From the ER to Zero Gravity: How Space Medicine Teaches Clinicians to Build in Startups with Dr. Marsh Cuttino

2 days ago
31 min read

From ER to Space Medicine: How Clinicians Create Systems Where None Exist

"Is It Just Me?" The Inner Critic of Startup Leadership with Executive Coach Lupe Prado

Dr. Marsh Cuttino is an emergency physician who turned curiosity into systems impact. Trained at Kennedy Space Center, he raised his hand early and became one of the few clinicians to support shuttle launches and conduct zero‑gravity medical research.

He founded Orbital Medicine to solve problems no one had addressed, including how to treat a collapsed lung in microgravity. His work secured NASA grants and was successfully tested aboard Blue Origin.

Beyond aerospace, he helped build the VCU Emergency Medicine Residency from scratch, proving clinicians can create systems where none exist.

This conversation explores the translation of lessons of clinicians from extreme environments to startup life. Navigating innovation, building from scratch, and raising your hand before you even feel ready.

This episode is for clinicians stepping into early-stage companies who want to understand how to balance strict protocols with startup creativity, how to create opportunity by showing up early, and how to reframe clinical expertise for innovation in healthcare and beyond.

Must-Hear Insights and Key Moments

Training at NASA and supporting 34 shuttle launches showed how clinicians can step into industries without precedent.
Founding Orbital Medicine proved that clinicians can design solutions for problems no one has solved, including collapsed lungs in microgravity.
Emergency medicine built resilience under pressure, a skill that translates directly into startup leadership.
Navigating strict NASA protocols revealed why systems discipline matters, even when building new ventures from scratch.
Flight hours in zero gravity highlighted the importance of adaptability and collaboration when others could not continue.
Building the ER residency at VCU mirrored startup life, showing how clinicians create systems where none exist.
Learning “engineer speak” demonstrated how clinicians must cross disciplines to lead innovation.
Raising your hand early created opportunities that shaped his career, reinforcing the value of stepping in before you feel ready.

Words of Wisdom: Standout Quotes from This Episode

“I just raised my hand and said, ‘I'm happy to go. I'm happy to do it.’ And then once you've done it, of course you're experienced.”- Dr. Marsh Cuttino
”In Aviation, we say “All regulations are written in blood." which means they have a reason. You may look at it and not quite realize what that reason is, but if you get down and understand it, you can understand why certain things are done a certain way, ”- Dr. Marsh Cuttino
“Animals and organisms respond to changes in their environment; you either adapt, you migrate, or you die. So when you come into a new situation, you need to decide how you're gonna respond.That kind of summarizes my path forward.”- Dr. Marsh Cuttino
“Definitely embrace the ambiguity. Embrace the opportunities to learn because when you come into an ambiguous situation, what that means is you either don't have enough knowledge or you don't have enough information.“- Dr. Marsh Cuttino
”Working, figuring out where barriers and opportunities are is something that I have always just enjoyed, and it is like a fun puzzle for me.” - Dr. Marsh Cuttino
“Step out, take the risk, do it, because it can really drive your career in a direction that you want versus waiting for years.”- Helen Tanner
“Strict protocols on one side, startup chaos on the other. Balancing both is really impressive.” - Helen Tanner
“Healthcare startups are full of them, clinicians, physicians who saw a gap, a broken system, an unmet need, and decided to build toward it.” - Helen Tanner
“Raise your hand in the room, even if you don't feel ready or even if you feel ready but it doesn't seem like the right time, because you just never know when is the right time.” - Helen Tanner

About Dr. Marsh Cuttino

Dr. Marsh Cuttino is a Board-Certified Emergency Physician who is experienced in aerospace medicine, disaster, and mass casualty medicine. He has an undergraduate BS degree in Chemistry from James Madison University, attended medical school and an internship in Internal Medicine at Virginia Commonwealth University and completed his Residency in Emergency Medicine at the University of Florida (Jacksonville) in 1998. He was a founding faculty at Virginia Commonwealth University for the start of the Emergency Medicine Residency. He provided bedside clinical training for US Special Operations Medics while at Virginia Commonwealth University. He has lectured extensively on mass casualty medicine and terrorism response for emergency departments. He continues to be a regular reviewer for the Elsevier journal Resuscitation on Emergency Medicine and resuscitation research and Wilderness and Environmental Medicine on parabolic microgravity.

He is the medical advisor to the Commercial Spaceflight Federation on the SARG (Space Applications Research Group) advisory board. He has assisted with the programs for the Next Generation Suborbital Researchers Conference since 2013. In 2020 he began to work for ZeroG corporation as medical advisor and flight coach, providing flight services for the parabolic microgravity flights with a focus on research flights and medical support.

He also founded Orbital Medicine, a space medicine startup that secured grants with NASA, and successfully tested a novel device to treat collapsed lungs in microgravity aboard Blue Origin.

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Blog Transcript:

Note: We use AI transcription so there may be some inaccuracies

Helen Tanner: Hi, I'm Helen, your host of The Early Hires. There is a particular kind of clinician who looks at the boundary of what medicine has figured out and does not stop there. Healthcare startups are full of them, clinicians, physicians who saw a gap, a broken system, an unmet need, and decided to build toward it, and that's the world this podcast lives in.

But today's guest has taken that idea further than almost anyone I know. did not just step outside of the walls of traditional medicine, he literally has left the atmosphere entirely or almost. Dr. Marsh Cuttino is one of the most innovative physicians bringing medicine into the frontier of space exploration.

He trained at NASA, worked at Kennedy Space Center as a launch and landing support physician for the space shuttle program, and flew on a parabol- parabolic flights to simulate zero gravity and conduct hands-on medical research. He then founded a space medicine startup to solve a problem that had never been solved, how to treat a collapsed lung in microgravity, securing NASA research grants, building a team of physicians and aerospace engineers, and successfully testing the device on the Blue Origin spacecraft.

He's one of a small number of physicians in the country who has actually done clinical and research work in zero gravity environments, and his expertise has made him a sought-after advisor for some of the most recognized names in commercial space industry, companies that are actively shaping the future of human space flight.

He's also a board-certified emergency physician. He has spent decades running one of the busiest ER departments in the Richmond region, His startup experience spans the full spectrum from founding and building his own to stepping in as CEO of an innovative med tech company and leading it through a critical chapter of growth.

has been the founder seat and the recruited executive seat. He knows what both feel like from the inside, and today he continues to consult and collaborate with a range of companies working at the forefront of space medicine industry. His career is a master class in what happens when a clinician refuses to stop at the boundary of what already exists, and what he has learned in those extreme environments has everything to teach the clinicians who are building in this one.

I am truly honored to have him here. Welcome, Dr. Cuttino.

Dr. Marsh Cuttino: Thank you, Helen. Very, very nice to be here.

Helen Tanner: So, earlier when we spoke, you described yourself as a child of the Apollo era. What does that actually mean for how you grew up, and how did that childhood fascination eventually shape what kind of physician you became?

And sure most everybody listening to this podcast- Is familiar with the Apollo area, but just in case, we're talking about the context of space exploration as referred to the Apollo program, which was the series of US space missions to the moon in the '60s. So

Child of the Apollo Era

Dr. Marsh Cuttino: Actually, my father was a little bit peripherally involved with the Apollo program. my, father was an oral surgeon and a dentist, and while he was, in the Air um, was actually an examining physician for the Apollo astronauts. when I was very young, was apparently displayed to some of the Apollo astronauts, and the Mercury Seven.

and I have, an Alan Shepard coin, uh, from his, first suborbital flight. Um-

I grew up, uh, watching, the launches and landings on TV. and,was fortunate enough, although I don't remember it, to see the Moon landing. but I have pictures of myself plopped in front of the TV at a quite young age watching this.

you as I grew older, I had, a desire to be an astronaut, like, many young children. cause it was just, uh, seemed like such a fantastical science fiction future that you could, uh, go into space and explore. So, really, I wanted to be an explorer when I was young, was what it was. I was fortunate enough to see talks by astronauts, high school, and so that kinda shaped my, career path, is I wanted to, be an achiever, the of person who might be able to be accepted into the Astronaut Corps.

so I was proficient in science, so ended up going to college and studying chemistry. and, my eyes were not great, so I I couldn't be, like, a military pilot. so I knew that the next highest chance of me getting into the Corps was to be, a physician. so, of course, the family business was medicine as well, so it wasn't a huge leap for me to decide to go into medicine.

and medicine, when I got into it, was different than what I expected. I actually went into medicine thinking that I was gonna be an orthopedic surgeon. I'm always looking forward to the next step, and, you What could I do to, you reduce risk, increase my chances of, succeeding and things like that.

So one of the things I decided as a first-year medical student was I wanted to increase my hands-on medical skills, and so I arranged to have a special elective in the emergency department. as a first-year medical student, one day a week, spent hanging out in the emergency room, doing procedures, starting IVs, and doing procedures which, most first-year medical students didn't get to do.

And I eventually decided that I liked that way more than surgery. and so I ended up becoming an emergency physician. early on, this was before the TV show ER was even a thing. I was very fortunate that I got before it was popularized. Of course, The Pitt has made things even more, spectacular now.

that is kinda how I ended up getting into medicine and my career, but a lot of it was always focused on aerospace and, exploration I guess would be the best term for that.

Helen Tanner: that's fascinating. Uh,

so before we get to building and in the startup phase, I wanna spend some time a little bit more on your formative years, because I think what you learned at NASA and maybe in your space training is foundational to everything that came after.

you trained at the University of Florida, um, if I'm correct, specifically because of its pathway to NASA. Is that right?

Dr. Marsh Cuttino: well, that wasn't the only reason I chose University of Florida. I had multiple reasons t- to choose University of Florida. When I was deciding on- Where I wanted to train, I wanted to pick a very challenging environment.

Building Trauma Center With NASA Pathway

I decided that I wanted to do a large, well-respected, level one trauma center- Ah ... so that I would always be able to handle anything that came in the door. so I chose that because I wanted to make myself self-sufficient as a physician. and it was actually just a huge bonus that I happened to know, University of Florida supplied the, launch and landing physicians for shuttle launches, which goes way back to, the early days of the Mercury program, uh, when one of the flight surgeons was a University of Florida professor, and so they ended up having the contract for the majority of the, space shuttle era.

and so that was just a huge bonus. So when it came down to my choices, the University of Florida was my first choice, and the one that I got, multiple Not just the NASA connection, but that definitely, pushed it over the edge. The best. Yeah.

it was a bonus.

so one of the things that I was you had to be a chief resident to actually do the, shuttle support operations. Um, so I was so interested in it that, I became, interested and was frequently talking to the people who were putting this on.

And, they were like, "Well, you're not actually supposed to be able to do this until you're chief. but we have an opening in the training coming up. If you wanna go ahead and take the training, you can do but we're not gonna allow you to do it for another couple of years." I'm like, "That's fine.

I just love this stuff so much. I just wanna do the training." so I went down to the Kennedy Space Center, and we did the orientation training. lot of studies on physiology, operations, things like how to cut an astronaut's, spacesuit, for, you know, if they're injured, and how to work with the helicopters in the military.

And then I was expecting not to be able to do this for several years, but then in a, series of coincidences, there was a shuttle mission which canceled multiple times to the point where everybody got a little sick and tired, and no one wanted to go. And there was a opening on basically the mission where they needed one more doctor.

and so I'm like, "Look, I'll go." I just raised my hand and said, "I'm happy to go. I'm happy to do it." and then once you've done it, of course you're experienced. So by that point I was invited to many other ones going on, and eventually I did 34 launch and landing operations of the shuttle. partly because I started doing it three years earlier than I was really supposed to.

but once I got in and got the experience, then you're experienced, and then, it's better to have the experienced person than a, newbie sometimes.

Helen Tanner: Yeah. I really wanna call that out. I'm very glad you brought that up, and I've actually made some notes here. you created your opportunity here because you saw this, you learned about it, you were super interested.

But instead of, you mentioned that that was a requirement, you needed to be the chief medical resident, you weren't there yet, but you went ahead, met the people, made yourself available, as you said, And because you did that, then there became an opportunity for you to raise the hand at the right time, and they already knew your interests and your drive and your grit to get in and do it.

And then hence, you had these incredible opportunities. And I,

So I just wanna call that out, that that was an impressive...

You knew what you wanted, and you went after it, and you put yourself in the room. Yeah. So well done. Yeah, I think we can all, think about times in our life where we've done that and, or not done that and wish we did. So, So you flew on parabolic flights.

Dr. Marsh Cuttino: after I finished my residency, I went into academic emergency medicine. I was actually, recruited back into VCU, where I'd gone to medical school.

Founding VCU’s ER Residency

Uh, happened to be my hometown. and the chairman, Joe Arnado, very, famous in the medical world, did a lot of things with ACLS, ATLS, just an amazing clinician, recruited me back because they wanted some homegrown ER doctors starting the ER residency. So they recruited me back- Okay

to help start the ER residency. So I was one of the founding clinicians for the VCU Emergency Medicine Residency. so that was, I guess you could say, my first startup, cause we were building that from the ground up. That's amazing. so I came, and they're like, "Okay, you what kind of research you wanna do?"

And I was like, "I definitely wanna do aerospace medicine." while at the University of Florida, I'd done some work with the helicopter and EMS, and so knew that I liked that. and so I started looking at the kind of things, that NASA needed that I could potentially get funding for. so, in essence, I was looking at what NASA needed and where my skills crossed- Mm-hmm

and trying to figure out what I could do. And so early on, we started doing research, uh, applications and grants, and first few weren't successful, and eventually got in on a successful one that, uh, flew in parabolic flight in a KC-135, which, was interesting experience. They do call it the vomit comet.

now one of the things is, uh, lack the gene for motion sickness, because I have never, ever gotten sick. and there were instances significant amount of people on some research projects would get sick and were not able to function. pretty soon, I developed a reputation as, "Well, if you want stuff, Marsh doesn't get sick."

"So he'll be one of the members on your team that hopefully won't fall out during the operations." Oh my

Helen Tanner: gosh, I wish I did not have that gene.

Dr. Marsh Cuttino: So over the years, I started having, friends and fellow researchers call me up going, "Hey, I'm, doing this project-" I started working with, Stanford, Purdue, all sorts of different, universities, as a co-researcher, sometimes just as an experimental subject, just because I didn't get sick and they knew that, they could get their research done.

And so over the years, I, flew on the KC-135, the C-9, and eventually the, 727-200, operated by Zero G, to the point where it eventually got enough where Zero G me a job, as a coach and, uh, working with them, to help get research done. So have, just accumulated flight hours over the, last 30 years, doing all sorts of fun, exciting things and seeing all sorts of amazing research.

Helen Tanner: I just have to kind of laugh and think, we're talking about, skills that can be translated in, different settings. And the very first time that you went in, a situation where most people would have nausea and vomiting and have these reactions, and you walked away like nothing, were you perplexed?

You're like, "Hmm, this is interesting. Let's try ," you Or how did you ultimately figure out, that you had this special skill?

Dr. Marsh Cuttino: So it took a while, actually. Yeah. early in day, uh, I had the equivalent of a class one medical, before I could ever fly in the KC-135.

Okay. They were they did a lot of testing on you before that. including everything up to, a decompression, an explosive decompression in a hypobaric chamber, which they don't really do anymore. But, was an amazing experience just getting to the point where I could fly.

And there was just so much mythos around the vomit comet, as you called back in those days. there was all these, mythic things that you know, you eat a banana and nothing else the day before, and take these medications, and- these ways to and act before you did it.

and part of me was going, "Well, that somewhat makes sense, but I know that all of it makes sense, and I just hope I don't get sick." Uh Yeah. I love roller coasters, so in retrospect, you I should have known it. But it is, completely different being weightless.

so was just excited I didn't get sick the first time, and then when it didn't happen the second time, then I kept going. And then I stopped, taking the medications that they would give you pre-flight, because the nausea medicines I felt were, making me fatigued and tired, and a little bit harder to concentrate.

And I felt that when I stopped taking the medications, I performed better, and I never had any nausea. Now, it would be really funny because they'd be passing out the meds, and I'd be like, " I don't want any." And they're like, "Are you sure? You really sure?" I'm like, "I'm really sure." Yeah. You know?

And you're like, "Okay, you've done this We'll let you go." the early experience, flying with the NASA KC-135 was, definitely, a learning experience for me. it was very, intensive on paperwork and how NASA functions, and understanding regulations and the reason regulations exist.

and one of the sayings we have in aviation is, "All regulations are written in blood." which means that, they have a reason. And may look at it and not quite realize what that reason is, but if you get down and understand it, you can understand why certain things are done a certain way, why checklists are important,

and that makes you a much safer, much more careful as well as a pilot. So I learned a lot with that in NASA.

Helen Tanner: Yeah. This is really interesting because you're talking about a very highly regulated industry, and with such strict protocols. but you yourself said you helped build the ER residency from scratch. It had never been done before at VCU. And then we'll go ahead and kind of jump and start to talk about your work inside of building and being in startups. It's such, a complete opposite situation.

And be able to balance both is really impressive. How were you able to kind of shift your mindset of, you certainly, have to be so strict with protocol and regulation on one side, but then you're actually building in the same industry from scratch. how did you manage that? know, explain a little bit about your thought process.

Dr. Marsh Cuttino: my thought process, when I'm building and designing something, which, you know, I started with the residency. we were building the research department from scratch, and so, I had to teach myself, what is needed to do research.

what checklists do you have to do? if you have human subjects, you have to have the review boards. where the regs are, where the gray areas are. and then you start overlaying what my interests are, cause there were some things I was just definitely not interested in and I didn't wanna do.

and then there were other things that the regs said you do. and then there were things that you could do if you obeyed certain regulations. part of it was a little bit like a puzzle that I enjoyed figuring out, of "How could I get this done?" and I can say this now 'cause the, guilty parties are gone.

wanted to give a present, in one of my later flights, to somebody. and it was bottle of bourbon. and s- my brother and I had started a distillery, so this was our bourbon. and this was an individual who'd significantly helped us over time. so manifested ethyl alcohol on my flight manifest.

and listed the amounts of it, didn't mention that it was actually whiskey. Uh, and so at the very last, parabola, pulled it out and I said, "I have a present for all that you've done for me over the years," and floated it over to him. Oh. And he looked at me. He goes, "That's what you manifested?"

That's hilarious. So I figured out how to get it on legally, even though that's probably stretching the regulations a little bit. so working, figuring out where, barriers and opportunities are is something that I've always just enjoyed, and it's like a fun puzzle for me.

Helen Tanner: you navigate the gray areas with the most utmost integrity, but also stretching just the little bit so that you can, I guess, stretch the boundaries a little and see, yeah. Uh, y-

Dr. Marsh Cuttino: you know, accomplish what is desired.

Helen Tanner: Exactly. so you founded a space medicine startup to address a problem that hadn't been addressed before.

If... Is that correct for me to say that? How to treat a collapsed lung in microgravity?

Dr. Marsh Cuttino: so after, a number of years at, uh, VCU, I decided to transition out, into the c- community, and I became, an emergency physician. initially just a run-of-the-mill emergency physician.

and I decided I wasn't fully satisfied with that. It was not enough excitement for me, guess I would say.

Helen Tanner: Shocking, shocking.

Dr. Marsh Cuttino: So the nice thing about being an emergency physician is, have variable schedules, fair amount of downtime. Yeah. wanted to continue to do research with NASA, cause I knew that there were, additional opportunities and needs that NASA had that I could obtain funding for.

Orbital Medicine & Space Startup

however, to do that, if not at a university, I needed another avenue to do that, so I started uh, consulting company, Orbital Medicine, which I then started running NASA grants through. and so it's a design and consulting organization, and I, worked with several large universities over the years.

it's still where I do the majority of my consulting and aviation work. for example, my, aviation medical exams, I'm an FAA senior aviation medical examiner. I do all that through Orbital Medicine, so I founded it.

who was involved with, the medical community for space? What is that peer community like for you in a clinician sense? And, is that something that you felt- Like you kind of wish you had more of, or you're like, "No, I'm fine. Let's just go." You like the engineers and the rest of the important crew doing this work is plenty?

Or... 'Cause then when you're building in an early startup, some of the hard things is that you're kind of the only person in your area doing it, and you don't have a huge community, you do in a hospital setting. Yeah, so-

Horizon of Language: Engineer Speak

Dr. Marsh Cuttino: definitely not a large community of, aerospace physicians just in general.

we are, a little bit of an eclectic bunch. but we do tend to all know each even though, somebody may be on, California time and I'm on, Coast time. but the ones of us do get together. but When I'm designing some of this stuff, there's usually not other physicians that have a clue about what I'm talking about.

but I do, work with a lot of the biomedical engineers and, research scientists and engineers. I had to learn engineer speak, uh, to the point of I had some people- Yes ... ask where I did my engineering. I'm like, "No, was a chemist undergrad."

Helen Tanner: Well, and I think that speaks to the fact that a lot of clinicians leaving clinical medicine and into innovative spaces, they have to learn the speak of who they're working with, engineers, the product teams, the, business side. so that's a great point that you bring up.

In order to really be successful and move things forward, you had to step out and really learn that.

Dr. Marsh Cuttino: Yes. for example, we're doing a large, uh, collaboration, between, University of Kentucky Louisville and Purdue, where I was the physician advisor. and so, this was a undergraduate, uh, aerospace engineering classes and biomedical engineering.

and we're all getting together and designing a surgical suite for microgravity. and I'm trying to explain the chaos of what's actually gonna happen. and you could just see some of the engineers. I'm like, "No, no, no, you can't assume that the blood will be in this one space. It's gonna bounce around and fly everywhere."

And they're like, "It does?" I was like, "Yes, think of a cut artery." "I don't wanna think of a cut artery." "Okay, but yes, that's what we're planning for. If an artery gets cut, how are we gonna collect that blood? And how are we gonna be able to get it so it can be recycled and reused in a remote, austere environment?"

And so sort of translating what the- Limits, and constraints are from a medical s- perspective into the engineering perspective obviously is what, you takes a little bit of talent to be able to explain to that. and that's, kind of how I l- got involved, with some of the medical startups because I was able to explain why this is critical and why I didn't think that would work, for other things, uh, as I got into the medical startup space.

Helen Tanner: Yeah. And I, and I wanna spend some time on the distso- definitely not a large community of, aerospace physicians just in general.

In order to really be successful and move things forward, you had to step out and really learn that.

Helen Tanner: Yeah. And I, and I wanna spend some time on the distinction. I think it's important. You know, You're a consulting firm. you started your own. but then also you were an advisor to one, and as I understand it, then recruited to be their CEO. So then you were also, recruited into a leadership role of an established startup.

Uh,

Correct. Now, I had a couple of failures before that as well, so I mean, an early- ... startup failure with disaster training program, which was designed to be a computerized, uh, program which, for illness of one of the founders never actually took off.

Dr. Marsh Cuttino: but I had learned a little bit from that. I had become an advisor, to a Silicon Valley based medical device company, called PhysioWave. and after working with me for several years, had asked... during the pandemic I got a little bit burned out on, uh, emergency medicine. when the pandemic started, I was a, regional director running 18 hospitals.

and I could tell that the pandemic was coming, and it really stressed me out.

so obviously on the front lines. and so it got to the point where I was like I actually stepped back from, leadership in emergency medicine. I was like, "I'm gonna be a regular ER doctor for a while, or maybe even-" Mm-hmm

cut back that. and they said, "Hey, we've been looking for a CEO for a while. Do you wanna give it a try?" And I'm like, " I have, absolutely zero experience, in doing that and fundraising, but I'm happy to give it a try if you wanna give me a chance." spent a year with them. it was my- business school, I say, 'cause I basically got the in-depth, learning to fundraise, learning to pitch, which was completely foreign from all the other startups I'd done because all the other ones had basically bootstrapped and self-funded.

Like, my brother and I founded Reservoir Distillery- here in Richmond, which my brother runs. and we basically bootstrapped that, and so when we started, I did every odd job in the distillery from humping barrels to pitching yeast, until we had grown to the point where we could hire people.

With Orbital Medicine, I was basically doing all the work and consulting myself, and used that to bootstrap. and with my earlier startup Resus, we, basically all the founders, pitched in together and, started that. But with PhysioWave, already had, existing funding, but was at a critical inflection point, where we had to redesign, bunch of the boards, and basically come up with the new, model and re-clarify exactly, what we were testing with this device.

So this device, was basically, a combination device which when tuned properly could measure your cardiac output- Mm ... with you just standing on a scale.

Helen Tanner: Mm-hmm.

Dr. Marsh Cuttino: Okay? And we had figured out a while that it actually could be used, not only to detect your cardiac output, but it could be used to, predict your cardiac risk.

so you could stand on this scale, and it gave you the same, test as, like, one of those cardiac CT scans. you could stand on it, and I can go either, " you're in really good shape, your heart's doing well." or you could stand on it and say, "Okay, hey, yeah, why don't you come over here?

I got a cardiologist I wanna introduce." Yes. Immediate referral. An immediate referral. When I came in as, uh, CEO, the board had gone through a couple of designs, really needed focus. so I came in and helped get it refocused, did some fundraising successfully, but not as much as I wanted.

And then, along came the Silicon Valley Bank collapse and things like that, and I decided that at that point, the company would not have been able to pay me, and I decided I needed to pay my mortgage, so I stepped away from Circulate at that point. They are still doing well. so and I am still in contact with them as well, and I do wish them well, but I am no longer their CEO.

Helen Tanner: Well, interesting, when you talk about the challenge of, pitching the company, versus, like earlier you gave an incredible example about, pitching yourself for new opportunities. Some people find it harder to pitch themselves than actually a company that they're representing.

how did you feel about that? It sounds like doing pitch decks and talking with investors put a different level of, I guess skill or just focus than obviously being able to pitch yourself for something in an innovative way that you wanted.

T- how was that different for you?

Dr. Marsh Cuttino: it's interesting. It all goes back, I had decided early on in my career that, I guess I had teased out that people who could do public speaking seemed to do better. and so one of the things I took in college was I took a public speaking class.

Yeah. cause I had in high school, done some talks, and I was like, "You know, I could do this better." my first year of college, I took a public speaking class that was offered at James Madison and that helped a lot, because it was standing up in front of a class, talking about all different things, including, talking about yourself was one of the assignments.

when I got into med school, obviously you are doing a lot of talking and expounding. and, you through residency and all this kind of stuff, we were teaching. my residency, sometimes the teaching would happen in critical so that was part of our training.

So we'd be doing, a, a critical procedure like an intubation, and one of the senior residents would be going, "Okay, what are the side effects of the medicines that you're administering right now?" And I'm like, "I'm trying to look down this guy's throat." And they're like, "I know. Do both." so it was a little bit of multitasking, going on.

and so if you could talk during that, you could pretty much talk during anything. And then obviously as a professor of emergency medicine and was doing a lot of classroom teaching and things like that, so it got to the point where actually doing a pitch almost is like teaching a class. Yes. and it's communicating.

the key thing, is that you are communicating your drive, your capabilities, and you're communicating and convincing. and so that they understand what the nuances are and how it can be dealt with.

Helen Tanner: I just resonate with this so much. The older I get, it just becomes so clear.

You must be able to communicate and articulate clearly in whatever industry you're in to really move forward in what you want career-wise, or if you wanna pitch a product, or if you have an idea for, something new. I mean, you have to be able communicate. If you're an

And I focus, on this now with me, even with doing this podcast and speaking with others about it. How can I articulate better? How can I get more training? I love to listen to people like Adam Grant, who focus on communication.

So I think that is so key. And you mentioned a great point that about during your emergency medicine training, your clinical training, you are challenged. You're in a very ambiguous, fast-paced setting in many ways, or at least having to make decisions in ambiguous situations with your patients.

Navigating Ambiguity & Innovation

how have you been able to translate that, the clinical side, into the startup side?

And what would you recommend for others who are interested of going from clinical to startup?

Dr. Marsh Cuttino: definitely embrace the ambiguity. and embrace the opportunities to learn because, when you come into an situation, what that means is you either don't have enough knowledge or you don't have enough information.

and so you need to evaluate that situation and figure out what you need. so it may be what information do you need to make a decision, and maybe what framework actually affects that decision. or it could be that no one's thought of this before, or 1,000 people have thought of it before and how could you execute and make it different.

I think a lot of it is figuring out what the limitations and constraints are, and then executing and operating within that.

Helen Tanner: we are at a time when there's so much change and innovation in medicine to be quite frank, digital tech, AI, and you were on the forefront of that early on with some

what do you think the next generation of clinician or clinical founders and leaders need to be paying attention to that maybe they aren't yet? Based on your experience

Dr. Marsh Cuttino: I think they need to be careful that the AI doesn't make the decisions for them.

AI is a useful tool, but it can't substitute for human ingenuity. so my personal opinion on AI is that it has, sucked in all this, information off the internet, which is a combination of hallucinations and reality, and it's kind of regurgitating the average. if you work with AI correctly, you can get some very good information out of it.

but it is not yet creative. most of what it's, at least with the current models, until they evolve some, they are still regurgitating averages. like, if you look at how the language learning models, generate their tokens and things like that, they are predicting what the average response is going to be.

Mm-hmm. That is great for certain things. Should not replace, uh, critical thinking and decision-making and creativity, in a leader, basically. It can be a tool, but it should not be replacing your thought.

Helen Tanner: for a clinician who's sitting on an idea, something they've seen in practice, they believe it could be built into something similar to, some of the things that you have done, what's the first real step in going from idea to reality and getting that out in the market?

You know,

Dr. Marsh Cuttino: so I used to, call this as, like, a self-educated expert, so I do a deep rabbit hole on everything surrounding it. so just go down, make sure you know, are there any, for example, legal requirements around it, what kind of safety things do you have to have?

If it's the medical device, what kind of plastics can you use? cause you can't just use anything. what kind of FDA regs are gonna be around it? who's gonna use it? Who's your target audience? Yeah. and does your target audience want it? because there are a lot of fun things that can help make your life easier- for example, going to impact your overall patient care, so, why would you need it?

when I'm, teaching students, I will tell them, "What tests are you thinking of ordering?" and I, like, "Why are you gonna order a test that's not gonna affect your outcome or your decision-making?" So if, for example, they want a ceramic level on somebody, I'm making something up obviously, I'm going to...

If the ceramic level is high, are you gonna discharge the patient? The ceramic level is low, are you gonna discharge the patient? No. Then why order a ceramic level? It's not useful information. So first of all, you gotta make sure that your idea and your concept is useful, that it's got a market, and it's not got regulatory burdens that make it difficult to produce.

and so you basically need to do a full analysis and risk matrix on what it is. And it is harder to do a device, to start up than you would think, especially ones with regs. during the beginning of the pandemic, one of the things, I looked in very deeply was, Cheap, simple to operate ventilators.

cause early on we were unclear. and I got fairly far down, basically a small ventilator, that could be produced for, 50 to $60. the regulatory burden at that level was still pretty high even- Mm ... with the changes in regulations. so I never ended up, getting it into operation.

Plus because at the same time I was, you taking care of lots of patients. it was a good idea. if we had required more ventilators, it might have been needed. but I eventually came to the decision that the regulatory burden at that point was too high.

Helen Tanner: Was

too much. Mm-hmm. Yeah. Yeah.

as we wrap up, I have two questions that I typically ask at the end of every podcast, and before we get there I just wanna ask if there's anything else that you'd like to share to this audience of, clinician leaders and startups. And also, what you are focused on right now.

You've

Dr. Marsh Cuttino: I would say that the majority of my opportunities have come through, networking and just meeting and being able to talk to people.

one of the biggest skills I have developed as a clinician, and I had to develop it, it was not there initially, was talking to everyone from the homeless patient to the CEO who comes in as a patient, And being able to adjust your descriptions and communication style to their knowledge, education level, and medical literacy.

So if you can explain your idea clearly so that even, someone who is completely unfamiliar with your field, is able to understand it and go, "Oh my God, that's a brilliant idea," that is the kind of communication skills that you need, to get yourself off the ground and actually flying. right now

I'm really working on a new company, that is, payload integration and operations, and it's gonna be providing zero gravity, lunar gravity, and Martian gravity on a multitude of platforms, everything from drones- to we are working with, consulting to one of the very big space names which you would recognize.so we're positioning ourselves as a, support so you can design and test your, uh, medical device or your research device and actually fly it in true zero gravity without having to go to orbit, so orders of magnitude- Ooh ... cheaper. so it's a multitude of parabolic flight programs. and we call it Reduced Gravity Solutions.

Um- Fascinating.

we have very early website, uh- Okay ... which you can follow us on. or if you are super interested, you can hit me up on LinkedIn.

Helen Tanner: good. So, well, I am super excited to be following along with you. And it's just really outstanding to see what you're doing on the forefront of space medicine and, and as we wrap up, what was the single most helpful resource for you, a person, a tool, book, framework, mindset, that has helped you in your career, of innovation, of startups, and why did it matter?

Dr. Marsh Cuttino: I'm gonna go back to my high school biology teacher.

Helen Tanner: Oh.

Dr. Marsh Cuttino: Oh. when she was, teaching how animals and organisms, respond to changes in their environment, you either adapt, you migrate, or you die.

so when you come into a new situation, you need to decide how you're gonna respond. And I guess that kind of summarizes, my path forward is when I get in a new situation, I either adapt, I get out of it, cause I don't wanna die. so I'm always learning, moving forward, and, trying to figure out what I can do, to make things work.

For example, I just completed my private pilot license, so I am now a fully licensed FAA pilot, which was, I started many years ago and came back into it. I'm continuing to adapt and challenge myself as I move forward. yes, I'm gonna come back to, Ms. Griffin, adapt, migrate, or die.

Helen Tanner: that is the best. I hope there's a biology teacher we can share this with and their impact for their future students of huge success. I love that. Thanks for sharing that. Of

Dr. Marsh Cuttino: course. I was actually fortunate enough, to have a very long discussion with her about a year ago. Really? Uh, yes, about the impact she's made on my career.

and just her teaching, was very impactful on me. and so have greatly appreciated. So I have gotten to tell her what an impact she's made.

Helen Tanner: That is the kindest thing that you can loop back and tell her. I'm sure that meant the world to her.

Yes. Absolutely, yes. and spoke a little bit about this with the communication, but how has being a clinician shaped the way you operate in startups, and how has startup work shaped the way you think as a clinician?

Dr. Marsh Cuttino: so definitely being a clinician, I wanna focus in on, what is going to make a difference.

Obviously in emergency medicine, I'm fast reacting, which is something I've had to learn to temper a little bit when it comes to business. because if I, make a snap decision, without fully understanding the situation, that can have much more severe consequences, obviously. if I, for example, make a decision and it might have negative legal implications- Mm-hmm

and I've not evaluated it. So, when I'm switching between being a clinician and being a businessman- I have found that while I'm great with the uncertainty, I will often slow down and actually get a better concept of what the constraints are, before I make a business decision. Now, if it is a business decision that requires a rapid response, I am able to do that, of course.

but feel that I do more research, for my business decisions. and I make my clinical decisions more based on experience and heuristics.

Helen Tanner: Excellent. Well, thank you so very much for your time today. This was an outstanding conversation. I'm very excited to share this with, the listeners, and I just, again, thank you very, very much for your time today, and cannot wait to follow everything you are doing.

Dr. Marsh Cuttino: Well, thank you, and thank you for having me on, Helen. It's been a pleasure.