The question I ask before I ask anything else

Every few months someone asks me if I’ll help start a new medical device company in a region I haven’t worked in before. Lately that question is coming from the Middle East and Africa more than anywhere else, and it’s usually about neurovascular technology or medical manufacturing.

My answer is almost never yes or no on the spot. It’s a longer question back: what problem, for which patient, solved by whom.

That sounds simple. It isn’t. A lot of companies get started because a market looks open, not because a problem is well understood. I’ve spent close to thirty years in medical devices, and the newcos that hold up are the ones built around a specific clinical gap, not a geography.

Why region and problem have to be solved together

When I think about starting something new in MEA, I’m not thinking about it as one market. Stroke care looks different depending on where the patient lives, how far they are from a comprehensive stroke center, and what’s already stocked in the cath lab. Manufacturing has its own version of the same question: what can be built locally, what has to be imported, and what regulatory path actually applies.

A newco that ignores those differences ends up with a product that’s technically sound and practically stuck. That’s true anywhere, but it’s easier to miss when a region is new to you and everything about it feels like an opportunity rather than a constraint.

So the first real work isn’t designing a device. It’s figuring out where the actual bottleneck sits, and whether it’s a clinical one, a supply one, or a training one. Those need different companies, sometimes different partners, and definitely different timelines.

What I look for in a founding team

I don’t start a company alone, and I’ve never wanted to. The physicians I work with are the ones who see the problem every day in the interventional suite, and that’s true whether the suite is in Orange County or somewhere in the Gulf. What changes region to region is who else needs to be at the table.

For neuro ventures, that usually means a physician who’s frustrated by a specific gap in stroke treatment, plus someone who understands the local regulatory and hospital landscape well enough to keep the company honest about timelines. For manufacturing ventures, it means someone who knows what can actually be produced and sourced in-region without pretending the supply chain works like it does somewhere else.

I’ve learned not to build the team around convenience. It’s tempting to fill a founding team with people who are easy to reach or easy to talk to. Neither of those is a reason to hand someone equity and a seat at the table. The reason is that they hold a piece of the problem nobody else does.

How I decide the shape of the company

Once the problem is clear, the next decision is what kind of company actually fits it. A device aimed at stroke treatment is a different animal from a manufacturing operation aimed at supplying components or finished product regionally. They have different capital needs, different regulatory paths, and different definitions of an early win.

I try to keep the early structure simple. A newco doesn’t need a five-year roadmap on day one. It needs a clear owner of the clinical problem, a clear owner of the technical solution, and an honest read on what the first eighteen months actually require in that specific region: not a general version of that answer, the one for this market.

That’s the part people rush. They want to move fast because the opportunity feels urgent, and in a growing region, it often is urgent. But moving fast on the wrong structure just means unwinding it later, usually after money and time are already spent.

What earns a yes

When someone brings me an idea for a new company in a new market, what earns my attention isn’t the size of the opportunity. It’s whether the person bringing it can explain, in plain terms, who the patient is, what they’re not getting today, and why this team is the one to fix it.

If that answer is specific, the rest is workable. If it’s vague, no amount of market size makes up for it. That’s true whether the newco is in neuro or manufacturing, and it’s true whether it’s starting in a market I know well or one I’m still learning.