• JoJo

Neurotech: Not Just for PH.D.s Anymore

I am a scientific anomaly. I am surrounded by people with the highest degrees and honors in some of the most challenging fields of study, yet I don’t share their pedigree. My understanding of biology is limited to the lyrics, and even only partial lyrics, of School House Rock songs. My understanding of engineering is a combination of slightly above average logic applied to some fancy words that I have picked up over my years in neurotech. I am not a scientist. I am not an engineer. I am an outlier, an aberration, a cowboy, an imposter. It wasn’t until a few years ago that I encountered a fellow traveler - a woman, far smarter than I, but not an engineer or a scientist either. It was a most surprising discovery to learn that Ana Maiques, the CEO and co-founder of Neuroelectrics, is an economist.

I first met Ana while caught in the heat of an inebriated Spanish yelling match. No one was angry, it was simply the spirited exchange of long-time friends, reuniting at a party in San Francisco for NER (it was an awesome party.) Jose Carmena and Michel Maharbiz had mentioned Ana in previous conversations and had made it a side-mission of the conference to introduce us. The Spanish melee was exuberant and I caught maybe every third word of the yelling and before I knew it, I was locked in a hug with a highly animated whirling dervish wearing an electrode cap. Ana was instantly my kind of person.

We have since discussed what it’s like to be an outlier in the neurotech field. Maiques admittedly focuses on the “business” side of things, but has definitely acquired what I like to call “street science” (it’s a little like “street smarts” mixed with healthy dose of multisyllabic vocabulary.) She attributes her scientific understanding to intense observation and necessity. “The science comes up in a lot of business meetings,” she explained. “Then there are follow up meetings on a project and you are always listening. I think that through the years you develop the language and a very, you know, high level understanding. That’s why I never get scared to come to conferences, but I would never say that I’m a scientist and I would never do a scientific talk because I’m not the right person for that. But I constantly talk to investors, and partners, and to the public.”

Maiques’s work husband is, in fact, her husband. Giulio Ruffini is the President of Neuroelectrics. “So my husband is a wonderful human being, but on top of that, he is a wonderful scientist. He’s a mathematician and a physicist,” commented Maiques. “I am trained in economics. I think we have very different minds; they are very different brains. We have different roles in the company. That’s part of the reason I think this collaboration has worked so well.

In any company, collaboration, partnership, friendship, or marriage, there are bound to be some disagreements. I asked Maiques how she manages the blending of work and marriage. “I think that before you create a company, you have to establish, you know, who will take the last word on what topics. Who is the authority on what subjects. And then you have to respect the authority even if you disagree. If not, you create chaos in the organization - people will try to go to both sides to get what they want. So, I think that it’s really important to decide who is going to be the decision maker on this topic, or that topic, or on this role - and stick to it.”

With your business partner as a spouse, or your spouse as a business partner, it can be easy to spend a lot of time outside of the office talking about work. You no longer have that disinterested, or maybe just less-than-enthusiastic partner telling you that it’s time to turn it off. Maiques and Ruffini attribute some of their ability to leave the office at the office to their four kids. “When you get home, they don’t care what happened at work. I think the more years you spend as an entrepreneur, the easier you take things. I remember when I started a bad thing could happen and it would look like a tragedy - like the company is going to shut down... if you lose a contract or a sale. The bottom line is that you get by, and if you’re a good entrepreneur, you almost always get by. I’ve also calmed down a bit.”

In addition to the challenges and rewards of family science and business, the couple is bi-continental. Neuroelectrics has offices in Cambridge, MA and Barcelona, Spain. I asked her what it was about straddling the Atlantic Ocean that had appealed to her.

“We opened our office in Cambridge in 2014 and then we moved there in 2015. We are selling our devices worldwide and Boston started to buy a lot. We thought we we needed to be close to those clients to understand what they are doing with our technology,” she explained. “Then, we went to do the FDA trial. Having the founders of a European company facing the FDA, I think it’s important, if you’re serious about something, you have to introduce yourself, right?”

Neuroelectrics received FDA approval for a clinical trial of at-home brain stimulation therapy via telemedicine in May, 2020.

In addition to the personal connections that Maiques espouses, she also believes that neurotech startups need to have a global dimension. “There are epileptic patients in US, in Europe, in Asia... everywhere. And if you’re developing something for all of them, you have to be in all these places.” Disease is not a regional adversary.

Maiques and Ruffini founded a company called Starlab in 2000. Starlab’s goal is to do cutting edge science and take it to market. This model is unique today and assuredly was novel twenty years ago. The company was funded primarily through non-dilutive sources and Neuroelectrics is the first spin out.

Neuroelectrics has developed a wireless technology that allows for brain monitoring and stimulation and provides a noninvasive way to provide personalized brain therapy. The first two conditions for Neuroelectrics are epilepsy and Alzheimer’s disease; the company will seek additional indications as well. “Can you imagine,” postulated Maiques, “a day when people will be sent home with this wireless technology and we’ll be stimulating patients at home and collecting their brain data, stimulating them again, and it will be truly personalized therapy at home.”

Translation and deployment to the patient population is a passion for Maiques. We discussed the hurdles (beyond the scientific ones) and while she acknowledged the amount of work required to obtain FDA approval, it was reimbursement that strikes her as an even bigger hurdle. As she sees it, there are a few different scenarios for earning reimbursement codes. “You can partner with pharma; a lot of pharma companies are changing their models from a drug delivery company to a patient-centered company. I truly believe that for epilepsy, partnering with established players would be a good market access opportunity. In terms of creating traction, I believe, especially in epilepsy, in the power of the patients,” she said.

Neuroelectrics’ Starstim solution is non-invasive so epilepsy study participants are not faced with the prospect of a craniotomy or implant. That’s a particularly compelling option. Maiques admits that the Neuroelectrics patient outreach for Alzheimer’s will be different than for epilepsy. “You may get a prescription from a doctor, but we’ll deliver directly to patients. Depending on the pathology, you may see different market access models. I would love to see companies like CVS or BestBuy, who are making investments in healthcare, becoming new players in the distribution channel. I think the future is interesting for these digital interventions.

With a noninvasive, take-home, closed loop system, there are obvious implications for use in healthy populations - enhancement instead of repair. I asked Maiques where she stands on the subject. “Of course, if we can reverse cognitive decline or improve memory, why couldn’t we do it in healthy subjects?” She opined. “I have more of an ethical debate, because I don’t think we know enough about electrical stimulation to provide these to healthy consumers. What are the long term effects of stimulating yourself every day? There are studies that show that maybe you are increasing working memory, but you may decrease dual tasking, for example. We need to know the long term effects of stimulation.

Maiques spoke on a ‘women in neurotech’ panel at a conference in Napa, California last fall. I noted that she was the only business person on the panel. She observed that diversity in neurotech isn’t only about skin color or gender; it can also be about about diversity of background and experience. “I think it’s true that women are even less represented on the business side than on the science side,” she said.

I’m not terribly keen on dissecting the gender or race distribution within any scientific community; I’m not qualified to have an opinion, but, as a business owner in neurotech myself, I felt comfortable talking to Maiques about the challenges she has faced as an entrepreneur in this field. Her fiery Spanish passion ignited immediately. “What you cannot do is just, you know, give up. You just have to persevere and keep on pushing doors until the right doors open. I think it’s a matter of knocking on a lot of doors, many more than a man would have to, to find the right people, and just change the rules of the game with those people.”

During the Napa conference, Maiques recounted to me some advice from a female VC, which was to hire a man to do the capital raise. Maiques quickly recognized that the VC, a friend, was honestly trying to provide some helpful options. “I have two sons, but I think that for my daughters, I couldn’t take the advice. I just had to try my way so that I can set an example, you know, to my kids, other women, trainees or scientists or entrepreneurs to come. We have to pave the way. We came later in the game and it’s a male, non-diverse dominated world. We have to change it and we will only change by doing and not just speaking about it. Put women in positions of power - as lab heads as heads of universities.”

When the world lets us gather again (please be soon, oh please, please, please be soon!) you will undoubtedly see the electrode-cap wearing Spaniard ruling a panel or running a room. Maiques is undeniable, unmistakeable, and unstoppable. I’m lucky to have anything in common with her. !Salud, mi amiga!

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