this is the story of how it came to be. John's the father of someone who has type one diabetes, and

Unknown Speaker 0:39
he tried to figure out how to help

Scott Benner 0:40
a long time ago when his son was diagnosed. This is what came of it. It's kind of crazy, right? While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan, or becoming bold with insulin. John's actually been involved in a lot of things around type one diabetes, we'll talk about all of it. But my initial reason for having him on was to learn about the birth of the Omni pod. An interesting idea, isn't it? Just something didn't exist? And then it did.

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John Brooks 4:55
Yeah, it started instantly. In fact, it's funny I was just on the phone like 10 minutes ago with, you know, my co founder and partner at prism, Dwayne Mason's. So we were just literally talking about that 20 years ago, 20 years ago in May 2000.

Unknown Speaker 5:11
Yeah. And now

Scott Benner 5:12
everything is getting ready to. I mean, I don't know how to think of it, they're gonna take the thing you guys made and supercharge it, right. Like, it's, it's getting ready to take a leap, don't you think?

John Brooks 5:22
Yeah, well, you know, I think, you know, if you think of the world that, you know, we started in, it was a device, right, a glucometer. You know, that? Well, a glucometer, you know, was then gonna drive an insulin pump. And now you look at it, you know, it's the whole closed loop, it's the automated insulin delivery capability. But I think what's most important is the fact that it's less about the device, it's really the data, and it's the use of that data to drive better decisions, better clinical outcomes. And I think, you know, with COVID, and the way healthcare has changed, you know, people want to be able to kind of get health care in their terms, you know, they don't want to feel like they have a job to manage your diabetes, but you know, the more of the burden we can take off of them, they want in today's environment, you know, people are more prone, they don't want to go to the doctor's office, they don't want to go to the clinic, they don't want to go to the hospital, you know, that they want to be able to, you know, get help and coaching and support for managing their diabetes, but on their terms, and, you know, I think that's the beauty, whether it's insulin or others, I mean, you know, really leveraging the data, the analytics, the ability to basically determine, you know, trends to be able to look at time and range to be able to look at, you know, where there are any hiccups, or, you know, risks of hypoglycemia. So, you know, it's kind of the evolution of healthcare that, you know, if there was a silver lining to COVID, its accelerated, you know, all this virtual care, remote care, connected care, you know, much faster than, you know, it would have happened on its own, it was pretty, pretty slow. And now it's, you know, changing dramatically.

Scott Benner 7:08
So in the beginning, really, the, it's about, it's a tool, and the tool is the whole, it's the whole story. And now really, the tool is just the way you take the data and and make the decision. And then you don't have to go back to the doctor who would look at whatever data you had, whether they were finger sticks, or log books or CGM graphs, as time goes on, and say, Look, I think you should turn this knob here make this small adjustment. Now the data kind of understands that for you, I guess.

John Brooks 7:34
It's Yeah, I mean, you know, it's pretty much I don't want to say autopilot, because we're not quite there yet. But the idea is that, you know, the algorithms, you know, the systems get to know you, they get to understand, you know, kind of what, you know, what you do, a lot of people tend to do similar things day after day, whether it's their eating or whatever. So at the end of the day, you know, the devices are going to become smarter and smarter and more predictive. And they'll try to determine not only what the right insulin dosing is, but, you know, based on your prior history, you know, based on what they've been able to track, you know, they can almost anticipate, here's what's going to happen, and, you know, kind of get ahead of the curve. So, you know, I think it's the power of AI, it's the power of analytics. And then to your point, you know, you know, in the early days, I remember at jocelynn, you know, you'd have doctors having to look at, you know, printouts from all the different flavors of bgms, there was, you know, a few folks on CGM, you know, you had some ability to download data off of a pump, but none of it was connected, none of was integrated, none of it was aligned, you know, there was no even understanding of the dates on all the devices were the same. And obviously, everything got shifted every twice a year when there was daylight savings time. So, again, I think we've come a long ways and, you know, more to go because, you know, the sad part is, despite a lot of great technology advances, you know, we still do not have enough people with diabetes, especially people on insulin, you know, meeting their objectives, you know, getting their time and range. I mean, you know, and again, I think it's an appreciation that, you know, despite the fact we're making advances, you know, there's more to you know, managing diabetes and just tracking blood sugars, you know, standing now more about stress, understanding more about sleep habits, understanding more about, you know, the food, we eat, nutrition, and even the whole behavioral mental health aspects of diabetes. So, so the good news is, you know, I think we're getting smarter. I think we're getting there. But you know, like anything else, it just doesn't happen overnight. Yeah.

Scott Benner 9:50
Well, let's kind of walk down memory lane for a second. So tell me a little bit how you How did you come to this and like you were saying before, like, I guess that kind of Concept wasn't as much about the pot at first as it was about, just take me to the beginning, like, what were you doing when this happened? Yeah.

John Brooks 10:06
So, um, if I kind of walk back 28 years ago, or then three year old son was diagnosed with Type One Diabetes, okay. And certainly, you know, no real, immediate family history, you know, I didn't quite understand how that came about. And we were living in Colorado at the time, I was working for Pfizer, on their device business. And, you know, I decided that, you know, I need to try to understand, you know, diabetes, both type one and then eventually type two. So, you know, as my career and life advanced, you know, diabetes was always an important component. And, you know, when I, you know, when Pfizer ultimately divested themselves from all the device businesses, they were in, I came back to Boston, I was a co founder of a venture capital firm, called prism, venture partners. And, you know, that's really what I said, in the early days, you know, you know, we were looking at, I was looking at, you know, companies that we're trying to work on, you know, non invasive glucometers, you know, people are trying to work on, you know, how to determine glucose, you know, in a very effective way. And, you know, and then, you know, as I said, you know, a little more than 20 years ago, you know, my partner and I were on a flight coming back from the west coast, and I was describing, you know, the challenges with, you know, trying to figure out insulin insulin delivery, and, you know, the problem with the existing, you know, pumps as they were back then, you know, with the tubing and the priming and the all the issues, and, you know, we kind of brainstorm that entire five hour flight, you know, and thought about, you know, how do we come up with a, you know, small, disposable insulin delivery system and the disposability happened to come out of a nother deal that we had done leveraging technology out of Sarnoff Corporation, which is where the RCA color TV was invented, if you will, and they had an interesting technology for a disposable hearing aid. And, you know, that's another whole story, I won't get down there. But, you know, we had the idea that disposability could be a very disruptive innovation, the idea is that every three days, someone puts on a new pod, you know, we knew we could, you know, hopefully do that in a very cost effective way, eliminate all the problems with the two meeting and the priming. And so you know, that that's kind of where the idea came from. And, you know, we got off the plane, the next day, we called up our patent attorney and said, Hey, we have this idea for a disposable insulin delivery system. And he said, Hey, no one's ever thought of that. And, you know, we got a whole bunch of IP, and then we went to our, you know, fellow partners in prison and said, Hey, we want some seed money, to kind of flesh out this idea of get it off the ground. And, you know, we did that. And, you know, we hired some people that had worked for us beforehand, we set up shop up in Beverly, Massachusetts, had a couple people and pretty much told them, you know, in the early days, just think about all the ways you can do this, think about all the ways to create an IP position, you know, and then little by little, we, you know, had more ideas, we had more IP, we had more prototypes. And then, you know, we went ahead and started to, you know, put together a management team, you know, build on the engineering team, and, you know, little by little, we brought other investors in, and, you know, here it is what, you know, 20 years later, you know, very successful in a multi billion dollar market cap company that, you know, continues to drive innovation, but that, that was kind of the germination of it. And then, you know, as I said, you know, and most of my career since then, you know, continues to be very heavily involved in diabetes. I had the opportunity, I guess, was probably about eight almost nine years ago to run the Joslin Diabetes Center as CEO. So, you know, somewhat unusual to have a fellow that I'm a UMass Amherst, graduate, undergraduate, and accounting, finance and systems. So, you know, you can see I learned enough over the years to be dangerous to be able to run a leading academic and medical research Education Center. But again, you know, it was part of, as I said, 28 years ago, I was bound and determined to try to understand, you know, how did my son get diabetes? And, you know, is there an opportunity to think about a cure and then, you know, as I get further involved, you know, came to appreciate that, you know, certainly type one is a challenge, but, you know, the whole epidemic, you know, I used to call it a pandemic of type two diabetes. with, you know, close to 400 and 60 million people around the world. So, anyhow, I could go on and on. But no,

Unknown Speaker 15:05
it's amazing how it came about.

Scott Benner 15:07
I'm wondering how, how long after you, you you take that plane ride? Are you holding a prototype?

John Brooks 15:14
It's a good question. Um, it was probably, yeah, I want to say probably nine months to a year, I mean, because, again, we spent a lot of time I mean, you know, we probably had some drawings and ideas, but, you know, we wanted to really think about the intellectual property to make sure we had a good patent position, you know, we wanted to make sure that, you know, we had a clear understanding that whatever we did, you know, we needed to have a, you know, kind of a novel way to engineer it, because, you know, most pumps have a motor. And, you know, you're thinking, if we have a disposable device, that, you know, we said, Hey, this thing's gonna have to, you know, cost less than, you know, I think it was, I don't know, maybe 15 $20. You know, and we said, well, you know, if you put a pump in there, you know, that's not going to do it. And then, you know, we thought about how to, you know, basically deliver very precise amounts of insulin. And in fact, kind of interesting enough, you know, we went back to sawn off and said, Hey, here's our problem. And they actually come up with the idea of a heated wire, which basically, is the mechanism that enables when you heat the wire it, you know, stretches and shrinks, and that ended up being kind of the mechanism to deliver the insulin very precisely, and in a very cost effective manner. So lots of, you know, as I said, I'm sure we have prototypes and ideas along the way, but, you know, it was more important to make sure that not only did we have a great design, did we have a design that was really gonna, you know, work, especially for kids and others. You know, we used to call it hassle free. So we didn't want priming, we didn't want to being, you know, we wanted to have a very easy way for the canula to get placed. So you know, it was iteration and it took, you know, it took a while, and then you got to figure out, you know, how to really make sure it works, you figure out what the regulatory requirements are? How do you make sure how we get the insulin in? How do we make sure that, you know, we can communicate, so, you know, lots of lots of steps along the way. So it doesn't happen overnight, and I took a really long process it were

Scott Benner 17:27
there points along the way, where you thought, we'll just get this to a certain point and sell it to somebody else. Did you ever think you were gonna be the company that made the pumps and sold them?

John Brooks 17:37
Well, I, you know, I think we did, you know, you know, we thought, Hey, this is a very, you know, novel idea. And, you know, we felt good about, you know, as we did some early interaction with, you know, customers and focus groups. And we had, I think, from the very beginning, you know, thought about the fact that this was the type of product that would lend itself to high speed automation. I mean, we actually thought, you know, at the time, we had set shop in trying to think where we were Bedford, I think, at the time, and after we left Beverly, where we started, and, you know, we had the idea, hey, we're gonna have a light sound factory, all these pumps are going to put to be put together by robots. Right, you know, and, you know, and then, you know, in some ways you go full circle, I mean, a lot of what takes place today, both in this great new factory that insulin built up in Acton, you know, a lot of automation, you know, lots of ways to produce, you know, massive numbers of pumps that are high quality. But you know, the answer your question, you know, I think we always stopped that, look, you got to build a great company, and maybe along the way, is someone likely to look at it. I mean, you know, what a Medtronic would somebody else say, Hey, this is interesting, but, you know, at the end of the day, I think we said, let's, let's do this, and I remember, you know, some of the greatest moments, you know, when I was a jostling member, we had a lot of Jocelyn had the Joslin camp for boys out in Oxford baths, and it was right next to the camp for for girls, but you know, seeing all the kids, you know, with their pods on swimming in the pond, I mean, that was pretty neat. Because before that is you know, you know, you're gonna disconnect your pump, you're gonna take it off, you know, you can't get it in water if you're using a traditional, you know, to pump and all so, you know, so I think we were always motivated by the fact that hey, this is a better way to help not just kids but families and people that want to get insulin and you know that they want to do it in a way that you know, it's discreet, it works for them. And they don't have to worry about all the hassle that you know, some of the other two pumps, you know, have gotten better but still exists.

Scott Benner 19:57
You know, my daughter has been wearing it on the pod every for 13 years, so, I'm completely aware of the just the benefits of just having your basal insulin while you're in that pond, you know, so amazing as before,

John Brooks 20:10
you know, kids would take the pumps off, and you know, it's a hot summer day, and maybe they even put them under the towel. But you know, the pumps are getting warm, and you know, maybe they're not wearing them for a certain amount of time. I mean, at the end of the day, that's just not good therapy. Right. Right

Scott Benner 20:25
now, it's 100%, I actually, I, I've been through the new manufacturing facility, I've taken that it's amazing, right? It's unbelievable, just astonishing what they accomplished. And, and watching it happen. And like you said, like, you know, things are kind of moving around automatically. And it's, it's not, and I don't think the precision is, is considered like, I want to try to understand without getting too like geeky and technical, you're telling me that inside of that pod, there's not a pump sending the insulin through the kanuma? It's,

John Brooks 20:57
yeah, so it's basically a mechanism that emulates a pump, but it's not a traditional pump with a motor and all. So, you know, so it's a different approach. And, you know, and I'd say, that's really the other, you know, key thing about, you know, being able to produce the number of pods that are needed, you know, where, you know, replacing them every three days. And so, you know, I think the other important thing was to, you know, put a lot of focus on dimensions, tolerances, the tooling, I mean, you know, that this is a product that, you know, that the tolerances are critical, the, making sure you're working with the right vendors, the vendors deliver the right product, and, you know, because we did have, you know, in the early days, you know, there was always a little bit of a concern about, you know, could we, you know, batch the batch consistency, you know, in the early days, we used to joke, we were shipping dollar bills with every pump, you know, because we didn't have the volume, we didn't have the scale, we didn't have the full economic benefits. So, but, you know, that's part of the learning curve. And then when we, you know, that they went to a generation to, you know, which was smaller, more precise, and more, you know, kind of cost effective, you know, that there were some hiccups in the early days, when, you know, you know, things don't quite go the way you expect, then, you know, you just kind of work through them, and hopefully, you know, convince your loyal users that, you know, Hey, sorry, and, yeah, we'll send you some replacements Hang in there. But, you know, the good thing is, I think that's all behind the company now. And I think now they're focused on, you know, kind of what I'd say is there, you know, Gen five product, they've got dash, they've got horizon. I mean, there really, as I said at the beginning, you know, recognizing that it's no longer just about delivering insulin, but it's the context of you know, doing it in a way that understands how that individual was living there live understanding, you know, kind of what their you know, smart CGM and other devices are saying and, you know, optimizing, you know, what their requirements are, so they're staying in range, they're avoiding hypose and hyper Roisin in their care team can continue to kind of fine tune, you know what they're doing. Did you

Scott Benner 23:23
are you still involved or did you eventually sell your share? Or how did how does that

John Brooks 23:27
Yeah, so when I went to the Joslin, you know, I just made a conscious decision. I think it was certainly the right one. You know, maybe not economically, but I i divested all my shares I you know, I just because we were doing some things and, you know, if you're the CEO of a not for profit with the prestige of Jocelyn, I just didn't want to have any perceived conflicts and also, right. So, you know, I'm happy to say today, I'm still an owner, but, you know, I pretty much you know, divested everything for the five years that I was running Joslin, I say, okay,

Scott Benner 24:03
Oh, alright, that's what we wanted the president to do, that he didn't do is that we were saying that that whole, like, you just sort of take yourself not to be political, but you.

John Brooks 24:11
Look, it's the right thing to do. I mean, you know, if we were doing some work, maybe some of the doctors at Joslin, which they were were doing different, you know, studies or, you know, clinical trials. Yeah, you could argue, well, I don't have anything to do with that. But it's appearances and it's really good governance. And frankly, you know, I think it's just having a good moral ethical compass. So, you know, was I going to influence results? No, but you never want to have even the suggestion of impropriety. And I just said, Look, this is the right thing to do. Right? That's excellent.

Scott Benner 24:45
Oh, that's very cool. So you're still you're still involved that and you're so you're an owner at this point still?

John Brooks 24:50
Well, I'm a shareholder share with you know, a small one. Other people yeah, there's

Scott Benner 24:55
you're saying somebody else is listening. This right now going? I have way more than john does.

Unknown Speaker 24:59
Yeah.

John Brooks 25:01
I'm sure every major, you know, you know, public equity fund out there, you know, mutual funds, but now I'm happy to, you know, be involved that in, you know, full disclosure, I have a stock holdings and other you know, diabetes companies because, you know, you know whether it's on the CGM side or it, you know, looking at pumps in and I work with, you know, a lot of young companies that are working on, you know, what I call the next generation solutions, whether it's new new insulins, whether it's a new type of CGM, there's some companies working on, you know, new pumps, the company's working on defeating the auto immune system, companies working on you know, better real time insulin type tration, and people with type two, so, about 80% of what I do, you know, these days is still, you know, helping, especially young companies, and I'm either doing it as the chairman of the board, board member, advisor, consultant, you know, trying to make sure that, you know, what I've learned over the years, and, you know, how can I help them turn themselves into a successful company that is going to further help people, you know, with type one or type two to, you know, live better, healthier, safer lives? That's cool.

Unknown Speaker 26:18
How old's your son now?

John Brooks 26:20
My son is going to actually turn 31. Next month, so just a few weeks away, he works for this company called livongo. I know Yeah, sure. heard of them. He was literally one of the very first people there. In fact, he was with the predecessor company called EOS health. So he's based out in Chicago has been with them, you know, I guess it's been eight years. And, you know, he manages their sales effort in the Midwest. So I guess he's had another, you know, I think, opportunity, he has type one. But, you know, he devotes a lot of his time to, you know, help lavon go get, you know, solutions for self insured employer employees who need help with diabetes, and now they're moving into hypertension, weight management behavior, et cetera, et cetera. And, you know, they went public, and now they're, you know, being acquired by teladoc. So, he's keeping busy, but he's pretty excited that he made a good career choice when he graduated from college, I have

Scott Benner 27:26
to ask you, I'm not sure where you're gonna go with this, but does he wear an army fine.

John Brooks 27:31
So he doesn't, you know, it's interesting,

Unknown Speaker 27:34
all this effort that you put into it.

John Brooks 27:37
But you know, at the end of the day, and I'm sure you might even know, with your daughter, you know, what, you know, it's their live, it's their decision. And, you know, and again, he, he's always been a fan. He's talked about it, but you know, just one of those things where, you know, I don't know why it just didn't fit his schedule, or didn't have the time. So at the end of the day, he may, but you know, today, he's not on it, but it's not a sign that he doesn't believe in, it's just, you

Scott Benner 28:07
know, no, I don't think that hey, listen, on the pod has been a sponsor of this podcast for since the beginning for many, many years. And I always tell people, the same thing, get a demo pod, try it for you, or it's not, it's you know, there are other insulin pumps, you could you could do MDI, you know, get an in pen, there's 1000 things you could do. Yeah,

John Brooks 28:28
the real, the real key is to, you know, use a use technology in a way that works for you. You know, and obviously, you know, whether it's a you know, CGM with a pump, and you know, the idea of this, I think people realize, you know, that, you know, all of a sudden, they're, their lives are better. They're, you know, they're in range. They don't have the glycaemic excursions and, you know, and it fits into their lifestyle. So I think that's really the key, we get up. You know, I do some work with the ADA. And, you know, we had a discussion recently with insolate. Just, you know, kind of getting to know each other up. Bob gubbay is the new chief medical officer, Chief Scientific Officer for the ADA, and he was on the call, I had hired him at Joslin, so he, he's a great person, but the whole idea is essentially just, you know, I think an appreciation that, you know, people that have been on MDI, you know, maybe just thought luck pumps are too complicated. They look like they're, you know, not going to work for me. And, you know, obviously, you know, I think once to your point, they try them. Also, they realize they're pretty straightforward. And, you know, and I think, you know, companies are sensitive to making sure that, you know, they're affordable and, you know, that they work for people. And again, I think the payers, you know, the insurance, I think, you know, understand that they're cost effective. I mean it wasn't too many years ago where, you know, you had to jump through hoops to justify Someone get a CGM or even a pump, you know, but, you know, the good news is the data is there and the values there and, you know, the world's, you know, continuing to evolve.

Scott Benner 30:10
What was the most difficult if there's one difficult part of getting the AMI pod to market? Was it the, the function of it and the mechanics of it? Or was it the FDA? Or is it insurance? Like, I guess?

John Brooks 30:26
It's a good question, you know, part of it, you know, I would say is just, you know, a disposable pump, you know, took a little while for people to get their heads around that I remember, we had some people saying, that's a stupidest idea I've ever heard of, I think the regulatory path, you know, we went through it, but I think, you know, I'm, you know, I spent years you know, kind of, uh, you know, working at Pfizer, you know, really a lot of device companies, you know, I do a lot of biotech and other things, but, you know, still know, the device base. But you know, my partner Duane knew that. So, you know, I think the key is, we weren't all that concerned about the regulatory, a big part of it was reimbursement. I mean, you know, you have to go kind of payer by payer across the country, you know, we kind of started in New England, and, you know, kept going west, to get payers to agree, you know, because it's a different approach. I mean, everybody else, you have this upfront investment for the pump, right. And then you have all the disposables. And in our case, you know, we were kind of turning that upside down, you know, it's really a subscription model effectively, and trying to get, you know, payers to understand that, how did it fit into their reimbursement, you know, even the federal government, you know, would say, you know, if you're on Medicare, you could only get, you know, one pump every four years, well, if you're getting a new pump every three days, and, you know, just things like that, I mean, sometimes the way the reimbursement was set up, but just, it didn't understand that, hey, this was a very different form factor, economic value proposition and, you know, you had to get people comfortable with and, and then they had to understand, you know, at the end of the day, you know, if you looked at it over four years, you know, versus the cost of a traditional pump, you know, they're pretty comparable, but, you know, when you're first starting off, you know, people there will, how does this work? And that's not the way we do it, and, you know, so that there was just a lot of, you know, pioneering and, you know, I think the other part of was just, you know, understanding the manufacturing, you know, despite the idea that we thought it would make sense to have this great lights out factory. You know, we realized that, you know, we needed a different solution, in fact, you know, ended up getting involved with Flextronics, you know, and, you know, leverage their expertise at high speed automation, and, you know, ended up setting up some, the supply chain, you know, generally in China, because, you know, we wanted to, you know, make sure our economics worked. And now, it's ironic, it's kind of coming full circle, back to the US, but so, you know, getting that manufacturing and getting the cost of goods sold was something that we always, you know, spend a lot of time on, because you don't, you know, you don't have a good business, if you're, you know, losing money on every shipment, but you've got to have the volumes, you have to have the, you know, sufficient economics to support, you know, getting the cost per unit down. And so that took some time.

Scott Benner 33:34
Who's gonna say, even understanding, hearing you talk about having to go state by state and explain to payers like, this is how it's going to work. And, yeah, I know, this isn't what you usually do. But this is this. I've had those conversations for my daughter, and back in the day, you'd have to get on the phone. Every time you reordered and say no, no, listen, listen, I know we just got a pump. That's not when then you'd have to re explain it to somebody was fascinating how many times I've done that.

John Brooks 34:00
Yeah, no, and you know, the if you think on the CGM side, I mean, you know, I remember in the early days, you know, payers reluctant to allow someone to have a CGM a reimburse them for it, you know, because if their numbers are in pretty good shape, you know, they say, well, you don't need a CGM. Or maybe you don't need a pump. And then the whole idea was, well, you almost had to have people deliberately, you know, mess up their diabetes management for 30 days to show that while you're not in good control, therefore you should get on I mean, if you think of the absurdity of that, yeah, but you know, that was part of it. And, you know, we used to have a lot of our great doctors that Jocelyn I mean, spending more time on the phone with insurers, you know, and even silly things like you know, why does someone with type one Why do you need to check your blood sugar's whether BGM you know, eight times a day what just do a two dads What are you doing? I mean, just absurdity.

Scott Benner 34:57
Ya know, the lack of understanding it permeate pretty much.

John Brooks 35:02
You know, type one versus type two. I mean, you know, a lot of people just still don't fully understand, you know that. Yeah, it's diabetes. But you know, it's a very different mechanism. It's not like if you have type one, avoid sugar, you're going to be great.

Scott Benner 35:16
It's I just was speaking with a person last night Whose child is more newly diagnosed. And this podcast, john, which you probably don't know anything about, I take great pride in it. It explains to people, among other things, how to use insulin, and my daughter is a one C with the dex comment on the pod is between five two and six, two for over six years. Now, she has a great diet restriction. She's doing terrific. I talked about what we do here, it seems to get to people in a way that they can understand it and replicate it for themselves. So I'm talking to this person, and she's like, I don't understand, why does my endocrinologist not understand? Like, why am I talking to you? And not her? And I said, I don't know. I don't I don't know what to tell you about that. But it just, it's what you it's what it made me think when you were talking through it, that most people would hear this and think, well, how could an insurance company not understand what diabetes is? or How could you know? And the answer is, because people don't, you know,

John Brooks 36:12
I mean, they, you know, and again, nothing against the people there. But, you know, anytime you bring something new or a different business model, different approach, you know, it doesn't kind of fit the traditional, you know, scheme, and you got to educate them, and you got to do the analysis, and, you know, uh, you know, they just tend to be a little bit change resistant, right?

Scott Benner 36:35
Yeah, you fall into something that you're comfortable with. And it works, whether you're a company or a person, and you stop being stop having reasons to wonder about other ways to do things. So exactly, you come along with this little pod, and you're like, Hey, listen, this is the way to go. And

John Brooks 36:49
that's like, what do you mean it after three days and throw it away? Like, why are you throwing it away? Right? That's designed that way. That's what it's for. Exactly.

Scott Benner 36:58
It really is. So if you if you can't say or you shouldn't, I'm not sure. But I've forever want to understand, while you know, you get your pot out, you fill it up it Prime's take off the needle cap, you put it on, and you say Go ahead, insert it, and then there's this clicking that is sometimes four times it clicks, sometimes it's five, sometimes it's six, and then, you know, blink of an eye, the candle is in, in my estimation, it's always been that something fires. A needle that's wrapped in a candle and the needle comes out leaves the candle behind, but is it not functionally firing? Is it tension? How does it do? Are you can you tell me how it does that?

John Brooks 37:40
Yeah, you know, I don't know what it does today, it's probably different than it was. But, uh, but I think your points accurate. And the whole idea was to get rid of needle phobia, to be able to have a very simple way to your point to deploy a Candela, you know, with a needle that would place it properly, and then, you know, disengage itself. So all you had was the candle lit to deliver the insulin. So yeah, I mean, I mean, I don't want to speculate, because I'm not sure how it works today. You know, the idea was to basically, you know, deliver it in a way that, you know, it would get into the skin at the right level, you know, and, you know, not caused any bruising or hypertrophy. I mean, there was a lot of work that went into the, you know, the needle design and the, in the shape and the insertion, pressure force, whatever you want to call it. So, but yeah, I'm probably, you know, it's been a while since I've looked inside one, it prompts me, I probably have an old one around here, I should look into

Scott Benner 38:38
I'm now wondering about the the day in the office where somebody was, like, I put it on me and push the button, and let's see what happens. That's how many how many people do you think in total? Were there in the beginning?

John Brooks 38:52
Well, in the very beginning, you know, there were two of us on an airplane. Right. But then, you know, we ended up as I said, we we had a team, we were up in the Cummings facility in Beverly mass, you know, after we have put our partners that put some seed money in, you know, we hired a guy that, you know, really brilliant in terms of, you know, just looking at the entire intellectual property landscape, you know, were there any other patents? Was anyone else doing anything? You know, and how would we, you know, think about creating the product? How would we think about, you know, what type of plastic what type of, you know, materials, you know, we thought a lot about, as I said, quote, unquote, the pumping mechanism, we thought a lot about the canula and the insertion mechanism, and, you know, what the battery life is and how to make sure that, you know, those accuracies, so in the early days, you know, was a bunch of really bright people, probably more engineering, you know, you know, folks had new devices, folks and new IP folks that understood we had to be able to make this thing very cost effectively and You know, you're kind of designing it and building it on the fly. And, and then, you know, we reached the point where, you know, I think we felt we had a good plan, we had a good business plan, we hired a fellow as our CFO who eventually became the CEO Dwayne to Cisco. And then, you know, we, as the company advanced, you know, we brought more money in, we brought in other venture partners, our our team continued to support it. And then, you know, we ended up getting, you know, new space, we left Beverly in, you know, we started to hire more, you know, a larger team, you know, in terms of, you know, recognizing that, you know, what do you need to have in, in, in addition, engineering, you know, you got to have people that are, you know, working on the supply chain, you got to have people that are working on, you know, understanding the whole regulatory process quality process, you know, starting to think about reimbursement starting to think about, you know, packaging. So, you know, you start building a team, and, you know, that took place over you know, a number of years, we go from kind of a, an idea that we had to you know, starting to think about, you know, what it should look like and again, just simple things, like, you know, what type of plastic and what type of plastic you're going to mold and what's the shape? And how much stuff can you fit into it and still have it work, but not be too big. And, you know, just lots of, you know, iterations that you know, you get a team and then you start getting people thinking about, how do you market it? What are we going to call it all that stuff, right? You know, in the early days, we used to call the op,

Scott Benner 41:42
it must be crazy to be a startup in a space that is, like, you know, pharma and device manufacturers, like bigger companies like Indy, you're sort of just these, your two guys coming off a plane and putting together things, by the way, the company still has a really good vibe, you know, throughout it, you can tell what the, as you're explaining what the roots of it are, it doesn't surprise me. Because I think it's grown in that direction.

John Brooks 42:07
And it's pretty neat. I mean, every now and then, in fact, at the last Ada meeting, not the virtual one, but, you know, My son was with me, and, you know, we were kind of walking the floor and, you know, went by the booths. And, you know, it's kind of one of those funny things where, you know, a couple of people start putting the dots together, wait a minute, you're the father, You're the son, I mean, yeah, you know, all sudden, they realized that, you know, we were kind of the, you know, that the, you know, My son was the inspiration and, you know, I was one of the co founders, every I kind of needed it, and again, you know, still having that, you know, you could call, you know, kind of that entrepreneurial spirit and, you know, really thinking, you know, what, I always like to think of disruptive innovation. And, and again, you know, I spent, especially back in those days, you know, most of my career was in the device world, I, you know, had ran a couple of businesses for Pfizer, and one of them was actually a company that had infusion pumps, and, you know, so, you know, we certainly knew a lot about, you know, delivering, you know, whether it's insulin or other drugs knew a lot about, you know, device manufacturing, regulatory, you know, so, anyhow, you leverage all that. And, you know, at the end of the day, you hire bright, smart, capable people who, frankly, thrive in a small company environment. I mean, you know, in a small company, I mean, you know, forget about your title, everybody's working hard. Everybody's working late, everyone has a passion for, you know, doing what we're doing, because we're going to improve the lives of people with diabetes really have honestly, hey,

Scott Benner 43:42
listen, is this to ham fisted? Or maybe this happens all the time. But do people call you the pod father? I mean, I've never heard anyone call me that. Well, then I'm doing it right now. Because that seems like an obvious pun. I mean, honestly, and, and, and what a, what a, what a, what an absolute parenting story, it is to like, you're like, let me do this thing for you. And you do it and you build this entire thing for it at the end, like, that's nice, but I'm not gonna use

John Brooks 44:12
it. And again, you know, he may very well you know, decide at some point he wants to do it. Yeah. And again, you know, he's a, he's doing great things in the world of, you know, helping employers and payers and all help their patients with diabetes. And now hypertension, weight management, as I said, it's really nice soon, you know, to be, you know, part of Tella Doc, which takes it even to a bigger stage.

Scott Benner 44:37
I'm having. I honestly, the experience that we've had with my daughter, doing telemedicine over the last number of months, I think has been an incredible improvement over what we had been doing prior to that, honestly, yes,

John Brooks 44:50
I agree. I mean, if you think of it, I mean, you know, and I did some piloting a Jocelyn. I mean, this is many years ago, and, you know, it was hard to get Add, you know, great clinicians, but you know, they were just used to, you know, meeting people in their, in their office, if you think of diabetes, I mean, it's the best, you know, way to treat people, because what do you do physically, you don't really need to do anything. There's no procedures, you're, you know, helping people and the diabetes nurse educators and the dietitians. And so but, you know, before we had to do it with COVID, you know, it's just people are convinced that you have to do it that way, right? Now. And in some ways, you know, it was just the, you know, people were resigned to the fact that I'm going to spend an hour to drive in the Boston, I got to spend 4050 bucks to park, I'm going to sit in the waiting room and wait, because this is a, you know, global leader and all the clinicians or bright and busy and, you know, that's the price you get to pay. And, you know, now if you said, hey, let's go back to that, you know, people there Nope, not gonna do it.

Scott Benner 45:57
I don't think that anything's been more gratifying in the last three months and sending an email to somebody and saying, hey, my daughter has hypothyroidism, too. And saying, Hey, I think Arden's a little hyper right now. And she fat and she emails back a script, we get a blood drawn, the next day, they move the tiersen down a level, and it's it's done in 24 hours almost. And before, like you said, get an appointment come in, take a day off from school, like all this other stuff to maybe get an answer in a month, if you're lucky. Really,

John Brooks 46:26
it's a it's a change. And again, I think it says we're saying I mean, I think diabetes lends itself to you know, having smart devices, analytics, AI and the ability to basically let the care team, you know, monitor from afar, how people are doing and make sure they get the right coaching, the right encouragement, you know, but but the idea is essentially, make the lives of people with diabetes easier, and take the burden off of them and, you know, give them an opportunity to basically live a, you know, healthy life and, you know, avoid, you know, the, you know, what, what used to happen, you know, was people developing complications, and, you know, not that they don't exist, but you know, I think we're doing a much better job of, you know, making sure we get ahead of the curve and not waiting for someone to have, you know, eye problems or kidney problems or vascular problems. I mean, the whole idea is, you know, a keep people in range and keep the excursions in, you know, don't let things get to the point where, you know, the the problems start arising.

Scott Benner 47:34
Yeah, you have to be proactive for certain I have two last questions for I thought I was only gonna have one, but now I have to because of your time at Jocelyn, how do you? Or do is it obvious to somebody like you that there's an issue with clinicians not understanding diabetes, as well as the people who have diabetes? And how do you speed up their understanding so that they can help newer people?

John Brooks 47:58
Yeah, no, it's it's a great question. And look, you know, whether it's Jocelyn or other place, Sherman just very talented individuals. But, you know, you know, especially a place like Joslin, you know, part of the Harvard complex, I mean, you know, academic medicine, you know, people are brilliant, but you know, there tends to be a lot of clinical inertia, you know, they want to see data, they want to see papers, they want to see peer reviewed journal articles before they fully get on board. And the other part of it is, you know, I think, you know, they're busy people. And, and, you know, as much as they're going to keep up with all the new developments, all the new information, you know, it just, it takes a little while and, you know, but but I think today, you know, with a lot of, you know, capabilities built into the electronic health records, you know, there's ways for, you know, clinicians to be able to, you know, get a better handle on how this individual is doing, what are the other potential comorbidities or factors that are going on? And then, you know, which is the right approach? And, you know, if you have type one, you know, what type of devices and, you know, do I still think about putting you on some sort of, you know, Sdlt, to inhibitor, I mean, so, but, but, but the issue is, I think it was just, you know, busy people and, you know, just trying to deal with all the stuff they had to deal with, and then after they get done seeing patients, make sure they put all of their information into the, you know, billing systems, so the bills could go out on time. And so, you know, I think it was just easy for people to kind of get into a, you know, I don't have time to think I just got to react. And so, you know, now I think it's easier with, you know, as we said, with kind of the whole virtual care, you know, I think it's just easier to be able to focus on for an individual, you know, what, what is it that we should talk about during this time we haven't, you know, that the doctors don't have to spend time kind of reviewing or trying to make sense on the fly out of CGM plots, and, you know, now that the information is there, it's more a question of helping, you know, determined for that person with diabetes, you know, what's the best way to, you know, help you even further improve? And, you know, to be there, you know, if people are still struggling, you know, because it's, you know, there's still challenges on the board of the college diabetes network Chairman there, and, you know, we spend a lot of time if you think of it, college students, you know, dealing with diabetes in this environment, you know, virtual hybrid classes, and, you know, the whole, you know, sided diabetes around depression, and, you know, behavioral health and also, you know, so in some ways, you know, life is getting easier, but life is getting more complicated, right, right

Scott Benner 50:48
now, it's interesting, I just have, I have such a personal experience over time, where it's gonna sound crazy, but I could sit down with you in an hour and explain diabetes to in a way where you would just understand it. And you'd, you'd be able to put it into practice, I've practiced for a decade or more writing about it and talking about it and, and just when you see someone struggling, who has great care, what really is considered great care. And then they come along, I mean, think about it, really Jimin, they come on and listen to our podcast, and then all of a sudden, they're like, Oh, I understand now. And then they're often there. Okay. It feels like there's a disconnect somewhere in between that, you know, what I mean?

John Brooks 51:26
Sometimes, you know, maybe, maybe the key is, you know, you know, you got to make sure you're connecting with people at their level, maybe some people I mean, you know, especially in type two, I mean, a lot of people are told by their, maybe it's your primary care doctor. And again, I'm not trying to malign anyone, but you have diabetes, and here's what you need to do. And I'm going to put you on Metformin. Well, you know, at the end of the day, I mean, I used to hear from many people, well, I don't really know what it means when I have diabetes. I mean, they don't understand things. And maybe they say, well, I'll avoid sugar. But you know, I can have pasta rice, that's healthy, right? I mean, no understanding, you know, kind of how our bodies work. I mean, when I was a kid, you know, many, many years ago, you know, we actually had something in school called nutrition class, and health classes, you actually had some idea how our bodies work, I don't think we're teaching that to kids anymore. So the idea is a lot of people just, even though if you're in it, it's kind of like, Well, why don't you understand it? Some people just don't fully understand like, Well, you know, what do you mean, my pancreas isn't gonna produce insulin or, you know, it's not producing enough insulin or, you know, I'm watching my blood sugar's but, you know, I'm in competitive sports, or I'm stressed out or, you know, when people start realizing there's all these other factors that affect your your glucose, I mean, you can eat the same meal every day, do the same thing. But if you're stressed out one day, or you didn't sleep well, or something, you know, you're going to have different results. A lot of people don't fully appreciate. Well, why is that?

Scott Benner 52:57
Yeah, I think that when, when I start talking to people, privately, which I do sometimes, just as I don't know, I think it makes me better at being on the podcast to have one on one conversations with people that aren't recorded sometimes. But when I start off by 10, I'm looking at to get your basal insulin, right, because nothing's gonna work. If that's not right. And then you really need to Pre-Bolus to understand how your insulin works. When I get to the third thing and say, You need to understand the glycemic load and the glycemic index foods, I don't think that's what they think they're going to hear next. And when you tell somebody that, you know, 10 carbs of one food in 10 carbs or another food are going to impact you differently. I completely agree with you, it fries their mind. They're like, no, they told me that not the

John Brooks 53:36
cause. And, you know, and again, we were learning a lot about, you know, again, you know, what else is affecting, you know, gastric emptying, you know, which foods tend to get into the bloodstream faster. I mean, again, there's a lot of complexity that, you know, not that we want to make it even more confusing for people. But the hope is that, you know, over time, you know, devices are going to start incorporating in, if you think of all the wearables, people are starting to pick up on heart rate variability, they're starting to pick up on sleep, and at some point in time, maybe those additional inputs, you know, might further cause the algorithms to be even smarter. Yeah. So all of a sudden, you know, we're having a better way to help people with diabetes, you know, understand that, yep. Blood Sugar is fine. But that's not the only ingredient that's kind of driving, you know, what's going on.

Scott Benner 54:26
Yeah, maybe one day the, the pump will know that, hey, I had pizza. So the cheese is slowing down the digestion. But now the cheese is gone. And everything's going through me quicker and not impacting me the same.

John Brooks 54:37
Yeah. And again, a lot of pumps are going to say, you know, hey, I remember the last time you had insulin and here's, here's what happened. And you know, instead of you having to figure out a square wave bolus, whatever, you know, the system is going to basically say, Yeah, I remember that. You know, let me make sure that I'm adjusting your insulin or if you're an athlete, I remember you know, when my son Played high school sports or you know, we've had a lot of kids that Jocelyn, you know, playing competitive sports and you know, the the issue is, you know, your blood sugar's you know, you may be fine during the game and then eight hours after game time you're crashing and you know, understand why why do that's, you know how do you get muscles reload? So anyhow, it's complicated but we're chipping away at, you know, getting it there and maybe in the background we've got people working on, you know, either, you know, beta cell regeneration protecting the immune system, I mean, you know, there's lots of other good things going on that I'm on top of as well. So maybe someday, we'll make all this moot.

Scott Benner 55:39
That's my last question is, what do you see coming that is exciting to you, because I just had a Dr. Jeffrey Millman on the other day from Wash U. And he was talking about stem cells and how they're getting cells. Now the sense glucose make insulin not seen as you're bound by your body as a farm. You know, that's, it's all amazing. Like, yeah, no,

John Brooks 55:59
it is, but you know, and it's happening, you know, in different parts of the world, you know, that there's people working on, you know, defeating the autoimmune process people working on, you know, basically protecting the beta cells, there are people working on regenerating the beta cells or people working on in capitalization, there are people working on, you know, new treatments. I mean, you look at some of the stuff, you know, the nice salsman, you know, at mgh with ECG, and you know, so lots of advancements, people are making headway, you know, you look at, you know, semma, which was a Doug Melton company, now part of vertex and all sudden, you get a very big pharmaceutical company working on, you know, kind of, you know, beta cell and capitalization, you know, you get other kinds of companies that are in that space. And little by little, you know, we're kind of cracking, you know, wider regulatories T cells go awry. And, you know, how do you do that? So, yeah, I mean, we could talk for another couple hours on, on, things that I see. And, you know, I'm usually involved because, you know, I just get motivated by that. And again, companies sometimes seek me out, because they know, I know enough to be dangerous, and maybe I can help them either get financed or advanced, right,

Scott Benner 57:15
understand how to get through the whole process. And that's got to be such a huge part of it. It's just having somebody with you, that can help guide you around the pitfalls, right. That's got to be

John Brooks 57:24
Yeah, I mean, you know, I've been, you know, doing this for a while, and, you know, seeing the good bad, the ugly, but, you know, the hope is that, you know, at the end of the day, you know, a lot of these companies to challenges, you know, getting the financing and having a value proposition that's compelling to investors, and, you know, making sure that they thought through the timelines around, you know, regulatory issues, quality issues, reimbursement issues. And in today's day and age, it's the old Wayne Gretzky line. You know, you don't want to develop something, you know, to solve today's problem. It's, where's that puck gonna be five years from now to

Scott Benner 58:01
skate? Where the puck rolling, right?

John Brooks 58:03
Yeah, where's that competitive landscape gonna be? Who else is out there? And how to make sure that you're, you know, kind of leapfrogging the competition, not just incrementally saying, Hey, I got a better mousetrap. And, you know, if you're already kind of behind the times, so I tell people when they're using their insulin, that everything you do now is for later, and everything that is happening now is from something that you did in the past. And I think that thinking like that, in general is a great idea. Well,

Scott Benner 58:29
john, thank you. I don't want to take up any more your time, but I do want to leave you with something. Because I, I don't know that I fully wrap my head around this sentiment that gets given to me a lot until you were talking about your son. But people thank me, my daughter does not come on this podcast, right. She's 16. She doesn't care about a podcast. And and people tell me all the time, how grateful they are that her situation led to their success. And now I'm realizing as I'm sitting here is that, that this podcast really is born out of my concern for my daughter, and she's wearing an insulin pump that was born out of your concern for your son. So it's very kind of chilling, honestly.

John Brooks 59:09
Well, I would, I'm sure he'd be interested. So at some point in time, you want to do a podcast with my son, I think you're gonna find you know, he's even sharper than I am. So I'm gonna do

Scott Benner 59:19
that. Yeah, No, I haven't. Yeah.

John Brooks 59:22
Yeah. I mean, he, I mean, if you think of it, I mean, you know, he, he's, you know, understands this disease, because he Elizabeth every day, and, you know, working for a company that you know, now is extremely successful. And, you know, what had some interesting experiences along the ways. So, you know, so yeah, you might want to get him on a podcast, I think you'd find it pretty entertaining. Well, it'll be easier for me to find him than it was for me to find you. Because, you know, you just would go around saying to people, like, you

Scott Benner 59:48
know, the guy that made the pot What's his name? And said, finally, somebody one of my friends had on the pods like, it's john. And I was like, Oh, is that him? And she goes, Yeah, I said, I think I know someone at t Wendy exchange. I'll be fine. Cuz like, I'll figure it out, which is another great organization that you you sit on the board of Is that right?

John Brooks 1:00:05
Yeah, yep. T Wendy exchange college diabetes network. You know, so you know, places diabetes related. You know, I'd like to think I can be helpful in some way.

Scott Benner 1:00:16
Well, I'll know I'm doing well, when you want to invest in me. Chad, thanks so very much. I really appreciate it. My pleasure. All right. Take care. Have a good day here.

Unknown Speaker 1:00:24
Yep. Bye. Bye.

Scott Benner 1:00:27
Hey, huge thanks to the pod father, john Brooks. Can you imagine it if people by the way, if you know john, start calling in the pod father, I'd like to see that pick up if you guys can make that happen. Thank you. Anyway, john, thanks so much for coming on the show. And for sharing your amazing and very unique experience dreaming up an insulin pump. Thanks also to the T one D exchange T one d exchange.org. forward slash juice box. Join that registry today support Diabetes Research, support the podcast and touched by type one touched by type one.org. Thank you to those sponsors. And of course, welcome g Vogue glucagon to the family of sponsors here at the Juicebox Podcast. Learn more about that pre mixed prefilled, glucagon or the hypo pen at GE Vogue glucagon.com. forward slash juice box. There are links in your show notes. And at Juicebox podcast.com. To all of the wonderful And may I say delightful sponsors of the Juicebox Podcast. Check them out if you would. Thank you. Hey, last thing, the Facebook page for the podcast is blowing up. I mean, that is what the kids would say. Right? It's it's blown up. Be like you know what they said about their phones and stuff. I'm I'm very old. I don't know what people say. But that's not the point is on Facebook. There's a public group. It's called bold with insulin. And there's a private group Juicebox Podcast, type one diabetes, that private group up to 6000 users just about, huh? Is that bananas, 6000 people and they're just helping each other out. It's amazing. It's the kindest place you'll ever find on Facebook hand to wherever you want to hold your hand up to when you're swearing on things. I mean, it I've never seen a nicer, kinder, more thoughtful, less egotistical, more lovely and delightful group of people helping each other with Type One Diabetes than I have right there in that group. I am as proud of how that group functions, as I am about anything else connected to this podcast. It's really, it's quite something. And the public group has like 10,000 people following it. I'm really stunned. I am not really a Facebook person, but turned out to be quite a little resource and I'm super happy about it. Alright, I hope you have a great day. I hope you've enjoyed this conversation with john learning more about how the Omni pod came to be. I really did and what else feels like I have nothing left to say. So that is that