David West of Proscia: Five Things You Need To Create A Highly Successful Startup

People come first. Success always comes down to the people, and they make a huge difference. I’m very lucky to have colleagues who I can trust on a very deep level and who are extremely talented at what they do.

Startups have such a glamorous reputation. Companies like Facebook, Instagram, Youtube, Uber, and Airbnb once started as scrappy startups with huge dreams and huge obstacles.

Yet we of course know that most startups don’t end up as success stories. What does a founder or a founding team need to know to create a highly successful startup?

In this series, called “Five Things You Need To Create A Highly Successful Startup” we are talking to experienced and successful founders and business leaders who can share stories from their experience about what it takes to create a highly successful startup.

I had the pleasure of interviewing David West, Co-Founder & CEO of Proscia.

David West is an entrepreneur and technologist with a background in computational biology. He co-founded Proscia in 2014, inspired by research at Johns Hopkins Medicine. Under David’s leadership, Proscia has earned recognition as a market category leader, raising a total of $35M in funding to date and securing customers including Johns Hopkins, Joint Pathology Center, and LabPON. David has been recognized by EY’s Entrepreneur of the Year 2021 Program, Forbes 30 Under 30, and Inc. Magazine as one of the top 50 Global Entrepreneurs Under 25. He has a degree in Biomedical Engineering from Johns Hopkins University.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

Proscia was founded to fight diseases like cancer by changing the way the world practices pathology. For me, cancer is very personal — I’ve seen family and friends battle it with good and bad outcomes. I’ve always viewed cancer as a big problem for humanity and, as a technologist at heart with a background in engineering, the intersection of medicine and technology is where my personal passion lies.

I got involved in digital & AI-enabled pathology at Johns Hopkins almost 10 years ago when the field was very much an academic niche. At the time, there was a well-established body of research demonstrating the potential of data-driven, image-based approaches to pathology — a discipline that is at the center of medicine but still based on microscopes and glass slides. In short, we knew we could use the data in images of tissue to solve big problems across medicine. But this technology lacked a bridge to the real world.

So, what started as a humble project became this big vision to accelerate pathology’s transition to digital and change how we look at diseases like cancer. Proscia was born with that goal. Our enterprise software platform powers digital pathology workflows by allowing labs to transition from microscopes to images and from brick-and-mortar to a globally-connected, data-driven paradigm. On top of this platform, AI applications help accelerate pathology lab operations and eliminate diagnostic subjectivity.

What was the “Aha Moment” that led to the idea for your current company? Can you share that story with us?

At Johns Hopkins, I saw us physically send hard drives with big pathology images to collaborators around the country. That seemed to defeat the purpose of digital pathology — why move from microscope to images if you still have to ship the images anyway? And while we had decades of work demonstrating the potential of algorithms, the foundational software technology to create digital workflows didn’t even exist. There was clearly a huge gap between what was technically and scientifically possible as demonstrated by a significant body of academic work vs. what was currently in practice. This brick-and-mortar paradigm was so ingrained in the culture of pathology. We had to radically rethink the field as software-based from the ground up.

Was there somebody in your life who inspired or helped you to start your journey with your business? Can you share a story with us?

I have two stories, one personal and one professional:

Personally, my mom is a cancer survivor, which had an impact on our whole family growing up. Seeing her and other family go through that journey is my “why.”

Professionally, two mentors of mine, Dr. Don Coffey and Dr. Bob Veltri, introduced me to this field and inspired the company. Dr. Coffey was a legend at Johns Hopkins, having founded the cancer center and contributing to breakthroughs that remain the foundation for progress in medicine today. Dr. Coffey had a unique journey as a scientist — he was dyslexic, but deeply curious — which colored his untraditional approach. He inspired me to follow curiosity over, say, a 4.0 GPA. He also connected me to his colleague Bob Veltri, who was a pioneer in what we would now call computational (or AI) pathology. That’s where my journey began.

What do you think makes your company stand out? Can you share a story?

We’re a mission-driven company working with exciting technology at the center of an explosive market in medicine. Technology has transformed nearly all aspects of life over the last 30 years, and now we are in the “decade of medicine.” To be well-positioned with transformative technology during such a time is a special combination that makes this an incredibly exciting time to be in the space.

Our customers are doing amazing work that underscores the impact this transformation can have. I think about the Joint Pathology Center (JPC). JPC houses the world’s largest human tissue archive, which includes 55 million glass slides dating back to the Civil War. Using Proscia’s platform, it is digitizing this data to provide increased access for driving medical advances related to cancer and infectious disease. JPC’s repository may even help us to combat COVID-19. In going digital, JPC is advancing a new paradigm of biomedical research that can unlock new insights and accelerate groundbreaking discoveries that deliver meaningful benefits for patients.

How have you used your success to bring goodness to the world?

Medicine touches what matters most — people — and helps to inform how we live healthy lives. Our mission is to perfect cancer diagnosis with intelligent software that changes the way the world practices pathology. The team at Proscia has developed tools that are redefining pathology and giving pathologists better ways to approach the fight against cancer today as well as make cancer diagnosis more efficient and effective for patients.

In addition, Proscia partners with the American Cancer Society (ACS) to advance our shared goal of improving patient outcomes. The team supports the ACS Hope Lodge program, which provides free lodging for cancer patients and their caregivers when the best hope for effective treatment may be located far from home.

You are a successful business leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?

Curiosity is at the core. If one is genuinely interested in something, they’ll work harder, rise to challenges, and absorb information to identify new ideas and opportunities. I like Einstein on this: “I have no special talent, I’m only passionately curious.”

Passion is so important, too. You’ve got to put your heart and soul into your craft. If you don’t have your “why,” it’s impossible to power through the lows. Part of that is picking the right things to work in (which is where curiosity plays a role). Passion helps you build a tribe, too. If your passion is genuine, you’ll be able to inspire others to join you.

Third is appetite for risk. However one defines success, it’s hard to get there by following the traditional path. And the earlier one takes risks, the better — you can’t afford to be patient. Common knowledge here is quite wrong; people tend to frontload low-risk choices in their life (e.g. get the degree, stable job, work your way up) with the expectation that they’ll have more flexibility to take risks later. What people miss is the leverage of time. Archimedes said, “Give me a lever long enough, I shall move the world.” Early on in your career you have the most time leverage — you can afford to fail and take risks, but in the long run you win. You see this play out in, say, 401k strategies — any financial advisor would say to be more risk tolerant early in life and decrease risk over time. But for some reason, people don’t apply this to their career choices.

Often leaders are asked to share the best advice they received. But let’s reverse the question. Can you share a story about advice you’ve received that you now wish you never followed?

There’s so much bad advice out there, whether it’s from your grandma or some YouTube guru. I had a teacher in grade school that told my parents I “asked too many questions” at a parent-teacher conference. That stands out as patently bad advice.

Can you tell us a story about the hard times that you faced when you first started your journey?

Starting a company is like eating glass. The highs are high, and the lows are low. It’s part of the game. Going through the entrepreneurial journey always seems great from the outside, but the job of the founder is to put out fires. It’s part of what it means to start something.

There’s a deep reverence for the “standard of care” in healthcare, and rightly so. But that makes healthcare hard, with regulatory, technical, and distribution hurdles that don’t exist in other fields. The microscope is deeply entrenched in pathology, so resistance to change is embedded in the culture.

Proscia has always had a big vision for the future of pathology and medicine, but we started with small steps and a customer-first approach. At this point, our products and traction had to speak for itself. We first built leverage with a free product for academics, then with an enterprise product for life sciences organizations (where regulatory barriers are lower), and now we have a commercially available diagnostic product. Our customers today include 10 of the top 20 global biopharma companies, government organizations, the largest pathology archive in the world, and large diagnostic labs across the US and Europe.

Where did you get the drive to continue even though things were so hard? What strategies or techniques did you use to help overcome those challenges?

Adaptability, communication, and transparency were extremely critical to help overcome challenges — not only during difficult times, but all the time. The one advantage startups have is nimbleness. That’s something small startups can achieve that big organizations can’t. In high-growth markets, you want to flex those muscles.

The journey of an entrepreneur is never easy, and is filled with challenges, failures, setbacks, as well as joys, thrills and celebrations. Can you share a few ideas or stories from your experience about how to successfully ride the emotional highs & lows of being a founder”?

There’s something to be said about being comfortable with the uncomfortable and with chaos. If you can’t build that comfort with chaos, then the entrepreneurial journey isn’t for you.

COVID took us for a spin. We were readying a fundraise in March of 2020 and, of course, investors stopped taking in-person meetings. Worse yet, funds were not sure whether they would be investing at all for the foreseeable future (despite the lip service that many paid to this on Twitter). We hit the pause button on the round and tightened our belt — an extremely painful move. Decisiveness was key here — we moved very fast and aggressively. With that under control, we doubled down on closing customers, which was hugely successful. In 2020, we grew 11x as nearly every pathology lab in the US accelerated its digital pathology plans and the FDA issued emergency use authorization expanding access to digital pathology for remote diagnostics in response to the pandemic. We restarted the round a few months later and closed an oversubscribed Series B.

Let’s imagine that a young founder comes to you and asks your advice about whether venture capital or bootstrapping is best for them? What would you advise them? Can you kindly share a few things a founder should look at to determine if fundraising or bootstrapping is the right choice?

Whether someone chooses fundraising or bootstrapping depends on the business. If you have a capital-intensive business with significant upfront R&D requirements, or if you need to build distribution very quickly, then outside capital is great. Some businesses are not going to be billion-dollar companies with a path to an IPO, but, sure, they can be very personally lucrative.

Ok super. Here is the main question of our interview. Many startups are not successful, and some are very successful. From your experience or perspective, what are the main factors that distinguish successful startups from unsuccessful ones? What are your “Five Things You Need To Create A Highly Successful Startup”? If you can, please share a story or an example for each.

People come first. Success always comes down to the people, and they make a huge difference. I’m very lucky to have colleagues who I can trust on a very deep level and who are extremely talented at what they do.

Second, you need a problem that people are willing to pay money to solve. You don’t start a business for the sake of starting a business. You start a business to solve a problem and to make the world different than it is today, to make the future different and better than today.

If you have those two things — great people and the solution to a problem — you’ll likely build a successful startup.

In addition, you need to be genuinely curious and passionate about the problem. Stack someone interested in the problem against someone who isn’t, and the less passionate person could feel like they’re working ten times harder, but they’ll never beat the passionate person. Anyone who is genuinely curious about a problem will always be thinking about that problem and devising solutions — even in their free time — so a dispassionate person will never outperform someone who is genuinely interested in solving a problem.

Finally, you need persistence. You’re going to hit lows, and if your motivation is too “short-term” or you’re only looking to make a quick buck, you’re probably missing out on the real potential. Without persistence, you’re going to fail along the way.

What are the most common mistakes you have seen CEOs & founders make when they start a business? What can be done to avoid those errors?

Every problem has multiple solutions. A common mistake is thinking that your solution is the only or best way of solving a problem. If you get stuck on one way of solving a problem rather than reasoning first principles, it’s going to become an issue.

Startup founders often work extremely long hours and it’s easy to burn the candle at both ends. What would you recommend to founders about how to best take care of their physical and mental wellness when starting a company?

I like Naval Ravikant on this topic — he’s written a great deal on happiness, health, and wealth. A rule of thumb is to find three activities you love: one that keeps you fit, one that earns you money, and one that stimulates you creatively/intellectually. If I were a professional surfer, I could combine all three, but unfortunately, I’m a very bad surfer so that’s not in the cards for me. I am lucky to have found something that combines the last two, and I’m a big believer that staying healthy is key to success in those areas. I’ll surf in my free time.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

Outside of healthcare, I’d like to see technology and humanity rise to the challenge of sustainably feeding the planet. I’m interested in the future of food (especially the future of protein).

We are blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them.

Sam Harris — if you’re out there, I’d love to have dinner. I admire Sam’s understanding of the mind and ability to communicate the complex. His thinking and writing touches a broad spectrum, never lacking in intellectual depth. I’m certain we’d get along, but I also welcome the opportunity to challenge him, knowing full well I wouldn’t make it out alive.

How can our readers further follow your work online?

Follow Proscia on Twitter and LinkedIn, and to follow me personally on Twitter — @davidwest_irl. You can sign up for email updates about the company and its activities on Proscia.com.

This was very inspiring. Thank you so much for the time you spent with this. We wish you continued success and good health!