Health Tech: David Utley on How Pivot’s Technology Can Make an Important Impact On Our Overall Wellness
Go big. You have to find the big problems and offer a scalable solution that is highly cost-effective. While many companies have been successful solving small problems (that tragically affect many, many patients), think big and solve big problems like tobacco, opioid addiction, and mental illness.
In recent years, Big Tech has gotten a bad rep. But of course, many tech companies are doing important work making monumental positive changes to society, health, and the environment. To highlight these, we started a new interview series about “Technology Making an Important Positive Social Impact.” We are interviewing leaders of tech companies who are creating or have created a tech product that is helping to make a positive change in people’s lives or the environment.
As a part of this series, I had the pleasure of interviewing David Utley, M.D. President and CEO at Pivot.
Dr. Utley graduated from Harvard Medical School (‘ 92) and completed his surgical training in otolaryngology-head and neck surgery, as well as facial plastic and reconstructive surgery, at Stanford University Medical Center, where he was subsequently appointed to the faculty as clinical assistant professor of surgery (1992–2003). He has over 25 peer-reviewed publications related to G.I., plastic and reconstructive surgery, and otolaryngology.
Prior to starting Pivot, Utley was the first employee and Chief Medical Officer for BARRX Medical from 2003 to 2014 (G.I. endoscopy, acquired by Covidien in 2012).
Utley has had additional roles as founder, chief medical officer, or member of the board of directors with several startup medical device companies, including Somnus Medical Technologies (ENT), Curon Medical (G.I.), Aetherworks (pulmonary), BAROnova (G.I.), Freedom-2 (plastics), and CoAlign Innovations (spine), and is the inventor on more than 65 issued U.S. patents and 100 published U.S. patents.
Thank you so much for joining us in this interview series. Before we dive in, our readers would love to learn a bit more about you. Can you tell us a bit about your childhood backstory and how you grew up?
I was born in 1964 outside of Detroit, Michigan. My parents were very young, just out of college. They had zero money. Everything they accomplished in their lives was out of pure scrappy effort. My mom, Heidi, was an elementary school teacher and my dad, Jack, was in hotel and restaurant management. After a couple of years in the hotel grind, my dad decided to take ownership of his destiny and avoid the disruption of having his family move every year for his work. So, he quit and hit restart. We moved to Erie, PA, where he worked as a delivery guy for a local florist while getting additional credits to apply to dental school. Then to Pittsburgh, PA, where he attended Pitt Dental School. Then to Key West for a stint in the Navy as a dentist. Then to Chapel Hill for an orthodontic fellowship at UNC. Then back to Erie, where he set up a solo orthodontic practice. All along the way, mom worked as a teacher or accounting manager to support us. Without her, we were not going to make it.
I saw my dad start a solo practice from scratch, compete against established practices, learn how to hire and operate a staff, run a real business that had no investors (it was all on him and my mom), carefully navigate loans and cash flow issues, and slowly build his reputation and business into the largest orthodontic practice in town.
I was lucky to get to know my parent’s circle of friends, many of whom were healthcare professionals. In high school, I scrubbed in on ortho, maxillofacial, head and neck, trauma, and plastic cases in the operating room. I was hooked. I wanted to be a surgeon.
My parents never pushed me. They challenged me and supported me, but they never pushed me. As I got older, we became more like close friends rather than parent/child. Without them, I would never have gone into medicine. And I never would have developed the work ethic or positive attitude that I live by.
Can you share the most interesting story that happened to you since you began your career?
Two pivotal moments that were personal game changers.
First, in med school, I made the decision to go into orthopedic surgery. I wanted to do the big cases; trauma, joint and sports. You have to make this call in your third year, apply for the match, get interviews, and move quickly. Late in the game, I rotated for a month at the Brigham and Women’s Hospital in otolaryngology, where I met the chairman of the department. He, Dr. Strohm, pulled me aside and said, “David…. you can’t go to ortho; you must come to our profession in otolaryngology.” I switched out of ortho and applied for an otolaryngology residency program. I matched at Stanford, moved to CA in 1992 with my amazing wife Kathy and our black Lab Boomer, and we have been here for 30 years. It was the right move, and I am lucky to have made that call.
Second, during fellowship at Stanford, I was surrounded by surgical innovators who had invented medical devices, started companies and changed the way we care for patients. Dick Goode, Rodney Perkins, Fred Moll, Tom Fogarty. Some of the greats. With inspiration from these innovators, I developed an idea for a surgical device, took it to a local med tech startup, thinking “they’ll love me, I am a Stanford surgeon, this idea is awesome, they’ll want to buy it, etc.” The V.P. of B.D. heard me out for 30 minutes and said, “no thanks, kid.” He then walked me to the lobby. While waiting for my ride, a guy walks in, asks me who I am, asks me about the idea, and invites me to his office. Turns out, he was the CEO of the startup. For the next 3 years, he and I worked together on a number of devices for sleep apnea and nerve ablative therapy. It was my first med tech gig. This experience totally enabled my next few companies, including BARRX in 2003. You write your own ticket, as my dad once said to me. But sometimes, you just need a lucky break.
Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
Absolutely, hands down, my best friend and wife…. Kathy.
I met my wife Kathy Boscher, in 6th grade. We started dating in high school (once again, it required a lucky break for me). Then we went to college together. She is a registered dietitian who interned at Cleveland Metro General, then worked at the Floating Hospital in Boston when I was in medical school at Harvard. Later, when I was training at Stanford, she worked at Stanford’s Lucille Salter Packard Children’s Hospital in the NICU as a nutrition support dietitian. We now have four amazing adult children. Kathy has supported my crazy journey from thinking about quitting med school to be a ski instructor, grinding through med school, 100-hour weeks as a surgical resident, uncertainty about career paths, leaving a faculty position at Stanford for the startup world, crazy invention processes, late nights, lots of travel, 24/7 founder/CEO life, the repetitive serial quest for the next cool solution to the next big problem, and the crucible. All the while being a healthcare professional, an athlete, an inspiration, and an amazing mom to our kids. Without this incredibly selfless support from Kathy, I wouldn’t have started any of our companies, and we wouldn’t be in a position to help millions of people quit tobacco with Pivot.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
No doubt, the most influential life lesson quote came from my dad in 1982. It was just six words. “You are writing your own ticket.” I had been at college for about a month. And was not taking class very seriously. Okay, I was not studying (much). I never studied in high school and just thought you could coast through college. I called Jack (dad) after getting a 40 (yes, a 40…out of 100) on my first calculus class with a gigantic red F on the cover. He simply stated those six words, which quickly turned on a few light bulbs in my brain. No one but me had my back. No one but me was in the driver’s seat. It was a 180 turnaround in terms of work ethic in class from that moment on.
My dad, Jack, also taught me about selflessness, leading by example — over and over again. It’s a leadership trait that we talk about later in this interview. He hid a $20 bill under a discarded bleach bottle at the side entrance of his dental office. He was testing human nature to see what his staff would do when they walked in every day going to work. Nine people came to work, stepped past the bottle, and went in the door. Then, the last person picked up the bottle intending ONLY to dispose of it. Because that’s the right thing to do. She was enlightened and selfless. The $20 was a bonus. She probably picked up more trash later that day, but not with the intent to find $20. That was a beautiful lesson for me.
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?
- Endurance. The road to starting your own company takes a long time, no matter how good your idea and solution are. BARRX was founded in 2003. We raised $70m in venture capital and proved that the intervention worked to treat early esophageal cancer. It was a huge lift, and hundreds of moving pieces had to come together over time. BARRX was acquired by Covidien in 2012, and the earn out was fully achieved by my team in 2014. As one of my close friends commented, “Utley, that was an 11-year overnight success.”
- Selflessness. As a leader, you have to be last in line, listen more than you speak, make sure your team is taken care of, and always put in more hours than anyone thinks is humanly possible. The buck does stop with the founder. I have filled more roles in urgent times than I ever thought possible when I first started new companies. Currently, I am running sales. Why? Because we have the need for a sales leader. I volunteered. My leadership team inspires me by doing exactly the same thing every day. My head of operations volunteered to be responsible for H.R., the coaching organization, clinical affairs, and myriad other huge roles in addition to his day job. That’s how scrappy startups succeed.
- Communication and Feedback. Regular standardized communication helps everyone in your ecosystem understand what’s going on, helps avoid myths and misunderstandings, and allows everyone to ask questions. We do weekly all-hands meetings at Pivot with a promise not to cancel due to busy schedules or lack of new news each week. It’s important! We strive for weekly 1–1s between team members and managers as well. Even if “just a social visit and check-in”, you need to stay connected and be open to answering questions and receiving feedback.
Let’s now shift to the main part of our discussion about the tech tools that you are helping to create that can make a positive impact on our wellness. To begin, which particular problems are you aiming to solve?
Tobacco use is the leading cause of preventable morbidity and mortality, health care costs, and lost productivity on the globe. Since the beginning of 2020, tobacco has killed 18m people, while COVID has killed 6m people.
The last drug approved to help people quit tobacco was in 2005 and is now off the market due to a recently discovered increased risk for cancer. And there has never been a medical device cleared by the FDA with claims to help people quit tobacco (until now).
That boggles my mind. How can we NOT have invested innovative minds and capital rateably to address this huge health care crisis.
That’s why we started Pivot.
How do you think your technology can address this?
The Pivot team is incredibly evidence driven. We create scalable solutions for massive public health crises, like tobacco use.
When we envisioned the Pivot solution, we did not try to reinvent the wheel. We know what works to help people quit (coaching, pharma, behavioral change support, community support). We added a medical device to measure carbon monoxide (C.O.) in the breath as a biomarker for tobacco use (think glucose monitoring or step counting). These interventions work.
We pulled them all together in a cohesive digital therapeutic solution where a tobacco user could sign up, get lifelong support to learn about their tobacco use, reduce, set a quit date, quit, and then remain quit. To help people with tobacco cessation, we had to make the UX amazing and fun. We do not blame or vilify — we support and assist.
In preventive service delivery, you have to have an intervention that people will use (get) and that works (effectiveness). In tobacco cessation, what has been missing is enrollment (people are not signing up). Pivot changes that by offering a solution that is accepting of all tobacco users (cigarettes, smokeless, vape) and all stages of change (readiness to quit). If you can increase enrollment by 10x for a preventive service (tobacco cessation, vaccination, colon and rectal cancer screening), you will increase the impact of that preventive service by 10x. The key is exposing as many people to the proven service as possible.
But for extra measure, after creating the solution, we rigorously tested Pivot in clinical trials, human factors testing, and a randomized controlled trial. We then submitted those data to the FDA — resulting in clearance of the device for tobacco cessation with claims stating that the device assists in helping tobacco users build motivation to quit, reduce their tobacco use, and make 24-hour quit attempts.
It has taken seven years, but we have built the product and then proven that we can increase enrollment at our clients by 10x (large companies offering tobacco cessation to their employees because it is the right thing to do, it’s an ACA mandate, it saves money, it improves productivity).
And, Pivot has a 34% quit rate.
Can you tell us the backstory about what inspired you to originally feel passionate about this cause?
First, all four of my grandparents died of tobacco related illness. Neither of my grandmothers smoked a cigarette in their lives (only secondhand smoke)
While at Stanford, I operated on my patients that had tobacco-related cancers of the head and neck. All preventable. We had no scalable effective programs to help them, or other patients quit tobacco.
I firmly believe that we should allocate innovation and preventive services resources ratably to disease states according to how badly each disease state impacts public health. Tobacco is the elephant in the room and deserves the most focus, effort and investment.
How do you think this might change the world?
Over one billion people on this planet use tobacco daily, and tobacco harms more people every year than any other condition (including COVID).
Getting people to quit tobacco is also a preventative cure for cancer, heart disease, premature death, etc.
Keeping “Black Mirror” and the “Law of Unintended Consequences” in mind, can you see any potential drawbacks about this technology that people should think more deeply about?
This one is easy to answer.
Tobacco cessation as a preventive service is graded as an A by the USPSTF.
That means, there is no doubt that helping a person quit delivers a proven and powerful impact to public health and to the individual. The jury is not out.
There are no drawbacks to tobacco cessation.
It’s one of the few preventive services that is dominant in cost-utility studies, meaning that it creates value (returns investment) for the health care stakeholder.
Here is the main question for our discussion. Based on your experience and success, can you please share “Five things you need to know to successfully create technology that can make a positive social impact”? (Please share a story or an example, for each.)
- Be continuously curious. Ask why something is like it is. Ask how we can do things better, quicker, easier, safer. When I was a surgical intern, I asked one of our faculty surgeons in the operating room what the difference between cut and coagulate was on our electrosurgical instruments (used every day in the OR). He said, “you push cut to cut and coag to coag.” If someone gives you an answer like that, don’t settle. Go figure it out yourself. Be continuously curious.
- See around the corner. Whether you’re in the operating room or in the left seat of a commercial aircraft, or starting a company, you need to know what’s coming next (and what you might do when it comes). You need to be constantly thinking about contingency plans. On Jan 15, 2009, Captain Sullenberger took off from LaGuardia with 153 passengers and crew. Less than two minutes after takeoff, he had a double engine bird strike taking out both engines. He rapidly assessed every landing option in the next 3 minutes. He chose the Hudson. Many pilots may have tried Teterboro or a turnaround to LaGuardia. Had he chosen those options, everyone would have died. He was thinking ahead. And it helped that he was an NTSB expert and a glider pilot.
- Go big. You have to find the big problems and offer a scalable solution that is highly cost-effective. While many companies have been successful solving small problems (that tragically affect many, many patients), think big and solve big problems like tobacco, opioid addiction, and mental illness.
- Don’t listen to everyone that gives you advice. Most advisors are well-intentioned and full of ideas that they think are easy to implement. No one, however, knows the details of what you are going through. Air traffic control told Captain Sullenberger that Teterboro and LaGuardia were his only options. He said, “I am going into the Hudson.” Everyone survived. Just know what you need to do and do it.
- Prepare yourself for the crucible. If you are planning to be a founder of a disruptive startup trying to change the world, like Pivot for tobacco cessation — prepare yourself for the crucible. You will be fried, burned, tested, bent, busted, and twisted beyond belief. You will think you cannot go another step, but you will. You will have hundreds of employees relying on you, and you cannot give up. You have a billion tobacco users on the globe relying on you. You will NOT give up. It’s the crucible. In 2020, a new investor-backed out on leading a round of financing at the last minute. This put Pivot on its back foot. Our insiders came through, and we launched Pivot at Target for their associates and spouses to quit tobacco, as well as at BCBS North Carolina for their members to quit tobacco. Win. This year we are doubling revenue. Next year, a huge inflection point. This is the crucible. If it’s important, as in 8m people will die this year from tobacco use, you must survive the crucible. Few can survive, but you will.
If you could tell other young people one thing about why they should consider making a positive impact on our environment or society, like you, what would you tell them?
Find a mentor.
Draft from the best.
Do what you want to do.
Is there a person in the world, or in the U.S. with whom you would like to have a private breakfast or lunch, and why?
I would have dinner with my grandmother Elsa Eva Brandenburg Martin (aka Mimi).
Firstborn U.S. citizen from her parents from Berlin, Mimi was selfless and scrappy and a bit like MacGyver. She helped raise me when my mom and dad were working and preparing for my dad to go to dental school.
It would be great to meet her now that I am an adult, to learn how she gave back and was so selfless in her approach to life.
Thank you so much for joining us. This was very inspirational, and we wish you continued success in your important work.