The Outsider's Notebook

Observations from thirty five years of building companies.

Essays on building companies, raising capital, and commercializing technology in markets that demand evidence. New pieces land here and on LinkedIn on a weekly cadence.

Featured essay

AI · Commercialization

Selling AI to People Who Are Not Allowed to Believe You

The hardest customer for AI is not the skeptic. It is the professional who is not allowed to believe you. What commercializing AI in medicine taught me about selling it anywhere, and the four questions every board should ask an AI proposal this week.

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The essays

AI & Defensibility

The Data Moat Nobody Has

Why a dataset is not a moat, why a thin layer over someone else's model gets eaten, and what defensibility actually looks like in medical AI.

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Commercialization

Go-to-Market Begins in the Procedure Room

There is no single procedure room. Three clinical worlds, three definitions of better, and the discipline that survives contact with all of them.

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Building Companies

Building the Commercial Engine

Spotting a market is the romantic half. The engine that captures it is where companies are actually won or lost.

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Capital & Regulation

Predicates Aren't Regulatory. They're Reimbursement.

The predicate you pick decides your reimbursement inheritance. The first commercial decision a MedTech company makes is buried in its 510(k) paperwork.

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Commercialization

Cleared, and Then Ignored

The most heavily endorsed tool in interventional cardiology is used in a minority of the cases where guidelines say it belongs. What that gap teaches about how innovation actually works.

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AI & Commercialization

Selling AI to People Who Are Not Allowed to Believe You

Every AI market is quietly becoming a clinical market. Three lessons from medicine and four questions for any board.

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Selected writing at VerAvanti

Business strategy series

I write regularly on the VerAvanti Insights page. The clinical and product pieces live there, where they belong. These are the business-strategy essays, the ones about how durable companies get built in any regulated market.

FDA Clearance Is Not a Business Model

Regulatory milestones are permission to compete, not a strategy for winning.

What It Actually Takes to Prepare for an Institutional Capital Raise

The unglamorous work that happens long before the first investor meeting.

In Medical Devices, Reimbursement Is the Real Product

Nobody pays for technology. They pay for a covered outcome.

The MedTech Staircase: How Value Actually Builds

Enterprise value compounds step by step, and skipping steps is how companies fall.

The Discipline That Builds a Durable MedTech Company

Why restraint, sequencing, and evidence beat speed in regulated markets.

Four Signals a Market Is About to Reorder

The pattern I watch for before committing capital to any industry.

Stay Focused or Pivot

The hardest board conversation, and how to have it with evidence instead of emotion.

Why Heart Disease Deserves a Different Bet

The investment logic behind my move into medical devices.

More essays are on the way, drawn from the same notebook as my forthcoming book, An Outsider's Playbook. If you want them as they publish, follow along on LinkedIn.