When Siemens Healthineers completed its acquisition of Varian Medical Systems in 2021, Varian president and CEO, Dow Wilson, decided it was time to step down. Looking back on his career, which began in the early 80s and included two decades at GE Healthcare, Wilson shared some of the highlights in an informal interview with HealthCare Business News.

He discusses the importance of being purpose-led in healthcare, his “Camelot” years surrounded by good company at GE, and the challenges he sees on the road ahead for healthcare, and why proton therapy may be the toughest market he’s seen in nearly 40 years of experience.

HCB News: What initially drew you into a career in healthcare?
Dow Wilson: Mostly serendipity. I was one of those college kids that couldn't get enough. I loved all the subjects. I knew I wanted to go on to graduate school, so it was important to me to learn how to think. So, I majored in English Literature, took a lot of philosophy, hard sciences, accounting and economics. After graduating in the summer of 1981 from BYU, I received a temporary four-week job doing data entry for a Booz Allen consulting project.

We were putting Medicare "paid claims" data into an HP3000 in a small computer warehouse in South San Francisco to enable a client to think about their hospital business as a set of products and services, not just a cost-plus profit margin business as healthcare was largely characterized before 1982. The project was the worst! I thought I was going to go crazy doing data entry 10-12 hours a day. In the third week of the assignment, a guy comes up to me and says, "what are you doing?" I told him. Turns out he ran a dedicated healthcare consulting firm. He wanted to make a business out of offering health care clients a new way to think about product line profitability. He told me I could lay out the strategy for them and they'd hire other data entry folks. I was sold. I finished my project for Booz Allen and away I went.

The new firm was spectacular. I got a broad overview of healthcare. We did a lot of financial work for our clients, but also Certificate-of-Needs (I worked on the first CON for the first MR machine in San Francisco), strategy work and more. It was great exposure to the industry.

I then went to business school at Dartmouth — the Tuck school. Coming out, I thought I wanted to go to NYC — doing either investment banking or consulting. My wife, Lynne, had other ideas. Our first baby had just joined the family and she did not like the idea of chasing him around the streets of the city. So I took a job with GE Healthcare in Milwaukee. Of my professional career, I spent 35 years in healthcare/MedTech and two in plastics. I've loved it!

HCB News: Is there anyone specific you credit with helping to build up your interest in the field?
DW: Many great mentors on the way — both at GE and Varian. But I'd have to credit customers and patients most of all. It's one thing we sometimes take for granted in our industry. We get to work with brilliant and compassionate care-givers... focused on curing patients. There's nothing like the purpose-led motivation of a career in healthcare.

HCB News: Prior to joining Varian, you spent 20 years with GE Healthcare. What are some of the most important lessons you learned during that time?
DW: I loved my years at GE. I moved through several important roles, and had the privilege of running the CT business there. At the time, it was one of GE's best franchises across the entire company. The team was amazing. Everyone was focused on the customer and the patient. We delivered four-slice CT innovation with our LightSpeed product. I was also on the ground floor of the PET business — a startup at the time.

I think of those years from 1985-1999 or so as "Camelot". I learned the importance of culture and people. It's interesting to see how many people from those days have gone on to become CEOs of big healthcare companies (Omar Ishrak, John Chiminski, Mike Mahoney, Mike Minogue, Peter Arduini, Joe Hogan, Jim Davis, ... to name just a few). These were all people I got to work closely with and they taught me a ton.

HCB News: How has the healthcare industry changed since you first entered it?
DW: I'd have to check the exact numbers, but I think healthcare as a percentage of GNP in 1983 was probably around 8%. Today it's more than twice that. So, some of it is just scale. With that scale has come both good things and bad things. Sometimes we don't move as fast as we did in the old days. On the other hand, I do like the orientation today around evidence-based medicine. Grounding innovation in either outcome or productivity has to be the way we focus innovation.

HCB News: What are some of the core values that shaped your career?
DW: I loved my first 15 years at GE, largely because there was great congruity between my values and the company's values. That started to change at some point. In particular, the company became much more internally oriented. It seemed to me that performance didn't matter so much as “how-good-was-your-presentation?” I loved the competitiveness of GE... and it brought out mostly the best of people. But when the incentives on growth, profitability, and market share started to be crowded out by other cultural norms... it was time to go.

So, I left in 2005. I joined Varian then as part of a long-term succession planning process. I loved Varian. I really enjoyed the transition from the diagnostics side of the business to the therapy side. It was always a purpose led company, and my leadership challenge was to make it even more focused on beating cancer. Our goal wasn't to snuff out our competitors (though growing market share was part of what we had to do), but to snuff out cancer! I found that inspiring — to have 11,000 of us focused on that goal together felt great.

While I was CEO, we nearly doubled our investment in R&D, from 5-6% of sales to nearly 10% of sales. It wasn't innovation for innovation’s sake, but focused on improving clinical outcomes and making our products safer and easier to use. It was a dream to do it with 11,000 friends. And over 15 years, we grew the number of patients we were treating or helping in one way or another from hundreds of thousands to many millions. The chance to lead such a purpose-led organization was a dream.

HCB News: Proton therapy expanded rapidly during your time as CEO of Varian. Do you have an idea of what the next chapter holds for protons?
DW: That's a really good question. Proton therapy is amazing. I just had the chance to refer a friend's 27-year-old relative with a brain cancer to one of our proton centers. For protons to be successful, it has to make sense clinically, financially and socially. There's good data to show the benefits of proton therapy in pediatric cancers, recurrent cancers, and advanced cancers requiring chemo and radiation together. How much capacity do we need to deliver protons in those cases? That's the question. Proton therapy can't follow a model where it diffuses aggressively on economic terms, like has happened in other medical technologies. it's just too expensive for that.

I am very excited about the prospects of the FLASH (super-high, super-fast doses of radiation) technology. It has the prospect of both improving cancer outcomes and lowering cost. At the end of the day, it may just come down to economics. I don't think any manufacturers are making any money in proton therapy and very few customers have managed to have it make sense. The small market and low volumes make investment in R&D very difficult. Varian and others have been at this a very long time now and I'd be surprised if anyone is anywhere close to a cumulative cash flow positive scenario. It is the toughest market I think I've seen in my nearly 40 years of medical technology.

HCB News: What is one of the best pieces of advice you've ever received?
DW: Early in my career, Jeff Schaper — an SVP whom I worked for at GE Healthcare — told me, “Talk personally to 50 people a day." Early in my career that was really hard. Later in my career, it was much easier... but still difficult. The point is to have individual conversations with 50 people every day. Conversations where there is real dialogue — growth, understanding, empathy, equality. Talking at a crowd of 50 doesn't count. It's got to be personal and you have to have a listen-to-speak ratio greater than 1!

HCB News: How are you spending your time these days, now that you've retired?
DW: Retirement so far is great... I miss the thrill of working on innovative new products that will make a difference clinically and operationally. I don't miss the stress of the constant 90-day cycle that unfortunately characterizes a lot of our business world. I am on a couple boards and I'm volunteering in a number of philanthropic initiatives with my wife Lynne, that we are finding very fulfilling. We are especially enjoying trying to help the significant refugees — Ukrainian, Afghan, Latin American, etc. – find a footing in our country.

HCB News: Any big picture predictions for the future of the healthcare industry?
DW: I have a brother who never weighed more than 160 pounds... ate carefully his whole life... exercised everyday religiously... but has bad cardiac genes (I, unfortunately, have the same genes). He had a massive heart attack at 60. He's on an LVAD (Left Ventricular Assist Device) which has basically taken over the pumping of his heart. It's a miraculous device and he wouldn't be here without it so we are very grateful. What he needs, though, is a wireless, tubeless LVAD or a heart transplant! The capacity of potential transplant hearts is way too small. Who's going to develop organ generating tools for hearts, kidneys, etc.? Wow... what an innovation that would be. And it's hard to imagine that we eventually couldn't do it much cheaper than a transplant. Well, that's a bit out of our field of cancer, but something that's personal to me right now.

I remain firmly committed to the belief that healthcare is an innovation game. It's a fair criticism that sometimes we innovate for innovation’s sake without a clear way of paying for the innovation or measuring its clinical impact. More and more though, I think the MedTech world and its customers are doing a much better job of gathering evidence to demonstrate the benefit of innovation. We need to do more of it. We have to find ways to make a better clinical impact at a lower provider and patient cost.