Y Combinator Startup Podcast
00:48:24 · S1
[00:48:24] S1: What are some of the hardest remaining engineering challenges involved in getting BCIs to work?
00:48:29 · Max Hodak
[00:48:29] S0: So in BCIs, we often feel very limited by power and thermal constraints on the implants, And so this creates a strong pressure to implant as little as possible and do the rest off the body. You can't pass a wire through the skin because the skin is a very important immune barrier. And the skin won't fully heal around it. If you have any connectors to the scalp, you're constantly at risk of a bacteria crawling down that and into the brain, and then the patient's going have a really bad time. And so you really have to be able to close the skin. That requires you to have implanted a radio or transceiver of some sort. And getting the power on that down there's a frontier at low power electronics, which is really important. As I mentioned earlier, a lot of this is now becoming increasingly biology as our biological engineering capabilities increase. But then on those implants, ironically, one of the harder, more open problems is what we call packaging. Our colleagues in Europe call it tropicalization. This is your ability to keep your device in and the body out of an implant that you put in the body. So there are no truly passive surfaces anywhere in the body. Even bone is constantly getting remolded. And so if I put a device in, it's going be getting attacked by the body, and it's not regenerating itself. And so you need a material that is going to survive that for an extended period of time. The classic example of this is the laser welded titanium can, which if you've seen a pacemaker or a deep brain stimulator, they've got this big titanium box. Obviously, we can't put a big titanium box in the eye. Interestingly, one of the earlier retinal prostheses before us ten years ago was a device that did have a titanium box that they attached to the eyeball. So it was a four and onetwo hour surgery. They had a little belt that went around the eyeball with a titanium box on the side of the eye with a battery and a little PCB. This didn't work. This was not good enough. They needed to get rid of that somehow. In our case, we've solved this with laser projection trick where we power it wirelessly.
00:50:28 · Max Hodak, S1
But having this next generation packaging, some type of conformal coating that we can use to protect the implant that is not degraded by the body, is also not harmful to the body, and is resistant to all of the ways the body will try and kill it, that material science is a very open ended field. If you're interested in material science, that is a thing that we need progress in. [00:50:50] S1: How did you approach interacting with the medical field to build your retinal implant?
00:50:55 · Max Hodak
[00:50:55] S0: Mean, business is just a fancy word for talking to people and doing things. You talk to them. You send them emails. So for our retinal implant, it was originally invented by a professor at Stanford almost fifteen years ago, I think. It was licensed to a European company that we were tracking. Let me back up a second. So when we started the company, I I came from Neuralink. Four of my five cofounders came from Neuralink. We kind of took a look around the world in early twenty twenty one and asked, like, what is the most valuable thing that we can do that will be likely to work in the near future that would have a big impact to patients and allow us to be the foundation for the type of scalable medical device company that we wanted to build? And we came to the conclusion that restoring vision to the blind by stimulating the retina was the thing. In that, you kind of have a choice of two types of cells in the retina that you can stimulate, these little bipolar cells or the optic nerve. And you could do that electrically or you could do that optically. We explored all four quadrants of that. We developed internally a state of the art gene therapy that optically stimulated one of those cells, and we identified this French company as being the state of the art in electrical stimulation. And so we I mean, it's a small community. You can meet people. You can talk to them. It eventually made sense for us to acquire them. We ended up with the license, the technology, and we and we work with surgeons and doctors all the time. If there's a new surgery that you want to figure out, typically, this is best going through networks so that people are more likely to respond to your email. But we cold email surgeons all the time saying, hey, we have a weird surgery to develop. Do you want to be a consultant? And people reply. Before I get to the next question, there is a real cultural thing here. So in my time hanging out around the periphery of SpaceX, I observed that, like, at least circa seven or eight years ago, probably, like, 20% of that company is what you might characterize as committed Martian colonists, and 80% are serious engineers. I think that those people are lunatics, they just wanna work on the highest performance methalox engines in the world. And you need both of those cultures to be really successful long term.
00:53:07 · Max Hodak, S1
And that's especially tricky in in med... In medicine, right, because that's a very, very conservative, arguably very authoritarian culture for the most part. And similarly, at our company, we have, I'd say, 30% I mean, it's an overtly transhumanist mission and then 70% serious clinicians and scientists and researchers and people who think that those guys are crazy, but we're going build some really valuable medical devices for critical unmet needs in the process. And I think one of the things that makes Science, the company, very special is that it has both of those cultures and is able to integrate them. And we're able to simultaneously do some really cool research that I think is really at the edge of the Overton window while simultaneously running clinical trials in six countries now with an approved medical device in Europe and clinical trial results in the New England Journal of Medicine. You have to be able to navigate both of those things, I think, to really reshape the future. [00:54:03] S1: Has biotech gotten easier to break into for earlier stage founders?
00:54:07 · Max Hodak
[00:54:07] S0: Biotech remains capital intensive, and so that is... I don't know that I'd recommend biotech if you have a choice of other stuff to do. I think for me, was realized almost thirty years ago that if you could alter the brain, could alter reality. And this was one of the biggest missions of the next thirty, forty years was building these things. And so for me, I think it's like, every now and then, think that my life would be way easier if I had just gone into AI instead of BCI. But somebody has to do it. And I think it's important to biotech is hard. It is a much harder path than many other things that you can do. But when you're successful, it has an impact on really what you see elsewhere. Think increasingly, there's I mean, it was Paul Graham that wrote a long time ago that you get vibes in different cities. And the vibe in Cambridge, Massachusetts is you should be smarter, or the vibe in New York is you should be wealthier, the vibe in San Francisco is you should be more powerful. Especially with the rise of things like artificial intelligence, I think people realize that this isn't just about money. And I think for many of the most effective startup founders, it's not about the money. It's about changing... Like, there's some way in which you want the world to be different, and it just turns out that for that project, the for profit company is an incredibly powerful way to marshal the resources required to cause the world to be different in that way. And this is this is not about money. This is about power, there and are many different types of power. There's economic power. There's military power. But the power to heal the sick is a very dramatic one. And when you get that, not only is that a real force to reshape the world, it's one that can be shared very readily. You can't share military power or economic power, but you can share the power of restoring sight to the blind or of giving life to the cancer patient. And I think that the world is getting more complicated, and there's big impacts of all the things that are being worked on by the people in this room. And biotech is hard. It's very capital intensive. It's a long road. When you start a company in this space, you're committing to a decade of your life that you will never get back no matter how it turns out.