May 2, 2025 • 22 mins
Joe Dustin shares his journey from a computer geek to a significant player in the clinical trials industry. He discusses the differences between corporate and startup environments, emphasizing the importance of embracing chaos in startups. Joe reflects on the challenges he faced, including getting laid off, and offers insights into navigating the current market trends in life sciences. He provides valuable advice for startups, highlighting the need for product-market fit and the importance of reducing risk for potential clients. The conversation concludes with personal insights and thoughts on the future of the industry.
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Episode Transcript
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SPEAKER_00 (00:07):
Joe Dustin.
How are you?
Better now.
How are you?
Good.
Hey, we need to start out with adisclosure, though.
I think disclosure time sayswe've known each other for a
long time.
And so if we talk like we'veknown each other for a long
time, it's because we have.
So who's Joe Dustin?
What have you done?
What are you doing now?
Well, there's the one side ofJoe Dustin that's like a guitar
(00:29):
player, travel geek, and spacenerd.
But then there's the other side,which is fell into clinical
trials industry 20 plus yearsago at a family barbecue.
And here I am.
Which one do you want?
A family barbecue?
Yeah, let's do that.
So I was getting out of collegein 2002.
I went to Roger WilliamsUniversity in Rhode Island.
(00:50):
And I was a computer geek.
I was a computer informationsystems major.
I was no biomedical science.
I didn't have a PharmD, none ofthis stuff.
It was, came out like one of thelast classes I took senior year
was like Windows NTadministration.
My first online experience wasgetting the free floppy disks
from AOL in the mail andstealing my mom's credit card
(01:12):
and canceling it right at the29th day to then do it again.
That was kind of how it all gotinto computers.
When I was a kid, my friends andmy family said, I'm either going
to, I'm either going to go on TVsomewhere or I'm going to be
doing something with computersbecause I was in cable access
really young in the local NellRose outside of Boston where I
did a lot of TV stuff, both infront or behind the camera.
(01:36):
So none of this has anything todo with clinical research
because it just kind of happenedout of nowhere.
I'm at a family barbecue inCambridge, Massachusetts.
So I'm sitting there at abarbecue with my uncle and aunts
and Pekka from finland and hesays uh oh so you're getting out
of school you know we could wecould use some people once you
(01:56):
come on bring your resume and uhonce once you're out and send it
over and we'll come talk to youso i did and uh that company was
called crf box back in the olddays which became crf health
which became signet health andso the founders from finland you
know a few of them were overover here and it was me and like
four fins and a couple guys fromthe boston area in an old
(02:17):
doctor's office buildinge-diaries on palm pilots Yeah, I
started as the IT guy.
And within six months, I wasproject manager.
So is this startup tip numberone is go to Barcues?
Yeah, get the sausage.
Amazing.
That's great.
All right.
So, you know, one of the thingsI respect about you a lot,
because I think it takes acertain amount of grit and
(02:38):
demeanor in your career is to bein corporate and to be in
startups and to do both.
is unique.
And, you know, I've done thathistorically.
It's been kind of fun for me tolearn and to grow and to figure
out going from corporateentrepreneur to, you know,
digital entrepreneur.
And you've had a similar track.
So what are the, what's the keydifference?
What's the thing that peopleneed to know that's so different
(03:00):
between working in acorporation, working in a
startup?
Don't be afraid of stability orinstability, I guess is, and it
also has a, is a, it definitelyrings true.
depending on the different pointin your life you're in.
That's for sure.
When I was 22, single, nodependents, and they were like,
yeah, we're going to send you toHelsinki.
(03:21):
This office has six people in itand there's no 401k.
You know, yeah.
Okay, cool.
And so at that point, I didn'tcare.
In fact, it was exciting.
And when I went back to likealumni day back in college, 10
years later, I was the only onethat did a startup.
It was fun.
It was crazy.
It got, it got really fun.
When I finally got out ofproject management, that's for
(03:42):
sure.
Cause I went from startup land,both from at CRF health and then
a company called e-trials.
And when I moved to Raleigh,that's what I right around sort
of when I met you in, in, inthat area and still startup, you
know, went from 60 to 120 peopleand you know, never have enough
budget, never enough resources,never set up for really for
(04:02):
success.
But it wasn't until they startedtaking me out on the sales calls
where it got really fun.
And I joined this little startupin 2008 out of New York called
Medidata.
And that's when things gotreally interesting.
So joining a startup to me ischaotic, but you kind of embrace
the chaos.
But there are things you get tofind that bring a little bit
(04:24):
more stability, not evenfinancially, just like in
yourself, right?
But there's three things I thinkthat really make sense.
You got to have a...
And you could look at this withstartups now where I...
Definitely, I'm seeing it.
You need to have a highlydifferentiated product, like
highly differentiated, becausethere's so many B2s out there,
with a hugely addressablemarket, with a really awesome
(04:45):
culture, and good leaders,right?
And sometimes you can't makethose leaders.
Something about the timing,territory, the talent, what's
happening in the world, and allthe other three things make a
startup successful.
UNKNOWN (05:01):
Yeah.
SPEAKER_00 (05:01):
You know, if you're doing something that is
different, that is new as astartup, there is intentionally
not a manual written alreadyabout someone who did what you
did.
So it's not like there's thelessons learned playbook that
you go pull from.
Yeah, there's certain things,and I'm sure you had this from
your corporate background.
I did too, right?
You walk into a situation,you're like, hey, I've seen some
element of this before.
(05:22):
This is what we need to avoid,or this is how to think through
this problem.
But a lot of times you'd runinto this issue.
And someone was like, what do wedo?
I'm like, well, no one's everdone this before.
So we are the ones that need tofigure it out.
And that wasn't a failure.
That was actually innovation,right?
It just was disguised asfailure.
It was, we figured that thingout.
At a conference in the earlydays, I remember back when the
(05:42):
innovation teams were firstgetting started in pharma, there
was one guy, but he said, weneed an SOP for things that
don't have SOPs.
It's just one of the things hesaid all the time, like, cause
they were so obsessed with SOPs.
Like we need one that just says,we don't know what's going to
happen.
And we're following that.
Did you guys write that SOP?
And can I get a copy of it?
Never.
I would love to.
But I mean, when I was in pharmaduring that time running
(06:06):
innovation, that was a challengebecause I came in bright-eyed
and bushy-tailed.
I'm going to come in and breakshit, right?
Well, it turns out people don'twant things broken.
What's the hardest thing you'vehad to do so far?
Like, what's the hardestchallenge you've had to
overcome?
Getting laid off for the firsttime was like, wait, this
doesn't happen.
(06:27):
Wait, what?
And when that happened, I wasn'tworried.
In fact, I wasn't surprised.
But I think we all go through itat some point in different ways.
The first thing I had to thinkof was, crap, what do I tell my
wife?
Second thing is, what am I goingto do about health insurance?
Because we live in America andthat's what we do.
And number three is, I wasn'tworried about getting another
(06:49):
job because I feel prettyconnected and at least I...
But it took five months, right?
And so even then, in a marketthat was just horrible, and
we're still running throughthat, just dealing with the,
what do I do now, was probablyone of the hardest things I had
to do.
But at the time, I was like,wait, that's hard.
So that's when I started aconsulting business.
I want to get out there and justhelp people and do the right
(07:11):
thing.
I've never felt like I was everin sales.
And I think that's probably whyI was really good at it, because
no one ever saw me as asalesperson.
But it's trying to sellyourself.
is really hard.
We have this like sort ofimposter syndrome sometimes.
And I think we all have toconfront that at some point in
other ways.
I'm getting better at it, but itwas the hardest thing I think
when it happened the first time.
(07:32):
Yeah, that's fair.
When I think equally, you know,setting up joedustin.com is
different, right?
When you have to sort of thinkabout yourself as an individual
contributor, right?
Like with what you mentioned,it's different to shift, right?
And in this market, it's a shiftyou see a lot of people doing.
I've had JoeDustin.com for a lotlonger than that, but I changed
(07:53):
what it was for sure.
Exactly.
So as we think about your storyand we get to the market, it's
not surprising to anybody.
The market we're in right now ischallenging.
Still is challenging.
We go through a pandemic.
We come out of a pandemic.
We've now got a lot of thingsgoing on around the world with
spending and money and politicsand everything in between.
And the market is interesting isthe word I would use right now.
(08:15):
What's the market look like foryou?
What's the market look like inlife sciences and clinical
research?
The market's in recovery.
This is not the recovery year.
I think the second half of thisyear called Q4, I think you'll
start to see some interestingdeals in the market that'll get
people excited that will thenset up for a good 2026, I hope.
(08:37):
Yeah.
So if you're a startup in amarket like that, there's sort
of this like balance though,right?
That's a good opportunitybecause there's still market
share to be taken.
There's still work being funded.
So if you're a startup in thismarket and you're trying to
really set yourself apart, whatadvice are you giving, Joe?
What are you telling startups todo in a market like this that
is, I would argue, is going intorecovery in the second half of
(09:00):
the year is what I would argue.
But let's just say that that isthe premise.
What do you tell startups?
What do you advise them to thinkabout to get through this period
and to actually change or evolveor grow their company when they
get into phases like this?
I think that the few things Isay are hold on tight and stay
true to what you believe isright.
If you have a product marketfit, keep crushing at validating
(09:22):
that that is true.
And there's a reason why so manygreat companies are created
during economic crashes, right?
I think we've witnessed probablytwo or three of them now in my
career lifetime for 20 plusyears.
We've had the dot-com bust, thehousing crisis, and the
post-COVID meltdown.
And I think in each of thosetimes, there are amazing things
that happen.
(09:42):
So when I look at startups,everyone always asks, who's the
next one, right?
So you get to find out, like, ifyou can just stick to what
you're doing and stick to it.
If people think you're crazy,sometimes just stick to it.
And so there's so many startupsI see now.
I'm working with at least threeof them on a more advisory
basis.
that I'm seeing a lot of reallycool things in recruitment tech
and clinical trial matching andtapping into clinical sites and
(10:05):
their data, whether it's an EHRor they're in infrastructure
in-house, like their site CTMSsystems.
There's a rise of the sitescoming where they're going to
start digitally transformingtheir own operations because
they have to.
And as a result of thathappening, more come online,
more data becomes standardizedand available.
You can do more things.
So they're getting ready forwhat's coming, but it's a dual
set of marketplace, right?
(10:26):
You're paying for everything,but the sites are seeing the
patients.
So how do you, make that work.
What's the old adage?
You know, history is the bestview of the future.
You know, this idea that if youwant to see what's going to
happen in the future, look atthe history and these things are
cyclical.
They continue to come around andaround.
And it's funny because I, youknow, looking at sort of like as
a guy who's a CEO and runs acompany and works with great
(10:48):
people and a great product tothese things today.
This market is challenged, butyou can actually still see
growth from it.
You can still see, like yousaid, people saying, hey, now
I've got a little bit more forceagent to make the change, or
I've got new thinking that's inmy company and I've got to take
a hold of that.
So I want to think differentlyabout how I digitize a clinical
trial or how much I use a DHT inmy study, right?
(11:09):
Those conversations come backaround because there's change.
Because there's motivation tofind the next success area.
What's been interesting to me isI think it's really easy to have
the AI discussion.
That's the easy discussion.
Everybody wants to talk aboutAI, AI, AI, and lots of
(11:29):
companies experimenting, usingit.
Some, it is the basis for theirentire company.
But the interesting thing iswhat I think it's actually done
is it's unlocked people's brainsaround AI.
innovation and so what we'reseeing in daily basis is is
people literally going i am r di'm not willing to go all the
way into this area of ai but canyou solve this unique problem or
(11:49):
can you build this powerpointfor me or can you take four
hours of my week out with aii'll buy that and that i don't
have to do an innovation pilotprogram for 17 months to figure
out if i want to do it andthat's been kind of fun actually
and i do think that like yousaid you know this this era of a
market has a natural inclinationto produce opportunity for
(12:10):
startups.
And I really do think now is thetime.
And I think there's a lot ofwinners that are going to be
winners because of what they'redoing right now, which is good.
I'm seeing a lot of AI beingapplied in pharma.
It's really not AI.
It's just intelligent automationand faster robotic process
automation that we used to dofive, 10 years ago in some ways,
right?
But that is becoming easier,cheaper, and faster to do.
(12:32):
And you can roll out thesethings so much faster.
But as that expands, I'm worriedthat we're going to be, we're
going to be automating reallybad processes and we're not
going to, we're not going to fixthe problem, the real problem.
Right.
And so it's cheaper just toautomate a really bad process as
opposed to going through amassive change management
effort.
Cause we know change managementis the hardest part of every
(12:53):
project for sure.
In some cases I would even stopcalling it change management.
I would call it adoptionmanagement because you need
people to adopt the new thing.
And in some cases, there's nochoice.
In startups, you can think ofthis too, where think about the
problem you're doing, theproblem you're working on.
It could be automating betterrecruitment, like calling
(13:14):
patients with robotic AI voicebots.
It could be matching betterpatients through their medical
records and preparing for chartreview with better AI agents in
the background that can get atthe data.
It could be smart protocols.
It could be structuredprotocols.
We were doing this 10 years ago.
right?
But now it's becoming so mucheasier.
If the problem, if the, if the,it's the change equation, right?
(13:36):
So if the problem that youhaving, if the change doesn't
give you at least a 10 Xbenefit, and if the pain is, if
the pain is not more than doingnothing, like if the, if the
pain of doing nothing is morethan the change, then you're
going to change.
And if not, no one's going tocare.
And so you really need tounderstand you being the Royal
you of startups.
(13:57):
Is the problem you're working onreally, really big?
I think everybody is trying toquantify that right now.
And that's, I always advisepeople like really, really
hammer on that one because ifit's questionable, understand
earlier if this has gotsomething, got some legs to it.
Because like you said before,some of these problems that
might not, it might be a new wayof doing things that no one
understands how.
And in five years, you'll say,okay, like smart protocols 10
(14:19):
years ago, we were doing that.
tech companies and CROs weretaking a stab at it.
Transcelerate was buildingstandards for it, but nobody had
a budget.
Nobody had a team.
Nobody had owned the process.
It was just, you're in word andthe scientists over here are
working with you over here.
That's all changed becausepeople were taught a new way to
do things.
And yeah, sometimes it can take10 years.
(14:39):
Yeah.
Fair point.
When you think about telling astartup that something could
take 10 years, there's probablylike investors only have five
years.
Yeah.
You know, I think, I think someof the startup founders probably
just went, Oh, thanks Joe.
Appreciate it.
You know, what's, what's theadvice you give to a startup
leader, right?
That says, Hey, I got to hang inthere.
I got to solve, solve a problem.
I got to solve a problem becauseI have to make revenue.
(15:01):
I need to make money, right?
The new world that we live inrewards making money as much, if
not more than, growth.
I think that there needs to besome sort of product that you
have that can solve a problemnow while you build the bigger
problem or the bigger productfor the bigger vision of the
problem you want to solve thatis going to take longer.
And so you need something thatworks today.
(15:22):
And that's sometimes really hardto find because a lot of times
you don't want to build a metoo.
You want to build somethingthat's revolution.
Pharma doesn't want revolution.
They can't adopt revolution.
The companies that have been themost successful in our industry
are And it pains me to say thissometimes, but when I talk to
startups about this, especiallywhen you're talking to a lot of
people that are rooted inSilicon Valley, they want to rip
(15:43):
the machine down and completelyredo everything and their hearts
in the right place, their mindat a better place.
Right.
But when I hear people likeengineers, where the real
innovation comes from theengineers, that's for sure.
I was, I was told many times inmy day, stop telling me how it's
done.
Tell me what the problem is.
I will show you a new way of howit's done.
And I'm like, Ooh, okay.
(16:03):
All right.
So then I stepped back and theycome back with some crazy stuff.
And I'm just like, that is,Whoa, you can do that.
And you did that like in a week.
But then the comment was like,well, the FDA won't let you do
that.
Well, we'll just tell the FDAthey should change it.
And then we'll show them andprove to them how our way is
better.
I said, cool, that's going totake you five years of building
an evidence base.
(16:24):
You can tell them that, but youneed to do your own studies.
There's a reason you and I bothlived ECOA for a long time,
patient reported outcomes.
When you have these newinstruments or these new
equivalency measures from thisto that, the older...
I would say even more legacy orcompanies that have been around
for a really long time did thehard work of their technology
(16:45):
might be older, but they did thehard work of like proving that
the thing that we did actuallyworks better and publish a
study, which then our clientswould go to FDA with a published
case study in a journalsomewhere and say, look, here's
the evidence.
But that would take three yearsto do that.
So that's where startups find areal challenge in our industry
is changing the regulators andchanging pharma because you need
(17:06):
to provide evidence.
So that is why you needsomething that requires less
evidence to start while you'rebuilding your evidence base as
you're going.
That has to be part of yourstrategic plan.
You want to make real change,you need to do the hard work.
And know that's going in.
And solving those complexproblems, right?
I think to your point earlier...
You know, like I'll see pitchesor somebody's like, hey, look at
(17:28):
this thing.
And that's cool, but nobodycares.
And the reason nobody cares isnot because what you built
wasn't cool.
It's because you didn't solveanything that's complex.
Someone would look at that andgo, well, if I had time and
money, I could solve it myself.
Right.
And I think once you run intothat thinking, you're sort of
brick walled already.
And so for me, I think it'syou've got to be able to solve
complex problems, not problemsthat somebody can easily work
out.
They just had a weekend and afew bucks to do it.
(17:48):
And I think that's why you see alot of people in startups that
are typically more successfulare the ones that have industry
expertise or experience or wereactually the buyers because they
knew what to solve for.
So it's really- When I went intopharma for the first time, I
learned so much in a shortamount of time, right?
You've been in on the other sideas well, on the CRO side.
(18:08):
Like when you see what's in themachine and how they make
decisions and why they makedecisions.
The month that I left, I went tothe Scope conference the
February after I left.
And I got to, first of all, I'mnow going from the client to the
vendor.
And they were nice enough to letme keep my speaking spot.
So that was, you know, shout outto Micah and those guys at
Scope.
They're awesome.
But my presentation was notabout the new company I joined.
It was about what I learned inpharma.
(18:29):
It was on YouTube.
You can see it.
But the biggest thing I had wasI found out who they are when
they say they won't let us dothat.
Do you want to know who it is?
Tell me who it is, Joe.
We'll get real quiet just tomake sure everybody hears.
I'm going to whisper.
It is an inspection report fromfour years ago from the FDA
that's flagged your companyabout a whole bunch of stuff.
(18:51):
And the VP of ClinOps says,don't ever let that happen
again.
And they build a mountain ofprocess and a mountain of
third-party risk managementprocesses that just snowball.
And then that lasts until thenext SVP comes in and rips the
whole place apart.
And you start anew.
And so sometimes people that arein pharma and institutionalized
for a long time, they neverforget.
(19:13):
And when you have team membersthat have sat in an inspection
with regulators and threatenedfor their job and feeling like
this might be my fault if I misssomething, they'll never want to
take a risk like that.
That is why We've become soconservative as an industry.
They is regulatory scrutiny andan inspection with someone
sitting in your office auditingyou and holding you accountable.
(19:36):
That's the problem.
Fair point.
Pharma will buy down risk at anyprice.
So startups remember that aswell.
If you reduce risk, they willpay for it.
You heard it.
All right.
I want to shift gears a littlebit.
Are you Apple Music or Spotifyor something else guy?
Good question.
I have been an Apple music guyfor a long time, but my kids all
(19:56):
use Spotify.
Most of my friends use Spotify.
And when I send them links tomusic, like why are you sending
me this Apple music?
I don't use this.
Okay, cool.
Do you have your phone on you?
Can you like open up your Applemusic?
All right, come on, open up yourApple music.
What's the last you can pickartist album or song that you
listen to?
What's the last, the last, let'sjust go.
You can pick artist album orsong that you listen to.
(20:18):
Yeah, okay.
Well, the last one was the lastalbum I just discovered was UFO.
UFO from the 80s.
This is basically the band thatinspired Kirk Hammett from
Metallica.
And I remember, so UFO is like,you know, thrash metal of some
sort.
And inspiration, UFO, Motorhead,Iron Maid, like all these people
(20:39):
are sort of in that same groupin the 70s and the 80s.
I was watching some YouTubevideo because sometimes I go
down the YouTube rabbit hole.
I'm much like, many of us uh andit was some video of kirk
hammett bought uh michaelshanker's like flying v from ufo
and i was like and he wastalking about i was looking at
this guitar in the back of thealbum for years as a kid and
(21:01):
this is why i went to look forthe album like i've never heard
that album so then i went is itgood yeah it sounds nothing like
metallica but like you you canhear some of the inspiration for
sure like oh yeah yeah it's butit's like late 70s, early 80s
heavy metal, which is kind oflike Black Sabbath.
How can people get a hold of youif they want to find you for
(21:22):
consulting support, if they justwant to reach out to you in
general to catch up or to meet?
How do they find you?
Yeah, so joedustin.com isprobably the easiest way to do
that.
There's a page that shows allthe ways to get a hold of me.
I got a whole bunch of links tostuff that I've done over the
past.
The consulting company I run iscalled eClinical Consulting.
I work with startups on theirproduct.
(21:43):
I do product strategy.
I'm doing fractional businessdevelopment, and I'm working on
various things, both in pharmaand in tech.
So you might see me as the guywho's helping run the next RFP
in pharma or working with a techcompany to figure out how to
become the next big thing andhave a little bit of subject
matter expertise in-house whilethey have some genius developers
(22:04):
and entrepreneurs that maybedon't have all the experience
that you and I have had in thisindustry.
So yeah, find me atjoedustin.com.
I'm there.
Perfect.
That's great.
Hey, thanks for your time.
It was good to see you.
Good to see you, John, asalways.
Joe Dustin.
How are you?
Better now.
How are you?
Good.
Hey, we need to start out with adisclosure, though.
I think disclosure time sayswe've known each other for a
long time.
And so if we talk like we'veknown each other for a long
time, it's because we have.
So who's Joe Dustin?
What have you done?
What are you doing now?
Well, there's the one side ofJoe Dustin that's like a guitar
(00:29):
player, travel geek, and spacenerd.
But then there's the other side,which is fell into clinical
trials industry 20 plus yearsago at a family barbecue.
And here I am.
Which one do you want?
A family barbecue?
Yeah, let's do that.
So I was getting out of collegein 2002.
I went to Roger WilliamsUniversity in Rhode Island.
(00:50):
And I was a computer geek.
I was a computer informationsystems major.
I was no biomedical science.
I didn't have a PharmD, none ofthis stuff.
It was, came out like one of thelast classes I took senior year
was like Windows NTadministration.
My first online experience wasgetting the free floppy disks
from AOL in the mail andstealing my mom's credit card
(01:12):
and canceling it right at the29th day to then do it again.
That was kind of how it all gotinto computers.
When I was a kid, my friends andmy family said, I'm either going
to, I'm either going to go on TVsomewhere or I'm going to be
doing something with computersbecause I was in cable access
really young in the local NellRose outside of Boston where I
did a lot of TV stuff, both infront or behind the camera.
(01:36):
So none of this has anything todo with clinical research
because it just kind of happenedout of nowhere.
I'm at a family barbecue inCambridge, Massachusetts.
So I'm sitting there at abarbecue with my uncle and aunts
and Pekka from finland and hesays uh oh so you're getting out
of school you know we could wecould use some people once you
(01:56):
come on bring your resume and uhonce once you're out and send it
over and we'll come talk to youso i did and uh that company was
called crf box back in the olddays which became crf health
which became signet health andso the founders from finland you
know a few of them were overover here and it was me and like
four fins and a couple guys fromthe boston area in an old
(02:17):
doctor's office buildinge-diaries on palm pilots Yeah, I
started as the IT guy.
And within six months, I wasproject manager.
So is this startup tip numberone is go to Barcues?
Yeah, get the sausage.
Amazing.
That's great.
All right.
So, you know, one of the thingsI respect about you a lot,
because I think it takes acertain amount of grit and
(02:38):
demeanor in your career is to bein corporate and to be in
startups and to do both.
is unique.
And, you know, I've done thathistorically.
It's been kind of fun for me tolearn and to grow and to figure
out going from corporateentrepreneur to, you know,
digital entrepreneur.
And you've had a similar track.
So what are the, what's the keydifference?
What's the thing that peopleneed to know that's so different
(03:00):
between working in acorporation, working in a
startup?
Don't be afraid of stability orinstability, I guess is, and it
also has a, is a, it definitelyrings true.
depending on the different pointin your life you're in.
That's for sure.
When I was 22, single, nodependents, and they were like,
yeah, we're going to send you toHelsinki.
(03:21):
This office has six people in itand there's no 401k.
You know, yeah.
Okay, cool.
And so at that point, I didn'tcare.
In fact, it was exciting.
And when I went back to likealumni day back in college, 10
years later, I was the only onethat did a startup.
It was fun.
It was crazy.
It got, it got really fun.
When I finally got out ofproject management, that's for
(03:42):
sure.
Cause I went from startup land,both from at CRF health and then
a company called e-trials.
And when I moved to Raleigh,that's what I right around sort
of when I met you in, in, inthat area and still startup, you
know, went from 60 to 120 peopleand you know, never have enough
budget, never enough resources,never set up for really for
(04:02):
success.
But it wasn't until they startedtaking me out on the sales calls
where it got really fun.
And I joined this little startupin 2008 out of New York called
Medidata.
And that's when things gotreally interesting.
So joining a startup to me ischaotic, but you kind of embrace
the chaos.
But there are things you get tofind that bring a little bit
(04:24):
more stability, not evenfinancially, just like in
yourself, right?
But there's three things I thinkthat really make sense.
You got to have a...
And you could look at this withstartups now where I...
Definitely, I'm seeing it.
You need to have a highlydifferentiated product, like
highly differentiated, becausethere's so many B2s out there,
with a hugely addressablemarket, with a really awesome
(04:45):
culture, and good leaders,right?
And sometimes you can't makethose leaders.
Something about the timing,territory, the talent, what's
happening in the world, and allthe other three things make a
startup successful.
UNKNOWN (05:01):
Yeah.
SPEAKER_00 (05:01):
You know, if you're doing something that is
different, that is new as astartup, there is intentionally
not a manual written alreadyabout someone who did what you
did.
So it's not like there's thelessons learned playbook that
you go pull from.
Yeah, there's certain things,and I'm sure you had this from
your corporate background.
I did too, right?
You walk into a situation,you're like, hey, I've seen some
element of this before.
(05:22):
This is what we need to avoid,or this is how to think through
this problem.
But a lot of times you'd runinto this issue.
And someone was like, what do wedo?
I'm like, well, no one's everdone this before.
So we are the ones that need tofigure it out.
And that wasn't a failure.
That was actually innovation,right?
It just was disguised asfailure.
It was, we figured that thingout.
At a conference in the earlydays, I remember back when the
(05:42):
innovation teams were firstgetting started in pharma, there
was one guy, but he said, weneed an SOP for things that
don't have SOPs.
It's just one of the things hesaid all the time, like, cause
they were so obsessed with SOPs.
Like we need one that just says,we don't know what's going to
happen.
And we're following that.
Did you guys write that SOP?
And can I get a copy of it?
Never.
I would love to.
But I mean, when I was in pharmaduring that time running
(06:06):
innovation, that was a challengebecause I came in bright-eyed
and bushy-tailed.
I'm going to come in and breakshit, right?
Well, it turns out people don'twant things broken.
What's the hardest thing you'vehad to do so far?
Like, what's the hardestchallenge you've had to
overcome?
Getting laid off for the firsttime was like, wait, this
doesn't happen.
(06:27):
Wait, what?
And when that happened, I wasn'tworried.
In fact, I wasn't surprised.
But I think we all go through itat some point in different ways.
The first thing I had to thinkof was, crap, what do I tell my
wife?
Second thing is, what am I goingto do about health insurance?
Because we live in America andthat's what we do.
And number three is, I wasn'tworried about getting another
(06:49):
job because I feel prettyconnected and at least I...
But it took five months, right?
And so even then, in a marketthat was just horrible, and
we're still running throughthat, just dealing with the,
what do I do now, was probablyone of the hardest things I had
to do.
But at the time, I was like,wait, that's hard.
So that's when I started aconsulting business.
I want to get out there and justhelp people and do the right
(07:11):
thing.
I've never felt like I was everin sales.
And I think that's probably whyI was really good at it, because
no one ever saw me as asalesperson.
But it's trying to sellyourself.
is really hard.
We have this like sort ofimposter syndrome sometimes.
And I think we all have toconfront that at some point in
other ways.
I'm getting better at it, but itwas the hardest thing I think
when it happened the first time.
(07:32):
Yeah, that's fair.
When I think equally, you know,setting up joedustin.com is
different, right?
When you have to sort of thinkabout yourself as an individual
contributor, right?
Like with what you mentioned,it's different to shift, right?
And in this market, it's a shiftyou see a lot of people doing.
I've had JoeDustin.com for a lotlonger than that, but I changed
(07:53):
what it was for sure.
Exactly.
So as we think about your storyand we get to the market, it's
not surprising to anybody.
The market we're in right now ischallenging.
Still is challenging.
We go through a pandemic.
We come out of a pandemic.
We've now got a lot of thingsgoing on around the world with
spending and money and politicsand everything in between.
And the market is interesting isthe word I would use right now.
(08:15):
What's the market look like foryou?
What's the market look like inlife sciences and clinical
research?
The market's in recovery.
This is not the recovery year.
I think the second half of thisyear called Q4, I think you'll
start to see some interestingdeals in the market that'll get
people excited that will thenset up for a good 2026, I hope.
(08:37):
Yeah.
So if you're a startup in amarket like that, there's sort
of this like balance though,right?
That's a good opportunitybecause there's still market
share to be taken.
There's still work being funded.
So if you're a startup in thismarket and you're trying to
really set yourself apart, whatadvice are you giving, Joe?
What are you telling startups todo in a market like this that
is, I would argue, is going intorecovery in the second half of
(09:00):
the year is what I would argue.
But let's just say that that isthe premise.
What do you tell startups?
What do you advise them to thinkabout to get through this period
and to actually change or evolveor grow their company when they
get into phases like this?
I think that the few things Isay are hold on tight and stay
true to what you believe isright.
If you have a product marketfit, keep crushing at validating
(09:22):
that that is true.
And there's a reason why so manygreat companies are created
during economic crashes, right?
I think we've witnessed probablytwo or three of them now in my
career lifetime for 20 plusyears.
We've had the dot-com bust, thehousing crisis, and the
post-COVID meltdown.
And I think in each of thosetimes, there are amazing things
that happen.
(09:42):
So when I look at startups,everyone always asks, who's the
next one, right?
So you get to find out, like, ifyou can just stick to what
you're doing and stick to it.
If people think you're crazy,sometimes just stick to it.
And so there's so many startupsI see now.
I'm working with at least threeof them on a more advisory
basis.
that I'm seeing a lot of reallycool things in recruitment tech
and clinical trial matching andtapping into clinical sites and
(10:05):
their data, whether it's an EHRor they're in infrastructure
in-house, like their site CTMSsystems.
There's a rise of the sitescoming where they're going to
start digitally transformingtheir own operations because
they have to.
And as a result of thathappening, more come online,
more data becomes standardizedand available.
You can do more things.
So they're getting ready forwhat's coming, but it's a dual
set of marketplace, right?
(10:26):
You're paying for everything,but the sites are seeing the
patients.
So how do you, make that work.
What's the old adage?
You know, history is the bestview of the future.
You know, this idea that if youwant to see what's going to
happen in the future, look atthe history and these things are
cyclical.
They continue to come around andaround.
And it's funny because I, youknow, looking at sort of like as
a guy who's a CEO and runs acompany and works with great
(10:48):
people and a great product tothese things today.
This market is challenged, butyou can actually still see
growth from it.
You can still see, like yousaid, people saying, hey, now
I've got a little bit more forceagent to make the change, or
I've got new thinking that's inmy company and I've got to take
a hold of that.
So I want to think differentlyabout how I digitize a clinical
trial or how much I use a DHT inmy study, right?
(11:09):
Those conversations come backaround because there's change.
Because there's motivation tofind the next success area.
What's been interesting to me isI think it's really easy to have
the AI discussion.
That's the easy discussion.
Everybody wants to talk aboutAI, AI, AI, and lots of
(11:29):
companies experimenting, usingit.
Some, it is the basis for theirentire company.
But the interesting thing iswhat I think it's actually done
is it's unlocked people's brainsaround AI.
innovation and so what we'reseeing in daily basis is is
people literally going i am r di'm not willing to go all the
way into this area of ai but canyou solve this unique problem or
(11:49):
can you build this powerpointfor me or can you take four
hours of my week out with aii'll buy that and that i don't
have to do an innovation pilotprogram for 17 months to figure
out if i want to do it andthat's been kind of fun actually
and i do think that like yousaid you know this this era of a
market has a natural inclinationto produce opportunity for
(12:10):
startups.
And I really do think now is thetime.
And I think there's a lot ofwinners that are going to be
winners because of what they'redoing right now, which is good.
I'm seeing a lot of AI beingapplied in pharma.
It's really not AI.
It's just intelligent automationand faster robotic process
automation that we used to dofive, 10 years ago in some ways,
right?
But that is becoming easier,cheaper, and faster to do.
(12:32):
And you can roll out thesethings so much faster.
But as that expands, I'm worriedthat we're going to be, we're
going to be automating reallybad processes and we're not
going to, we're not going to fixthe problem, the real problem.
Right.
And so it's cheaper just toautomate a really bad process as
opposed to going through amassive change management
effort.
Cause we know change managementis the hardest part of every
(12:53):
project for sure.
In some cases I would even stopcalling it change management.
I would call it adoptionmanagement because you need
people to adopt the new thing.
And in some cases, there's nochoice.
In startups, you can think ofthis too, where think about the
problem you're doing, theproblem you're working on.
It could be automating betterrecruitment, like calling
(13:14):
patients with robotic AI voicebots.
It could be matching betterpatients through their medical
records and preparing for chartreview with better AI agents in
the background that can get atthe data.
It could be smart protocols.
It could be structuredprotocols.
We were doing this 10 years ago.
right?
But now it's becoming so mucheasier.
If the problem, if the, if the,it's the change equation, right?
(13:36):
So if the problem that youhaving, if the change doesn't
give you at least a 10 Xbenefit, and if the pain is, if
the pain is not more than doingnothing, like if the, if the
pain of doing nothing is morethan the change, then you're
going to change.
And if not, no one's going tocare.
And so you really need tounderstand you being the Royal
you of startups.
(13:57):
Is the problem you're working onreally, really big?
I think everybody is trying toquantify that right now.
And that's, I always advisepeople like really, really
hammer on that one because ifit's questionable, understand
earlier if this has gotsomething, got some legs to it.
Because like you said before,some of these problems that
might not, it might be a new wayof doing things that no one
understands how.
And in five years, you'll say,okay, like smart protocols 10
(14:19):
years ago, we were doing that.
tech companies and CROs weretaking a stab at it.
Transcelerate was buildingstandards for it, but nobody had
a budget.
Nobody had a team.
Nobody had owned the process.
It was just, you're in word andthe scientists over here are
working with you over here.
That's all changed becausepeople were taught a new way to
do things.
And yeah, sometimes it can take10 years.
(14:39):
Yeah.
Fair point.
When you think about telling astartup that something could
take 10 years, there's probablylike investors only have five
years.
Yeah.
You know, I think, I think someof the startup founders probably
just went, Oh, thanks Joe.
Appreciate it.
You know, what's, what's theadvice you give to a startup
leader, right?
That says, Hey, I got to hang inthere.
I got to solve, solve a problem.
I got to solve a problem becauseI have to make revenue.
(15:01):
I need to make money, right?
The new world that we live inrewards making money as much, if
not more than, growth.
I think that there needs to besome sort of product that you
have that can solve a problemnow while you build the bigger
problem or the bigger productfor the bigger vision of the
problem you want to solve thatis going to take longer.
And so you need something thatworks today.
(15:22):
And that's sometimes really hardto find because a lot of times
you don't want to build a metoo.
You want to build somethingthat's revolution.
Pharma doesn't want revolution.
They can't adopt revolution.
The companies that have been themost successful in our industry
are And it pains me to say thissometimes, but when I talk to
startups about this, especiallywhen you're talking to a lot of
people that are rooted inSilicon Valley, they want to rip
(15:43):
the machine down and completelyredo everything and their hearts
in the right place, their mindat a better place.
Right.
But when I hear people likeengineers, where the real
innovation comes from theengineers, that's for sure.
I was, I was told many times inmy day, stop telling me how it's
done.
Tell me what the problem is.
I will show you a new way of howit's done.
And I'm like, Ooh, okay.
(16:03):
All right.
So then I stepped back and theycome back with some crazy stuff.
And I'm just like, that is,Whoa, you can do that.
And you did that like in a week.
But then the comment was like,well, the FDA won't let you do
that.
Well, we'll just tell the FDAthey should change it.
And then we'll show them andprove to them how our way is
better.
I said, cool, that's going totake you five years of building
an evidence base.
(16:24):
You can tell them that, but youneed to do your own studies.
There's a reason you and I bothlived ECOA for a long time,
patient reported outcomes.
When you have these newinstruments or these new
equivalency measures from thisto that, the older...
I would say even more legacy orcompanies that have been around
for a really long time did thehard work of their technology
(16:45):
might be older, but they did thehard work of like proving that
the thing that we did actuallyworks better and publish a
study, which then our clientswould go to FDA with a published
case study in a journalsomewhere and say, look, here's
the evidence.
But that would take three yearsto do that.
So that's where startups find areal challenge in our industry
is changing the regulators andchanging pharma because you need
(17:06):
to provide evidence.
So that is why you needsomething that requires less
evidence to start while you'rebuilding your evidence base as
you're going.
That has to be part of yourstrategic plan.
You want to make real change,you need to do the hard work.
And know that's going in.
And solving those complexproblems, right?
I think to your point earlier...
You know, like I'll see pitchesor somebody's like, hey, look at
(17:28):
this thing.
And that's cool, but nobodycares.
And the reason nobody cares isnot because what you built
wasn't cool.
It's because you didn't solveanything that's complex.
Someone would look at that andgo, well, if I had time and
money, I could solve it myself.
Right.
And I think once you run intothat thinking, you're sort of
brick walled already.
And so for me, I think it'syou've got to be able to solve
complex problems, not problemsthat somebody can easily work
out.
They just had a weekend and afew bucks to do it.
(17:48):
And I think that's why you see alot of people in startups that
are typically more successfulare the ones that have industry
expertise or experience or wereactually the buyers because they
knew what to solve for.
So it's really- When I went intopharma for the first time, I
learned so much in a shortamount of time, right?
You've been in on the other sideas well, on the CRO side.
(18:08):
Like when you see what's in themachine and how they make
decisions and why they makedecisions.
The month that I left, I went tothe Scope conference the
February after I left.
And I got to, first of all, I'mnow going from the client to the
vendor.
And they were nice enough to letme keep my speaking spot.
So that was, you know, shout outto Micah and those guys at
Scope.
They're awesome.
But my presentation was notabout the new company I joined.
It was about what I learned inpharma.
(18:29):
It was on YouTube.
You can see it.
But the biggest thing I had wasI found out who they are when
they say they won't let us dothat.
Do you want to know who it is?
Tell me who it is, Joe.
We'll get real quiet just tomake sure everybody hears.
I'm going to whisper.
It is an inspection report fromfour years ago from the FDA
that's flagged your companyabout a whole bunch of stuff.
(18:51):
And the VP of ClinOps says,don't ever let that happen
again.
And they build a mountain ofprocess and a mountain of
third-party risk managementprocesses that just snowball.
And then that lasts until thenext SVP comes in and rips the
whole place apart.
And you start anew.
And so sometimes people that arein pharma and institutionalized
for a long time, they neverforget.
(19:13):
And when you have team membersthat have sat in an inspection
with regulators and threatenedfor their job and feeling like
this might be my fault if I misssomething, they'll never want to
take a risk like that.
That is why We've become soconservative as an industry.
They is regulatory scrutiny andan inspection with someone
sitting in your office auditingyou and holding you accountable.
(19:36):
That's the problem.
Fair point.
Pharma will buy down risk at anyprice.
So startups remember that aswell.
If you reduce risk, they willpay for it.
You heard it.
All right.
I want to shift gears a littlebit.
Are you Apple Music or Spotifyor something else guy?
Good question.
I have been an Apple music guyfor a long time, but my kids all
(19:56):
use Spotify.
Most of my friends use Spotify.
And when I send them links tomusic, like why are you sending
me this Apple music?
I don't use this.
Okay, cool.
Do you have your phone on you?
Can you like open up your Applemusic?
All right, come on, open up yourApple music.
What's the last you can pickartist album or song that you
listen to?
What's the last, the last, let'sjust go.
You can pick artist album orsong that you listen to.
(20:18):
Yeah, okay.
Well, the last one was the lastalbum I just discovered was UFO.
UFO from the 80s.
This is basically the band thatinspired Kirk Hammett from
Metallica.
And I remember, so UFO is like,you know, thrash metal of some
sort.
And inspiration, UFO, Motorhead,Iron Maid, like all these people
(20:39):
are sort of in that same groupin the 70s and the 80s.
I was watching some YouTubevideo because sometimes I go
down the YouTube rabbit hole.
I'm much like, many of us uh andit was some video of kirk
hammett bought uh michaelshanker's like flying v from ufo
and i was like and he wastalking about i was looking at
this guitar in the back of thealbum for years as a kid and
(21:01):
this is why i went to look forthe album like i've never heard
that album so then i went is itgood yeah it sounds nothing like
metallica but like you you canhear some of the inspiration for
sure like oh yeah yeah it's butit's like late 70s, early 80s
heavy metal, which is kind oflike Black Sabbath.
How can people get a hold of youif they want to find you for
(21:22):
consulting support, if they justwant to reach out to you in
general to catch up or to meet?
How do they find you?
Yeah, so joedustin.com isprobably the easiest way to do
that.
There's a page that shows allthe ways to get a hold of me.
I got a whole bunch of links tostuff that I've done over the
past.
The consulting company I run iscalled eClinical Consulting.
I work with startups on theirproduct.
(21:43):
I do product strategy.
I'm doing fractional businessdevelopment, and I'm working on
various things, both in pharmaand in tech.
So you might see me as the guywho's helping run the next RFP
in pharma or working with a techcompany to figure out how to
become the next big thing andhave a little bit of subject
matter expertise in-house whilethey have some genius developers
(22:04):
and entrepreneurs that maybedon't have all the experience
that you and I have had in thisindustry.
So yeah, find me atjoedustin.com.
I'm there.
Perfect.
That's great.
Hey, thanks for your time.
It was good to see you.
Good to see you, John, asalways.
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