Sergio Espinoza Torres
Rice University
Houston (29.7° N, 95.3° W)

featuring Jacques Zaneveld, Founder and President, Lazarus 3D, Houston (29.7° N, 95.3° W)

In 2014, Dr. Jacques Zaneveld met a resident physician who had prepared for the removal of a cyst from a woman’s uterus by doing a practice “surgery” on a green bell pepper. As ridiculous as it may sound, this is the type of practice that healthcare professionals must rely on for lack of better options. Noble efforts to improve these options and the life of others come with great sacrifice and persistence, as illustrated by Dr. Zaneveld’s interview with Longitude.site contributor Edward Sheu, a computer science student at NYU.

Dr. Zaneveld is the founder and president of Lazarus 3D, a startup that produces 3D printed silicone models that mimic human organs. He earned a BS in mathematics and honors biology with a minor in biochemistry from the University of Oregon and a PhD in molecular and human genetics from the Baylor College of Medicine. As part of his path in developing his project, Dr. Zaneveld had to learn quickly and broadly, a recurring theme on his journey. In his interview for Longitude.site, Dr. Zaneveld stressed a few powerful experiences and reflections that are invaluable for someone seeking to bring their own ideas to fruition.

The first step was finding an idea. The green bell pepper anecdote shows how Dr. Zaneveld saw a gap in the healthcare industry that needed to be addressed: there was not an accurate way for surgeons to practice their skills. Simply having an idea was not enough, however. Dr. Zaneveld emphasized how important it is to build something tangible and then go from there, since “no one would have put money behind this idea when it was just an idea.” During his limited free time at Baylor, he learned the ins and outs of 3D printing, built his own printers, and sold models at anime and science fiction conventions to earn money. He also expressed the importance of surrounding oneself with people who are knowledgeable in distinct areas and listening to their advice, so everyone focuses on what they do best. Besides knowledge and experience, sharing a vision with other members of the company holds this dream together.

Dr. Zaneveld made very interesting remarks relating to the approach of his company. Lazarus 3D uses a design process that promises consistent, realistic, and prompt production in a single facility here in the United States, which provides security and facilitates quality control. Their focus is to produce the organ models themselves, not simply to sell printers to hospitals, because that saves doctors from having to learn yet another thing. Most importantly, Dr. Zaneveld runs the company with urgency and takes challenges head-on. Taking his selling of models at anime and science fiction conventions as an example, Dr. Zaneveld said, “Is that the vision? No. But that is an important step to get there…To get somewhere, actually do something.” Lazarus 3D is a noble company that is fighting for the opportunity to address a need and make a vital difference. To overcome their challenges, Dr. Zaneveld and his team keep the main goal in mind, because “we know that this is something the world needs.”

It is an immense privilege to learn about the emergence of Lazarus 3D. This interview has shined some light on how, with enough willpower, one is able to create something new. By reading selected excerpts from the interview transcript below, you will bear witness to the kind of ingenuity, sacrifice, and urgency that Dr. Zaneveld and his team have relied on to make Lazarus 3D happen. In a climate where it is getting tougher to “make it” financially, daring to build something from scratch is intimidating, but this interview may inspire creative entrepreneurs to take the first step.

Highlights from the interview

Could you give a brief overview about what you do and what your company does?

Absolutely. There’s a massive problem in medical training today where people have almost no hands-on experience before they start doing some extremely complex procedures. If you take something like brain surgery—people will study it in the books for years, they will watch people performing these operations, but then when it comes time for them to actually do that surgery, they’re pretty much learning on the patient that they are treating. That’s not really their fault; it’s a problem with the medical system, and it’s because there isn’t any good way for them to acquire those hands-on skills. You can’t really use cadavers because it’s very hard to, in this example, find people that have tumors in their brain that are in the cadaver population. Similarly, you can’t use animals; the anatomy is too different, and it’s very hard to find them with any particular pathology like a brain tumor. And also, generic medical modeling companies haven’t tackled this problem because it’s very expensive to design and build a new training model. So they won’t do it for all these specialized tasks where there’s a limited market. Instead, they focus on larger-appeal products like a CPR trainer, which has very broad appeal. So looking at this problem, we know that hundreds of thousands of Americans die every year because of medical errors. It’s not something you can address with traditional manufacturing. I thought, well, maybe this is a problem we can solve using 3D printing.

Now, the problem is that the current 3D printers that are available through other companies cannot produce models that actually mimic real tissue. The closest you can get is something that is out of a relatively hard plastic or rubber, and those machines themselves are exorbitantly expensive. So I dedicated some time and personal resources while I was doing my PhD to develop a system to rapidly prototype in soft silicone materials, as well as some other materials, to closely mimic real tissue. What we can do with that is really solve this training gap. So if you want to learn how to do brain surgery, I can design and build a brain tumor model that feels and looks very similar to the real thing, backed up by actual data from patients and actual mechanical testing information on material. I can do that entire design and production process in under 24 hours and get it out to you. This is economically feasible because I use the exact same capital expenditure, the exact same machinery and process, to build brain tumors today and hearts tomorrow and lungs the next day. So I have a capability to target all of these different niche markets that, in and of themselves, would be small but in aggregate represent a massive problem in medicine. So that’s a quick overview.

Another very exciting thing that this technology has been able to do is to be able to be modelled to individual patients. Because we’re so fast at designing and building things, if, God forbid, you have a disease, I can build a copy of you overnight, and your doctor can rehearse your surgery ahead of time. So those are some of the activities we’re pursuing at Lazarus. We see this as a multibillion-dollar market opportunity and also an opportunity to help hundreds of thousands of other citizens get better medical care.

You gave a really great overview. One interesting thing you brought up is the patient-specific models. Giving the patient the opportunity to see exactly what is going on could also be really helpful. What do you have in mind for how these models can be used to educate the patient about what their surgery would be like and how you can make them feel more comfortable and aware with the technology?

Absolutely. So that is a side benefit, I would say, of using this technology…that it does help facilitate that communication. Medicine as a field is sort of locked off; it dramatically affects your life, but it can be very difficult to understand what a doctor is saying. What we’ve found is that when people have an opportunity to see their organs, and see what their problem is, and to have their doctor explain it with that sitting right in front of them, it can help facilitate that communication. It can help a patient to understand these…the complex terminology and what’s going on in their actual case. Much more so than looking at an MRI, which pretty much look likes a bunch of grey blobs. So to a standard patient, it’s basically impossible to see what’s going on. And that’s not true when you have a full, real, physical copy of the organs in front of you.

What would you say are the ethical concerns to having these types of models? Because you are a private company, how do you go about navigating having patient data and stuff like that?

It’s covered by HIPAA [Health Insurance Portability and Accountability Act] laws, healthcare information privacy act laws. Basically what they state is that we are only able to get that information from patients which is medically necessary and necessary for us to do our job. For example, if we were to build a model of you, we would not get your name, we would not get any private information about you. All we would get is a patient’s ID and the raw MRI or CT scan data. So that is the raw black and white images looking inside of your body. That’s the only information that we’re getting. It’s de-identified other than that information. Nonetheless, we still want to protect that and make sure that we don’t share that with the world. We have security protections around that data. It is stored in a separated…HIPAA compliant database, and that database has no interaction with any other elements of our computer system, and it is encrypted behind a firewall and protected to the highest level as possible. So, when a physician uploads data, we always request that they upload anonymized data, and they can only upload it directly on this separate, HIPAA compliant secure server. And that’s really the only risk that we perceive the patients are taking on…a data security risk. That data is already created as part of their standard work up, so there is no additional information that is tracked, and the connection between the patient ID, which is what we receive, and the actual patient information is only kept by the hospital, which already has a copy of that patient’s information, so we aren’t creating any new record of that patient’s private information.

Could you explain the 3D printing process?

We follow the same process whether or not you are getting a patient-specific model or a generic training model. That is, the data—or whatever requirements the client has—are sent to Lazarus 3D headquarters. All manufacturing and production is done in a single facility here in the United States. And that’s for several reasons. One of them is that it helps us maintain security; another is that it helps us with quality control. Rather than have different facilities across the country where God knows what people are doing, we have everything standardized in a single place where we can ensure quality, we can do inspections day-to-day. Also, what we found is that selling a printer…what I firmly believe is that selling a printer to a hospital is the wrong way to go about it. Because printing is a new technology, it involves a specialized set of skills. And if I were to hand a printer to a physician, they wouldn’t know what to do with it or how to properly use it. It makes a lot more sense to have a dedicated team who can ensure quality every single time. Doctors can focus on what they should be doing, which is treating patients, and we can offer an end-to-end service, so we do everything…as soon as they upload the data, we take care of every single step of the process until they get a model that has been well-checked and meets all standards.

How would you go about accommodating more time-sensitive surgical practices?

Unless it is an emergency operation, they are typically planned at least one to two weeks ahead of time. We have made models and have hand-delivered them to a physician in as short as 16 hours. Overnight shipping of a model is not a significant concern, cost-wise. Also, there are even same-day shipping options, which are provided by certain carriers, where literally, as soon as it’s done, it gets on a flight and it goes there and it’s received. We have used that option in the past, but typically most surgeries of the types we are addressing, which initially are surgeries to remove tumors and surgeries to remove cancer…these are typically planned several weeks ahead of time, giving more than enough time for overnight production of a model, followed by overnight shipping.

When did you first see yourself working on this project? What information did you learn or what decisions did you make that made you realize that this is what you wanted to do?

So, around 2014 I met a resident who was telling me that he’d done a practice surgery on a green bell pepper, and the next day he was going to remove a cyst from a woman’s uterus. And, quite frankly, that was pretty horrifying that that was all the hands-on experience that that individual had had. And this is someone at one of the leading medical schools in the country. So it’s not like it’s better anywhere else. That was pretty shocking, and it seemed to me that 3D printing could potentially offer a solution.

So I developed a multiyear plan in order to try and address this problem. The PhD I was pursuing at the time was totally unrelated, so this was all done during nights and weekends. Step one was I needed to learn how 3D printers work and start building some of my own machines and getting them up and running. As a student, I didn’t have a lot of money to work with, so what I decided to do was build my own 3D printer from parts and then use it to make various models that I sold at anime conventions and science fiction conventions. And that paid for plastic and allowed me to do some tinkering and get familiarized with 3D printing technology. I pursued that over the course of a couple of years. Then after that, I knew that in order to follow through on this dream, I needed to figure out how to analyze data and create models of individual humans from actual PP-MRI data. So I volunteered for a study at Baylor College of Medicine where they scanned my brain. I was able to get the researchers to give me a copy of the data. I took it, and I used it to print a physical hard plastic copy of my brain, and then I used that physical copy of my brain to convince some lawyers to let me help out on personal injury cases. In personal injury cases, you’ll often have people arguing about how severe an injury is. We could provide demonstrative evidence to those cases by taking actual scans of someone from before and after an incident…using a physical hard plastic copy to show what that change was. So, for example, if someone gets hit by a truck, we can show what their spine was like before they got hit and what it was like after they got hit and then use that in a court case. Through that process, I was able to generate some money because this was very valuable to these multimillion-dollar lawsuits. I was also able to teach myself how to analyze CT and MRI scan data and produce accurate, verifiable results from that data. I did that for about a year.

After that, the remaining challenge was to rapidly prototype in materials that actually simulate real tissue. For doctors, looking at something in hard plastic isn’t that helpful. They can already see it on a computer screen. What they need is a way to actually do that surgery. Using the revenue I generated from these court cases, I did a lot of tinkering and finally got a method working to rapidly prototype in suitable silicone materials where we could adjust the physical property. I got that working on a Thursday night. I submitted a provisional patent on that technology that Saturday, which just recently got a letter of allowance from the US Patent [and Trademark] Office, so woohoo. And then on Monday, we tested it in the clinic for the first time. And the doctors were blown away. They’d never seen anything like it. And we started our first clinical trial pretty shortly thereafter…All of this, of course, when I was still a student.

Wow, that’s quite a story. What would you say are the skills that you find yourself utilizing the most throughout this journey?

The ability to learn quickly is exceedingly important. We’re still a startup, and that entails doing all sorts of things you never thought you would have to deal with. Everything from how do you vet a investor pitch to make sure it complies with all SEC [Security and Exchange Commission] regulations, to how are insurance companies going to react to this. The most important thing is to learn quickly, rely on advice from domain experts in areas where you aren’t competent, and move quickly with a lot of energy. With regards to 3D printing itself, I think the most important skills that we have and that we’re looking for when it comes to our anatomy engineers—which, by the way, we have positions available for, so please reach out—the skills we are looking for are people who are able to analyze MRI and CT scan data, who have familiarity with medicine, and who have an ability to design organic shapes. So a lot of CAD programs are really great for building a screw but not so great for building a model of a human head, and so some of the more sculpting-based CAD programs, things like Zebra, can be really effective for this kind of work. So that’s another skill set on the engineering side that we see as very valuable.

You spoke a lot about consulting for outside advice. Did you have any mentors that guided you along this path, and if so, when did you balance trusting your own intuition versus taking the advice of other experts and professionals?

Yes, absolutely. Everything that we’ve done would not have been possible without our extremely accomplished advisory board for Lazarus 3D that consists primarily of previous entrepreneurs. There’s a general partner at a venture capital firm on our advisory board. There’s five different doctors with PhDs and MDs. Some regulatory consultants who’ve taken technologies through the FDA. I think where it’s really important to pay attention to advisors is on everything, because if you’re a first-time startup founder, you probably haven’t done a lot of this before. And especially on more technical details. You probably have no idea what SEC regulations are or how to structure an investment deal that complies with all appropriate standards, but if you do that wrong, you’re in serious legal trouble. You better pay attention to someone who knows how to do it right. I think it’s important to find your own areas where you are an expert. No one else has done this before. People have never previously made copies of body parts that you can do a realistic surgery on, at least for soft tissue. And so that’s where it’s really important that I myself build up a skill and develop the expertise there that has not been done before. There are people who are really great at marketing; let them do the marketing. And as much as possible…then you can focus on what you’re uniquely talented for. Now, that becomes more possible the more research you have. So at the beginning when we were running it out of the kitchen, no way we are getting someone else to do marketing because there was zero budget for marketing. Marketing is whatever pamphlet you can put together. So I think that’s really the balancing act.

You’re giving me a lot to think about. What would you say—you’ve had obviously a very long journey—is the biggest challenge you’ve faced? And how did you keep yourself motivated to push through that?

So, we were working in my kitchen about three and a half years ago, when we had challenges meeting payroll, and that’s extremely stressful. So literally at any point in time, we were a week or two away from the company completely closing down, and especially as more people are relying on you for their income, to take care of their families, that’s extremely stressful. But I’m not sure there’s a lot I could do about it other than try my best, every day, to bring value, to keep things afloat, to get sales to stay in business. It’s extremely stressful. It remains stressful even though it’s gotten a lot better because we’ve actually shown more success, so we’re in less of a bad position financially. But it’s still not great. It’s still like, a few months from now, things could go bad.

I’m not really sure what to say other than the best thing to get through it is…both myself, and everyone else on my team, we know this is something the world needs. A lot of people are dying; a lot of people are having medical problems because this technology is not as prominent as it should be. So we need to do what we can to grow this idea, to bring this as a service to the people that need it, and that mission is really what drives you through everything. That, and the fact that both myself and every single member of our team, whenever we bring someone on, we’re extremely clear that this is very tough. This is not a standard job. It’s likely everything will fall apart. A standard startup company has about a 5-10 percent chance of succeeding, which means you have a 90-95 percent chance of failing. So going into the situation with your eyes open, aware of your risks, aware of what you’re getting yourself into…be driven by the mission and by what you have the potential to do. How you have the potential to change people’s lives.

I guess behind every great idea is a different kind of company culture. What would you say is the most unique part about your community at Lazarus?

I think the dedication of everyone involved is pretty superb. People have not joined my team because they are looking for short-term monetary gain. So, like we said, every person that is considering the job, I will flat-out tell them, “You will not make as much money here as you would anywhere else. You’re going to work much longer hours than you would anywhere else. This is the situation.” I’m not sure that it’s entirely unique, but in startups, this is unfortunately common. But if you want to have a big impact in the world, you’ve got to work for it, and we’ve got an extremely dedicated team which is willing to pull the extra hours. We have not had a weekend off in at least three weeks at this point. We’re almost at a month now that, literally, we’ve been in every single day and on the weekends, both myself and my entire production team. So that kind of dedication is what it takes, and I’m incredibly privileged to have people that share in this vision and that can work together to achieve something that’s extremely difficult.

I’m a computer science student at NYU, and I’m on the pre-medical track. I very much care about healthcare. I’m passionate about it. Your field is great; it’s at the intersectional part of technology and healthcare. What advice would you give someone who’s interested in getting themselves into this field?

I guess, go for it! Find a big problem and try and come up with a solution to that big problem that’s practical.

Another huge point of advice is don’t count on something to come in…So if you seriously have a big problem, you think you might have a solution, your plan should not be, “I’m going to go out for six months. I’m going to raise a million bucks, and that’s going to let me hire a bunch of people.” No. You figure out how you can achieve it with whatever resources you have. If you can get your parents to throw in a hundred thousand bucks, how are you going to build this company out of a hundred thousand bucks. Because if you try it the other way, you may well run into a situation where you never raise that money. Figure out a way where you start selling something right now. I know that’s really hard, but if you listened to my story earlier, that’s how you actually get somewhere. No one would have put money behind this idea when it was just an idea. I had to teach myself how to 3D print stuff, and I had to figure out how to make money doing it because, as a student, it’s not like I had another choice. So 3D printing things at anime cons it is. Is that the vision? No. But that’s an important step to get there, and trying to rely on something else, whether it’s investments or finding a partner, that can be very difficult. To get somewhere, actually do something. Actually take concrete steps towards your goal.

As someone trying to get into this field, what would you try to take away from an undergrad education, maybe in computer science, to advance yourself further?

I would not place more significant value on someone who had a college education taking particular courses versus someone who had never gone to college. What I care about is what you can actually get done. Insofar as your coursework can help you get stuff done, then go for it. Fundamentally what matters is what you can do. There’s specific things for my company that we value—again, those are ability to design things in organic shapes using certain types of CAD programs, understanding anatomy, understanding of healthcare, understanding of 3D printing, ability to use 3D printers and build them. Those can be supplemented by particular degrees and programs, but those don’t need to be. Maybe you got it because you worked in a machine shop for a while, and, honestly, I don’t care. It is what you can get done that matters.

Interview excerpts have been lightly edited for clarity and readability and approved by the interviewee.