By Lewis I. Rice

Nassib Chamoun, E'84, writes on a whiteboard, looking like the teacher he might have become. He's explaining his company's financial history. This is almost as intricate as the lecture he could give on biomedical signal processing.

There were fifteen rounds of financing, totaling more than $165 million. They started with Chamoun's own credit cards, then progressed to funding from venture capital firms, an initial public offering, and a corporate partnership.

Chamoun pauses to recount a milestone in the process that, to him, is just as important—perhaps even more so—than the rest of it. Before raising the money from the IPO, he notes, the company nearly went bankrupt.

He says this with the good cheer of a CEO who knows his company, Aspect Medical Systems, recently turned its first profit after eighteen years of existence, whose stock price has more than doubled over the past year.

A medical-device manufacturer, Aspect produces brain-monitoring technology—called bispectral index, or BIS, technology—that assesses the consciousness of patients under anesthesia. To date, BIS technology has been used to monitor more than eleven million anesthetized patients. It may prove to have wider applications for understanding clinical depression and Alzheimer's disease.

But Chamoun's not merely happy the tough times seem to be behind him and his company.

He's happy he had to go through the tough times.

Minding the business

In that sense, Chamoun has been fortunate indeed, with many chances to learn from adversity, both professionally and personally.

The lessons began at an early age. He spent his teen years in Lebanon, his homeland, during a bloody civil war. Arriving in the United States for the first time as a Northeastern undergraduate, he faced anti-Arab slurs. The money for his education suddenly dried up. Later, the company he founded dodged two near bankruptcies, a tortuous FDA clearance process, and a clinical trial that "blew up spectacularly," he says.

Along the way, Chamoun, who serves as Aspect's president and a member of its board of directors, learned the secret of success: capitalizing on failure. "Success is sometimes blinding and can hurt more than help," he says, "because people lose touch with reality and think they're the best. And they get complacent. They get arrogant. Success is very bad if you don't rein it in and put it in perspective. In fact, I think failure is a greater motivator and driver of focus for me and this company, in trying to understand what went wrong. And truly learning from it to do better."

With this willingness to embrace setbacks, it's not surprising Chamoun chose an entrepreneurial path over the safer courses available to him. After graduating from Northeastern with a degree in electrical engineering, he earned a master's in computer engineering at Boston University. He conducted PhD research on cardiac electrophysiology at the Harvard School of Public Health's Lown Cardiovascular Research Laboratory, under the direction of cardiologist Bernard Lown, who received the 1985 Nobel Peace Prize for cofounding the group International Physicians for the Prevention of Nuclear War.

One day, an anesthesiologist doing a fellowship at the lab told Chamoun that, sure, the heart is interesting, but he really ought to look into the most vital organ of all, the brain. He explained that, thousands of times a day, in hospitals across the world, patients undergoing surgery are given drugs to alter their brain function, rendered unconscious, then woken up. Yet no one knew how the process affects the brain. If someone could find out? That would be a groundbreaking innovation.

The anesthesiologist's challenge made an impact on Chamoun, who accepted an invitation to observe an operation. Ultimately, he decided to set up a company that would develop a brain monitor for use during surgery. "As an engineer, you always try to figure out if you can come up with a solution," he says. "It was a fascination for me to try to understand the brain better. And the anesthesia application seemed to be a very logical first place to start."

But when Chamoun told Lown, his mentor and adviser at Harvard, that he was planning to drop out of school to start the company, Lown told him that was anything but logical, beseeching him to remain in academia. Another mentor did just the opposite. Charles A. Zraket, E'51, H'88, the former head of Mitre Corporation, in Bedford, Massachusetts, told Chamoun an academic setting likely wouldn't offer him the time or the money to accomplish his goals.

The latter's advice resonated with Chamoun, and not just because Zraket, who died in 1997, was a fellow Northeastern grad of Lebanese descent. The risks and rewards of business appealed to him. The pace and bureaucracy of academia didn't. Yet he remains grateful to the Lown Cardiovascular Research Foundation for fully funding his graduate studies, and credits Lown himself with imbuing in him the social mission that helped form Aspect's identity.

Chamoun started his company in 1987 at the age of twenty-five. He figured it would take two or three years and a few million dollars to perfect a technology that would transform patient care.

Measure of success

Aspect's headquarters is located on a busy street in Newton, Massachusetts, lined with retail outlets like Filene's Basement and New England Mobile Book Fair. (Aspect also maintains an international office in the Netherlands.)

The building contains not only the corporate offices, but 20,000 square feet of manufacturing space, where the company's BIS sensors and monitors are assembled and shipped. Like the nearby retail stores, Aspect is a volume business, one that pumps out an average of 18,000 sensors a day. In a room filled with electronic components, circuit boards, and cables, workers assemble and test monitors. Adam King, AS'00, an Aspect communications associate, says the company sometimes sends e-mails looking for employees who'll volunteer their heads for fifteen minutes to help check equipment.

About a third of all U.S. operating rooms have adopted BIS technology, which is used in 160 countries. Sensors affixed to patients' foreheads allow the attached monitor to measure consciousness on a scale of 0 (absence of brain activity) to 100 (fully conscious). The information helps anesthesiologists assess a patient's level of consciousness and adjust anesthesia as needed, generally aiming for a reading between 45 and 60 during surgery.

John Coolidge, vice president of manufacturing operations, says to keep inventory lean Aspect tries to manufacture day by day only about as many products as it sells. The company's operation is modeled after the Toyota production system, or Kaizen method, which rewards employees who make suggestions that improve efficiency.

The CEO encourages an all-for-one attitude at every level of the company. The trimly built forty-three-year-old dresses in the same casual manner as his employees, often wearing a white pullover shirt with the letters BIS imprinted on one short sleeve. Before he launched Aspect, he had never managed a business. He understands his limitations, he says, and credits others for bringing business savvy to the organization and developing technology for the prototype he invented.

Philip Devlin, E'79, ME'83, who joined Aspect in 1990 as the director of product development, enthuses about working at a start-up company after his stints at Raytheon and Beth Israel Hospital. He likens the experience to a roller coaster, exciting for those with the right temperament. "We've had a lot of ups and downs," he says.

Chamoun is a great engineer and visionary, he says. Just as important, he knows when to let go.

"Some entrepreneurs fail because they can't grow with the company," says Devlin, now Aspect's vice president and general manager of neuroscience. "They have to control everything. Nassib does have that entrepreneurial spirit, where it's very important for him to be involved in all aspects of the business. But he's had to learn how to let the company grow, and empower others."

Chamoun says he laughs now at his early "entrepreneurial naivete," which shielded him from the reality of how difficult his venture would be.

For example, the FDA clearance process for the BIS sensor took nine years, following a failed clinical trial that examined patient movement under anesthesia. "If you're deep, you shouldn't move. If you're light, you should move. But there was almost no association," Chamoun remembers. "You couldn't design a more spectacular failure in a clinical trial, even if you planned it that way. Most people would have packed their bags and said sayonara."

Instead, Aspect personnel designed another trial that looked at consciousness and sedation. They were able to show that using BIS technology reduces the amount of drugs patients receive, lessens nausea and vomiting, and accelerates recovery—practical benefits that brought FDA clearance in 1996, and allowed Aspect to become the first company to sell a product that measures the effects of anesthesia on the brain.

Medical awareness

In 2003, the FDA granted clearance for a new indication for BIS monitoring, related to intraoperative awareness—when undersedated patients awaken during surgery but remain unable to move or speak (and therefore can't indicate they're awake). These rare but traumatic instances gained national exposure after being described by a 1997 Time magazine article.

Studies showed BIS monitoring helped reduce such incidents by approximately 80 percent. The Time article quoted Chamoun calling his device "anesthesia's Holy Grail."

Not all anesthesiologists have shared his enthusiasm, however. In a commentary published earlier this year in the American Society of Anesthesiologists newsletter, Dr. Orin F. Guidry, the organization's president-elect, wrote, "There are a number of anesthesiologists who have not embraced the technology and loudly question either the value of the monitors or the way they are marketed." In a letter published last year in the same newsletter, one member asked the organization to "take out large, one-page ads in USA Today and other media outlets to counter this ongoing campaign by Aspect Medical (the manufacturer of the BIS monitor), which frightens and misinforms our patients."

One of Aspect's challenges, says Chamoun, has been to convince anesthesiologists to change the way they've practiced their specialty for decades. Raising a difficult topic involving patient safety engenders resentment among practitioners, he adds.

"The minute the issue of awareness came up, that created a lot of controversy, created a lot of anxiety, and created some frustration for those who just didn't want to talk about it," he says. "And it's created what I would say is a certain amount of tension between some members of the specialty and Aspect, because we were talking about an adverse outcome, a complication that probably doesn't make some feel comfortable."

According to Chamoun, anesthesiologists' resistance to the technology is subsiding. He notes that Guidry in his commentary urged ASA members "to do what is best for our patients based on science and not paint ourselves into a corner by opposing brain function monitoring because of external forces."

Indeed, every claim Aspect makes is backed by science, says Chamoun, who points to more than 1,900 published studies that support the benefits of BIS technology. Early on, the company marketed its products by touting their capacity to monitor for awareness, not their capacity to reduce the risk of awareness. Only when clinical studies showed that occurrences of awareness were reduced with the use of BIS monitoring did the company begin to make that claim, he says. Aspect's marketing strategy also emphasizes that the technology helps hospitals save money, by reducing sedative drug use and length of stay in intensive care units.

Over the next few years, Chamoun predicts, applications for BIS technology will expand beyond the world of anesthesia. Toward that end, he announced in May a partnership with Boston Scientific, a giant medical-device manufacturer headquartered in Natick, Massachusetts. The company, which owns 27.5 percent of Aspect's stock, will provide $25 million for research into the diagnosis and treatment of clinical depression and Alzheimer's disease.

Aspect believes its technology will lead to huge advances here. The company cites studies that indicate brain monitoring can predict in a few days whether an antidepression treatment is likely to work, thereby improving patient care and compliance, and can also identify the cognitive decline that precedes the onset of Alzheimer's.

Across all the hoped-for applications, the market potential for Aspect's technology would amount to several billion dollars of annual revenue, says Chamoun. This would, of course, make him and the company lots of money. But, when he discusses the future, he focuses on the social ramifications, the satisfaction of helping possibly tens of millions of patients every year.

"That's really the goal we're shooting for," he says. "Truly taking brain monitoring and turning it into a tool that's as practical, useful, and easy to use as the electrocardiogram, and making it part of managing and enhancing the care for millions of patients in the hospital or the doctor's office."

Entrepreneurial passion

In Chamoun's eyes, you're either an entrepreneur, or you're not. The same might be said about scientists. You either approach decisions scientifically, or you don't.

When it came to romance, Chamoun operated like a scientist. As the head of a small start-up, he worked eighty hours a week. He didn't like the atmosphere in bars, or the cigarette smoke. So he turned to the logical solution: personal ads.

Over the course of three or four years, he met more than a hundred women. It was a great opportunity, he says, to learn about the kind of relationship he wanted and the kind of person he wanted it with.

"It was almost a process," he says. "It wasn't just because I met somebody and said, ?ÄòLet's get married.' Those are lifetime decisions. You want to be with somebody who shares your values, your religion; who can accept your culture, and contribute their culture to help bring children up properly, to help educate them, to be a good parent, teacher, or mentor to them."

He found that person in his wife, Maureen Kelly-Chamoun. When they met, she worked as a speech pathologist, helping students in the Boston public schools during the day, the elderly at nursing homes in the evening. He liked her sense of compassion and work ethic, and felt she could guide a family's life and education. Now Maureen stays at home raising the couple's four children, ages ten, eight, six, and four. Chamoun says he's glad for the children's sake that she was raised in this country, because she understands far better than he what it's like to grow up here.

A tranquil childhood in Boston is certainly a long way away from what he knew. His home country, he says simply, was a mess. Before coming to Northeastern, he was barely able to attend school at all. Lebanon's schools shut down for extended periods during the country's civil war, which began in 1975. As a teenager, Chamoun was forced to educate himself, largely missing the three years of coursework that were supposed to prepare him for college.

"I absolutely consider that the civil war robbed me of my teenage years," he says. "I was very desperate to get out and have a new home and new country. I really wanted to put it behind me and move on. Coming to Northeastern was the best thing I've done."

He had learned about the school from an uncle, a graduate of Boston University and Harvard Business School, who urged him to study in Boston. Northeastern, he told his nephew, had a reputation as a cosmopolitan school flexible about accepting international students.

That was true, says Chamoun. But when he arrived in America in August 1980, in the midst of the Iranian hostage crisis, he entered an atmosphere of hostility toward people of Middle Eastern descent. Walking around campus, he heard "f—-ing Arab" and the like regularly. (Back in his homeland, as a Lebanese Catholic, he had faced bigotry because he was not Muslim.)

He used the insults to his advantage. Every time people mocked his heavy accent, he would ask them how to say an English word correctly. The harsh treatment forced him to adapt and work harder, he says. Like many immigrants to the United States, he believed it to be a country in which hard work was rewarded.

At Northeastern, he added credits to his course load, wanting to finish his degree quickly. He even petitioned to opt out of the co-op program, telling his stunned adviser that it would be a waste of his time. But he soon needed a co-op job to help pay for school when he lost his parents' financial support after Israel invaded Lebanon. The Lown Lab, which would later accept him as a teaching and visiting fellow, offered him that co-op. He finished his five-year undergraduate program in three years, three months.

Now Aspect is itself a Northeastern co-op employer. Students and all other employees are given a statement of company values, which advises that adversity breeds opportunity and emphasizes the honoring of commitments.

"I'm the anti grass-is-greener philosophy guy," Chamoun says. "Everybody thinks, If I trade my wife, I'm going to get a better wife—or my job. It doesn't mean that, in certain circumstances, that's not the case. But people overdo it, and you end up with people who just spend life bouncing around between jobs, between relationships, and end their lives with nothing to show for it.

"You've got to stick with it," he says. "Think deep down inside about who you want to marry, what kind of job you want to do, and why you want to do any of the things you want to do in life, and just stick to that through thick and thin."

Over the course of a conversation in his office, Chamoun has cataloged all the struggles he's faced during eighteen years of building a company. Now he says, almost as if he were dissecting a case study in front of a class, "If you had known how hard it would be, would you have done it?"

It's a question he doesn't need to answer.

Lewis I. Rice, MA'96, is a freelance writer who lives in Arlington, Massachusetts.

  Nassib Chamoun
  Photography by Webb Chappell