Andrés Herrero-Yraola CEO & Founder at i2medi

Julio Martinez-Clark (00:02.856)
Welcome back to another episode of the Lata Metec Leaders Podcast. Today we have Andrés Herrero, CEO and founder of I2MET, Germany. Andrés, it's great to have you here with us. Welcome to the show.

Dr. Andres Herrero - I2medi (00:26.4)
Thank you Julio, thank you. It's a pleasure and we feel very honored and proud to be part of this session and the collaboration with you.

Julio Martinez-Clark (00:35.515)
Excellent. All right, Andres, let's get started by asking you about your journey. How is it that you got to where you are today?

Dr. Andres Herrero - I2medi (00:46.254)
Well, know, basically I started in medical device industry 25 years ago. As you can see from the cut of my hair, has some years that passed by. And I started to work in cardiology and afterwards in neurology for big multinational companies, amongst them, Biotronic or Abbott.

And then finally, 10 years ago, a little bit more than 10 years ago, I decided to found my own company, Itomedi, where we had the target to bring products to the Latin American market. And I have a PhD in biochemistry and a master degree in economics. And I have been working in all the aspects of commercialization of medical devices.

in all this time. And then I said, okay, when I do this for companies, maybe I can do this also for customers. And that's why I teamed up with some very experienced people in the different countries and we founded the company that has then evolved. yeah, I'm half German, half Cuban. That is the reason why I'm so, let's say, intrigued by the Latin American culture.

And now you, I leave it up to you and the team to decide if I got the best of both cultures or the worst.

Julio Martinez-Clark (02:18.113)
Hahaha!

Julio Martinez-Clark (02:22.712)
sure you have the best of both cultures. mean it's rare to find somebody who can navigate the two cultures and of course you speak Spanish, you speak German, you speak English and who knows what else and that combination is really priceless when you want to do business internationally especially in Latin America. So tell us more about i2Medi. I mean what's really the value proposition? What's the problem?

that itumiri tries to solve for the industry and why your solution is the best.

Dr. Andres Herrero - I2medi (03:00.844)
Yeah, perfect. First of all, we are a multinational distribution and market access company. And what we are trying to do or what we are doing is bringing companies with real innovations to the Latin American market. We have own offices in Brazil, in Mexico and in Colombia. And we're also partnering with some distributors in other key markets like Chile.

for example, Peru or Costa Rica. Now, we are focused on helping the customers really to enter the market with a real and sustainable value proposition for their product and their right positioning. The big problem that we face nowadays, and I think in almost all countries, is that we have a very agile development industry.

with new innovations which is meeting a very rigid reimbursement system and healthcare systems that does not want to have any innovation and changes. And this is what we try to do to bridge these, let's say, completely opposed positions and try to bring them in a successful synteny.

Julio Martinez-Clark (04:07.152)
Mm-hmm. Yes.

Julio Martinez-Clark (04:13.147)
That is true.

Julio Martinez-Clark (04:27.237)
That's fantastic. the way you go about that is by loving the different reimbursement stakeholders in each country. How do you bring innovation to these markets that are hungry for innovation, but as you said, the system is so rigid that it is

almost impossible to get a coat to get reimbursed because most of these countries as we all know here, the public system covers the majority of the population. So it's really, really key to have a coat to be able to sell the products and hospital can get paid for them. So how do you solve that?

Dr. Andres Herrero - I2medi (05:19.896)
Okay, first of all, we need to distinguish between the kind of solutions that you want to bring into the market. If you have a solution that, or WoW's benefit is to increment the efficiency and it's an investment of the health care provider, then of course you're not finding the necessity for the reimbursement, but still you need to convince the customer.

The other thing is if you have a product like an implantable device where you need insurance coverage in order to get reimbursement, then in this case, definitely the topic of the reimbursement is very essential. Now, in principle, Latin America is even more friendly to the introduction of some innovations than, for example, Europe. The regulatory burden, yeah, the regulatory burden to get a

Julio Martinez-Clark (06:10.776)
Interesting, really.

Dr. Andres Herrero - I2medi (06:14.83)
The here in Germany is, for example, I would say it's a three years, three and half years process. Very, very, very complex and very costful with very low probabilities of success unless you have a very sound health technology assessment with a very, very predominant and dominant outcome. Now.

Julio Martinez-Clark (06:38.725)
Hmm.

Julio Martinez-Clark (06:43.513)
Wow.

Dr. Andres Herrero - I2medi (06:44.022)
In Latin America, have the private and the public market and the private market is a little bit more flexible and it allows sometimes the innovations to be introduced to certain, let's say, certain extent into the system quicker than in Europe. So.

Even though the healthcare system as a global from a public perspective is maybe not that sophisticated than in many countries in Europe. And I'm not meaning this disrespectful. I'm simply talking about the economic power of the insurance companies. Sometimes for the private insurances, I have experienced a more flexible way in, let's say, in accepting

certain innovations and certain codes to be used for certain innovations. Now, your question was, how do we proceed? It's not a thing that comes overnight. And that has to be very clear to all of our customers. we tell this our customers, you're not getting this into the market. And the next year, you're going to have a code and invoice a big amount of money. But it has to go step by step with some

specific smaller successes in the country with a reference site. You need to build a local reference site first. You need to talk to the societies, to some key opinion leaders in the societies in order to as first step after they have experienced the product that they accept and would.

Julio Martinez-Clark (08:16.204)
Yes.

Dr. Andres Herrero - I2medi (08:32.756)
introduce the product into the guidelines. That is the first step that needs to be taken. Sometimes this requires a clinical study, also locally. We can talk about this later in more detail. Sometimes not. And then once the guideline has been published, this is the basis for making a submission to the private insurances. Typically first,

Julio Martinez-Clark (08:36.525)
Yes.

Dr. Andres Herrero - I2medi (09:00.192)
and the governmental instruments is typically later for approval of the new solution into healthcare code. Of course, we're always trying to find an existing code that we may use, which is our first approach to do a very detailed analysis to see how there exists something. Let's say I have a 3D mapping system for any electro-mechanical

Julio Martinez-Clark (09:15.351)
Yes.

Dr. Andres Herrero - I2medi (09:28.128)
analysis and there exists a code that is similar that we can use then we use that one in order to avoid the whole process but in many cases or in some cases this is not possible then we need to go that step.

Julio Martinez-Clark (09:41.133)
Hmm. That's fantastic. So I imagine that you are one of the few companies doing this in Latin America because I haven't seen anything like this before. If I recollect correctly, I've been doing this work in Latin America, helping companies do

clinical trials, medical device companies clinical trials, and I've had some experience with market access projects. I've gotten regulatory registrations in Mexico, in Brazil, Colombia, in several countries. sometimes I have to do research, I have to get involved in some market access, a couple of related activities, and I haven't been able to find anybody like ItoMedi, to be honest with you.

So I think the solution to that reimbursement problem or to the market access problem is something that is badly needed in the industry, foreign companies, US companies, European companies that are looking to diversify their revenue and also looking for easier.

Dr. Andres Herrero - I2medi (10:47.758)
The solution to that reimbursement problem is something that is badly needed in the industry, foreign companies, US companies, European companies, where we're to diversify revenue and also easier ways to start selling before they get into an argument. In other words, US company...

Julio Martinez-Clark (11:09.358)
ways to start selling before they get into the larger markets. In other words, if a U.S. is interested in getting European approval, as you said, getting a coat in Germany, etc., and the different countries in the European Union, sometimes it's a lot easier to do that in Latin America, in countries like Mexico, Brazil, Colombia. Is that the first statement?

Dr. Andres Herrero - I2medi (11:32.398)
Yeah, I think that is that is correct first I believe one of the reasons why there are not so many companies doing what we do is that the companies the multinational companies from let's say or I would say the companies that would like to Internationalize their business. They first look to if they come from the US they look to Europe and maybe to Asia and

Julio Martinez-Clark (11:58.957)
Europe. Yes.

Dr. Andres Herrero - I2medi (12:02.114)
from Europe they look to the US first. And Latin America sometimes is managed in an opportunistic way. Let's pick a distributor and hope that he will sell the product over there. I don't want to use a lot of time and efforts to do that. The people under, yeah.

Julio Martinez-Clark (12:04.322)
Yes.

Julio Martinez-Clark (12:12.062)
Yes.

Yes, yes.

Julio Martinez-Clark (12:19.558)
Exactly. And hold on, hold on. I'm sorry, I'm sorry. In that, I'm sorry to interrupt, but I think you are bringing up a great point, Andres. Usually that opportunity happens at a conference or something, and they find a distributor, and they have a couple of drinks. And the distributor promises that with no effort, they can get into the Mexican market, and the distributor will pay for everything, the registration.

Dr. Andres Herrero - I2medi (12:43.81)
Ha

Julio Martinez-Clark (12:48.589)
But they don't tell the company that the distributor will control the registration for 10 years or five, 10 years, whatever the expiration time period is. So yes, you're absolutely right. It's too bad. think there's going to be a lot more education in the industry to tell US companies, European companies that Latin America has, I mean, the size of the market is double the size of the United States. Over 600 million people.

The issue is that it's very fragmented, but that also creates opportunities because that brings barriers of entry for the competition. So if you are a medical device company from Europe or the US, I think you have to look carefully at Latin America as a way to start generating revenue before you get into those larger markets like you said, Asia or Europe that take usually longer. And they're closer to home in case of American companies, right?

Dr. Andres Herrero - I2medi (13:46.602)
Absolutely, absolutely. could not, let's say, concur more with what you said. mean, Brazil is the seventh biggest health care market in the world. So it's not, let's say, if you talk, have, of course, you have the United States, you have Japan, you have Germany, and then you have Italy.

Julio Martinez-Clark (13:57.771)
Wow.

Dr. Andres Herrero - I2medi (14:10.344)
And already France and then already you start getting with China and then you have already starting to get into Brazil as one of the key markets. And Mexico is also a significant market. Now, therefore, I think there is an underestimation and sometimes and of course, the customers I have to admit in Latin America in particular in Brazil are very innovation driven. They are very tech friendly. They

Julio Martinez-Clark (14:18.432)
Yes. Yes.

Dr. Andres Herrero - I2medi (14:38.444)
They like new technologies and new approaches. So you find this on the ground. I have to admit this for the people in Germany, which I also know very well as you know, they sometimes see the glass half empty. So it's always, the innovation. What is the risk? What is the problem? When you go to Brazil, you always find the people with the glass half full. Wow, this is great. What other opportunities that we can...

Julio Martinez-Clark (14:53.964)
Hmm.

Dr. Andres Herrero - I2medi (15:07.34)
leverage with this. So I think that is an important point. Now coming back, the companies many times want to exploit Latin America with not a lot of effort. So distributor, you do your stuff and then continue. And if I have a product, for example, if I'm coming with the 15th cranial plate that I'm going to sell,

Julio Martinez-Clark (15:24.511)
Yes, yeah, exactly.

Dr. Andres Herrero - I2medi (15:35.478)
and I have a good price, then okay, you may have luck with the distributor to do this. But if you're coming with an artificial intelligence algorithm for improving the diagnostic, for example, for coronary artery disease, you immediately have a complex discussion with the clinicians and the healthcare body about sensitivity, specificity, positive predictive value, negative predictive value, you are the

Julio Martinez-Clark (16:01.491)
Yes.

Yes.

Dr. Andres Herrero - I2medi (16:04.93)
You are the clinical trials experts who know that. then of course, there comes the question about the reimbursement. This is something that has not existed. So how do you fit this into a screening program that exists and that has established values? Therefore, you need to or use much more experience and thoughts and analytics to do that. And of course, and this is the last thing to add,

I have to admit that of course we work in an interesting way that's called the hybrid distribution model. So we have a lot of what we get is based on success but not everything because we cannot bear the risk for all this introduction completely alone.

Julio Martinez-Clark (16:51.188)
Sure, yes, yes. But there's a component of success, of course. So your interest is aligned with the interest of the client.

Dr. Andres Herrero - I2medi (17:00.695)
Yeah, it's the biggest part. for us, it's basically more or less we work on a very low cost basis for doing all the effort and the work. But if we reach certain milestones, then we continue. We have a long-term agreement. Most of the clients we're working with, we work with them for more than four or five years, at least.

Julio Martinez-Clark (17:02.888)
Yes.

Julio Martinez-Clark (17:16.339)
Excellent.

Julio Martinez-Clark (17:22.687)
Wow, that's great, that's great, Andres. All right, so let's talk about going back to the issue of the distributor because you also touched on a very interesting point. it is my perception, maybe you're wrong, please correct me, but I think distributors are looking for easy products to sell. Something that can generate revenue for them tomorrow. If you present a distributor with a

product that is highly innovative, as you said, artificial intelligence method to diagnose early on coronary disease, heart failure, things like that. And there's no code. And they recognize that it's a very innovative product. mean, it's an awesome product. But it's going to face so much resistance from these scientific societies, from

the health care system in general to introduce the product. mean, not to mention the reimbursement. If there is no reimbursement, how will distributors sell the product? So I don't think distributors are in the business of solving all those matters, doing all these lobbying with the scientific societies, and getting involved with clinical trials and all that, because the payoff will probably happen in five years. So what do you think about that?

Dr. Andres Herrero - I2medi (18:49.422)
Yeah, that that is a Spot-on question and a very important aspect The distributors typically are I always say Say is I like the water it goes where where it disappears as easiest So if I have a possibility to do a lot of sales with a very simple way by responding to a tender

Julio Martinez-Clark (19:09.915)
Yes, yes, yes.

Dr. Andres Herrero - I2medi (19:17.058)
filing a document, send it over, just offer an easier price. I'm not making a lot of margin, but I take it with me. Now, what we do is much more affordable and therefore we look for real partnership. In a certain way, as me and the team that we're working together, we all have been working for multinational companies many years and we all have the, let's say, a corporate approach.

Julio Martinez-Clark (19:17.363)
Yes. Yeah. Yes.

Dr. Andres Herrero - I2medi (19:46.41)
not a distributor approach to the market. therefore, let's say, if I tell my customers, we are kind of an externalized branch of their company in the country. And just to give you a highlight for Impulse Dynamics, which is a manufacturer of a completely innovative heart failure implant, we are the

Julio Martinez-Clark (19:46.749)
Yes, exactly.

Dr. Andres Herrero - I2medi (20:13.274)
only market outside the direct markets that has achieved guideline acceptance. Only in markets where they have been working with the direct distribution company, so their own daughters, they have achieved guideline acceptance. And we did this in Brazil, where you can open up the file for implantable devices and you'll find a specific section.

Julio Martinez-Clark (20:20.613)
Wow.

Julio Martinez-Clark (20:34.056)
Wow.

Dr. Andres Herrero - I2medi (20:40.372)
on cardiac contractility modulation that we were able to lobby in there. And we're at the moment submitting the file to the private insurance authorities. We have written a complete health technology assessment according to the Brazilian guidelines. And if that comes through, that is a big game changer.

Julio Martinez-Clark (20:44.926)
Hmm.

Julio Martinez-Clark (20:53.981)
Wow.

Julio Martinez-Clark (20:58.354)
Yes.

Julio Martinez-Clark (21:02.534)
Yes, yes. I will represent a big revenue increase for the client, for your client.

Dr. Andres Herrero - I2medi (21:10.018)
But as you said, it took us more than five years to reach that point. have to admit there were two years of Corona that let's say have slowed down everything because nothing was working. But let's say in the meantime only that we are implanting in private centers with private customers in the best institutions in the country. But to really go

Julio Martinez-Clark (21:24.712)
Yeah.

Dr. Andres Herrero - I2medi (21:39.17)
big by the numbers, you need to have a code and an acceptance.

Julio Martinez-Clark (21:44.006)
Yes, yes, yes. Okay, so the profile of your clients, I imagine are visionary companies. I mean, most companies, as we just discussed, address just one easy thing to do or the customary thing to do. Just if you're from Europe, you go to the United States. If you're from the United States, you go to Europe and maybe Asia, Japan and China, if you're aggressive enough, and that's it.

Dr. Andres Herrero - I2medi (21:45.806)
This is.

Julio Martinez-Clark (22:11.529)
And the rest of the world is opportunistic. If a distributor comes along, knocks on my door, I just give them the power of attorney to register my product. And if they sell something, great. If not, who cares? I'm already working on Europe or the United States. Anyway, my point is that I guess the profile of your clients are companies that are more visionary than the traditional manufacturer. I companies that really recognize Brazil as the seventh largest market in the world.

Dr. Andres Herrero - I2medi (22:21.748)
You

Julio Martinez-Clark (22:41.242)
Argentina, Mexico, Colombia as big potential revenue generating markets, right? I what makes your clients different from the other companies? That's probably what I'm trying to ask you.

Dr. Andres Herrero - I2medi (22:58.614)
Okay, I think our clients that we are having, understood that they have a cunning innovation, but the innovation is not enough. Many companies believe the product is enough and this is not true. is, let's say for us, if the product is not good, of course it's much harder to sell it than if you have a good product.

Julio Martinez-Clark (23:08.968)
Isn't it enough?

Julio Martinez-Clark (23:14.972)
Hmm.

Dr. Andres Herrero - I2medi (23:26.53)
But if you have a good product and you have no, let's say, not the right positioning, not the right market approach, not the right price, not the right segment that you're positioning it to, then the product will also fail. And I think our customers have understood that they have fantastic innovation because we are looking for real innovations. If somebody makes, let's say, a pacemaker,

Julio Martinez-Clark (23:40.924)
Hmm.

Dr. Andres Herrero - I2medi (23:51.198)
This piece smaller. This is not a real innovation for us or it has one year more longevity nice It's an incremental but when you come with a complete different thing whether you have to say the doctor listen for this heart failure patient There's nothing new or we have sold and we are selling density to meters and That work on ultrasound basis. Yeah. Yeah and

Julio Martinez-Clark (23:54.705)
Yeah. It's just an incremental thing. Yeah.

Julio Martinez-Clark (24:14.501)
Yes, I saw that. Yes, you told me that.

Dr. Andres Herrero - I2medi (24:18.126)
And that is a real, real innovation that the patient gets not radiated anymore. But you have to face the concerns of the radiologist. Is it working? Is it good? Is it as good as the existing? But again, to your question, our customers have understood that there needs to be done the lobby work and that it's not coming for free.

Julio Martinez-Clark (24:27.14)
Yes, fantastic.

Dr. Andres Herrero - I2medi (24:46.99)
And that if you want to have sustainable growth, in a particular positioning, then you need to partner with people and multiply the resources and the power. And they also understood one thing that the opportunity, the window of opportunity nowadays is shorter than ever. There are so many innovations that you can be

Julio Martinez-Clark (25:13.029)
Hmm.

Dr. Andres Herrero - I2medi (25:15.946)
sidelined in one year by a complete new technology. That means that you need to be more sensible and look into the relevant markets. That's what we also do. We are trying to focus. We have selected these countries also where we have direct organizations due to the fact with the access to regulatory, let's say, do the positioning in Brazil. takes long.

Julio Martinez-Clark (25:20.068)
You are absolutely right. Great point.

Dr. Andres Herrero - I2medi (25:44.982)
In Mexico, it's intermediate and in Colombia, it's fast. And then we can help to start to generating something.

Julio Martinez-Clark (25:47.78)
Yes, exactly. You can strategize. Yes, yes, yes. Very good. So, Andres, going back to my comment earlier about similar companies or competitors of yours or I too many, have you seen anybody doing anything like this at the level or with the sophistication that you guys do it?

I mean, is this a blue ocean or is this a red ocean? What do you think? What makes you different from what is out there?

Dr. Andres Herrero - I2medi (26:21.28)
No, this is definitely a...

I think it makes us different because of the completeness of the solution that we are offering and that we are starting when others stop. So you have lot of companies doing regulatory approval processes. If you want to go to regulator, you go to Emergo and you go to Vera Rosas in Brazil or whatever and we are not competing with them. If you have the registry already,

Julio Martinez-Clark (26:40.899)
Yes, yes, that's a commodity. Yes.

Dr. Andres Herrero - I2medi (26:53.506)
Fantastic for us. We don't need to do it. We're not focused on that. But once it is there, you need to manage the market introduction. And then you have on one hand the distributors that we talked about and we have on the other hand, let's say our model, which is a kind of hybrid distribution model. And it can be even we have a customer for whom we invoice. They have a power of attorney with a lawyer.

Julio Martinez-Clark (26:54.585)
Yes, that's great. Exactly. Yeah.

Julio Martinez-Clark (27:20.217)
Wow, really?

Dr. Andres Herrero - I2medi (27:22.42)
We invoice for them, but it's their bank account. So it's a kind of virtual company for, let's say, for the customer. We only use our vehicle to invoice, but the money goes to the company without having to fund the company. And so we have a lot of models in this direction that help the customers.

Julio Martinez-Clark (27:25.55)
Wow.

Julio Martinez-Clark (27:32.261)
Great.

Julio Martinez-Clark (27:41.155)
Yes. Yes.

Julio Martinez-Clark (27:48.143)
That's fantastic, Andres. All right, Andres, we're close to the end of the show, but I wanted to ask you about clinical trials because that's really what I do every day. it really tricks me. How is it that you guys use critical research as a part of the whole solution for market access? Can you elaborate on that, please?

Dr. Andres Herrero - I2medi (28:09.573)
Yeah. Julio, think we are basically the clinical trials. are also not, we have never found a customer or we're never looking for a customer to say, we're going to do a trial in Latam. This is not our thing. But when, for example, let's take the example of the densitometer. We went into Latin America and we had in the backbone, a European study of 1,300 patients.

Julio Martinez-Clark (28:22.286)
Yes.

Julio Martinez-Clark (28:27.406)
Yes.

Dr. Andres Herrero - I2medi (28:34.894)
head to head with the actual gold standard showing more than 90 % specificity. You know what the Latin American customers told us? It's a different ethnicity. That's not here. It's not in Latin. You don't have Latin American data. So you have to prove it. And then we said, come on. The study has been done. They said, no, no, no, no. And then at the end of the day, there was no other way to.

Julio Martinez-Clark (28:39.736)
Hmm.

Julio Martinez-Clark (28:50.882)
Hmm.

Yeah.

Yeah. Yeah.

Dr. Andres Herrero - I2medi (29:15.842)
She key opinion leader.

Julio Martinez-Clark (29:19.364)
He was a key opinion leader, investigator leading the study.

Dr. Andres Herrero - I2medi (29:32.11)
in 343 patients. that is every patient got the two exams in a double, let's say in a blinded way. We had to deliver the data to a committee from our technology and they delivered the data to the committee from the DEXA system, which is the gold standard. And then they compared and they figured out that there was a bigger than 90 % specificity and sensitivity. And then the customer said, okay.

Julio Martinez-Clark (29:38.518)
Wow.

Yes.

Julio Martinez-Clark (29:59.044)
Wow.

Dr. Andres Herrero - I2medi (30:02.2)
This is working. And another one we did in Mexico that they say, wow, this is not relevant market for us and et cetera, that was a little bit later. So we could already reference on the different ethnicity. And then they conducted in the Clinica Cuatro, which is the biggest genealogical clinic in Mexico, a study in 400 and I think 445 patients, women on the prevalence.

Julio Martinez-Clark (30:04.045)
You

Dr. Andres Herrero - I2medi (30:29.97)
and of osteoporosis in a younger patient group. And imagine that 11 % of the women have osteoporosis going on a, let's say, routine checkup. Everybody was coming in, intention to treat, 11 % found with osteoporosis, which was a significant finding. And after that,

We have sold two regions in Mexico with the secretary of the La Salud of a specific region some devices on the trucks to travel around the country measure the women to prevent osteoporosis and fractures and this is a gorgeous project. This is a very good project.

Julio Martinez-Clark (31:07.374)
Mm-hmm.

Julio Martinez-Clark (31:12.26)
Hmm.

Julio Martinez-Clark (31:17.771)
Yes, I'm sure.

Dr. Andres Herrero - I2medi (31:20.222)
So this is what we do in studies. We are doing at the moment study in Chagas disease. As you know, a very Latin American problem. And we have also conducted an artificial intelligence study, again, to show and prove that it's working. In a specific context, this was in the chest pain clinic where we then showed the sensitivity and specificity of the algorithm compared to the actual standard of care.

Julio Martinez-Clark (31:29.785)
Yes.

Dr. Andres Herrero - I2medi (31:49.644)
So as I said, we are using that studies if it's necessary to be part of either filing a dossier, convincing the customers in the market introduction, not as a standalone solution. And in this context, have to say, I'm very much looking forward in the future to also work with you and BioAccess as you are the experts. And hopefully we, let's say, can join forces on one or the other.

Julio Martinez-Clark (31:57.162)
Yes.

Julio Martinez-Clark (32:04.799)
Exactly.

Julio Martinez-Clark (32:11.734)
Thank you.

Julio Martinez-Clark (32:17.972)
Yes.

Dr. Andres Herrero - I2medi (32:18.67)
a stunning project in Latam. And that brings me to a question to you. are the expert. What about the regulatory environment, the outlook for hurdles for starting studies in Latam? Europe is terrible. It's very complicated. It's very expensive. It takes ages. How is the current situation in Latam and what is your prediction as well in that context for the future?

Julio Martinez-Clark (32:46.219)
Yes, Andres. Latam is going through a period in its history where the different countries, in its history and its evolution, the region is evolving very rapidly. evolving, mean, the way the different countries are now looking at the world, the way or...

these different countries are looking at their economic models. And they are transitioning from being some agriculture societies in Latin America are transitioning to industrial societies. Some industrial societies in Latin America are transitioning to knowledge societies. So you see this shift in the way

Dr. Andres Herrero - I2medi (33:28.27)
Thanks

Julio Martinez-Clark (33:44.258)
the new laws are being enacted in the different countries. You see this shift in the interest of many Latin American countries in joining the OECD, the Organization for Economic Cooperation and Development, which is the club of wealthy countries around the world with the best practices in all matters related to society, economics, politics.

Dr. Andres Herrero - I2medi (33:56.014)
joining the OECD, the Organization for Economic Cooperation.

Julio Martinez-Clark (34:13.386)
importation, exportation, intellectual property, et cetera. So my point with all these is that many countries in Latin America are looking at science, technology, and innovation as the engine of their future. So exporting bananas, exporting avocados, coffee, it's not really going to make it. It's not really going to be a sustainable, or oil too, a sustainable

Dr. Andres Herrero - I2medi (34:30.552)
Mm-hmm.

Julio Martinez-Clark (34:42.497)
way of leading the country towards the next 20, 30, 50 years. because you're depending on pricing, competition, other countries, if the country next door starts producing bananas cheaper than you, you're going to get caught out of the banana business very easy. So the best way for these countries to compete in a global

Seen is by becoming knowledge societies. And the way you become a knowledge society is by embracing science, technology, and innovation in your country. So with that said, I am seeing the shift of many countries towards that direction. So they are looking at clinical research as a way for them to bring talent.

from overseas to get this transfer of knowledge, advanced knowledge that comes from the United States, that comes from Europe, that comes from certain parts of Asia, to do studies with the local investigators. And eventually that will produce a more innovative society in the local countries. It's like, I usually joke, I tell people, it's like, if you want to have a great soccer team in Colombia, for example.

Dr. Andres Herrero - I2medi (35:58.958)
more innovative society.

Julio Martinez-Clark (36:08.757)
Just bring Messi, Ronaldo, and a few other players, great players, to play in my team for a year. So eventually, Colombia is going to start producing its own Messi and Ronaldo players. So that's the same thing with science and innovation. You have to bring trials to the country to start learning how to innovate. How do you test these hypotheses?

Dr. Andres Herrero - I2medi (36:24.918)
So that's the same thing with science and religion and innovation.

Julio Martinez-Clark (36:34.111)
So this is a great way for countries to become knowledge societies eventually down the road and also to bring foreign direct investment that positively impact the local economies. So I've seen a positive shift in the regulations. I've seen countries like El Salvador, countries like Panama, Paraguay, countries that you wouldn't expect issuing these laws to make the regulatory environment more

attractive, mean friendlier for foreign companies, pharmaceutical medical device companies to come and do clinical trials. Even Mexico is trying its best. It's been difficult because all the baggage that Carrefer-Price has, but even Mexico is doing whatever it can with whatever they have now to make the country more attractive for clinical trials. Brazil, yes, a year or so ago.

issue a new law, two different laws. One for medical devices, one general law for clinical trials that will probably make Brazil a powerhouse for clinical research. Argentina issued a new law in 2017, something like that. So my point is that there's a positive shift towards making countries in Latin America more attractive for clinical trials. So I'm very optimistic about the future.

Dr. Andres Herrero - I2medi (37:59.374)
So I'm very happy to use it with you.

Julio Martinez-Clark (38:00.744)
of Latin America. And before I conclude, there are two events that happened that kind of confirm what I'm saying. Velocity Research, the largest site network in the world, just started an operation in Latin America. They opened an office in Brazil. They are going to start acquiring clinical research sites in Brazil, in Mexico, and in Argentina as a start before they're starting in other countries.

And there's also another private equity company that I forget their name a couple of weeks ago. They just bought their second site in Brazil. So there's a positive win in Latin America for clinical research.

Dr. Andres Herrero - I2medi (38:43.352)
Fantastic, fantastic news. That's a helping you and helping us and helping the customers, the companies and the patients. basically it's helping everybody.

Julio Martinez-Clark (38:49.437)
Yes, exactly. Yes, the patients, they have access. Yes, helping everybody. Patients have access to these innovative technologies faster than before. So, Andres, we're close to the end of the show. Any last comments, any words of wisdom? What would you say to the CEO of a smaller medical device company with an innovative product that is just learning about your services or just learning about Latin America?

What would be your words of wisdom to him or her?

Dr. Andres Herrero - I2medi (39:21.71)
I think I would tell him look at the evidence that has been generated when you buy a stock fund you look into the past to see the future and to predict the outcome and I'm happy to share with everybody of them what we have done our track record in order to convince them that this is the right way

We all have a mission to bring innovation and better therapy and better quality to patients and to doctors, to the societies in Latin America. This is our mission and our vision and everybody with whom we can share this vision is welcome that we do and to try harder to achieve that.

Julio Martinez-Clark (40:08.283)
Excellent. Beautiful. All right, Andres, thank you so much for being in the show today. I look forward to staying in touch.

Dr. Andres Herrero - I2medi (40:11.758)
Thank you so much. Thank you.

Dr. Andres Herrero - I2medi (40:16.253)
Absolutely we will Julio and hopefully soon in 3D

Julio Martinez-Clark (40:20.671)
Absolutely. Ciao.

Dr. Andres Herrero - I2medi (40:21.518)
Hahaha!

So.