Here is what nobody tells you about building a platform technology: the hardest strategic decision is not what you can do. It is what you choose not to do. Yet.

I have spent 35 years investing in and building companies around technologies that change how people live. Semiconductors. Mining. Telecom. And now medical devices. Across every one of those sectors, I have watched the same tension play out. You build something powerful enough to serve ten markets, and the board, your investors, and your own instinct all scream the same question at the same time: why are we only going after one?

The Siren Call of the Platform

Platform technologies are seductive. When you have an architecture that can serve interventional cardiology, pulmonology, hepatobiliary, gynecology, urology, and neurovascular applications, the temptation to chase all of them at once is overwhelming. Every conversation with a new clinician opens a new door. Every clinical paper you read confirms another unmet need your technology could address. The total addressable market math becomes intoxicating.

I get it. I live it. Every single week.

At VerAvanti, we are developing a scanning fiber endoscope platform that could eventually serve procedures from head to toe. One millimeter outer diameter. Piezo-actuated optical fiber. RGB laser forward illumination. An architecture that is fundamentally different from the chip-on-tip cameras the rest of the industry relies on. When you sit with that reality, the natural instinct is to run in every direction at once.

But that instinct, left unchecked, is how platform companies die.

The Focus Imperative

The conventional wisdom in medtech is clear: pick one indication, nail it, get your clearance, build your commercial proof point, and then expand. It is clean advice. It looks great on a whiteboard. And it is incomplete.

Focus matters because regulatory bodies do not clear platforms. They clear specific devices for specific intended uses. The FDA does not care that your technology could revolutionize six specialties. They care about the one you put in front of them. Clinical evidence is built indication by indication. Reimbursement is negotiated code by code. Sales teams are trained specialty by specialty. These are sequential realities, not parallel ones.

So yes, focus is essential. But framing the question as "stay focused or pivot" creates a false binary that ignores how platform companies actually win.

The Real Question

The right question is not whether to focus or pivot. It is how to sequence. How do you honor the platform while building the discipline to win one beachhead at a time?

This is where most founders, and most investors, get it wrong. They treat sequencing as a calendar exercise. "We will do cardiology first, then pulmonology in year two, then hepatobiliary in year three." That sounds orderly. It is also fiction. Clinical development does not care about your Gantt chart.

Real sequencing is driven by three forces that rarely align neatly:

First, regulatory pathway clarity. Which indication gives you the most direct path to clearance? Where is the predicate device landscape most favorable? Where can you build on existing clinical literature rather than generating everything from scratch?

Second, clinical pull. Where are clinicians actively telling you they need what you are building? Not where you think the market is biggest, but where the pain is sharpest. A $500 million market where surgeons are begging for a solution beats a $5 billion market where everyone is comfortable with the status quo.

Third, commercial leverage. Which beachhead creates the strongest pull into adjacent indications? If you win in interventional cardiology and your installed base of consoles can be upgraded for pulmonology with a different probe, you have built a commercial flywheel. If your first indication is an island with no bridge to the next one, you have just built a single-product company with platform costs.

What This Looks Like in Practice

For us, the beachhead is interventional cardiology, specifically chronic total occlusions and complex PCI. Not because it is the only indication where the scanning fiber endoscope could make a difference, but because it sits at the intersection of all three forces. The regulatory pathway builds on established predicate devices. Interventional cardiologists are actively frustrated by the limitations of current visualization in occluded vessels. And a cardiology installed base creates direct leverage into adjacent vascular and structural heart applications.

But here is the part that makes platform founders twitch: while we are building commercial traction in cardiology, we are also advancing the pulmonology program. Not launching it. Advancing it. Running investigator-initiated research. Recruiting key opinion leaders. Building the clinical evidence base so that when the time comes to expand, we are not starting from zero.

That distinction matters. Advancing is not the same as launching. You can run a parallel clinical development program without splitting your commercial resources. You can have a pulmonology KOL generating evidence while your sales team is singularly focused on cath labs. The key is that the commercial machine stays pointed at one target while the clinical engine prepares the next one.

The Investor Conversation

This is also where the investor conversation gets interesting. Early-stage investors want to see focus. They want to know you can execute against one indication and win. Growth-stage investors want to see optionality. They want to know the platform is real and that the next indication is not a five-year science project.

The art is showing both simultaneously without contradicting yourself. "We are a cardiology company" is too narrow. "We are a platform company" is too vague. "We are a cardiology company building a platform" is the right frame. It tells the early-stage investor you will not lose discipline. It tells the growth-stage investor the ceiling is high.

I have raised north of $95 million across multiple companies. The investors who wrote the biggest checks were never the ones who wanted a single-product story. They were the ones who wanted proof that you could execute sequentially without losing the strategic thread.

The Honest Answer

So, is it "stay focused or pivot"? No. It never is. The real discipline is holding two truths at the same time: you must win where you are fighting today, and you must prepare for where you are fighting tomorrow. Companies that only do the first become niche players. Companies that only do the second become vaporware.

The ones that do both build franchises.

That is not a simple answer. But it is the honest one.

References

1. Christensen, C.M. et al., "Innovation in the Medical Device Industry," Harvard Business Review, 2009.

2. FDA Guidance: "Factors to Consider Regarding Benefit-Risk in Medical Device Product Availability, Compliance, and Enforcement Decisions," 2016.

3. McKinsey & Company, "Medtech Platform Strategies: Sequencing Growth Across Indications," 2023.