Allisa Song: From Medical Student to CEO of MU Medical

Hello everybody and welcome to another edition of Entrepreneur RX, where we help the builders and backers and everyone in between understand how companies actually get built. Welcome back to Entrepreneur RX, where we get the pleasure of talking to founders and industry leaders today. I am excited to connect with Alyssa Song. Alyssa runs a phenomenal company that she started as a medical student at Mayo, if you can believe that as if she had nothing else to do. Alyssa, how are you? I'm doing well. Thank you for having me back. Good to see you. I'm not a pleasure. Good to see you back so you will not let any grass grow under your feet. We have been busy. Very cool. So give people who don't know the story a little bit of your background because you have an unusual background. Yeah, absolutely. So I have been recently saying I accidentally fell into entrepreneurship when I was in the application cycle for medical schools. I read an article that inspired NanoDropper, which is now mu medical. It was an article on ProPublica that was talking about these class action lawsuits about the problem of oversized eye drops and how it was negatively impacting outcomes and care for glaucoma patients. It turns out that all eye drops are too big for the human eye, about up to five times the capacity of your eye. And folks that are on expensive medications, for example, glaucoma patients, they were running out before insurance was ready to cover the next refill. And I saw the oversized eye drops as an opportunity to intervene. And by changing the size of the droplet to something that's more anatomically and physiologically congruent to the human eye, AKA make smaller drops, we're able to make that same bottle last three times as long for patients. And of course glaucoma is an irreversibly blinding disease, the chronic disease. So patients are on these drops for life. And they were costing up to $600 out of pocket without insurance coverage. Just so sad. You know, it's funny. There's all sorts of things I've seen over the course of my career. When somebody suggests them to you, you're like, of course, how do I not think of that? This was one of them. And I don't say it very often. But anybody who's put an eye drops or is a physician, I put an eye drops and you see half of her run on the person's cheek. And of course we need smaller eye drops, never cross my mind. So it's really impressive that while you're applying to medical school, makes this obvious, non-obvious leap of faith. What do you attribute that to? I think that's a really interesting nuance because a lot of people experience problems like that, but don't know where to attribute the problem to. And I think as patients, especially having talked to so many of them over the past few years, I think a lot of the problems that we see in healthcare and in medicine patients attribute them to something that they're doing wrong. Right. And it was really unfortunate to see that patients felt a lot of shame around this problem too. They don't know why they're running out. They don't know why it's running down their face. And I like to attribute the way that I was problem solving back in 2018 when I read that article initially to actually my experience in the harm reduction world. Before I started medical school, when I was doing addiction medicine research at the University of Washington, I started volunteering for a local harm reduction alliance. It was a peer-to-peer group at needle exchanges in Seattle where you are volunteering alongside current past and non-drug users of all backgrounds, unhoused folks, folks in temporary housing, and of course, people with permanent homes all working together under this idea of how do we create solutions that are pragmatic? How do we reduce harm, regardless of the individual that you're servings, choices, or lifestyle, or current drug use status? And I think that was really in the background when I read that article. And so it wasn't about necessarily the pharma companies or the fact that patients are having to pay so much out of pocket. It was about how do we create a solution that we can deliver to the patients hands and give them some of that ownership back? You get pushback. I mean, you don't have no choice but to why, because we were an early investor. Did you get pushback from pharma companies where like, what do you mean? You're a decreased our profits because these things last three times longer now. That is a very long question. Yeah, actually at first, we were really nervous. I mean, this was my first intro into the healthcare industry. This was before I even started medical school. So I think we have all of these perceived notions of who is big pharma, who is running book pharma, what are their incentives? And of course, the story is so much more complicated than what we think of like, it's this big organization. They all talk to each other about how are we going to squash the little guys at NanoDropper? And we made a lot of proactive steps in trying to protect our product, to make it modular, so we can always retool at a cheaper price than pharma ever could. But it turns out that we were still able to find aligned incentives, even for pharma. So for example, there are a lot of brand name medications that are used in glaucoma and other ophthalmology specialties where patients can't stay on the medication because of poor tolerability. And when we dug into the research, it turns out the bigger eye drops are actually overdosing the patient. And bigger eye drops create worse side effects, both locally and systemically. So beta blockers are used in glaucoma, for example. And of course, that has systemic side effects. And so there were these new medications that were coming out and they had up to a 50% discontinuation rate just because of a local side effect of hyperemia. So really, really red eyes. And with the NanoDropper, we ran a pilot and now we've also done preclinical studies to show that you can maintain the main efficacy while reducing that major side effect that was making patients not be able to tolerate their medication. So those are some of the ways that we found alignment in the nuances. And that was a very welcome finding sense. We were able to show that we can do good for everyone and not make at least a big enemy, a big pharma. Yeah, you found a way to pull a win-win out of that, which I think was very creative on your part. Just so people really have to speak what we describe what the NanoDropper is. Yes. So the NanoDropper adapter is an adapter for eye drop medication bottles that reduces the volume of the droplet itself by two thirds. So it's about 30% of the original volume of the droplet. And by doing so, we make that same bottle last three times as long. And we have now completed eight clinical trials to demonstrate that when it used over a long period of time, we can actually improve intracurricular pressure control for glaucoma patients while reducing the side effects locally by about 67% systemically by an energy of 60% and the most recent study actually showed an improvement in the adherence metric that we measured, which was early bottle exhaustion where patients run out too quickly. And that was about an 80% improvement. Wow. Interesting. But having switched gears on here a little bit. We see a lot of companies that come through a jet stream and excel in ventures. And so one of the things we try to do is one look for pattern recognition. We've seen this before. It was successful. Maybe we can help make it successful again. But the other thing we do is we look for traits of founders that we believe have what it takes to be a successful founder and then go on and run their company. What traits do you believe you have that make you successful? Because by all measures, you've been very successful. What are those traits? Thank you. I would say I also sometimes joke that this is my toxic trait, but I think I have a healthy dose, maybe a little more than healthy dose of eternal optimism and persistence and something that I learned as a medical student was the offer lifelong learning. I think being a medical student really sparked that in me, really feeding this hunger to want to learn more. and the tools to be able to look at the research and actually feed that hunger. And I think that's served our company and our team really well. I think it's a trait that's shared with my co-founders and a trait that I see pretty common in my colleagues in the startup world as well. - Let me summarize. So lifelong learning, you wanna keep on learning to iterate, grit and resilience. You don't take no for an answer, I would agree. Optimism, I agree on one. I don't think it's ever a toxic trait, but it's probably an annoying trait because I share it where people are like, oh, for God's sakes, make the service say, no, I'm taking it seriously, but I'm not familiar with it. - Yeah, exactly. - The one that you didn't say that I see in you is you have the ability to tell a story. You communicate very well and you can pitch without pitching. You can explain what you're doing while you're doing it very easily and naturally. People are like, oh, yeah, that makes total sense. And you'd be surprised at how many people show up here to do pitches and they cannot, in 20 minutes, explain what they're trying to do. It's funny and they usually get what they're trying to do 'cause that's seen the deck, but boy, for them, explain it, I'm like, oh boy, this person's never gonna be able to sell anything because it just can't talk about it. You've done that very well. It's them always natural for you. - I don't think so. And I am a little surprised because I never thought of myself as the very good storyteller. It's something that I have tried to like listen to other podcasts and I really envy in public speakers and such and other CEOs that I really respect, but thank you. I'll take that compliment. - I'll keep working on it. - That's also very obvious. The other thing, and I battle this because we try to use predictive analytics to which founders are gonna be successful. So I want to go back and think, would I have bet on Steve Jobs showing up in standels, unwashed, unshawored, late, the kind of Perkins what I have invested in, Zuckerberg shows up and pajamas late. And the answer is probably not. And I would have been wrong. And so do you see this trait of what's the good way to say it? I guess abstinence or I'm not sure. It's basically uncouchability. I look at them and be very different of their coach. I don't see you that way at all. So I like founders who are coachable. They may not have to take your advice, but they kind of strong convictions loosely held. In other words, with the data they can change their mind. Do you see that as positive? - Yeah, yeah. I think as a team, my co-founders as well, we like to ground as many decisions as possible in evidence. And I think that's just part of medical training. And my founders also have technical backgrounds. McKenzie and I, we actually met in the same neuroscience lab. We know how to value evidence. I think that's something that a lot of folks don't learn how to do unless you go through academic training to do so. And I think a common factor in maybe the folks that you have mentioned is that they have maybe the optimism and the persistence and conviction in themselves. But they don't change their minds in the face of evidence. I mean, everyone loves Steve Jobs, except folks in the medical community know what happened at the end of his life when he had a very treatable form of cancer that he, I don't know why. Yeah, exactly. - They went on a very holistic sort of cure regimen that I think he weighed about six months. I read the book by Isaacson and there was a long period of time when he did not get treated appropriately. - Yeah, exactly. And that just really confused me when I was early in the entrepreneurship journey. But now I see that that is just a subtype of entrepreneurs and founders that I really do see. And I think there's just a flavor of entrepreneurs that I think if I was a VC, I probably would have missed out on the opportunity too. But I think that there should be a place for founders to make decisions based on data and evidence and will change your mind in the face of evidence in healthcare specifically. - Look at Elizabeth Holmes. So intelligent articulate tells the right story seems to be the data driven yet pulled the wall over everybody's eyes including her board. You know, it took the grand son of one of her board members to basically expose the lie. - Yeah. - For the police. We always battle with this. Like how do you tell if it's really convicted, strong personality, leading from the front CEO versus the Travis Kalinex or the Elizabeth Holmes that are just so toxic that they cross that line. And then how do you know when they're getting to that line? That always struck me as a conundrum. - Yeah, so true. And I always wonder like how many physicians were part of making that decision on the investments. And I think maybe accelerants and other groups that have physician founders who were able to vet the science that's being pitched. I feel like that's a really critical component. - That's interesting. So it's funny. I used to have people come in and learn to department and say, oh, I got my labs down at Walgreens. And you look at them and like, okay, you should be dead because you're potassium's 12 or you potassium's 1. So clearly something's wrong. And I think when you talk to physicians, we were all like, yeah, that's not possible. And the power to that was ignorance because it turned out that we were right. But at the time, I was like, yeah, this whole one drop of blood because we would see the results people come in with. They were like, hey, this isn't possible but because you'd be dead. - Yes. - How is this still going on? Because it's just so overtly wrong. So I think you're right. I think if we're clinicians, remember she went and she pitched out one of the hurt for her professors and staff. But I think the woman bases ran her out of the office. - Yeah, yeah. - So yeah, I think that's true. All right, another question for you. When we first invested in you, we loved the product but we also was concerned. And when I say we, this was the royal we, I was concerned that you were kind of a one trick pony because you had this kind of top. Really cool idea. But you know, I kind of like, okay, this is amazing. Is a copy, though. Well, yes, my P protection, which was cool. But is there a way around it maybe? But you've managed to take a one trick pony and turn it into something where you had a now. This really was impressive to me. - Oh, yeah. Thank you. - I feel like you say you might have passed on Steve Jobs and I know Steve Jobs here, but you also, (laughs) that's right. I can't wear a turtle necks because of a lens of a thome. (laughs) - That is true. - She has really ruined the turtle necks. - All women entrepreneurs out there. (laughs) - But you must have seen something before I even knew that about myself that our team's strength is digging deep. We learned about the industry because we all collectively needed to know the why. Why something happens in our little world of eye drops? Why the oversized eye drops persisted for the past 50 years despite the evidence saying that smaller drops are putter. And we weren't able to convince forma that they should be making smaller drops from the get go. And so these were some of the questions that were starting to come up as we were going down the NANO dropper journey. And when we put the puzzle pieces together, we realized that there were so many opportunities for us to intervene. At first, when we started NANO dropper, it was really for the patient. And it was a band-aid solution to the problem of oversized eye drops because all of these new medications were continuing to come out with improper packaging and oversized eye drops. And we asked ourselves, how do we fix the problem so that in 10 years, every single new topical of family that's coming on the market is properly sized. We asked ourselves the question, how do we create a world where after market parts like NANO dropper adapters don't need to exist? And so we learned that in ophthalmology, the vast majority of big pharma companies have exited the R&D world. They don't do their own R&D. So of course, by the time that they've acquired the new fancy medication, the packaging is finalized, the FDA has already approved it with the packaging and that was a change of 2021 where you can't change the packaging after it's been approved. And so we learned about the lifecycle and the supply chain of topical ophthalmics. And we realized that the folks that we need to talk to and the products that we need to create before are the little pharma companies where you wouldn't recognize their name, but they were the drug developers behind all of these blockbuster medications in Europe and in Asia. And so we started talking to folks that are in preclinical and phase one, two, phase, it's going to be years down the line by the time that their medication is available for patients. But we realized that we needed to be part of that journey and create primary packaging solutions for them. Find the incentives to align with the little pharma companies. that's creating the new future drugs and make solutions that make sense for them. So that's how we created our second vertical that we've been working for almost two years now. The first is called GT2, where it's an alternative insert for your typical eye drop bottle that you think of. And the reason why we created the tip insert instead of a whole new bottle system, like we saw our competitors do, is because we asked the little pharma companies, hey, like, what is your packaging and fill and finish look like? And it turns out they don't do it themselves either. They don't manufacture the bottles, they purchase the bottles, and they purchase the bottles based on what their contract manufacturers and their machines can use. So we had to create a tip insert that doesn't disrupt our process or make that contract manufacturer required to invest in new capital equipment. - Very good. So how did you do the pivot? Because you've added some more verticals. - Yes. So the GT2 came first as a non-destructive way to integrate microvolume delivery. So instead of the rigid plastic tip, you utilize new medicals GT2 insert at the fill and finish step. And then we created a single unit dosing, a module called MuVi. That's our second product in the primary packaging vertical. And we also wanted to create an optimized drug delivery platform for very expensive biologics and molecules that will probably be available in the next five to 10 years that are targeting retinal diseases. - Wow. So, okay, I've heard of a buzz term called Ikealomics. - Yes. - Ikealomics. - Yeah, educate me. - So to my understanding, the word itself, it's a play on the words very similar to genomics, but Akealomics, I forget who actually coined that term, but we started hearing the buzz around, I don't know, Q1, Q2 of 2025. So it's a little very new. And I'm sure you'll see it more at conferences in the next few years. But Akealomics is taking images that are taken from the eye and being able to gain insights that are systemic. So, ophthalmologists and optometrists have known this for as long as the profession has been alive, that you look at the retina and you can see cardiovascular markers and you can diagnose systemic diseases from a finding from a split-lamp exam. But in the world of AI, companies have started to try and actually extract and put objective measures and markers and targets that are beyond just the eye. There's a ton of companies that have popped up that are trying to utilize fundus imaging. So pictures of the retina and trying to pull out cardiovascular risk factors since it's one of the only non-invasive way to image vicarvascular chart. - Very interesting. So, back when I was in law school, I had this law school professor, Harvard Law School, he was a PhD and he was probably the only true genius I've ever met. He was off the charts. But I remember him, he was sort of like you. - Easy, oh God, please. He would let you without notes for a solid hour and the people would be spellbound. But I remember him telling this story, it wasn't a story that big blue diving supercomputer could diagnose pancreatic cancer and no one could figure out how. It was very high sensitivity, high specificity. And when they went back and asked big blue how it could do this, it could not give them a discernible answer. But that sounds like to me early economics. It was using retinal scan and the big blues of the world to diagnosis and I actually as you were talking, I was looking to stop to see if I misread or misheard him, but no, sure enough, it says that actually was true using this AI model. So, you can just imagine a world where you got the mildest now and you look in a split lamp or another device and it says, oh, you're gonna be at risk for XYZ here in the next three to five years and coupled that with the genomics and holy cow. It was gonna be a whole new level of personalization. - Yeah, exactly. Oh my gosh, going better, combining the two. I think what excites me about AI is that there's a future where individualized medicine and precision in therapeutics and customization to the individual is possible with AI at scale. - Totally, yeah, it'll be cool. It'll be your generation, my generation, but it's pretty cool. (laughs) - Yeah, my peers are working on really cool things. - Totally. So, what's next for you? Remember telling your way back when stay in medical school, do your residency and do this dual track and you probably wisely ignored me, but I'd say the same thing and yeah, and what's next for you? What's the game plan? - I think for me, I always have this personal goal of at some point, I wanna go back, finish my training, I miss seeing patients, I miss being in the OR, there's nothing that will replace that. I think what I struggle with is balancing that personal want with what I see I can accomplish in the field, for the field and the scale of impact that it can have. - So it's kinda interesting, but if you look at it one respect, you went from treating one patient in the time to treat the population. - Yes, exactly. - I mean, you've been a mew and nano-drop our force multipliers, so if they're gonna listen, multiply it or out, so now you're effectively treating hundreds and thousands of patients. - Yeah, exactly, and we get those individual stories from patients themselves and from ophthalmologists, like there was a patient who really failed, all therapies had just a little bit of vision left and one eye, the ophthalmologist, through all the surgical procedures that are available at this patient and they just could not tolerate medical therapy. So I drops because they had such a narrow therapeutic window, like just the local side effects were so severe that the patient couldn't stay on them, even to save their vision. And the only thing that was able to get them back on the drops was an antirdropper. Like when I hear stories like that, and like, I can't leave. - Yeah, go ahead. - Exactly. And when I see what mu medical can accomplish for the field, if we can successfully take over that last little bit that's needed in packaging and the supply chain and meet the needs there, we actually can envision a future where patients don't have to worry about running out. Medications can be cheaper to manufacture ship and deliver. And of course, that means the end price as well. And where we are minimizing, basically min-maxing where the main effects versus side effects, we see this world and we see how mu medical can make that happen. So I think that is really what grounds us is our patient stories and we're gonna create that world with you, John. - Think of me doing most of the work. - Okay, almost done. Does work-life balance exist for an entrepreneur? - Whoa. I guess it depends on who you ask for me. Mu medical is an extension of me. It's an extension of my values, what I think companies should be doing in healthcare, how founders should be practicing stewardship in all the ways. And because I feel like it's such a core part in an extension, I have work-life balance because it is my life. - That's actually a phenomenal answer. That would be the answer less eloquently, but that would be the answer I would give. Like I do have work-life balance because this is my life and I feel very bad. - Exactly. - But if an outsider looked at you, they would look at you and like, oh my God, she's working seven days a week, 12 hours a day, you should never, you know, you pay all that. And I don't know that to be true, but I suspect that's true. - So I think from the outsider, you probably have zero work-life balance. That's maybe I do too, but I feel very balanced. - Yeah, I feel balanced. So there's nothing else I'd rather be doing. - Yeah, not funny. Okay, not that you're old, the list of yet, but what would old the list of tell young a list of? Now with everything you've learned over the since 2018, so you've been doing this seven, eight years, would now old the list of tell young a list of when you started? Oh, like right now versus earlier on. - What have you learned to go back, Josh, I wish I would have, I wish I knew that then. - I think I would tell the younger a list of that, everyone doesn't know what's going on either. (laughing) - We're all fake. - We're all fake. We're all faking it. They're all faking it too. - All right, great. You would have struck me, and this may be true as a perfectionist, but I don't know if you can be a perfectionist as an entrepreneur because you have to, it's just because nothing's ever perfect, but as an ophthalmologist, You probably need to be pretty close to perfectionist, particularly in. with the fields that you're in. How do you balance that desire for perfectionism and the fact that you have to move the needle forward? - That was one of my earliest lesson that I learned is that you can't wait for all the evidence to come in before you make that decision. And that was a really hard shift for me where we're so cautious in medicine before making that final decision or making that final cut. But in the startup world, you have to move so much faster. And by nature of you doing something new, there is no one out there that actually has the answers either because you're doing it for the first time. So I think the goal post has changed a little bit and it's not necessarily perfect that I'm going after but it's the closest that I can get to having all the information that's available to me. So have we read all of the papers that exist and that has to be good enough? When we were looking into the supply chain of philanthropist facilities in the US, have we exhausted the list? Have we talked to all of them? So I our search for the answers and feeling like we have exhausted that avenue is good enough for us now. But I also have learned to appreciate that that is a lot more effort and a lot more due diligence that we're doing that isn't the norm or the expectation of startup founders. And I think we should move towards that, especially in healthcare. - Yeah, there's that balance between, you know, harm. So you can't move so fast as you're in harm patient, you know, Elizabeth Holmes, bad blood test for, and God knows hopefully nobody reacted to them because they were so ridiculous. But there's that versus not moving at all because you're trying to be perfect. So I think you clearly have achieved a decent balance of that final thing is we see a lot of companies and there's this Peter Thielbuck that he co-wrote and it was from one of his lectures about zero to one and one to N. So zero to one is something no one's ever done before. You have a brand new idea, brand new concept executed. One to N is somebody's already done that and now you're trying better it. You know, one down are the hamburger stands. There's millions hamburger stands. How can yours be 10 times better? But you did a zero to one thing and that's really unusual nowadays in this world. So I want to congratulate you. We see very few zero to ones and you're one of them. - Thank you. - I understand on the shoulders of giants in our fields. I mean, we were the first ones that actually execute but I mean, there were decades of ophthalmologist fighting for this who did the research who tried to make this happen and we wouldn't be here without them. - You know, it's interesting. I have a friend and an ophthalmologist and I pitched her on what you guys were doing and she's a former thinkin' ophthalmologist and an investor and our fund. She said, oh, there's no data to support this and she kind of was negative about it. And I ignored her, fortunately. But it was surprising that you just said that a lot of ophthalmologists have worked on this problem because I did not get that to be the case. - Yeah, even that article that I read that inspired nanostropper, it was actually ophthalmologist and their patients that were suing Big Pharma. - No kidding. - Yeah, and Dr. Alan Robin, who is one of the greats in glaucoma, he testified to the fact that one of the companies, Arquana, had created their own microvolume delivery type back in the '90s and he squashed it and they had done the clinical trials and they were squashed. It all came out during discovery and there's a famous Pfizer internal memo that came out. It was like part of their board meeting or something like that. - I did not know that. That's really cool. - It was a hidden big secret. - Wow. - Well, yet again, there's always more to learn so thank you for educating me on all this. It's been, as always, a pleasure talking to you. - Always a pleasure. Thanks, John. - Well, that's a wrap on today's edition of Entrepreneur RX. Thanks for hanging out with us. New founder conversation dropped next week. You can also learn more about a Southern Bench at www.aSouthernBentures.com.