Startup Life in Clinical Research w/ Joe Dustin

Joe Dustin shares his journey from a computer geek to a significant player in the clinical trials industry. He discusses the differences between corporate and startup environments, emphasizing the importance of embracing chaos in startups. Joe reflects on the challenges he faced, including getting laid off, and offers insights into navigating the current market trends in life sciences. He provides valuable advice for startups, highlighting the need for product-market fit and the importance of reducing risk for potential clients. The conversation concludes with personal insights and thoughts on the future of the industry.

Thank you for joining Inclusion Criteria: a Clinical Research podcast hosted by me, John Reites. This is an inclusive, non-corporate podcast focused on the people and topics that matter to developing treatments for everyone. It’s my personal project intended to support you in your career, connect with industry experts and contribute to the ideas that advance clinical research.

Inclusion Criteria is the clinical research podcast exploring global clinical trials, drug development, and life‑science innovation. We cover everything clinical research to deepen your industry knowledge, further your career and help you stay current on the market responsible for the future of medicine.

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Transcript

SPEAKER_00: 0:07

Joe Dustin. How are you? Better now. How are you? Good. Hey, we need to start out with a disclosure, though. I think disclosure time says we've known each other for a long time. And so if we talk like we've known each other for a long time, it's because we have. So who's Joe Dustin? What have you done? What are you doing now? Well, there's the one side of Joe Dustin that's like a guitar player, travel geek, and space nerd. But then there's the other side, which is fell into clinical trials industry 20 plus years ago at a family barbecue. And here I am. Which one do you want? A family barbecue? Yeah, let's do that. So I was getting out of college in 2002. I went to Roger Williams University in Rhode Island. And I was a computer geek. I was a computer information systems major. I was no biomedical science. I didn't have a PharmD, none of this stuff. It was, came out like one of the last classes I took senior year was like Windows NT administration. My first online experience was getting the free floppy disks from AOL in the mail and stealing my mom's credit card and canceling it right at the 29th day to then do it again. That was kind of how it all got into computers. When I was a kid, my friends and my family said, I'm either going to, I'm either going to go on TV somewhere or I'm going to be doing something with computers because I was in cable access really young in the local Nell Rose outside of Boston where I did a lot of TV stuff, both in front or behind the camera. So none of this has anything to do with clinical research because it just kind of happened out of nowhere. I'm at a family barbecue in Cambridge, Massachusetts. So I'm sitting there at a barbecue with my uncle and aunts and Pekka from finland and he says uh oh so you're getting out of school you know we could we could use some people once you come on bring your resume and uh once once you're out and send it over and we'll come talk to you so i did and uh that company was called crf box back in the old days which became crf health which became signet health and so the founders from finland you know a few of them were over over here and it was me and like four fins and a couple guys from the boston area in an old doctor's office building e-diaries on palm pilots Yeah, I started as the IT guy. And within six months, I was project manager. So is this startup tip number one is go to Barcues? Yeah, get the sausage. Amazing. That's great. All right. So, you know, one of the things I respect about you a lot, because I think it takes a certain amount of grit and demeanor in your career is to be in corporate and to be in startups and to do both. is unique. And, you know, I've done that historically. It's been kind of fun for me to learn and to grow and to figure out going from corporate entrepreneur to, you know, digital entrepreneur. And you've had a similar track. So what are the, what's the key difference? What's the thing that people need to know that's so different between working in a corporation, working in a startup? Don't be afraid of stability or instability, I guess is, and it also has a, is a, it definitely rings true. depending on the different point in your life you're in. That's for sure. When I was 22, single, no dependents, and they were like, yeah, we're going to send you to Helsinki. This office has six people in it and there's no 401k. You know, yeah. Okay, cool. And so at that point, I didn't care. In fact, it was exciting. And when I went back to like alumni day back in college, 10 years later, I was the only one that did a startup. It was fun. It was crazy. It got, it got really fun. When I finally got out of project management, that's for sure. Cause I went from startup land, both from at CRF health and then a company called e-trials. And when I moved to Raleigh, that's what I right around sort of when I met you in, in, in that area and still startup, you know, went from 60 to 120 people and you know, never have enough budget, never enough resources, never set up for really for success. But it wasn't until they started taking me out on the sales calls where it got really fun. And I joined this little startup in 2008 out of New York called Medidata. And that's when things got really interesting. So joining a startup to me is chaotic, but you kind of embrace the chaos. But there are things you get to find that bring a little bit more stability, not even financially, just like in yourself, right? But there's three things I think that really make sense. You got to have a... And you could look at this with startups now where I... Definitely, I'm seeing it. You need to have a highly differentiated product, like highly differentiated, because there's so many B2s out there, with a hugely addressable market, with a really awesome culture, and good leaders, right? And sometimes you can't make those leaders. Something about the timing, territory, the talent, what's happening in the world, and all the other three things make a startup successful.

UNKNOWN: 5:01

Yeah.

SPEAKER_00: 5:01

You know, if you're doing something that is different, that is new as a startup, there is intentionally not a manual written already about someone who did what you did. So it's not like there's the lessons learned playbook that you go pull from. Yeah, there's certain things, and I'm sure you had this from your corporate background. I did too, right? You walk into a situation, you're like, hey, I've seen some element of this before. This is what we need to avoid, or this is how to think through this problem. But a lot of times you'd run into this issue. And someone was like, what do we do? I'm like, well, no one's ever done this before. So we are the ones that need to figure it out. And that wasn't a failure. That was actually innovation, right? It just was disguised as failure. It was, we figured that thing out. At a conference in the early days, I remember back when the innovation teams were first getting started in pharma, there was one guy, but he said, we need an SOP for things that don't have SOPs. It's just one of the things he said all the time, like, cause they were so obsessed with SOPs. Like we need one that just says, we don't know what's going to happen. And we're following that. Did you guys write that SOP? And can I get a copy of it? Never. I would love to. But I mean, when I was in pharma during that time running innovation, that was a challenge because I came in bright-eyed and bushy-tailed. I'm going to come in and break shit, right? Well, it turns out people don't want things broken. What's the hardest thing you've had to do so far? Like, what's the hardest challenge you've had to overcome? Getting laid off for the first time was like, wait, this doesn't happen. Wait, what? And when that happened, I wasn't worried. In fact, I wasn't surprised. But I think we all go through it at some point in different ways. The first thing I had to think of was, crap, what do I tell my wife? Second thing is, what am I going to do about health insurance? Because we live in America and that's what we do. And number three is, I wasn't worried about getting another job because I feel pretty connected and at least I... But it took five months, right? And so even then, in a market that was just horrible, and we're still running through that, just dealing with the, what do I do now, was probably one of the hardest things I had to do. But at the time, I was like, wait, that's hard. So that's when I started a consulting business. I want to get out there and just help people and do the right thing. I've never felt like I was ever in sales. And I think that's probably why I was really good at it, because no one ever saw me as a salesperson. But it's trying to sell yourself. is really hard. We have this like sort of imposter syndrome sometimes. And I think we all have to confront that at some point in other ways. I'm getting better at it, but it was the hardest thing I think when it happened the first time. Yeah, that's fair. When I think equally, you know, setting up joedustin.com is different, right? When you have to sort of think about yourself as an individual contributor, right? Like with what you mentioned, it's different to shift, right? And in this market, it's a shift you see a lot of people doing. I've had JoeDustin.com for a lot longer than that, but I changed what it was for sure. Exactly. So as we think about your story and we get to the market, it's not surprising to anybody. The market we're in right now is challenging. Still is challenging. We go through a pandemic. We come out of a pandemic. We've now got a lot of things going on around the world with spending and money and politics and everything in between. And the market is interesting is the word I would use right now. What's the market look like for you? What's the market look like in life sciences and clinical research? The market's in recovery. This is not the recovery year. I think the second half of this year called Q4, I think you'll start to see some interesting deals in the market that'll get people excited that will then set up for a good 2026, I hope. Yeah. So if you're a startup in a market like that, there's sort of this like balance though, right? That's a good opportunity because there's still market share to be taken. There's still work being funded. So if you're a startup in this market and you're trying to really set yourself apart, what advice are you giving, Joe? What are you telling startups to do in a market like this that is, I would argue, is going into recovery in the second half of the year is what I would argue. But let's just say that that is the premise. What do you tell startups? What do you advise them to think about to get through this period and to actually change or evolve or grow their company when they get into phases like this? I think that the few things I say are hold on tight and stay true to what you believe is right. If you have a product market fit, keep crushing at validating that that is true. And there's a reason why so many great companies are created during economic crashes, right? I think we've witnessed probably two or three of them now in my career lifetime for 20 plus years. We've had the dot-com bust, the housing crisis, and the post-COVID meltdown. And I think in each of those times, there are amazing things that happen. So when I look at startups, everyone always asks, who's the next one, right? So you get to find out, like, if you can just stick to what you're doing and stick to it. If people think you're crazy, sometimes just stick to it. And so there's so many startups I see now. I'm working with at least three of them on a more advisory basis. that I'm seeing a lot of really cool things in recruitment tech and clinical trial matching and tapping into clinical sites and their data, whether it's an EHR or they're in infrastructure in-house, like their site CTMS systems. There's a rise of the sites coming where they're going to start digitally transforming their own operations because they have to. And as a result of that happening, more come online, more data becomes standardized and available. You can do more things. So they're getting ready for what's coming, but it's a dual set of marketplace, right? You're paying for everything, but the sites are seeing the patients. So how do you, make that work. What's the old adage? You know, history is the best view of the future. You know, this idea that if you want to see what's going to happen in the future, look at the history and these things are cyclical. They continue to come around and around. And it's funny because I, you know, looking at sort of like as a guy who's a CEO and runs a company and works with great people and a great product to these things today. This market is challenged, but you can actually still see growth from it. You can still see, like you said, people saying, hey, now I've got a little bit more force agent to make the change, or I've got new thinking that's in my company and I've got to take a hold of that. So I want to think differently about how I digitize a clinical trial or how much I use a DHT in my study, right? Those conversations come back around because there's change. Because there's motivation to find the next success area. What's been interesting to me is I think it's really easy to have the AI discussion. That's the easy discussion. Everybody wants to talk about AI, AI, AI, and lots of companies experimenting, using it. Some, it is the basis for their entire company. But the interesting thing is what I think it's actually done is it's unlocked people's brains around AI. innovation and so what we're seeing in daily basis is is people literally going i am r d i'm not willing to go all the way into this area of ai but can you solve this unique problem or can you build this powerpoint for me or can you take four hours of my week out with ai i'll buy that and that i don't have to do an innovation pilot program for 17 months to figure out if i want to do it and that's been kind of fun actually and i do think that like you said you know this this era of a market has a natural inclination to produce opportunity for startups. And I really do think now is the time. And I think there's a lot of winners that are going to be winners because of what they're doing right now, which is good. I'm seeing a lot of AI being applied in pharma. It's really not AI. It's just intelligent automation and faster robotic process automation that we used to do five, 10 years ago in some ways, right? But that is becoming easier, cheaper, and faster to do. And you can roll out these things so much faster. But as that expands, I'm worried that we're going to be, we're going to be automating really bad processes and we're not going to, we're not going to fix the problem, the real problem. Right. And so it's cheaper just to automate a really bad process as opposed to going through a massive change management effort. Cause we know change management is the hardest part of every project for sure. In some cases I would even stop calling it change management. I would call it adoption management because you need people to adopt the new thing. And in some cases, there's no choice. In startups, you can think of this too, where think about the problem you're doing, the problem you're working on. It could be automating better recruitment, like calling patients with robotic AI voice bots. It could be matching better patients through their medical records and preparing for chart review with better AI agents in the background that can get at the data. It could be smart protocols. It could be structured protocols. We were doing this 10 years ago. right? But now it's becoming so much easier. If the problem, if the, if the, it's the change equation, right? So if the problem that you having, if the change doesn't give you at least a 10 X benefit, and if the pain is, if the pain is not more than doing nothing, like if the, if the pain of doing nothing is more than the change, then you're going to change. And if not, no one's going to care. And so you really need to understand you being the Royal you of startups. Is the problem you're working on really, really big? I think everybody is trying to quantify that right now. And that's, I always advise people like really, really hammer on that one because if it's questionable, understand earlier if this has got something, got some legs to it. Because like you said before, some of these problems that might not, it might be a new way of doing things that no one understands how. And in five years, you'll say, okay, like smart protocols 10 years ago, we were doing that. tech companies and CROs were taking a stab at it. Transcelerate was building standards for it, but nobody had a budget. Nobody had a team. Nobody had owned the process. It was just, you're in word and the scientists over here are working with you over here. That's all changed because people were taught a new way to do things. And yeah, sometimes it can take 10 years. Yeah. Fair point. When you think about telling a startup that something could take 10 years, there's probably like investors only have five years. Yeah. You know, I think, I think some of the startup founders probably just went, Oh, thanks Joe. Appreciate it. You know, what's, what's the advice you give to a startup leader, right? That says, Hey, I got to hang in there. I got to solve, solve a problem. I got to solve a problem because I have to make revenue. I need to make money, right? The new world that we live in rewards making money as much, if not more than, growth. I think that there needs to be some sort of product that you have that can solve a problem now while you build the bigger problem or the bigger product for the bigger vision of the problem you want to solve that is going to take longer. And so you need something that works today. And that's sometimes really hard to find because a lot of times you don't want to build a me too. You want to build something that's revolution. Pharma doesn't want revolution. They can't adopt revolution. The companies that have been the most successful in our industry are And it pains me to say this sometimes, but when I talk to startups about this, especially when you're talking to a lot of people that are rooted in Silicon Valley, they want to rip the machine down and completely redo everything and their hearts in the right place, their mind at a better place. Right. But when I hear people like engineers, where the real innovation comes from the engineers, that's for sure. I was, I was told many times in my day, stop telling me how it's done. Tell me what the problem is. I will show you a new way of how it's done. And I'm like, Ooh, okay. All right. So then I stepped back and they come back with some crazy stuff. And I'm just like, that is, Whoa, you can do that. And you did that like in a week. But then the comment was like, well, the FDA won't let you do that. Well, we'll just tell the FDA they should change it. And then we'll show them and prove to them how our way is better. I said, cool, that's going to take you five years of building an evidence base. You can tell them that, but you need to do your own studies. There's a reason you and I both lived ECOA for a long time, patient reported outcomes. When you have these new instruments or these new equivalency measures from this to that, the older... I would say even more legacy or companies that have been around for a really long time did the hard work of their technology might be older, but they did the hard work of like proving that the thing that we did actually works better and publish a study, which then our clients would go to FDA with a published case study in a journal somewhere and say, look, here's the evidence. But that would take three years to do that. So that's where startups find a real challenge in our industry is changing the regulators and changing pharma because you need to provide evidence. So that is why you need something that requires less evidence to start while you're building your evidence base as you're going. That has to be part of your strategic plan. You want to make real change, you need to do the hard work. And know that's going in. And solving those complex problems, right? I think to your point earlier... You know, like I'll see pitches or somebody's like, hey, look at this thing. And that's cool, but nobody cares. And the reason nobody cares is not because what you built wasn't cool. It's because you didn't solve anything that's complex. Someone would look at that and go, well, if I had time and money, I could solve it myself. Right. And I think once you run into that thinking, you're sort of brick walled already. And so for me, I think it's you've got to be able to solve complex problems, not problems that somebody can easily work out. They just had a weekend and a few bucks to do it. And I think that's why you see a lot of people in startups that are typically more successful are the ones that have industry expertise or experience or were actually the buyers because they knew what to solve for. So it's really- When I went into pharma for the first time, I learned so much in a short amount of time, right? You've been in on the other side as well, on the CRO side. Like when you see what's in the machine and how they make decisions and why they make decisions. The month that I left, I went to the Scope conference the February after I left. And I got to, first of all, I'm now going from the client to the vendor. And they were nice enough to let me keep my speaking spot. So that was, you know, shout out to Micah and those guys at Scope. They're awesome. But my presentation was not about the new company I joined. It was about what I learned in pharma. It was on YouTube. You can see it. But the biggest thing I had was I found out who they are when they say they won't let us do that. Do you want to know who it is? Tell me who it is, Joe. We'll get real quiet just to make sure everybody hears. I'm going to whisper. It is an inspection report from four years ago from the FDA that's flagged your company about a whole bunch of stuff. And the VP of ClinOps says, don't ever let that happen again. And they build a mountain of process and a mountain of third-party risk management processes that just snowball. And then that lasts until the next SVP comes in and rips the whole place apart. And you start anew. And so sometimes people that are in pharma and institutionalized for a long time, they never forget. And when you have team members that have sat in an inspection with regulators and threatened for their job and feeling like this might be my fault if I miss something, they'll never want to take a risk like that. That is why We've become so conservative as an industry. They is regulatory scrutiny and an inspection with someone sitting in your office auditing you and holding you accountable. That's the problem. Fair point. Pharma will buy down risk at any price. So startups remember that as well. If you reduce risk, they will pay for it. You heard it. All right. I want to shift gears a little bit. Are you Apple Music or Spotify or something else guy? Good question. I have been an Apple music guy for a long time, but my kids all use Spotify. Most of my friends use Spotify. And when I send them links to music, like why are you sending me this Apple music? I don't use this. Okay, cool. Do you have your phone on you? Can you like open up your Apple music? All right, come on, open up your Apple music. What's the last you can pick artist album or song that you listen to? What's the last, the last, let's just go. You can pick artist album or song that you listen to. Yeah, okay. Well, the last one was the last album I just discovered was UFO. UFO from the 80s. This is basically the band that inspired Kirk Hammett from Metallica. And I remember, so UFO is like, you know, thrash metal of some sort. And inspiration, UFO, Motorhead, Iron Maid, like all these people are sort of in that same group in the 70s and the 80s. I was watching some YouTube video because sometimes I go down the YouTube rabbit hole. I'm much like, many of us uh and it was some video of kirk hammett bought uh michael shanker's like flying v from ufo and i was like and he was talking about i was looking at this guitar in the back of the album for years as a kid and this is why i went to look for the album like i've never heard that album so then i went is it good yeah it sounds nothing like metallica but like you you can hear some of the inspiration for sure like oh yeah yeah it's but it's like late 70s, early 80s heavy metal, which is kind of like Black Sabbath. How can people get a hold of you if they want to find you for consulting support, if they just want to reach out to you in general to catch up or to meet? How do they find you? Yeah, so joedustin.com is probably the easiest way to do that. There's a page that shows all the ways to get a hold of me. I got a whole bunch of links to stuff that I've done over the past. The consulting company I run is called eClinical Consulting. I work with startups on their product. I do product strategy. I'm doing fractional business development, and I'm working on various things, both in pharma and in tech. So you might see me as the guy who's helping run the next RFP in pharma or working with a tech company to figure out how to become the next big thing and have a little bit of subject matter expertise in-house while they have some genius developers and entrepreneurs that maybe don't have all the experience that you and I have had in this industry. So yeah, find me at joedustin.com. I'm there. Perfect. That's great. Hey, thanks for your time. It was good to see you. Good to see you, John, as always.