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Joe Kiani never delivered the neatly typed keynote he carried into the packed ballroom at the LSI USA ’25 summit in Dana Point. He looked at the pages, slipped them into his jacket, and spoke off-the-cuff — about babies who would have gone blind, about billion-dollar court fights, and about a 75-year-old tennis fan who pressed a tiny angel figurine into his hand days earlier. “Maybe,” he told the room, “I’ve had angels watching over me this whole time.” The audience went quiet, then leaned forward.
Fixing a blinking red light
Kiani’s engineering crusade began in an Irvine garage with a $40,000 loan and a nagging question: Why do pulse oximeters fail when a patient moves? His answer — Signal Extraction Technology (Masimo SET) — filtered out motion artefacts that had been costing premature infants their eyesight. Hospitals wanted it; entrenched purchasing cartels did not. In 2002 he teamed with Pulitzer-winner Walt Bogdanich, exposed the pay-to-play racket in The New York Times, and testified before Congress. The market gates swung open.
Angels, IPOs and improbable court wins
The road ahead was anything but angelic. Masimo spent years litigating with giants like Nellcor, Covidien and, later, Apple, eventually winning more than a billion dollars in damages and royalties. Yet Kiani’s favourite statistic is the $35 million he stuffed into a suitcase and handed to employees as surprise bonuses, followed by fat dividends to the early angels who could have been squeezed out before the IPO. “The investors that believe in us are at least as important as the ideas we try to bring to life,” he likes to remind younger founders.
Why control still matters
Success came with a catch. Shareholders holding positions in rival behemoths tried to nudge Masimo away from lawsuits that threatened their wider portfolios. Dual-class shares and tight governance, Kiani now argues, are not ego trips; they protect missions that put patients before quarterly spreadsheets.
Willow Labs: preventing, not patching
Today the 60-year-old engineer is back in stealth-mode start-up territory at Willow Laboratories, surrounded by 90 fellow “purists” on UC Irvine’s campus. Their first product, Nutu, gamifies weight-loss nudges for people with prediabetes; drop five percent of body weight and you can often derail the disease entirely. The bigger bet is to shove diabetes care so far upstream that hospitals never even flip on the fluorescent lights.
Four rules from the arena
Kiani seldom traffics in bullet points, but his improvised manifesto in Dana Point boiled down to four takeaways:
- Recruit craftspeople who care more about solving problems than polishing résumés.
- Let principle, not price, set the product roadmap.
- Work like life depends on it — because sometimes it does.
- Remember the original wound that put you on the path; it will outlast any product life cycle.
A final thank-you
He closed the keynote by borrowing a line from a teenage tennis phenom who had just won her first WTA title: “I’m going to thank myself for not giving up.” The ballroom rose. If med-tech needs a new working definition of audacity, it may be that — thanking yourself not for the money or the patents, but for the stubborn insistence that patients, present and future, deserve better than the status quo.
