December 8, 2022 • 27 mins
Josh Cohn has 15 years of experience in the medical device field, rising to National Sales Director of PENTAX Medical, a major endoscope provider. He has a strong history of leading successful sales organizations, building winning strategies, and launching disruptive programs aimed at changing marketplace conventions. As product champion and strategist for all EUS sales, he has attended hundreds of procedures and has established relationships with key opinion leaders, hospital and ASC administrators, and device distributors. In his current role as CCO, Josh will be responsible for the pre-and post-commercialization Sales and Marketing strategy designed to ensure the integrated commercial success of the organization.
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Speaker 1 (00:00):
Welcome to the Latin MedTech Leaders podcast, a
conversation with MedTechleaders who have succeeded or
plan to succeed in LatinAmerica.
Please subscribe on yourfavorite podcasting platform.
Apple Podcast, Spotify, GooglePodcast.
Amazon Music is teacher tuning.
I heard radio, Pandora, or theseare
Speaker 2 (00:21):
Welcome back to the Mex Leaders podcast, a
conversation with leaders whohave succeeded or plan to
succeed in Latin America.
Please subscribe on yourfavorite podcasting platform.
Apple Podcast, Spotify, GooglePodcast, Amazon Music, et cetera
.
Today our guest is Josh k He isthe Chief Commercial Officer at
(00:44):
Endo Sound, a company dedicatedto expanding access to
endoscopic ultrasound technologyworldwide.
So Josh, it's great to have youhere today.
Welcome to the
Speaker 3 (00:53):
Show.
Thank you for having me.
Glad to be here.
Speaker 2 (00:55):
Awesome, Josh.
So let's get started with yourjourney to the region, to Latin
America.
Josh, how is it that you gotinvolved?
Speaker 3 (01:02):
Well, I mean, my journey to Latin America started
at birth, so I'm proud to, to be, um, a descendant of a
Venezuelan.
My mother migrated to the UnitedStates, uh, in college, and, um,
she's been here ever since.
So my affinity, uh, to LatinAmerica started at birth and
I've had the opportunity to beimmersed into that culture from
(01:22):
a very early age.
Um, had the opportunity to visitVenezuela a dozen or more times
over the years.
And, um, my love for Venezuelaand Latin America kind of
started there.
Um, from a, from a businessperspective, uh, my journey
started a little bit later, ofcourse, um, had the opportunity
to meet a number of KOLs andphysicians, um, who visited the
(01:46):
states for conventions.
Um, I was the resident Spanishspeaking person in the booth
when my Latin Americancolleagues were at other
meetings or hadn't arrived tothe booth quite early enough.
Um, so that helped me forge arelationship with those folks in
the sense that I could, um, helpcommunicate with their customers
when they weren't there.
Um, and that helped me forge arelationship with them that
(02:07):
really, uh, was ongoing for anumber of years.
Um, so we, we kept in touch.
We talked about strategy, etcetera, et cetera.
And then, um, when I started atEndo Sound, my friends there
really encouraged me to, and theorganization to, to look at
Latin America as an opportunityto do a lot of our early work
and, and, and reach out to someKOLs down there.
(02:28):
And, and we took their adviceand it's been fantastic.
Speaker 2 (02:32):
Excellent.
I'm so glad to hear that.
Uh, Josh, so let's talk about,uh, trends in Latin America.
What do you see happening in theregion that is relevant to the
discussion about, uh, clinicalresearch or commercialization of
medical technologies
Speaker 3 (02:46):
In Latin?
Yeah, I mean, uh, historicallymed device would go to Europe.
Um, that was the kinda feedingground for early device work,
first in man work.
Um, and you know, at Pinax itwas always a struggle to see all
those devices being developedand sold in Europe first, and
then it would come to the UnitedStates.
And now, um, with what isperceived to be a much more
(03:07):
difficult and arduous processwith the mdr, um, medical device
companies are looking for otherareas to do some early, um,
stage work, and I'm seeing a lotof, uh, companies like Endo
sound, uh, look to Latin Americawhere there's lots of
opportunity, um, to work and,and learn.
And the, the, the ground inLatin America is fertile with
(03:31):
wonderful, um, physicians, KOLsthat are very well respected
here in the United States andaround the world, and, um, are
experience down there has beensecond to none.
Um, so I see, I see a lot ofcompanies starting to do what
they did in Europe years ago,now going to Latin America and
doing a lot of that early stagework.
Speaker 2 (03:49):
Excellent.
Yes, I see that too.
That's, that's, um, certainly,uh, a train that, uh, is been
happening for probably fiveyears now, where, um, in, in
essence I see Latin Americagetting more mature.
Um, and, and companies arelooking more seriously at the
region as a, as a, as a workclass region for many, for many
(04:13):
activities, uh, includingclinical research and also
commercialization.
Speaker 3 (04:18):
It's great for patient care, right?
Because, um, especially in LatinAmerica as well, right?
The patients there are, aregetting access to technologies
that they may not have receivedpreviously, but quite frankly,
it's really expediting thesetechnologies to become available
to people around the world,right?
Um, just in the same manner asit was done in Europe.
Now it's done in Latin America.
And, um, you know, I think ifcompanies take advantage of the
(04:41):
opportunity down there, uh,they'll see some enormous
benefits from a time to marketperspective to building better
products, being to marketsooner, but also with a better
product that that enhancespatient care.
Speaker 2 (04:53):
Yeah.
So now topic of trends.
Um, what I have your take onwhat's happening in Europe for
the audience to understand whatis it that we're talking about
here?
Uh, what do you think ishappening in Europe?
What is it that is so difficultto commercialize or to do
research in in that region?
Speaker 3 (05:10):
You know, the, the, I'm no expert right, in regards
to the regulatory environment in, in Europe, however, um, some
of the clinical requirementsthat are required as part of the
MDR has really made it moredifficult to, to go to Europe.
Um, it's a much longer process.
There are a lot morerequirements that are required.
Um, you know, then there's the,um, the process of, um, oh, I
(05:35):
can't think of it now, myapologies.
But there's, there's a number ofpolicies that are in place that
are making it a little bit moredifficult, um, to go there.
Speaker 2 (05:42):
Yeah.
And the number of notifiedbodies, uh, got produced
dramatically.
So there's a backlog.
Yeah,
Speaker 3 (05:48):
That's correct.
Yeah.
That, that's another issue aswell.
Um, getting in with the notifiedbodies and now that they've
reduced them is also a challenge.
Yeah.
Speaker 2 (05:56):
Okay.
So hopefully that means morebusiness and newer technologies
in Latin America.
Speaker 3 (06:03):
I think so.
I, I, I really do.
Um, you know, I've been, youknow, working for a startup now,
really in a consulting andfull-time capacity for over
three years now.
I've had the opportunity to meetand talk to other leaders of
startups and, um, this idea ofgoing to Latin America is very
intriguing.
Um, and there are so manyadvantages to going down there.
(06:23):
I think we're gonna continue tosee the trend of folks going to
Latin America and getting somework done.
Speaker 2 (06:28):
Beautiful.
Beautiful.
Alright, so let's talk about,um, what you're doing in Latin
America today.
Speaker 3 (06:33):
Yeah.
Um, so, you know, we started inEcuador.
We've done all of our first inman or all of our clinical work
in, in Ecuador.
And, and we've done a littleover a dozen cases.
Um, and it's been incrediblybeneficial from not just a
commercial perspective, but anengineering perspective and an r
and d perspective.
Uh, we went to Ecuador understrict clinical readiness
(06:56):
reviews, um, to be sure that the, the product was ethical and
safe for patients.
Um, our physician partner, um,you know, received our protocol,
looked at our protocol, acceptedour protocol.
After a number of changes and wewere able to get a bunch of
feedback, we've actually beenable to iterate or quickly, uh,
whereas if we would've, um, notgone to Latin America prior to
(07:20):
commercialization, we might nothave as good a product to
market.
So we've been able to, yeah, we,our engineering team has been
able to take feedback from someof those early cases.
And we've actually iteratedwe've changed the product to do
a little bit different thingsand we thought it could do.
Um, and, and it's beenincredibly helpful.
Um, the gentleman that we'repartnering with is Dr.
(07:40):
Carlos Robles.
Um, he is a thought leader, notjust in Latin America, but in
the United States.
He's on the circuit here in theus.
He visits here quite, quitefrequently.
Um, and, and many of the thingsthat he has learned down there
has informed, um, informed our rand d group.
And we believe that when we goto market in the next six
months, we're gonna have abetter pro better product, which
(08:02):
is gonna give better patientcare, um, et cetera, et cetera.
Speaker 2 (08:05):
Very good.
Wow.
And how is it that you found Dr.
Rus, uh, in Ecuador?
Speaker 3 (08:10):
Yeah, so, um, having, uh, been at Pinax for 14 years
and, and having developedrelationships with the Latin
American team, um, the, the USside used Carlos as well as a
speaker, um, as someone who wecould get early feedback on
devices that Pentax may havegone to Latin America with first
.
So I had the opportunity tofirst meet him there.
(08:32):
Um, and then one of mylatinamerican mentors, Peter,
who has run the Latin Americanmarket for a number of different
companies, um, you know, reallyencouraged us to reach out to
Carlos.
Um, early on we did that, and,and Carlos actually did a lot of
our early animal work as well.
Nice.
Speaker 2 (08:50):
Okay.
Speaker 3 (08:50):
So he came over here and, um, helped us with that.
So it's been, been an awesomepartnership.
It really has.
And I believe he's going to bestarting a, a study here in, in
the next couple months, um, youknow, in regards to our
technology and how it comparesto those that are already
existing.
Very
Speaker 2 (09:07):
Good, very good.
The study in the United Statesled by Dr.
Carlos.
Well,
Speaker 3 (09:11):
He, yeah, he's gonna, he's gonna do the study in
Ecuador and he will lead, he'lllead the study.
Speaker 2 (09:16):
Oh, ok.
Ok.
So, Josh, any, um, commentsabout the hospital
infrastructure in Ecuador, aboutthe skills of the investigators
or the team, the research teamand all that?
Speaker 3 (09:29):
Yeah, great question.
Um, you know, the, the, thefacility that we've done our,
um, device work at is reallysecond to none.
Um, the folks are, um, alwayssurprised when we, when we take
'em down there with us, we takeour folks down, look at it, and,
you know, they have the latestand greatest equipment on the
(09:50):
market, really is a benefit toan early stage company because
that's what we're comparingourselves to, right?
When we come to the UnitedStates, they're gonna, they,
they don't want you to compareyourself to a, to an older
technology that might not be onmarket.
So in our case, we actuallycompare ourselves to equipment
that is the latest and greatestbeing sold across around the
world.
So from an equipment perspective, from a facility perspective,
(10:13):
second to none.
And then from a clinicalexpertise perspective, second to
none.
So the, the center that we use,um, is a training center, um, is
endorsed by the world endoscopyorganization and a number of
other societies.
Um, they, uh, train a number of,uh, advanced fellows every year.
Um, I had the opportunity tomeet, uh, a number of those
(10:35):
fellows, uh, that have now goneback to Mexico, for example, in
one that's gone back to Romania.
And the benefit to them is thatthey're getting their hands on
the latest and greatest oftechnologies.
Um, and they've had theopportunity to see and, and use
Endo sound as well, which isbeen a great benefit.
Um, and they're, they're highlymotivated to, to, to continue to
(10:59):
work with Endo sound causetechnology can bring benefits to
their markets as well.
So, um, the clinical, the, theclinical team there, the
research team, again, second tonone, we, we have no, uh,
reservations in regards to, todoing our clinical research
there and, and, and doing ourearly stage work
Speaker 2 (11:16):
There.
Wow.
I'm, I'm so happy to hear that.
Uh, in, in Ecuador, it's not acountry that I usually hear
companies, uh, um, do researchon.
Uh, so, um, usually you hearColumbia, ua, other countries,
Mexico, but it's the first timethey hear Ecuador.
So that's why I'm so curiousabout your, your experience.
Speaker 3 (11:38):
Yeah, you know, the staff is amazing.
Um, you know, maybe it'sendoscopy, maybe it's different
specialties have their differentareas in Latin America or
whatnot.
Um, you know, maybe it's, maybeit's a new and up and come in.
And, and, and Carlos certainlyis one of those folks that, uh,
is highly respected and he, hedid a lot of his training in
(11:59):
Europe as well.
Um, I think builds somecredibility for him.
And, um, in any event, there's anumber of companies in the end
actually and centers Ecuador.
Um, so if we find Ecuador to be,again, just a wonderful place to
work from a culture perspectiveand ease to work there.
(12:20):
Um, you know, and, and in, inregards to this particular, it's
five minutes from the airport towork every day.
So it's convenient.
The food's not bad.
Uh, we like to have fun seafood,right?
.
Yeah.
Speaker 2 (12:40):
Excellent.
Thank, glad, thank, glad.
And, uh, do you have to gothrough at this committee review
or Ministry of Health review,uh, what was experience, uh, in
that area?
Speaker 3 (12:49):
So the account, um, handles it all right.
So we provide them with aprotocol, we provide them with
our clinical readiness reviews,show that we've done certain
tests to make sure it's safe andapplicable.
Um, and then they handle thatthrough their IRB process mm-hmm
.
.
So they kinda handle all of theins and outs of what's required,
um, for us to come there and doearly stage work.
Speaker 2 (13:10):
Nice.
Very good.
So you do have to use theservices of, uh, consultant,
regulatory consultant or thirdparty agency, uh, CRO or
anything like
Speaker 3 (13:19):
That?
Correct.
It's, it's turn, it's turnkey,uh, which they make it very easy
right.
To work with.
Um, now we do consult and wehave consulted with our
regulatory consultant to makesure that the things that we're
doing down there, um, you know,are, are able to be done, et
cetera.
You know, one of the things thatwe also were allowed to do, uh,
and this is just based on thefact that Carlos is a rockstar,
(13:41):
um, he's, he's been invited, uh,to be on global, um, endoscopy
courses, live endoscopy courses.
So back in, um, I guess it wasearlier part of this year, um,
there's a program calledEndoscopy on Air.
And, um, Carlos and Endo Soundwere, were asked to participate.
So we were able, um, to do somecases with Carlos in preparation
(14:04):
for that.
And then we went live, so we hada live case done on, on a
patient in Ecuador wherethousands, thousands position
we're able to see thetechnology.
And again, because the facilityis second to none, you know, uh,
they're able to pipe in, youknow, the, the recorders and,
(14:24):
and video everything andstreamed perfectly.
And, uh, the responses that wereceived worldwide were almost
too many that we could handle.
Small team, absolutely smallteam.
Um, but that was another hugeadvantage of going down there.
We, we could have never donethat in the United States, but
(14:44):
cause Carlos was asked toparticipate, he thought highly
enough of our technology to useit.
And, um, it was just an awesomeopportunity that we took
advantage of.
Speaker 2 (14:54):
Beautiful.
I'm so happy to hear that.
And do you mind naming the cityin Ecuador?
Speaker 3 (14:59):
Yeah, it's, sorry, it's
Speaker 2 (15:01):
Beautiful city, right by the water.
Speaker 3 (15:03):
Yes.
Chance to the Galapagos, butthat's, um, it's on my bucket.
That's when I go down thereagain soon.
Speaker 2 (15:11):
Have you gone to keto ?
To keto?
Speaker 3 (15:14):
You know, we have not been to keto yet.
Speaker 2 (15:17):
Okay.
Tito's in I city.
Very historical.
Yeah.
So you fly directly from the USto gu,
Speaker 3 (15:22):
Miami, GU, four hours, five minutes to the
hotel,
Speaker 2 (15:28):
Nice
Speaker 3 (15:31):
Hotel bar, and then
Speaker 2 (15:33):
.
Great.
Set up.
Love it.
I love it,.
Alright.
So Jeff, let's talk about your,your future plans in Latin
America.
What is it that you wannacontinue doing in Latin America?
Or you wanna do differently inLatin America?
Speaker 3 (15:47):
Yeah, I, I think our, um, our experience down there
has been so good, um, that weplan to continue down there.
Um, there are certain marketsthat are a little bit easier to
navigate in regards to theregulatory environment, and we
plan to take advantage of thoseopportunities.
(16:08):
Um, we are in discussions withmarkets such as Venezuelan, uh,
Venezuela, uh, Costa Rica,Brazil, um, Chile, um, and we,
we intend on going down therevery soon after our submission
to the fda.
So once, once we have all of ourvnv work done, everything where
(16:28):
we feel like, um, we're ready topass the test here in the u in
the US with our, uh, submission,we plan to be aggressive in
Latin America.
So we'll be attending a numberof those countries.
Um, certainly Columbia is alsoanother country that we're
interested in going down and,and working in because it'll be
an opportunity to, to get a lotof more work done.
(16:48):
So our goal is to, to get, youknow, a hundred, 200 cases done
down in Latin America prior tofull commercialization in the
United States.
And as you can imagine, it givesus enormous advantages to our
strategy to commercializesuccessfully.
Um, and then once we get donewith those, those cases in Latin
America, we'll be a much moreinformed organization in regards
(17:11):
to what this technology can doon a larger scale.
Um, and then we plan to, to, towork on distributorships down in
Latin America, because LatinAmerica, um, for our technology
in particular, um, could bereally a game changer.
Um, unfortunately the technologythat we're looking to not
necessarily replace, but to, um,to, to be a compliment to is
(17:36):
very, very, very expensive.
And unfortunately, uh, manycountries have very little
access to this technology.
Uh, patients have to drivehundreds of miles to get to the
main center.
Um, and even then, it may be along wait, um, to get in and
we're able to provide the sametechnology at 10, 15% of the
(17:58):
cost of traditional systems.
So, um, you can imagine whatkind of access that will provide
to folks in Latin America.
So we're really excited aboutthe opportunity down there.
Uh, we're exploring, uh,distributor ships down there
that make the most sense for us.
Uh, and when the time comes to,to fully launch in Latin
America, hopefully we'll beprepared to take care of
patients down there as well.
Speaker 2 (18:17):
Beautiful, beautiful.
Have you had prior experience,uh, with regulatory approvals
for commercial devices in LatinAmerica, your prior company?
Speaker 3 (18:26):
So I do not, I do not have any of that experience, but
again, one of my mentors inLatin America, um, has been, uh,
very helpful and insightful inregards to kinda the regulatory
environment.
And he doesn't claim to be anexpert either, but certainly
having run Latin America for acouple decades now, he has folks
that he relies on from aregulatory perspective that has
(18:49):
given us a little bit offeedback here and there.
And when I think when we'reready to, to launch down there
and, and, and go through theprocess of each country's
ministry of help, I think we'llbe looking for experts like you,
right.
That, uh, thank you.
Could help navigate, could helpus navigate those waters.
Speaker 2 (19:04):
Absolutely.
Absolutely.
Yeah.
Latin America, it's, um,certainly, uh, a challenging and
potentially lucrative regionchallenging because it's, you
know, you have 33 countries,every country with a different
regulatory body, regulatoryapproval process and all that.
But 33 countries, most companiesonly focus on about five to
(19:26):
seven countries.
You know, the, the usualsuspects, uh, Brazil, Mexico,
Columbia, Argentina, Chile, Peru, uh, maybe Panama, Costa Rica,
Ecuador, uh, and, and, and therest of the countries are very
small.
Speaker 3 (19:43):
Now, what, what's been your experience with the
regulatory environment once youhave FDA clearance?
Um, very
Speaker 2 (19:51):
Good, very good.
I mean, I, I will say that F fdaor C mark approval is kind of
the, the seal of, of, of, ofacceptance of q leader
acceptance.
For example, I'm gonna give you,uh, the, the case of Chile.
Chile is a country doesn't havea regulatory approval process by
(20:14):
law is, is wide open.
You can import devices tomorrowin Chile without a regulatory,
uh, certificate.
However, if you come to Chilewith a product that is not FDA
approved or see Mark approved,no q opinion leader in a
reparable hospital will buy theproduct or will use the product
(20:35):
on patients.
So it's kinda a, a, a marketdriven regulatory process.
.
Yeah, yeah, yeah.
That's how it works.
So also in Columbia, I mean,you, you get, especially with,
with lower risk technologies,you get all these Chinese Indian
companies trying to sellproducts in Latin America.
Uh, however, uh, I see the valueof American products being on
(21:00):
the, on the higher riskspectrum, on the, on the more
sophisticated on on innovation,that's where American products
really have a fit in the marketor a market fit, I'm sorry.
And, um, and, and ands leaderswill accept any fda, uh,
approved product.
I mean, any, any day, uh, in the, in, in the case of the
(21:23):
regulatory approval process, theevery country in Latin America
has a different set of referencecountries.
Uh, for example, uh, Mexico usesf FDA as a reference country,
Canada, I mean the US fda,Canada, and, uh, Japan.
Speaker 3 (21:41):
Okay.
Mexico
Speaker 2 (21:42):
Doesn't accept C a c and that's odd.
That's really odd.
Mexico doesn't accept teamworkas a reference country or Europe
as a reference country.
However, Columbia accepts Europeas a reference country.
So if you have FDA approval, uh,Canadian approval, uh, European
approval, c a c, uh, JapaneseAustralian approval, then it is
(22:05):
very straightforward to registera product in Columbia.
Or you also need home countryapproval.
Let's say you are a company fromKorea, right?
It's not a reference country,but you have the approval of
your national regulatory agencyto sell the product in Korea.
So you have home approval.
So that will help you get, um,uh, access to the marketing
(22:29):
Columbia.
However, a key opinion leader,as I said, will not look at the
product favorably because itdoesn't have FDA or C market
approval.
Right?
So,
Speaker 3 (22:38):
Makes all the sense in the world.
Yep.
Makes all the sense.
Speaker 2 (22:41):
So anyway, Josh, so, um, before we end the interview
here, uh, any final words ofwisdom, any final thoughts that
you wanna share with, uh, theaudience?
I mean, if you have the CEO of anewer medical device company
looking to do anotherfeasibility, uh, trial or to
sell innovation Latin America,what would you say to him or her
(23:02):
?
Speaker 3 (23:03):
Yeah, I would say find a key opinion leader in
Latin America that is respected.
Um, it also, I will say this, italso depends on that particular
device company's exit strategy,right?
Um, you know, I, I would arguethat if their exit, I would
argue that their, regardless oftheir exit strategy, that Latin
(23:23):
America is a good place to go.
Um, but if their exit strategyis not acquisition and it's a
brick and mortar long term, thenI would absolutely go down to
Latin America.
And that choosing the right KOLmight not be as important.
Um, if acquisition's not atarget, for example, we may
(23:44):
choose, um, a KOL based on oneof our potential acquirers,
right?
Someone that know that they use,someone that they respect, et
cetera.
If your acquisition isn't yourexit strategy, then that might
not inform who you work with,right?
You might go down there and workwith who makes the most sense
for your company, right?
(24:04):
Regardless, you know, choosingthe right KOL is important.
That's a great point.
Hmm.
I never heard of it.
.
Yeah.
So I, I would encourage them to,to go and find KOLs in, in the
country that they find, um,easiest to work and, and, and to
do work in.
And then, um, develop thoseprotocols alongside that
physician.
(24:24):
I would, uh, I would encouragethem to use their counterparts
if it's a US company to validatesome of the things that you're
doing back and forth.
I will say this, one of the hugeadvantages of working in in
Carlos's lab, for example, arehe receives physicians from the
United States all the time.
Huge names down work with him.
(24:44):
So we've had the opportunity,for example, Dr.
Sandy Patel outta Texas, um, avery, uh, respected name
actually did a case with, withEndo sound in Ecuador on another
live course that was beingstreamed globally.
Um, so there was huge advantagesthere in the sense that an
American doctor was now able touse our technology as well.
But I would, I wouldstrategically, I tell them to,
(25:07):
you know, choose the right KOLand, um, do as much work down
there as possible to inform ther and d team.
Do it as early as possible,right?
Um, you know, doing it afteryour, your manufacturing process
is validated and you have ago-to-market product isn't
advantageous to anyone, right?
Because they're not able toinform anything.
(25:27):
So as early as they can get toLatin America, um, with a KOL
safely, I would go down thereand learn, and I'd have your r
and d turnt team learn, youknow, the pros and cons of your
device.
I would iterate quickly and thenI would get down there for
additional clinical work as soonas you have your next device,
(25:47):
um, or prototype.
And then from a commercial, froma commercial perspective, again,
I would highly encourage, um,those companies to go down and
do as much work as possible oncethey've submitted to the fda.
I've been, um, a part of twovery large organizations and,
um, you know, some of the, theclinical work that that was
(26:08):
being done in the United Stateswere oftentimes the first time,
uh, representatives like myselfthat were there, saw the
equipment in, in, in use.
And I believe that wasopportunity lost, right?
If, if, uh, we train our peopleon the products that we're
selling at an earlier stage, um,that really benefits everyone.
So we intend to go down therewith our market development team
(26:30):
to Latin America.
We plan to train them down thereso that when they're in the US
they're not watching their firstendo sound case that they've
ever seen, right?
They, and they know the benefitsof our product, right?
Not every product is perfect.
Um, actually there is no perfectproduct.
So be able to understand theadvantages and the disadvantages
of the product so that we canset expectations with our
(26:52):
customers here in the UnitedStates is gonna be priceless.
Speaker 2 (26:54):
Beautiful.
Thank you so much, Josh, foryour insights and words of
wisdom.
So thank you for being the showtoday.
I really appreciate your timeand you sharing your knowledge
with your audience, and I lookforward to being in
Speaker 3 (27:06):
Touch.
Yeah, thank you.
Welcome to the Latin MedTech Leaders podcast, a
conversation with MedTechleaders who have succeeded or
plan to succeed in LatinAmerica.
Please subscribe on yourfavorite podcasting platform.
Apple Podcast, Spotify, GooglePodcast.
Amazon Music is teacher tuning.
I heard radio, Pandora, or theseare
Speaker 2 (00:21):
Welcome back to the Mex Leaders podcast, a
conversation with leaders whohave succeeded or plan to
succeed in Latin America.
Please subscribe on yourfavorite podcasting platform.
Apple Podcast, Spotify, GooglePodcast, Amazon Music, et cetera
.
Today our guest is Josh k He isthe Chief Commercial Officer at
(00:44):
Endo Sound, a company dedicatedto expanding access to
endoscopic ultrasound technologyworldwide.
So Josh, it's great to have youhere today.
Welcome to the
Speaker 3 (00:53):
Show.
Thank you for having me.
Glad to be here.
Speaker 2 (00:55):
Awesome, Josh.
So let's get started with yourjourney to the region, to Latin
America.
Josh, how is it that you gotinvolved?
Speaker 3 (01:02):
Well, I mean, my journey to Latin America started
at birth, so I'm proud to, to be, um, a descendant of a
Venezuelan.
My mother migrated to the UnitedStates, uh, in college, and, um,
she's been here ever since.
So my affinity, uh, to LatinAmerica started at birth and
I've had the opportunity to beimmersed into that culture from
(01:22):
a very early age.
Um, had the opportunity to visitVenezuela a dozen or more times
over the years.
And, um, my love for Venezuelaand Latin America kind of
started there.
Um, from a, from a businessperspective, uh, my journey
started a little bit later, ofcourse, um, had the opportunity
to meet a number of KOLs andphysicians, um, who visited the
(01:46):
states for conventions.
Um, I was the resident Spanishspeaking person in the booth
when my Latin Americancolleagues were at other
meetings or hadn't arrived tothe booth quite early enough.
Um, so that helped me forge arelationship with those folks in
the sense that I could, um, helpcommunicate with their customers
when they weren't there.
Um, and that helped me forge arelationship with them that
(02:07):
really, uh, was ongoing for anumber of years.
Um, so we, we kept in touch.
We talked about strategy, etcetera, et cetera.
And then, um, when I started atEndo Sound, my friends there
really encouraged me to, and theorganization to, to look at
Latin America as an opportunityto do a lot of our early work
and, and, and reach out to someKOLs down there.
(02:28):
And, and we took their adviceand it's been fantastic.
Speaker 2 (02:32):
Excellent.
I'm so glad to hear that.
Uh, Josh, so let's talk about,uh, trends in Latin America.
What do you see happening in theregion that is relevant to the
discussion about, uh, clinicalresearch or commercialization of
medical technologies
Speaker 3 (02:46):
In Latin?
Yeah, I mean, uh, historicallymed device would go to Europe.
Um, that was the kinda feedingground for early device work,
first in man work.
Um, and you know, at Pinax itwas always a struggle to see all
those devices being developedand sold in Europe first, and
then it would come to the UnitedStates.
And now, um, with what isperceived to be a much more
(03:07):
difficult and arduous processwith the mdr, um, medical device
companies are looking for otherareas to do some early, um,
stage work, and I'm seeing a lotof, uh, companies like Endo
sound, uh, look to Latin Americawhere there's lots of
opportunity, um, to work and,and learn.
And the, the, the ground inLatin America is fertile with
(03:31):
wonderful, um, physicians, KOLsthat are very well respected
here in the United States andaround the world, and, um, are
experience down there has beensecond to none.
Um, so I see, I see a lot ofcompanies starting to do what
they did in Europe years ago,now going to Latin America and
doing a lot of that early stagework.
Speaker 2 (03:49):
Excellent.
Yes, I see that too.
That's, that's, um, certainly,uh, a train that, uh, is been
happening for probably fiveyears now, where, um, in, in
essence I see Latin Americagetting more mature.
Um, and, and companies arelooking more seriously at the
region as a, as a, as a workclass region for many, for many
(04:13):
activities, uh, includingclinical research and also
commercialization.
Speaker 3 (04:18):
It's great for patient care, right?
Because, um, especially in LatinAmerica as well, right?
The patients there are, aregetting access to technologies
that they may not have receivedpreviously, but quite frankly,
it's really expediting thesetechnologies to become available
to people around the world,right?
Um, just in the same manner asit was done in Europe.
Now it's done in Latin America.
And, um, you know, I think ifcompanies take advantage of the
(04:41):
opportunity down there, uh,they'll see some enormous
benefits from a time to marketperspective to building better
products, being to marketsooner, but also with a better
product that that enhancespatient care.
Speaker 2 (04:53):
Yeah.
So now topic of trends.
Um, what I have your take onwhat's happening in Europe for
the audience to understand whatis it that we're talking about
here?
Uh, what do you think ishappening in Europe?
What is it that is so difficultto commercialize or to do
research in in that region?
Speaker 3 (05:10):
You know, the, the, I'm no expert right, in regards
to the regulatory environment in, in Europe, however, um, some
of the clinical requirementsthat are required as part of the
MDR has really made it moredifficult to, to go to Europe.
Um, it's a much longer process.
There are a lot morerequirements that are required.
Um, you know, then there's the,um, the process of, um, oh, I
(05:35):
can't think of it now, myapologies.
But there's, there's a number ofpolicies that are in place that
are making it a little bit moredifficult, um, to go there.
Speaker 2 (05:42):
Yeah.
And the number of notifiedbodies, uh, got produced
dramatically.
So there's a backlog.
Yeah,
Speaker 3 (05:48):
That's correct.
Yeah.
That, that's another issue aswell.
Um, getting in with the notifiedbodies and now that they've
reduced them is also a challenge.
Yeah.
Speaker 2 (05:56):
Okay.
So hopefully that means morebusiness and newer technologies
in Latin America.
Speaker 3 (06:03):
I think so.
I, I, I really do.
Um, you know, I've been, youknow, working for a startup now,
really in a consulting andfull-time capacity for over
three years now.
I've had the opportunity to meetand talk to other leaders of
startups and, um, this idea ofgoing to Latin America is very
intriguing.
Um, and there are so manyadvantages to going down there.
(06:23):
I think we're gonna continue tosee the trend of folks going to
Latin America and getting somework done.
Speaker 2 (06:28):
Beautiful.
Beautiful.
Alright, so let's talk about,um, what you're doing in Latin
America today.
Speaker 3 (06:33):
Yeah.
Um, so, you know, we started inEcuador.
We've done all of our first inman or all of our clinical work
in, in Ecuador.
And, and we've done a littleover a dozen cases.
Um, and it's been incrediblybeneficial from not just a
commercial perspective, but anengineering perspective and an r
and d perspective.
Uh, we went to Ecuador understrict clinical readiness
(06:56):
reviews, um, to be sure that the, the product was ethical and
safe for patients.
Um, our physician partner, um,you know, received our protocol,
looked at our protocol, acceptedour protocol.
After a number of changes and wewere able to get a bunch of
feedback, we've actually beenable to iterate or quickly, uh,
whereas if we would've, um, notgone to Latin America prior to
(07:20):
commercialization, we might nothave as good a product to
market.
So we've been able to, yeah, we,our engineering team has been
able to take feedback from someof those early cases.
And we've actually iteratedwe've changed the product to do
a little bit different thingsand we thought it could do.
Um, and, and it's beenincredibly helpful.
Um, the gentleman that we'repartnering with is Dr.
(07:40):
Carlos Robles.
Um, he is a thought leader, notjust in Latin America, but in
the United States.
He's on the circuit here in theus.
He visits here quite, quitefrequently.
Um, and, and many of the thingsthat he has learned down there
has informed, um, informed our rand d group.
And we believe that when we goto market in the next six
months, we're gonna have abetter pro better product, which
(08:02):
is gonna give better patientcare, um, et cetera, et cetera.
Speaker 2 (08:05):
Very good.
Wow.
And how is it that you found Dr.
Rus, uh, in Ecuador?
Speaker 3 (08:10):
Yeah, so, um, having, uh, been at Pinax for 14 years
and, and having developedrelationships with the Latin
American team, um, the, the USside used Carlos as well as a
speaker, um, as someone who wecould get early feedback on
devices that Pentax may havegone to Latin America with first
.
So I had the opportunity tofirst meet him there.
(08:32):
Um, and then one of mylatinamerican mentors, Peter,
who has run the Latin Americanmarket for a number of different
companies, um, you know, reallyencouraged us to reach out to
Carlos.
Um, early on we did that, and,and Carlos actually did a lot of
our early animal work as well.
Nice.
Speaker 2 (08:50):
Okay.
Speaker 3 (08:50):
So he came over here and, um, helped us with that.
So it's been, been an awesomepartnership.
It really has.
And I believe he's going to bestarting a, a study here in, in
the next couple months, um, youknow, in regards to our
technology and how it comparesto those that are already
existing.
Very
Speaker 2 (09:07):
Good, very good.
The study in the United Statesled by Dr.
Carlos.
Well,
Speaker 3 (09:11):
He, yeah, he's gonna, he's gonna do the study in
Ecuador and he will lead, he'lllead the study.
Speaker 2 (09:16):
Oh, ok.
Ok.
So, Josh, any, um, commentsabout the hospital
infrastructure in Ecuador, aboutthe skills of the investigators
or the team, the research teamand all that?
Speaker 3 (09:29):
Yeah, great question.
Um, you know, the, the, thefacility that we've done our,
um, device work at is reallysecond to none.
Um, the folks are, um, alwayssurprised when we, when we take
'em down there with us, we takeour folks down, look at it, and,
you know, they have the latestand greatest equipment on the
(09:50):
market, really is a benefit toan early stage company because
that's what we're comparingourselves to, right?
When we come to the UnitedStates, they're gonna, they,
they don't want you to compareyourself to a, to an older
technology that might not be onmarket.
So in our case, we actuallycompare ourselves to equipment
that is the latest and greatestbeing sold across around the
world.
So from an equipment perspective, from a facility perspective,
(10:13):
second to none.
And then from a clinicalexpertise perspective, second to
none.
So the, the center that we use,um, is a training center, um, is
endorsed by the world endoscopyorganization and a number of
other societies.
Um, they, uh, train a number of,uh, advanced fellows every year.
Um, I had the opportunity tomeet, uh, a number of those
(10:35):
fellows, uh, that have now goneback to Mexico, for example, in
one that's gone back to Romania.
And the benefit to them is thatthey're getting their hands on
the latest and greatest oftechnologies.
Um, and they've had theopportunity to see and, and use
Endo sound as well, which isbeen a great benefit.
Um, and they're, they're highlymotivated to, to, to continue to
(10:59):
work with Endo sound causetechnology can bring benefits to
their markets as well.
So, um, the clinical, the, theclinical team there, the
research team, again, second tonone, we, we have no, uh,
reservations in regards to, todoing our clinical research
there and, and, and doing ourearly stage work
Speaker 2 (11:16):
There.
Wow.
I'm, I'm so happy to hear that.
Uh, in, in Ecuador, it's not acountry that I usually hear
companies, uh, um, do researchon.
Uh, so, um, usually you hearColumbia, ua, other countries,
Mexico, but it's the first timethey hear Ecuador
So that's why I'm so curiousabout your, your experience.
Speaker 3 (11:38):
Yeah, you know, the staff is amazing.
Um, you know, maybe it'sendoscopy, maybe it's different
specialties have their differentareas in Latin America or
whatnot.
Um, you know, maybe it's, maybeit's a new and up and come in.
And, and, and Carlos certainlyis one of those folks that, uh,
is highly respected and he, hedid a lot of his training in
(11:59):
Europe as well.
Um, I think builds somecredibility for him.
And, um, in any event, there's anumber of companies in the end
actually and centers Ecuador.
Um, so if we find Ecuador to be,again, just a wonderful place to
work from a culture perspectiveand ease to work there.
(12:20):
Um, you know, and, and in, inregards to this particular, it's
five minutes from the airport towork every day.
So it's convenient.
The food's not bad.
Uh, we like to have fun seafood,right?
Yeah.
Speaker 2 (12:40):
Excellent.
Thank, glad, thank, glad.
And, uh, do you have to gothrough at this committee review
or Ministry of Health review,uh, what was experience, uh, in
that area?
Speaker 3 (12:49):
So the account, um, handles it all right.
So we provide them with aprotocol, we provide them with
our clinical readiness reviews,show that we've done certain
tests to make sure it's safe andapplicable.
Um, and then they handle thatthrough their IRB process mm-hmm
.
So they kinda handle all of theins and outs of what's required,
um, for us to come there and doearly stage work.
Speaker 2 (13:10):
Nice.
Very good.
So you do have to use theservices of, uh, consultant,
regulatory consultant or thirdparty agency, uh, CRO or
anything like
Speaker 3 (13:19):
That?
Correct.
It's, it's turn, it's turnkey,uh, which they make it very easy
right.
To work with.
Um, now we do consult and wehave consulted with our
regulatory consultant to makesure that the things that we're
doing down there, um, you know,are, are able to be done, et
cetera.
You know, one of the things thatwe also were allowed to do, uh,
and this is just based on thefact that Carlos is a rockstar,
(13:41):
um, he's, he's been invited, uh,to be on global, um, endoscopy
courses, live endoscopy courses.
So back in, um, I guess it wasearlier part of this year, um,
there's a program calledEndoscopy on Air.
And, um, Carlos and Endo Soundwere, were asked to participate.
So we were able, um, to do somecases with Carlos in preparation
(14:04):
for that.
And then we went live, so we hada live case done on, on a
patient in Ecuador wherethousands, thousands position
we're able to see thetechnology.
And again, because the facilityis second to none, you know, uh,
they're able to pipe in, youknow, the, the recorders and,
(14:24):
and video everything andstreamed perfectly.
And, uh, the responses that wereceived worldwide were almost
too many that we could handle.
Small team, absolutely smallteam.
Um, but that was another hugeadvantage of going down there.
We, we could have never donethat in the United States, but
(14:44):
cause Carlos was asked toparticipate, he thought highly
enough of our technology to useit.
And, um, it was just an awesomeopportunity that we took
advantage of.
Speaker 2 (14:54):
Beautiful.
I'm so happy to hear that.
And do you mind naming the cityin Ecuador?
Speaker 3 (14:59):
Yeah, it's, sorry, it's
Speaker 2 (15:01):
Beautiful city, right by the water.
Speaker 3 (15:03):
Yes.
Chance to the Galapagos, butthat's, um, it's on my bucket.
That's when I go down thereagain soon.
Speaker 2 (15:11):
Have you gone to keto ?
To keto?
Speaker 3 (15:14):
You know, we have not been to keto yet.
Speaker 2 (15:17):
Okay.
Tito's in I city.
Very historical.
Yeah.
So you fly directly from the USto gu,
Speaker 3 (15:22):
Miami, GU, four hours, five minutes to the
hotel,
Speaker 2 (15:28):
Nice
Speaker 3 (15:31):
Hotel bar, and then
Speaker 2 (15:33):
Great.
Set up.
Love it.
I love it,
Alright.
So Jeff, let's talk about your,your future plans in Latin
America.
What is it that you wannacontinue doing in Latin America?
Or you wanna do differently inLatin America?
Speaker 3 (15:47):
Yeah, I, I think our, um, our experience down there
has been so good, um, that weplan to continue down there.
Um, there are certain marketsthat are a little bit easier to
navigate in regards to theregulatory environment, and we
plan to take advantage of thoseopportunities.
(16:08):
Um, we are in discussions withmarkets such as Venezuelan, uh,
Venezuela, uh, Costa Rica,Brazil, um, Chile, um, and we,
we intend on going down therevery soon after our submission
to the fda.
So once, once we have all of ourvnv work done, everything where
(16:28):
we feel like, um, we're ready topass the test here in the u in
the US with our, uh, submission,we plan to be aggressive in
Latin America.
So we'll be attending a numberof those countries.
Um, certainly Columbia is alsoanother country that we're
interested in going down and,and working in because it'll be
an opportunity to, to get a lotof more work done.
(16:48):
So our goal is to, to get, youknow, a hundred, 200 cases done
down in Latin America prior tofull commercialization in the
United States.
And as you can imagine, it givesus enormous advantages to our
strategy to commercializesuccessfully.
Um, and then once we get donewith those, those cases in Latin
America, we'll be a much moreinformed organization in regards
(17:11):
to what this technology can doon a larger scale.
Um, and then we plan to, to, towork on distributorships down in
Latin America, because LatinAmerica, um, for our technology
in particular, um, could bereally a game changer.
Um, unfortunately the technologythat we're looking to not
necessarily replace, but to, um,to, to be a compliment to is
(17:36):
very, very, very expensive.
And unfortunately, uh, manycountries have very little
access to this technology.
Uh, patients have to drivehundreds of miles to get to the
main center.
Um, and even then, it may be along wait, um, to get in and
we're able to provide the sametechnology at 10, 15% of the
(17:58):
cost of traditional systems.
So, um, you can imagine whatkind of access that will provide
to folks in Latin America.
So we're really excited aboutthe opportunity down there.
Uh, we're exploring, uh,distributor ships down there
that make the most sense for us.
Uh, and when the time comes to,to fully launch in Latin
America, hopefully we'll beprepared to take care of
patients down there as well.
Speaker 2 (18:17):
Beautiful, beautiful.
Have you had prior experience,uh, with regulatory approvals
for commercial devices in LatinAmerica, your prior company?
Speaker 3 (18:26):
So I do not, I do not have any of that experience, but
again, one of my mentors inLatin America, um, has been, uh,
very helpful and insightful inregards to kinda the regulatory
environment.
And he doesn't claim to be anexpert either, but certainly
having run Latin America for acouple decades now, he has folks
that he relies on from aregulatory perspective that has
(18:49):
given us a little bit offeedback here and there.
And when I think when we'reready to, to launch down there
and, and, and go through theprocess of each country's
ministry of help, I think we'llbe looking for experts like you,
right.
That, uh, thank you.
Could help navigate, could helpus navigate those waters.
Speaker 2 (19:04):
Absolutely.
Absolutely.
Yeah.
Latin America, it's, um,certainly, uh, a challenging and
potentially lucrative regionchallenging because it's, you
know, you have 33 countries,every country with a different
regulatory body, regulatoryapproval process and all that.
But 33 countries, most companiesonly focus on about five to
(19:26):
seven countries.
You know, the, the usualsuspects, uh, Brazil, Mexico,
Columbia, Argentina, Chile, Peru, uh, maybe Panama, Costa Rica,
Ecuador, uh, and, and, and therest of the countries are very
small.
Speaker 3 (19:43):
Now, what, what's been your experience with the
regulatory environment once youhave FDA clearance?
Um, very
Speaker 2 (19:51):
Good, very good.
I mean, I, I will say that F fdaor C mark approval is kind of
the, the seal of, of, of, ofacceptance of q leader
acceptance.
For example, I'm gonna give you,uh, the, the case of Chile.
Chile is a country doesn't havea regulatory approval process by
(20:14):
law is, is wide open.
You can import devices tomorrowin Chile without a regulatory,
uh, certificate.
However, if you come to Chilewith a product that is not FDA
approved or see Mark approved,no q opinion leader in a
reparable hospital will buy theproduct or will use the product
(20:35):
on patients.
So it's kinda a, a, a marketdriven regulatory process.
Yeah, yeah, yeah.
That's how it works.
So also in Columbia, I mean,you, you get, especially with,
with lower risk technologies,you get all these Chinese Indian
companies trying to sellproducts in Latin America.
Uh, however, uh, I see the valueof American products being on
(21:00):
the, on the higher riskspectrum, on the, on the more
sophisticated on on innovation,that's where American products
really have a fit in the marketor a market fit, I'm sorry.
And, um, and, and ands leaderswill accept any fda, uh,
approved product.
I mean, any, any day, uh, in the, in, in the case of the
(21:23):
regulatory approval process, theevery country in Latin America
has a different set of referencecountries.
Uh, for example, uh, Mexico usesf FDA as a reference country,
Canada, I mean the US fda,Canada, and, uh, Japan.
Speaker 3 (21:41):
Okay.
Mexico
Speaker 2 (21:42):
Doesn't accept C a c and that's odd.
That's really odd.
Mexico doesn't accept teamworkas a reference country or Europe
as a reference country.
However, Columbia accepts Europeas a reference country.
So if you have FDA approval, uh,Canadian approval, uh, European
approval, c a c, uh, JapaneseAustralian approval, then it is
(22:05):
very straightforward to registera product in Columbia.
Or you also need home countryapproval.
Let's say you are a company fromKorea, right?
It's not a reference country,but you have the approval of
your national regulatory agencyto sell the product in Korea.
So you have home approval.
So that will help you get, um,uh, access to the marketing
(22:29):
Columbia.
However, a key opinion leader,as I said, will not look at the
product favorably because itdoesn't have FDA or C market
approval.
Right?
So,
Speaker 3 (22:38):
Makes all the sense in the world.
Yep.
Makes all the sense.
Speaker 2 (22:41):
So anyway, Josh, so, um, before we end the interview
here, uh, any final words ofwisdom, any final thoughts that
you wanna share with, uh, theaudience?
I mean, if you have the CEO of anewer medical device company
looking to do anotherfeasibility, uh, trial or to
sell innovation Latin America,what would you say to him or her
(23:02):
?
Speaker 3 (23:03):
Yeah, I would say find a key opinion leader in
Latin America that is respected.
Um, it also, I will say this, italso depends on that particular
device company's exit strategy,right?
Um, you know, I, I would arguethat if their exit, I would
argue that their, regardless oftheir exit strategy, that Latin
(23:23):
America is a good place to go.
Um, but if their exit strategyis not acquisition and it's a
brick and mortar long term, thenI would absolutely go down to
Latin America.
And that choosing the right KOLmight not be as important.
Um, if acquisition's not atarget, for example, we may
(23:44):
choose, um, a KOL based on oneof our potential acquirers,
right?
Someone that know that they use,someone that they respect, et
cetera.
If your acquisition isn't yourexit strategy, then that might
not inform who you work with,right?
You might go down there and workwith who makes the most sense
for your company, right?
(24:04):
Regardless, you know, choosingthe right KOL is important.
That's a great point.
Hmm.
I never heard of it.
Yeah.
So I, I would encourage them to,to go and find KOLs in, in the
country that they find, um,easiest to work and, and, and to
do work in.
And then, um, develop thoseprotocols alongside that
physician.
(24:24):
I would, uh, I would encouragethem to use their counterparts
if it's a US company to validatesome of the things that you're
doing back and forth.
I will say this, one of the hugeadvantages of working in in
Carlos's lab, for example, arehe receives physicians from the
United States all the time.
Huge names down work with him.
(24:44):
So we've had the opportunity,for example, Dr.
Sandy Patel outta Texas, um, avery, uh, respected name
actually did a case with, withEndo sound in Ecuador on another
live course that was beingstreamed globally.
Um, so there was huge advantagesthere in the sense that an
American doctor was now able touse our technology as well.
But I would, I wouldstrategically, I tell them to,
(25:07):
you know, choose the right KOLand, um, do as much work down
there as possible to inform ther and d team.
Do it as early as possible,right?
Um, you know, doing it afteryour, your manufacturing process
is validated and you have ago-to-market product isn't
advantageous to anyone, right?
Because they're not able toinform anything.
(25:27):
So as early as they can get toLatin America, um, with a KOL
safely, I would go down thereand learn, and I'd have your r
and d turnt team learn, youknow, the pros and cons of your
device.
I would iterate quickly and thenI would get down there for
additional clinical work as soonas you have your next device,
(25:47):
um, or prototype.
And then from a commercial, froma commercial perspective, again,
I would highly encourage, um,those companies to go down and
do as much work as possible oncethey've submitted to the fda.
I've been, um, a part of twovery large organizations and,
um, you know, some of the, theclinical work that that was
(26:08):
being done in the United Stateswere oftentimes the first time,
uh, representatives like myselfthat were there, saw the
equipment in, in, in use.
And I believe that wasopportunity lost, right?
If, if, uh, we train our peopleon the products that we're
selling at an earlier stage, um,that really benefits everyone.
So we intend to go down therewith our market development team
(26:30):
to Latin America.
We plan to train them down thereso that when they're in the US
they're not watching their firstendo sound case that they've
ever seen, right?
They, and they know the benefitsof our product, right?
Not every product is perfect.
Um, actually there is no perfectproduct.
So be able to understand theadvantages and the disadvantages
of the product so that we canset expectations with our
(26:52):
customers here in the UnitedStates is gonna be priceless.
Speaker 2 (26:54):
Beautiful.
Thank you so much, Josh, foryour insights and words of
wisdom.
So thank you for being the showtoday.
I really appreciate your timeand you sharing your knowledge
with your audience, and I lookforward to being in
Speaker 3 (27:06):
Touch.
Yeah, thank you.
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