“failure Is The Preamble To Success”
HE COULD HAVE BEEN A CONTENDER. AS A teenager growing up in Cincinnati, Thomas Fogarty was a Golden Gloves champion who yearned to turn pro. That dream died after his first professional match. “They told me I won,” he says, but the losing fighter had hit him harder than anything he’d experienced as an amateur. A single punch knocked the desire to box right out of Fogarty. To this day his professional record remains at 1-0.
It was a very unusual path that led him from the boxing ring to the National Inventors Hall of Fame. In his teens he worked as a surgical scrub technician. That gave him a close look at the way operations were performed in the 1950s. Back then, surgeons cleared blocked blood vessels by cutting long incisions to reach deep into the body. High death rates were common. This inspired Fogarty to think of a radically new approach. He took a latex glove, snipped off the pinkie, then connected the pinkie to a plastic catheter, using fly-tying techniques he had learned as a fisherman. His embolectomy catheter, patented in 1969, was the world’s first balloon catheter. It triggered the rapid development of a whole suite of minimally invasive surgical procedures.
Today Fogarty, 69, is a professor of surgery at Stanford University Medical School. He holds more than 70 patents, including many for a wide range of specialized balloon catheters. He’s equally renowned for his innovative expandable stent, which can be inserted in a constricted blood vessel and then expanded into place by inflating a balloon. He owns a number of companies that develop and sell his inventions, and he is also the owner of Thomas Fogarty Winery, which produces well-regarded reds and whites in the mountains east of San Francisco.
That’s where this conversation transpired. Before sitting down to talk, Fogarty took a sip of his own brand of pinot noir and noted that moderate wine consumption is good for your health. “Wine is health food in liquid form,” he said.
I understand you were an indifferent student.
That’s kind. I was not a good student. My mother used to say I majored in nonsense. I didn’t figure out until my senior year in high school that grades were important. I just found other endeavors more interesting. School to me was a discipline—which it is—and I was more interested in exploration than in discipline.
Maybe you needed a better outlet for your creativity.
The first thing about creativity in young people is not to discourage anything. Accept the premise that anything’s possible, and allow them to pursue it, even though an adult may think it’s fruitless. I think the pursuit is the process. Once you learn the process, you usually end up with something successful.
How did you finally become a better student?
In my senior year of high school I had to make a choice about a profession. When I figured out a pugilistic career was not for me, I wanted to go to college. My grades and discipline were so bad the high school principal said it would be a waste of time, but one of the priests at the school interceded and I was accepted on probation.
It then became obvious to me that school was necessary. I wasn’t going to get anywhere by fighting it. I was going to have to get good grades, particularly if I wanted to get into medical school. At the college I went to, Xavier University, in Cincinnati, we started with a pre-med class of 100. The tradition was that there were usually 20 to 25 left by the fourth year. There was a very high attrition rate, and it was always grade-related.
You got a job that brought you into contact with surgery when you were quite young. How did that happen?
My father died when I was eight, so work became part of getting along. There weren’t many jobs for preteens back then, but you could get a job in a hospital, because they were exempt from the child-labor laws. I worked in what was called “central supply” at Good Samaritan Hospital in Cincinnati. It provided supplies for the patients’ needs—IV solutions, the oxygen tent, the oxygen mask—so I became involved in sterilizing supplies and also in taking care of the oxygen source. I started that in the eighth grade.
I think I first saw surgery when I was 12. It was from a distance, but I saw it. By 13 I was actually sterilizing the surgical instruments in the operating room, so I got much closer. The nurses thought I could probably make a good scrub tech, the one who hands the instruments to the surgeon. At somewhere around 14 or 15, I started to train as a scrub technician.
How could such a young kid realize that the surgeons needed better techniques?
It wasn’t really that profound an observation. One fairly common operation was to remove an obstruction in a major blood vessel, usually in a leg. To get the clot out of the artery, they’d make multiple incisions. Often an incision would start in the abdomen and extend all the way down to the knee. They would open these arteries and try to pick the clots out. It was a very long operation, and very complicated, and there was usually a second operation: an amputation. It didn’t take a lot of insight to see that something better should occur.
But you were a teenager. Why didn’t the surgeons have the same opinion?
Disciplines are interesting. You are taught to do certain things and not to violate certain principles. There’s such a vast amount of knowledge to assimilate in medicine that you don’t get very far if you question basic premises. That’s just the nature of the educational process. I think it’s true of medicine, and it’s true of other disciplines. If you look at major innovations, most of them are not accepted right away. They’re challenged, because tradition tells us they won’t work. That’s why so many inventors are initially viewed as crazy.
How did the doctors react when you showed them your invention?
My mentor, Dr. Jack Cranley, encouraged me in the effort. But we both came under harsh criticism. In fact, my invention was viewed as dangerous. When you identify what you think is a valuable procedure, technique, or instrument, you report it in the medical journals. My first invention was submitted to the three major American surgical journals, and all three turned it down because it was so unconventional. Dr. Cranley was criticized at the first presentations at major meetings. As I became more advanced at the medical level, the technology and the instrument were still being challenged when I made presentations. It’s hard to upset tradition.
Did you ever imagine surgery would embrace so many noninvasive techniques?
No. In talking to other inventors who have been involved in paradigm shifts, they never really appreciate the breadth of what they’ve started until it’s under way. That makes sense. Other people come to recognize the thing’s utility, and then they apply it in many different areas. That was true of the embolectomy catheter. I was focused on one disease state that was poorly managed. If a patient had an obstruction in an artery in the late fifties or early sixties, half the time he’d die. If he lived, half the time he’d eventually have to have an amputation. That was what I wanted to correct. I didn’t see the procedure as the birth of less invasive surgery. But it did everything that surgeons try to accomplish, and in less invasive ways. You can make smaller incisions or eliminate a number of incisions. You can use less anesthesia and decrease the pain and suffering during recovery. Certainly the technology served all those purposes.
What are you working on now?
I think there are many disease states that represent major unrecognized public health issues with not a lot of technology addressing them. One is obesity. We’re finally recognizing that even a small degree of overweight is detrimental. If you reduce that overweight, you decrease the risk of associated illnesses like hypertension and diabetes. That’s not really been addressed effectively.
Another area that has gone unattended is sleep apnea. People interested in major public health issues now recognize that sleep apnea has not been paid proper attention, not only in terms of treatment but also in terms of diagnosis. Those are two areas I’m currently involved in. I’m working on technology that I hope will improve both those disease states.
I’ve heard that you have thoughts about making medicine more patient-centered.
For me, satisfying the needs of the patient is paramount. Sometimes there’s a disconnect between what patients think they need and what they really do need. But that’s a matter of education, and most patients today are very willing to be informed. There are a lot of things patients weren’t so knowledgeable about previously. It’s very easy to access a Web site now to learn about your disease state, and I see more and more patients doing that. I encourage them to become part of the process. If we’re going to really take care of them well, they have to be part of the process, and that means knowing a lot about their disease.
You make a distinction between having ideas and being an inventor.
Well, ideas are only ideas. I’ll tell people about something, and they’ll say, “Oh, I had that idea.” But the idea alone has absolutely no value. Thinking about something doesn’t in and of itself help anybody. It’s the implementation of the idea that brings value to the public.
You invented a new kind of clutch when you were a teenager, and that didn’t work out so well for you. What happened?
I had a motor scooter, and small engines back then had mechanical shifts with standard clutches. There were usually two gears, low and high. If you were in high gear going up a hill and you had to shift into low gear, the motor scooter would jump about 10 yards ahead of you, and your ass was on the street. I wanted to make the transition smoother and not have that jerky action that caused you to lose control of the scooter.
I was working part-time with a friend of mine in a small engine-repair shop, and we came up with the idea of a belt that would slip from a disk of large diameter down to a smaller disk and increase power. We developed it in the machine shop where we were employed. It became what is known as a centrifugal clutch.
Were you able to patent it and make a million dollars?
No, I wasn’t, and it was a good lesson. There is a thing called shop rights. If you’re employed by somebody and you use their equipment to build or construct something, they own certain rights to it.
So the owners made the money from your invention?
I’m sure. But those are the rules. They probably deserved to make money. They were paying me to do things, and I was doing this in their shop.
Did you handle things differently when you developed your first catheter?
Oh, I did. I retained my own attorney and did all the building in my attic. That’s where I created the first catheter system.
What do you think about being recognized in the National Inventors Hall of Fame alongside people like Edison, Marconi, and Bell?
I think it’s wonderful. I never really aspired to be anything except what I am. I’m a physician who uses innovation and invention to make things better for patients. That’s the way I view myself. I think I’ve done well enough to help a lot of patients, and that’s the important thing.
Have any of your inventions gone a little awry?
Let me count the ways. You know, failure is the preamble to success. Most first efforts don’t work. If you persist, you’ll eventually figure it out. Most of the time.
What is more satisfying, caring for patients face-to-face or inventing things that provide care for people you never see?
Both are wonderful. I still operate, and I still get immediate gratification from a success with an individual patient. Someone comes in with something that needs to be repaired, you operate for a couple hours, and you go out and say, “He’s better.” That’s a wonderful feeling. Perhaps more rewarding is coming up with a concept that other physicians can use to make their own patients better. It’s a different feeling. It’s not as personal, but it’s still wonderful to have physicians come up and say, “Gee, I’m glad to meet you. You’ve helped me so many times.” That’s nice.
I can’t imagine what it must have been like when you were a medical student and the surgeons who were training you were themselves being trained to use your procedure.
I was in medical school when we developed the catheter. When I started to work with Dr. Cranley during my internship, I wasn’t qualified to do surgery. But I assisted him, and after I went on to my residency training, I ended up training my seniors in the technique and technology. That was a very unusual circumstance. There was an occasional senior who was perhaps a little resentful, but that was the exception. Most of them say, “Hey, Tom, we’ve got a case. Come over and help us.”
Most of your inventions are medical devices, which are heavily regulated. Has regulation made it harder to be inventive?
I am concerned about regulators not recognizing how innovation actually works. When you think about it, innovation and regulation are polar opposites. Innovators don’t like reference points. Regulators rely on reference points. And regulation occurs at the federal level, the state level, and the local level. There are so many regulatory bodies that it makes innovation very cumbersome, to the detriment of the patient. The longer it takes to document and approve a therapy, the more patients suffer. I have real concern there.
As a patient I find the medical profession unbelievably innovative. Every time I go to the doctor, I hear about some new technology or new treatment. Is that different from your view from the inside?
No, I think that’s the right view. But when you look at the length of time it takes to get a new drug actually out into clinical use, it can be 10 years. It can be 5 to 7 years for a new device, particularly one that’s implantable. A lot of new medical technology is technology that’s been available in other industries for a while and is just now being transferred into the medical arena. That has gotten more cumbersome because of the regulatory hurdles.
In addition to being an inventor and a doctor, you’re a businessman. Do you have any advice for people who want to be more creative, more innovative, in their business?
Yes. I believe that if you emphasize doing good, making things better, improving society, you’ll end up getting rewarded. A lot of people start at the other end, and I don’t think that works as well. The most successful people I’ve seen acknowledged a problem and said, “We can fix that.” They end up being rewarded, and that’s the way it should be. That’s the system we live in.