The Remarkable John Barrett: Creative Ortho Problem Solving

John Barrett, born in Cleveland, Ohio, and armed with degrees in mathematics and economics, grew up to become a successful medical device entrepreneur. Over his 25-year career, Barrett has been a Johnny Appleseed of technology, planting multiple groundbreaking surgical technology seeds which have grown and matured into incredibly fruitful businesses. Barrett is as passionate about orthopedic innovation as ever and he is working on the next generation technologies.

Here is Barrett’s journey and, most importantly, what his latest game changing technologies and companies are.

Education and Early Work

Barrett grew up in Cleveland, Ohio, and left to attend the University of Virginia, graduating with degrees in mathematics and economics. He later moved to California and earned an MBA from University of California Los Angeles. “The first part of my career, I was in the cardiovascular side of the business, where I got a chance to work for a couple of great companies including Baxter and then Abbott Vascular.”

Barrett cut his teeth at Perclose, the legendary startup that innovated a method for controlling femoral artery bleeding during angioplasty and stent procedures. Perclose was later bought by Abbott and it was Barrett’s first experience working with a great company that was built up to be acquired by a larger company. Barrett was involved with the development of Perclose’s closure devices. Perclose’s device became the standard for millions of angioplasty procedures—because effectively controlling femoral artery bleeding was a huge unmet clinical need.

Like many other cardiovascular executives in the late 1990s, early 2000s, Barrett heard the siren call of sleepy orthopedics where there were many unsolved, interesting clinical problems where his experience in cardiovascular could be a game changer. During this time, Barrett engaged with several top orthopedic surgeons and began to learn the clinical issues that bedeviled surgeons. Eventually, Barrett and his new spine surgery colleagues decided “we wanted to start a company.”

CoAlign Innovations was the result in 2007-2008. The team quickly identified a need for expandable interbody technologies for fusion cases. Barrett told OTW that while today there are maybe 20 companies pursuing this work, CoAlign was one of the first. “That was a really fun company,” said Barrett. “We had a great team.”

The type of expandable interbody technology Barrett and the team were exploring would eventually become  a standard in the field. Of course, CoAlign went through the now familiar journey of raising funds, developing prototypes, testing, testing, testing, managing the regulatory gauntlet and, again, a successful commercial launch. It took all of $20 million in funding to create the team and the product. CoAlign was eventually bought by Stryker in 2014.

Of course, Barrett teed up yet another new technology company.

After CoAlign…Changing Pediatric Spine Surgery

“After CoAlign, I was looking around for new projects and new companies,” said Barrett. “In the spine world, I didn’t see a lot of real innovations.” Barrett, ever the innovator, saw only what he calls “me too” products and incremental technology development. While he understood their value in terms of marketability, he wasn’t satisfied. He saw no true “game changing” tools, technologies or innovation. Until, that is, he focused on pediatric spine fusion as an area with a significant need for creative thinking.

Fusion surgery on children is deeply invasive and creates permanent spinal change. “Fusion was still this thing that was so automatic and pervasive but still so traumatic,” explained Barrett. “It’s just one of those surgeries that every time you observe one you’re like, I can’t believe we still do this…almost medieval.”

“I met a couple of pediatric surgeons and I became familiar with a procedure called vertebral body tethering,” Barrett said. Some surgeons had devised this new technique as a less invasive alternative to fusion. “This was a very clever approach where you essentially used the growth of the kids to help straighten their spines,” said Barrett.

Several years ago, surgeons were looking for motion sparing and less invasive alternatives to fusion. They looked seriously at a system of anchoring one side of the spine with a tether to guide spinal growth as the child grew. At the time, this was an off-label procedure. Barrett said, “I saw a couple of these procedures done and thought, wow. this is what we need to do.”

Barrett knew “clearly there was a better way to do this procedure” and set out to figure out how. He partnered with Mohammad Diab, M.D., of University of California San Francisco. “I thought, I can marry that technology with another technology that was used in growing rods and combine them and create this new dynamic vertebral body tethering system,” Barrett told OTW. Together with Diab and his team from CoAlign, Barrett formed a new company called Auctus Surgical.

The Auctus Surgical team, including orthopedic surgeons Steven Hwang, M.D., and Harsh Grewell, M.D., of Shriners Hospital in Philadelphia, took notes from the tethering procedure developed by pediatric orthopedic surgeon Dr. Amer Samdani, who many regard as the father of vertebral body tethering technique.

“Tethering is such an elegant procedure when you see it, compared to fusion surgery,” said Barrett. Especially in the treatment of the pediatric spine, where surgeons are often eager to engage in a less aggressive surgical approach.

Auctus Surgical’s dynamic, adjustable vertebral body tethering system is now headed toward initial clinical trial. Barrett and his team also see a pathway for its use in young adults, who they feel it could benefit.

But wait, Barrett has still more.

Zero Knee Replacement?!

Barrett has recently founded ZKR (Zero Knee Replacement) Orthopedics, a company focused on developing a new family of knee implants to address patellofemoral osteoarthritis. Working with sports orthopedist Jeff Halbrecht, M.D., of San Francisco, ZKR is developing a less invasive, outpatient surgical treatment alternative which employs the use of implants.

Patellofemoral osteoarthritis is common, hard to treat, as well as painful. Barrett explained that patients often spend years engaging in conservative therapies. Many find that even after enduring shots, oral medications, physical therapy, they still end up resorting to invasive surgery with significant recovery time.

ZKR is currently developing an implant-based knee procedure, which treats the condition by taking pressure off the patellofemoral joint. The idea is that by elevating the kneecap with implants, pain and inflammation can be reduced via a 30-minute outpatient procedure, without the invasive surgical bone cuts and long recovery time involved in a total knee replacement surgery. Clinical trials were set to begin last month but are pending due to the current pandemic. Barrett said that patients can walk the very day of procedure, with no long recovery process.

Themes in Barrett’s Career Story: Simple Solutions for Complex Problems

After 25 years of experience in areas of business, fundraising, product development and marketing and navigating the realms of clinical trial fundraising, intellectual property and regulatory affairs, Barrett’s intent remains clear. “The consistent thread with all these companies is a simple technology—and I love simplicity and I love elegance—so let’s find simple and elegant approaches to solve vexing clinical problems that are often addressed with far more complex solutions.”

These themes of addressing unmet orthopedic surgical needs with simple and effective approaches are woven throughout the story of Barrett’s career. “We preach that every day with all the engineers I work with. If you can do something with two parts versus five—let’s figure that out.”

Barrett has found this work gratifying, especially “working with a great team. This is a tough business where very few companies actually achieve successful outcomes. The pathway through product development requires more steps than any other industry. You need a great group of independent thinkers and doers who can solve problems and keep marching together. I have had the good fortune to be associated with multiple great teams over the years.”

He continued, “I think anyone in the medical device business would agree how deeply satisfying it is to see a new therapy successfully used clinically for the first time. It goes back to many years of work from the idea or concept to improve patient care, to making the correct decision to pursue it and doing all the work necessary to carry this therapy into the clinic where it might become a standard of care. That is a long and complex road and I have had the good fortune to accomplish this on multiple occasions.”

Looking Ahead

Barrett is nurturing a new project that we can look forward to hearing more on soon. A new company he’s working on will be offering more innovative trauma products, Barrett told OTW. There will be more news on the horizon about this project soon.

Barrett and his team welcome any partnerships and support in their efforts to bring these innovative approaches into orthopedics. “I’ve got a great group that I’ve worked with consistently, whether it’s the surgeon or the team, and we’re working to advance all these technologies to the next level.”