Latest / The Science of Skin / Jonah Shacknai: The road map to owning two of the most successful companies in dermatology.

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Jonah Shacknai: The road map to owning two of the most successful companies in dermatology. · The Science of Skin

• 0:09
  SPEAKER_00: Hi, I'm Dr.
• 0:10
  SPEAKER_00: Patty Ferris, and I'm your host for this episode of Skin Care Confidential.
• 0:14
  SPEAKER_00: Just as a reminder, Skin Care Confidential is an outreach of the medical meeting that I started with Dr.
• 0:18
  SPEAKER_00: Ted Lane called the Science of Skin Care Summit.
• 0:21
  SPEAKER_00: So we started the podcast to give our listeners sort of a 360 view of the cosmetic industry.
• 0:27
  SPEAKER_00: And today I am speaking to somebody who honestly is a legend in dermatology.
• 0:33
  SPEAKER_00: I can't say it any more clearly than that.
• 0:35
  SPEAKER_00: And that is Jonah Shacknai.
• 0:37
  SPEAKER_00: And Jonah, I've known you for a long time, but I learned a lot about you Googling you on the internet.
• 0:42
  SPEAKER_00: So Jonah received his medical degree from Georgetown University and was a senior partner at the law firm Royer Shackney and Mill from 1982 to 1988.
• 0:52
  SPEAKER_00: And the firm represented multinational pharmaceutical companies, medical device makers, and four of the major industry trade associations.
• 1:01
  SPEAKER_00: He also served as scientific advisor to the chairman for the subcommittee on domestic and international scientific planning for the U.S.
• 1:07
  SPEAKER_00: House of Representatives, counsel to the chairman of the subcommittee on consumer protection and finance for the House of Representatives, and also counsel to the chairman of Subcommittee on Natural Resources, Environment, and Agricultural Research for the U.S.
• 1:20
  SPEAKER_00: House of Representatives.
• 1:21
  SPEAKER_00: And I'm going to ask you how you did that and what that was all about.
• 1:24
  SPEAKER_00: But more interesting was that in 1988, he founded what he's probably the most famous for, although he's famous for a lot of things, and that is being the chairman and CEO of Medicys Pharmaceutical and the founder of that company.
• 1:36
  SPEAKER_00: Meticys was a full-service dermatology blowing and going company for many years.
• 1:41
  SPEAKER_00: And they brought us legendary products like Solodyne comes to mind first and foremost.
• 1:47
  SPEAKER_00: So that was one of their big blockbusters, but also brought us the aesthetic products, Wrestling and Discord.
• 1:53
  SPEAKER_00: He sold that company to Valiant in 2012, but he did not stop there.
• 1:58
  SPEAKER_00: In 2016, he co-founded Skin Better Science and serves as the served as the chairman of Skin Better, which is a brand that's really very deeply rooted in dermatology and is one and still the few dispensing brands in dermatology.
• 2:11
  SPEAKER_00: So we thank you for that.
• 2:12
  SPEAKER_00: And we're going to talk all about Skin Better Science.
• 2:14
  SPEAKER_00: But in 19, I'm sorry, in 2022, he ultimately sold that company as well to L'Oreal.
• 2:20
  SPEAKER_00: And Skin Better Science, which is one of my favorite brands, is now part of the L'Oreal Dermatologic Beauty Group, and that houses the brands Skin Suticles, Vichy, Cerrove, LaRoche-Possay, and now Skin Better.
• 2:32
  SPEAKER_00: Did I get them all?
• 2:33
  SPEAKER_00: I hope so.
• 2:34
  SPEAKER_00: Somebody will be mad at me if I didn't.
• 2:36
  SPEAKER_00: He now serves as the Chief Strategic Officer for L'Oreal Dermatologic Beauty.
• 2:41
  SPEAKER_00: He's got lots of awards, including, including the Freedom Foundation National Award.
• 2:45
  SPEAKER_00: He received an ASDS Presidents Award.
• 2:47
  SPEAKER_00: He was Arizona Entrepreneur of the Year finalist and U.S.
• 2:51
  SPEAKER_00: Entrepreneur of Entrepreneur of the Year.
• 2:53
  SPEAKER_00: And he also received an honorary doctorate from Columbia University.
• 2:56
  SPEAKER_00: And that's not your whole bio, Jonah, but that's that's a nutshell of what I could say.
• 3:01
  SPEAKER_00: Um welcome to Skin Care Uh the Skin Care Confidential Podcast.
• 3:07
  SPEAKER_00: And we're super excited to have you here.
• 3:09
  SPEAKER_02: Well, thanks.
• 3:10
  SPEAKER_02: It's uh great to be with you.
• 3:11
  SPEAKER_02: And you're right that you and I have uh known one another for many, many years, and certainly I've admired and uh respected your many personal contributions to dermatology and particularly to aesthetics.
• 3:23
  SPEAKER_02: So we uh I don't know if I'm a legend, but certainly you are.
• 3:28
  SPEAKER_00: Well, thank you for that.
• 3:29
  SPEAKER_00: I appreciate it.
• 3:30
  SPEAKER_00: I think we've been we've been tangling around the same block for a very long time.
• 3:35
  SPEAKER_00: And I remember the first time I met you, and this was such a long time ago, but you had invited a big group of people to a party at your house in Arizona when you were living in Phoenix.
• 3:46
  SPEAKER_00: And I remember thinking how odd it was that a CEO of a major company was inviting people to their home.
• 3:51
  SPEAKER_00: But of course I was along for the party, and we went there and you threw a fabulous party.
• 3:55
  SPEAKER_00: But what struck me was that you literally knew every dermatologist at that party by name, where they practiced, who their husband was, who their wife was.
• 4:06
  SPEAKER_00: I I you are a phenomenal people person, and that is part of your charm for sure, and I think part of your success.
• 4:14
  SPEAKER_00: And one of the things that I think about you is that your leadership style is really so legendary.
• 4:20
  SPEAKER_00: And I've known so many people who've worked for you over the years, Jonah, and they're so loyal and they're so grateful.
• 4:26
  SPEAKER_00: And I I want you to talk a little bit, let's start for kind of in the early days.
• 4:30
  SPEAKER_00: You were in a law firm, obviously representing some pharmaceutical company.
• 4:34
  SPEAKER_00: So, how did you start a pharma company as big as Metasys?
• 4:37
  SPEAKER_02: Yeah, well, uh, in addition to working at that firm, I had a job with a company called Key Pharmaceuticals.
• 4:45
  SPEAKER_02: And that company uh was really the first specialty pharmaceutical company in the United States.
• 4:50
  SPEAKER_02: We had really two big products: Theodur, which was a bronchodilator for the treatment of asthma, and NitraDur, which was a transdermal nitroglycerin patch for the treatment of angina.
• 5:02
  SPEAKER_02: Our chairman was Dr.
• 5:04
  SPEAKER_02: Phil Frost.
• 5:05
  SPEAKER_02: And uh Phil, of course, uh, you know, maybe is the most successful dermatology entrepreneur of all time.
• 5:12
  SPEAKER_00: Absolutely.
• 5:14
  SPEAKER_02: Uh we became very close.
• 5:16
  SPEAKER_02: We worked closely together, and you know, I certainly consider him a mentor in many ways.
• 5:21
  SPEAKER_02: And it was really through Phil that, you know, whatever medical and scientific background that I had honed in on dermatology.
• 5:28
  SPEAKER_02: Uh and he was sold to sharing plow.
• 5:32
  SPEAKER_02: So, you know, these companies always seemed to turn over in one way or another.
• 5:36
  SPEAKER_02: And when it was sold, Phil went on to found IVAX, which became the largest generic company in the United States.
• 5:43
  SPEAKER_02: Uh, I was on the board of that company, the founding board.
• 5:46
  SPEAKER_02: Uh, but at, you know, at some point generic drugs really weren't for me.
• 5:50
  SPEAKER_02: And though I respected and still do Phil tremendously, uh, that just wasn't something that I was terribly interested in.
• 5:57
  SPEAKER_02: So, probably with a lot of false confidence, I founded medicine.
• 6:02
  SPEAKER_02: Um, and what I the insight around Medicist was really very simple because we had no products to speak of.
• 6:07
  SPEAKER_02: We did not have a platform technology.
• 6:10
  SPEAKER_02: What we had was really the following perspective.
• 6:13
  SPEAKER_02: Most major pharmaceutical companies were abandoning dermatology, whether it was Roche, Syntex, uh, Westwood, which was Bristol Myers, Glaxo, Sharing, all these companies had moved on to really major therapeutic areas, cardiology, diabetology, cancer, and just ceremoniously uh left dermatology.
• 6:35
  SPEAKER_02: And what the insight that I had, largely because of my time with Phil, was that dermatology is an extraordinarily personal specialty more than perhaps any other.
• 6:45
  SPEAKER_02: The relationships with patients is personal, the relationships with industry uh has been personal.
• 6:52
  SPEAKER_02: So I had the insight with our colleagues that if no one was going to fill this gap uh with these companies exiting the space, that we should do it, that we should become medicists, the dermatology company.
• 7:06
  SPEAKER_02: So that's what we did.
• 7:08
  SPEAKER_02: We started with relatively primitive products and then continued with our success to invest in more and more sophisticated research and development to the point where uh when we left uh in 2012, we were the largest independent dermatology company um in the United States with good success in medical dermatology, great success in aesthetics.
• 7:31
  SPEAKER_02: Um we did not purposefully sell the company.
• 7:35
  SPEAKER_02: We were approached very aggressively by uh what was then Valiant, now Bausch.
• 7:40
  SPEAKER_02: Um wasn't my first choice.
• 7:43
  SPEAKER_02: Uh, I'm frank to say that.
• 7:45
  SPEAKER_02: I did not think very highly of the people at Valiant uh or their business philosophy, but we were a New York Stock Exchange traded company.
• 7:53
  SPEAKER_02: Uh you know, though I was the largest individual shareholder, I knew that I was a fiduciary for all the public shareholders.
• 8:01
  SPEAKER_02: So when a very aggressive offer came in, uh, despite the fact that I was holding my nose, we accepted it and the company, the company was sold.
• 8:10
  SPEAKER_02: But, you know, uh I imagined at the time that I probably would have stayed there, you know, probably for the balance of my career had I been able to.
• 8:17
  SPEAKER_00: Interesting.
• 8:18
  SPEAKER_00: I didn't know all those details.
• 8:20
  SPEAKER_00: So we can't talk about Medicist without talking for a minute about Mitch Schwartzman, who was so essential to your company, and he made such huge contributions to dermatology and then even followed you with to Skin Better, continued innovating and you know, doing all kinds of research and creating really innovative products for dermatologists.
• 8:41
  SPEAKER_00: He was a trailblazer for sure and a huge contributor to our specialty.
• 8:46
  SPEAKER_02: No doubt.
• 8:47
  SPEAKER_02: Uh may he rest in peace.
• 8:49
  SPEAKER_00: Yes.
• 8:49
  SPEAKER_00: Great guy.
• 8:50
  SPEAKER_02: Yeah.
• 8:51
  SPEAKER_00: He was a How did you meet Mitch?
• 8:53
  SPEAKER_00: How did you meet him?
• 8:54
  SPEAKER_02: Yeah.
• 8:54
  SPEAKER_02: So Mitch was the president of Neutrogena.
• 8:58
  SPEAKER_02: And I was sort of a little guy that, you know, I mean, I was in my late 20s.
• 9:03
  SPEAKER_02: I mean, that's just to provide some perspective around this historically.
• 9:08
  SPEAKER_02: And uh I saw Mitch at meetings.
• 9:10
  SPEAKER_02: He was very friendly.
• 9:11
  SPEAKER_02: We sort of developed a relationship.
• 9:13
  SPEAKER_02: Uh, and when at Medicys we really had the need for a uh chief scientific officer, which was about in 1995, uh, I took Mitch to lunch.
• 9:23
  SPEAKER_02: I remember uh being uh exactly where we were at the Shutters Hotel in Los Angeles.
• 9:29
  SPEAKER_02: So we had a we had a nice lunch, and I sort of popped the question as to whether Mitch might have interest in joining us.
• 9:35
  SPEAKER_02: Uh we talked a lot about it.
• 9:37
  SPEAKER_02: We had other meetings, but I think Mitch, um, like his mentor Lloyd Coateson, uh, may he rest in peace, at the the one of the principals and maybe the founder of Neutrogena, certainly the guy that took it to the high level, um, you know, really ran a tight ship that was very entrepreneurial, uh, very aggressive.
• 9:58
  SPEAKER_02: Um, and I think once Johnson Johnson acquired Neutrogena, Mitch sort of lost that personal feeling.
• 10:04
  SPEAKER_02: Lloyd was gone.
• 10:05
  SPEAKER_02: Right.
• 10:06
  SPEAKER_02: Uh the company changed a lot.
• 10:08
  SPEAKER_02: Um, so I think he was ripe for the picking, which I sensed when I approached him.
• 10:12
  SPEAKER_02: And certainly at Medicys and at Skinbetter, he's made enormous contributions.
• 10:18
  SPEAKER_00: Oh, absolutely.
• 10:19
  SPEAKER_00: So you were at Medicys, and then what precipitated you founding Skin Better?
• 10:26
  SPEAKER_02: Well, um, I I think the idea of working, continuing to work with many of my Medicys colleagues was the major impetus.
• 10:36
  SPEAKER_02: I mean, uh, you know, I'm not the sort of guy that's gonna sit around.
• 10:39
  SPEAKER_02: So, you know, clearly something had to happen uh in my own.
• 10:43
  SPEAKER_02: So I approached two of my uh great friends and colleagues from Medicys, uh, Seth Rodner and Justin Smith, and asked them if they'd like to join me in founding uh Skin Better Science.
• 10:56
  SPEAKER_02: And, you know, of course, at the time they asked, well, what are our products?
• 10:59
  SPEAKER_02: What are we gonna do?
• 11:00
  SPEAKER_02: And I sort of shared with them the same insight, which was we don't have any products.
• 11:05
  SPEAKER_02: We're gonna have to develop them, we're gonna have to invent them.
• 11:08
  SPEAKER_02: But uh, I sense a gap.
• 11:09
  SPEAKER_02: I sense that many of the companies that were in professional skincare or dispensing were not selling quality products.
• 11:17
  SPEAKER_02: Uh, they were not products with any scientific integrity or clinical uh validation, number one.
• 11:22
  SPEAKER_02: And number two, many of them were becoming available outside professional settings.
• 11:28
  SPEAKER_02: So, you know, more than any product, we agreed that our principle would be to always honor that relationship with dermatologists and other aesthetic practitioners, and that we would never sell a product where the practitioner was not involved in the transaction.
• 11:44
  SPEAKER_02: So whether it was selling into their office or with the our Practice Connect, now Better Connect program, uh, a dermatologist or other aesthetic practitioner was always gonna be involved.
• 11:55
  SPEAKER_02: So they would never have to be concerned that our products would be online, they'd be at various uh retail operations.
• 12:03
  SPEAKER_02: And that's what's happened, of course, to many products that are in the category.
• 12:08
  SPEAKER_00: I was gonna say most of them have left the left the dispensing office and gone into the onto the internet or on Amazon, which has made it very hard for dermatologists to continue to dispense skincare.
• 12:20
  SPEAKER_00: So I think you have a lot of loyalty built up, obviously, because your core values support the dermatologists, which again goes back to your core values at Medicys.
• 12:30
  SPEAKER_00: You were doing the same kinds of things there.
• 12:33
  SPEAKER_02: I think the principles are exactly the same, which is to really consider our customer the center of our universe.
• 12:39
  SPEAKER_02: I mean, it's it's really reduced to that degree of simplicity.
• 12:42
  SPEAKER_02: So our first principle is always respect and honor the customer, always put their interests ahead of our own short-term interests, and make sure that, of course, we always make them look good with their patients.
• 12:55
  SPEAKER_02: So that means great service, obviously.
• 12:57
  SPEAKER_02: It means awesome products that really do what they're promised to do, to have great packaging, to make sure that when a patient is given a recommendation by a dermatologist or aesthetic practitioner, uh they can really value that recommendation by using the product, which again, I think reflects very well on the practitioner who offered them that advice in the first place.
• 13:20
  SPEAKER_02: So this is sort of a virtuous uh circle.
• 13:23
  SPEAKER_02: Uh, if our products do what they're supposed to do, if they are restricted in their distribution so that there's that franchise or cachet with the practitioner, and the products um really deliver in every respect of the transaction and the patient's expectations, everyone wins in that value chain.
• 13:42
  SPEAKER_00: Couldn't agree more.
• 13:43
  SPEAKER_00: So we have to talk for a minute about Alpharet because that was such an innovative molecule.
• 13:49
  SPEAKER_00: I actually just finished a retinoid review paper, like it seems everybody was asking me to write the same thing.
• 13:55
  SPEAKER_00: But each time I write that paper, there's more and more information coming out.
• 13:59
  SPEAKER_00: There's a lot of new retinoids, as you know, they're coming into the marketplace.
• 14:03
  SPEAKER_00: But Alpha Ret is extremely unique.
• 14:05
  SPEAKER_00: It's gentle.
• 14:07
  SPEAKER_00: It is a conjugated molecule that delivers two active ingredients to the skin, not one.
• 14:13
  SPEAKER_00: So how did that I mean, was that the brainchild of Mitch Schwartzman or who developed that molecule?
• 14:19
  SPEAKER_02: Well, it's phenomenal.
• 14:21
  SPEAKER_02: It was actually presented to us uh by uh one of the the leading inventors uh in the in the category.
• 14:29
  SPEAKER_02: So he called me and said, listen, I've got this thing.
• 14:33
  SPEAKER_02: Uh he showed me some data.
• 14:35
  SPEAKER_02: I immediately saw that this would be a massive huge upgrade in the way that uh patients are treated with retinoids, including retinoic acid or tritinoin.
• 14:47
  SPEAKER_02: I thought this was better.
• 14:49
  SPEAKER_02: Uh so um we immediately began a clinical study uh and quickly determined that this uh was no less contributory from an efficacy standpoint than tritinoin, but actually was much more tolerable and that patients preferred it.
• 15:06
  SPEAKER_02: So we knew that we had a winner, and you know, though it was one of our first products, it remains the gold standard in retinoid therapy in professional skincare.
• 15:14
  SPEAKER_02: I mean, we've since improved it.
• 15:17
  SPEAKER_02: We've got uh an eye uh preparation, we have a blemish control preparation, uh, not to proliferate it uh for the sake of doing it, but because each one of these uh individual products has uh things in it that contribute uh even more than just plain alpha red.
• 15:35
  SPEAKER_02: Uh so we're very proud of that molecule.
• 15:38
  SPEAKER_02: It's been one of our top sellers since the day we launched it.
• 15:42
  SPEAKER_02: Uh but I'm glad to say that we have several other products that are keeping it great company.
• 15:46
  SPEAKER_00: Oh, I'm sure.
• 15:47
  SPEAKER_00: Uh like Alto, which is a wonderful antioxidant, and now you have the next generation of Alto.
• 15:53
  SPEAKER_00: And I probably should say that all of those studies have been published.
• 15:57
  SPEAKER_00: The studies that were done, uh, I believe David McDaniels did some of your original work is looking at Alpha Ret and comparing it to trentinoin.
• 16:06
  SPEAKER_00: And then also the Alto product, which was tested very favorably against other leading antioxidants in the marketplace.
• 16:13
  SPEAKER_00: And that contains 19 antioxidants.
• 16:15
  SPEAKER_00: So it's it's got quite a breadth of active ingredients in it and protected not only against ultraviolet light, but also against pollution.
• 16:23
  SPEAKER_00: So that's another home run product.
• 16:25
  SPEAKER_02: It is.
• 16:26
  SPEAKER_02: Trio is a home run product.
• 16:27
  SPEAKER_00: I was just gonna say, then you've got trio.
• 16:29
  SPEAKER_00: That's another great one.
• 16:30
  SPEAKER_02: Yeah, maestro, which we introduced fairly recently, is already becoming one of our top-selling products to create a balance or uh homeostasis on the skin.
• 16:40
  SPEAKER_02: It's a all these are very complex products.
• 16:43
  SPEAKER_02: I mean, I think that's what's interesting about our company.
• 16:45
  SPEAKER_02: Uh, our formulations are not, you know, one or two tricks, they're really very comprehensive solutions to a number of different skin issues that are either reflective of aging or environmental exposure, uh, or some hormonal imbalance that's that's showing up on the skin as it often does.
• 17:06
  SPEAKER_00: Yeah, it's sort of interesting.
• 17:07
  SPEAKER_00: A lot of companies are really looking now at that sort of post-menopausal female category.
• 17:12
  SPEAKER_00: It seems to be quite popular.
• 17:14
  SPEAKER_00: And you do have quite a few things that work, sort of maybe not by design, but certainly work well in that category of patients.
• 17:23
  SPEAKER_00: It's it's a big buying group for us as dermatologists and aesthetic services as well as skincare.
• 17:29
  SPEAKER_00: And they're very interested in products that are designed to address their unique needs.
• 17:34
  SPEAKER_00: Dry skin.
• 17:36
  SPEAKER_00: They don't want retinoids that are going to make them dry and peely because they're already dry.
• 17:40
  SPEAKER_00: So something like your alpha ret with lactic acid to give them some hydration and exfoliation, and it's it's a nice product for them.
• 17:49
  SPEAKER_02: No, thanks.
• 17:49
  SPEAKER_02: Yeah, I think we've got a very good suite of products that's really suited to almost any age group in any population.
• 17:56
  SPEAKER_02: So customizing uh the application by a dermatologist or other aesthetic uh practitioner becomes really important because we have this suite of products to choose from, and matching the patient's pathology or uh you know expectations uh with the product really becomes the critical insight, which is why it's critical to always have these products available from practitioners and not have patients self-diagnosing online.
• 18:24
  SPEAKER_02: Uh, because we can do, we can do lots of harm by putting even a benign sounding product on the wrong patient.
• 18:31
  SPEAKER_02: We can cause uh sensitivity reactions, we can exacerbate uh existing uh pathologies.
• 18:37
  SPEAKER_02: So it's critical that the practitioner be the one that really makes this call and not have this uh freelancing uh Wild West that is so prevalent on the internet.
• 18:49
  SPEAKER_00: Especially when you look at social media.
• 18:51
  SPEAKER_00: It's just wild out there.
• 18:53
  SPEAKER_00: It really is.
• 18:54
  SPEAKER_00: It's unbelievable.
• 18:56
  SPEAKER_00: Uh some of the trends that have come out of social media and things that people are doing, from slugging to who knows what.
• 19:03
  SPEAKER_00: There's all kinds of crazy things people do.
• 19:06
  SPEAKER_00: But it, you know, it it gets legs on social media and then just goes on and on and on.
• 19:11
  SPEAKER_00: So it's it's like a freight train that we can't stop.
• 19:14
  SPEAKER_02: No, but you've got to fix the problems when they show up in your office.
• 19:17
  SPEAKER_02: I mean, that's it that's so true.
• 19:20
  SPEAKER_00: And so much money wasted, people buying the wrong things and not seeing the right sources to get products.
• 19:26
  SPEAKER_00: And now the influencers are almost as, I would say, popular and influential as the dermatologists who are on social media, although there are a lot of us out there you know trying to to teach and preach the truth, but it it's just we're swimming with the sharks, let's put it that way.
• 19:44
  SPEAKER_00: We're for sure swimming with the sharks.
• 19:47
  SPEAKER_00: So let's talk sort of future trends because you're always such a trendsetter and seem to be a step ahead of the industry anyway.
• 19:54
  SPEAKER_00: And I think uh interesting, and I think it's a great match, skin better science in the L'Oreal Dermatologic Beauty Profile, because I'm a huge fan of all those brands anyway.
• 20:03
  SPEAKER_00: But so, where do you see things going in terms of the skincare industry and you know what directions do you think?
• 20:11
  SPEAKER_00: What things are gonna become important as we move forward, say in 2024 or 2025?
• 20:18
  SPEAKER_02: Sure.
• 20:18
  SPEAKER_02: I mean, I'm not gonna talk about our own research because we've got by the motto that loose lips are proprietary.
• 20:24
  SPEAKER_02: Yes.
• 20:25
  SPEAKER_02: And certainly we don't want to telegraph competitively what we're working on or what we plan.
• 20:30
  SPEAKER_02: But I think it's it's safe to say that we're really on the cusp of a biotechnology revolution within dermatology and aesthetic skincare.
• 20:39
  SPEAKER_02: So instead of just you know putting together uh chemicals or substances that are known, I think we're on the cusp of a breakthrough uh at a mechanistic or cellular level where we really understand how to tag different receptors, uh how we can up and down regulate um different outcomes on the sand that are really the the genesis of a lot of the pathologies that we're uh that we're seeing.
• 21:06
  SPEAKER_02: Um and um so uh uh I think this is this is what's coming, whether it's in regenerative medicine.
• 21:15
  SPEAKER_02: Um you mentioned uh important demographic, which is uh peri and uh postmenopausal women.
• 21:22
  SPEAKER_02: Uh that's obviously a huge category.
• 21:25
  SPEAKER_02: Uh, but I think men too are becoming far more conscious uh of their aging profile.
• 21:32
  SPEAKER_00: It's so interesting.
• 21:33
  SPEAKER_00: I think you might have been one of the first companies, and you did it in the early days with Skin Better that used some artificial intelligence to look at the face and and I remember that in the beginning.
• 21:46
  SPEAKER_00: Am I remind remembering this correctly?
• 21:49
  SPEAKER_00: Because I thought it was so fascinating.
• 21:51
  SPEAKER_02: Yeah, I mean, our first iteration before we began selling any products was really to capture images of consumers.
• 22:00
  SPEAKER_02: In this case, hundreds of thousands of them, and begin working with Canfield Scientific to be able to draw certain conclusions about what was important to patients, so how they self-identified versus how they presented.
• 22:14
  SPEAKER_02: Because as you know, because you've done, you know, hundreds of thousands of consultations, you know, rather than you're saying, uh, okay, well, I see you're here because you've got uh wrinkles and you've got uh dispigmentation and you know your fat pads are disintegrating, like no dermatologist, maybe a plastic surgeon would do that, but no dermatologist.
• 22:34
  SPEAKER_00: No derm would.
• 22:35
  SPEAKER_02: So, you know, you you would begin a consultation by saying, What brings you here?
• 22:39
  SPEAKER_02: What are we going to work on today?
• 22:41
  SPEAKER_00: Right.
• 22:41
  SPEAKER_02: You know, many people take out a mirror and ask them to identify things that concern them.
• 22:47
  SPEAKER_02: So we did that, but on a massive scale, using artificial intelligence to really identify the nexus between self-identified problems and what people actually had.
• 22:59
  SPEAKER_00: Um to understand I bet that was vastly different.
• 23:02
  SPEAKER_02: Uh it wasn't, yeah, I think certain conditions were um identical between what was perceived and what is or what was.
• 23:13
  SPEAKER_02: Uh, but there were other conditions that um either understated or sort of dysmorphically stated uh conditions.
• 23:20
  SPEAKER_02: So, you know, this was a great source of insights that helped us to fashion uh a lot of the way we're gonna run the business.
• 23:28
  SPEAKER_00: Yes, that's what I thought it was really interesting.
• 23:30
  SPEAKER_00: I remember doing it myself, going, well, this is so much fun.
• 23:33
  SPEAKER_00: Now a lot of companies have jumped into that market.
• 23:35
  SPEAKER_00: And I think one of the reasons they have is there's such a drive with the consumers for individualized skincare.
• 23:41
  SPEAKER_00: You know, everybody wants their own regimen.
• 23:43
  SPEAKER_00: They want to know what do I have and what do I need?
• 23:46
  SPEAKER_00: And they don't always go to the dermatologist to get that advice.
• 23:49
  SPEAKER_00: So they can go to some of these websites and even big consumer companies now are using that to help select products for patients.
• 23:56
  SPEAKER_02: There's no question.
• 23:57
  SPEAKER_02: And, you know, I think with color cosmetics and things like that, it's it's a brilliant application because people can really, and L'Oreal is an industry leader in this, but people can really try on different looks uh and see how it suits them.
• 24:12
  SPEAKER_02: So it's a sort of you know image that gives them a virtual impression of how they would appear in different ways.
• 24:19
  SPEAKER_02: Um there's no question that self-diagnosis is is interesting to consumers.
• 24:24
  SPEAKER_02: Um, but again, it's it's really this disconnect in many cases between uh reality and perception from consumers, from patients.
• 24:35
  SPEAKER_02: And you know, if companies just do what consumers want without an intervention that's sort of medically realistic, they're not necessarily doing anyone a service.
• 24:45
  SPEAKER_02: So it's why the intermediary, the practitioner, is really critical.
• 24:49
  SPEAKER_02: You know, and VIZIA and other tools help you as a practitioner to gain insights and as much as anything to demonstrate to the patient what's going on.
• 24:59
  SPEAKER_00: More than anything.
• 25:00
  SPEAKER_02: So you can see it with your trained eye.
• 25:02
  SPEAKER_00: Yeah.
• 25:03
  SPEAKER_02: But for patients uh to be able to see it, to visualize it, really gives them, I think, the confidence to undertake a treatment program that you would prescribe.
• 25:12
  SPEAKER_00: I agree.
• 25:13
  SPEAKER_00: The gamification is really important and trying to get the patients engaged.
• 25:17
  SPEAKER_00: And I think AI is actually, I know a lot of dermatologists are worried about AI and how it might impact our specialty, but I think in the aesthetic arena, it really sticks it's the glue that sticks the patient to whatever you're doing.
• 25:30
  SPEAKER_00: And it gives them what they need to believe in what you've said.
• 25:34
  SPEAKER_00: It's kind of crazy, but people believe ChatGPT now more than their doctor.
• 25:39
  SPEAKER_00: And, you know, they would believe an AI thing that they did.
• 25:42
  SPEAKER_00: And and and some of the technology is so phenomenal nowadays.
• 25:47
  SPEAKER_00: It's really it is quite good.
• 25:48
  SPEAKER_00: So it's it's I think it's all good, and I think it's all moving in a direction that again sticks the glue.
• 25:55
  SPEAKER_00: It's the glue that sticks the patient to the practitioner.
• 25:58
  SPEAKER_02: No, I think that's right.
• 26:00
  SPEAKER_02: And you know, really serious treatments can only be done in a medical setting.
• 26:04
  SPEAKER_02: So whether it's uh the injection of uh neuromodulators or dermal fillers or energy devices, this is not for the faint of heart.
• 26:13
  SPEAKER_02: These things really have to be approached with careful with great care and with skilled hands.
• 26:18
  SPEAKER_02: And um, you know, these are not these are not consumer trends that should be showing up in a beauty parlor.
• 26:24
  SPEAKER_00: I know.
• 26:25
  SPEAKER_00: It's unfortunately they've they've percolated out a little bit more than I feel comfortable with.
• 26:29
  SPEAKER_00: I think filler's the thing that most of us are the most afraid of and see the most problems with.
• 26:34
  SPEAKER_00: Yeah.
• 26:34
  SPEAKER_00: That's that's where you really need to be a pro.
• 26:37
  SPEAKER_00: But you're right about that.
• 26:38
  SPEAKER_00: And I still think that the smart consumer, the educated consumer, goes right to the expert, to the dermatologist, to the plastic surgeon.
• 26:46
  SPEAKER_00: Um, you know, for the the confidence level and the I always tell people when things are going great, anybody can do anything, but when things go bad, that's when you really need somebody who's a professional.
• 26:58
  SPEAKER_00: So that's been challenging.
• 26:59
  SPEAKER_00: And you were in the injectable so early with Disport and Restalane.
• 27:03
  SPEAKER_00: I mean, Restalane was really the bread and butter of dermatology, was the first widely used filler in dermatology.
• 27:10
  SPEAKER_00: I don't remember when y'all launched Restalane, but I know it was eons ago, and it's still widely used.
• 27:17
  SPEAKER_02: No, it um, you know, many people still think it's the gold standard in Philly along with uh Juvederm.
• 27:23
  SPEAKER_02: Uh and we were proud to be the first thyuronic acid product uh introduced, and you know, reams of data uh I think validated both the safety and efficacy of the product used correctly.
• 27:37
  SPEAKER_02: So our first indication was nasolabial folds, where it's a little harder to get into trouble.
• 27:42
  SPEAKER_02: There's one artery sitting there, but not a lot.
• 27:45
  SPEAKER_02: Uh but I think as as uh the product has sort of proliferated around the face uh to different sites, you know, there are different nerves, different uh vascular junctions that have gotten people in trouble.
• 27:58
  SPEAKER_02: Uh and you're right that you know, if an expert doesn't know the anatomy, uh there's really the potential for a lot of harm.
• 28:05
  SPEAKER_02: And even the best experts will occasionally come upon a patient that has some anomaly in their vasculature that you know wouldn't have been predicted just from an anatomy uh chart.
• 28:17
  SPEAKER_02: Um and even there, uh there can be problems.
• 28:19
  SPEAKER_02: There's some incredibly talented people who have had uh major sequel these kinds of injections.
• 28:25
  SPEAKER_00: Absolutely.
• 28:26
  SPEAKER_00: No one's immune.
• 28:27
  SPEAKER_00: And the more you inject, honestly, the greater your chances of getting it.
• 28:30
  SPEAKER_00: So that big injectors can't be.
• 28:32
  SPEAKER_02: It's like the old story in plastic surgery where you know, if someone says, Well, I've never had a complication, you know, an experienced plastic surgeon will say, Well, you just haven't done enough cases.
• 28:42
  SPEAKER_00: Exactly.
• 28:43
  SPEAKER_02: Because these things are inevitable and uh it's bad when it happens, but being able to treat it effectively, uh, in the case of fillers with hyaluronidase or some other intervention is really the critical element.
• 28:55
  SPEAKER_02: Like that's that's kind of the game as to why uh an experienced practitioner is the only place that a patient should be.
• 29:04
  SPEAKER_00: Absolutely.
• 29:05
  SPEAKER_00: And you know, we were kind of cowboys out there in the early days.
• 29:07
  SPEAKER_00: We didn't have hyaluronidase in our office.
• 29:09
  SPEAKER_00: We didn't even really know about it in the early days of fellers.
• 29:13
  SPEAKER_02: So we were it was the sort of the same with neurotoxins.
• 29:16
  SPEAKER_02: I mean, I remember when Botox was first approved, and we have to credit Botox as the pioneer.
• 29:23
  SPEAKER_02: Uh now there are many other good options, but they were using EMG devices attached to a needle.
• 29:29
  SPEAKER_02: I remember it.
• 29:30
  SPEAKER_02: Late uh the late Arnie Klein and Rick Glogau, uh, who and Fred Brandt, may he rest in peace, um, were were total pioneers, but they were using these devices almost like Geiger counters that would uh that would find the nerve junction uh and the and where and the musculature and inject on that basis.
• 29:50
  SPEAKER_02: And of course, now you know people do it with their eyes closed uh because better understanding of how these neurotoxins perform and where they work.
• 29:59
  SPEAKER_02: But uh it this whole thing was the Wild West, and many people think that energy devices are in that category right now.
• 30:06
  SPEAKER_00: And unfortunately, that's one of the things that we're starting to see into the med spas.
• 30:11
  SPEAKER_00: And you know, and energy devices are not to take, they're not to be taken for granted.
• 30:16
  SPEAKER_00: We see a lot of complications from them, used on the wrong skin types, used the wrong settings.
• 30:22
  SPEAKER_00: It can be really quite frightening.
• 30:25
  SPEAKER_00: But, you know, I guess just like everything else, it it's gonna find its way, and it's gonna find its way to the to the right patients gonna find their way to the right practitioners, hopefully.
• 30:35
  SPEAKER_00: I want to ask you one thing because we're getting near our 30 minutes and I don't want to keep you too long.
• 30:40
  SPEAKER_00: You're involved in a lot of interesting philanthropic ventures.
• 30:45
  SPEAKER_00: Um children and cigarette smoking and some very interesting things that, again, I did not know about you.
• 30:52
  SPEAKER_00: Maybe speak to some of the things that you're interested in.
• 30:56
  SPEAKER_02: Yeah.
• 30:56
  SPEAKER_02: Well, back when I was on Capitol Hill, I worked very closely with a congressman called Henry Waxman, uh, as well as uh as Vice President Al Gore when he was then a young congressman.
• 31:08
  SPEAKER_02: Uh and uh we worked together with with many others and with the support of many medical groups to try to uh pass legislation that would restrict uh cigarettes and regulate them, uh, which ultimately we succeeded in doing.
• 31:23
  SPEAKER_02: And I've understood because of my interest in public health, that cigarette smoking is still the number one factor in premature death in the United States, and all deaths for that matter, whether it's uh through uh development of cancer, uh cardiovascular disease, I mean the damage, you know, we can say that of course the skin is affected, but you know, internal organs much more profoundly and meaningfully.
• 31:48
  SPEAKER_02: So um I've been interested in this literally since I was a young, very young staffer on Capitol Hill, uh, and have carried that interest uh for many years, and I've been privileged uh probably for the past 15, 20 years to be a member of the board of the campaign for tobacco free kids, which is the leading anti-smoking organization in the world, the tobacco control organization.
• 32:13
  SPEAKER_02: So it's funded by all the major foundations.
• 32:17
  SPEAKER_02: Uh, we have representation from the American Heart Association, the American Cancer Society.
• 32:22
  SPEAKER_02: Uh, every meaningful medical group uh is constituted on our board.
• 32:27
  SPEAKER_02: And we've had tremendous success, at least in the United States, in lowering uh tobacco consumption dramatically.
• 32:34
  SPEAKER_02: Uh and that's that's a success story.
• 32:37
  SPEAKER_02: Vaping is a big concern, and whether that becomes a gateway to cigarettes is a whole nother kettle of fish.
• 32:44
  SPEAKER_02: And internationally, we've had great success as well with the support of uh Bloomberg philanthropies.
• 32:50
  SPEAKER_02: So um it's it's been a great cause and one where I think we've made a huge impact.
• 32:56
  SPEAKER_02: Uh, there are a few other things that I'm involved with, uh, an organization called Max in Motion, which uh is sort of named for my uh late son uh Max, and we provide scholarships to young athletes who could not otherwise afford to participate in organized sports, whether it's uh soccer, uh, which was uh Max's passion, uh, or uh many other uh sports.
• 33:22
  SPEAKER_02: And we also provide funding for um a place called Ability 360, which uh provides uh not only a place but leagues for kids that suffer from one disability or another.
• 33:37
  SPEAKER_02: So power soccer, uh wheelchair tennis, uh things wheelchair basketball.
• 33:42
  SPEAKER_02: So these are all uh very important things to me and uh to my family.
• 33:48
  SPEAKER_00: Fantastic.
• 33:49
  SPEAKER_00: Well, I am going to let you go and thank you profusely for taking the time and the trouble today.
• 33:56
  SPEAKER_00: And I know everybody's gonna enjoy this podcast.
• 33:58
  SPEAKER_00: So, Jonah, thank you so much.
• 34:00
  SPEAKER_02: Patty, it's always great to be with you, and maybe I'll see you next week at the ASDS.
• 34:04
  SPEAKER_00: I'm sure we will run across each other.
• 34:06
  SPEAKER_02: All right, all the best.
• 34:08
  SPEAKER_00: Thank you.
• 34:08
  SPEAKER_02: Bye bye.