On a November morning in 2002, Alex Tilson ran farther than a marathon without surrendering marathon pace. He covered 50 kilometers in 2 hours, 51 minutes and 48 seconds, an American record at the time. The arithmetic is severe: a little more than 31 miles at roughly 5 minutes and 32 seconds per mile. Seven years passed before another runner lowered the mark.
Tilson's record sits outside the usual founder biography, which is exactly why it belongs near the beginning. His career has been a sequence of long, physical problems: propel a car with scarce sunlight; make a mechanical animal move convincingly for a camera; control a surgical robot; manufacture a balloon that behaves reliably under pressure; give a flexible endoscope more stability deep inside the body. He is not a theorist passing through hardware. He keeps choosing work that can break on the bench.
Today Tilson is the founder and CEO of Neptune Medical in Burlingame, California. The company develops endoscopy products built around Dynamic Rigidization, a way of toggling a thin-walled tube between flexible and rigid states. Neptune says its first FDA-cleared product, Pathfinder, has been used in more than 15,000 procedures. Its newer project, Triton, applies the company's control ideas to robotic endoscopy.
The car taught the company
The pattern began at Stanford in 1989. Tilson and fellow mechanical-engineering student Mark Scheeff helped lead the Stanford Solar Car Project. Their teams designed, built and raced several generations of vehicles across the United States and Australia. A 1993 technical report lists Tilson as Stanford's team captain. In a 1991 interview, he called solar cars “the supreme engineering challenge,” even while arguing that they were too constrained to make sense as everyday transportation.
That tension mattered. A solar racer is a rolling budget. Energy is scarce. Weight is costly. Every component negotiates with every other component. Stanford competed with better-funded teams, and Tilson and Scheeff later credited the experience with giving them a lean mindset. Long before startup culture turned “lean” into a shelf of books, they had learned it in fiberglass, battery mass and miles of exposed road.
After Stanford, the route became more eclectic. At Edge Innovations, Tilson worked on animatronic special effects for films including Free Willy and Anaconda. Then came early surgical robotics at Intuitive Surgical, business school at Harvard, new-venture work at Guidant, implantable coronary devices at Converge Medical and extended-wear hearing devices at InSound Medical. The industries look different from a distance. Up close, each job involved building reliable motion inside tight constraints.
A garage and two wrong turns
Tilson's first founder-CEO job began after an unceremonious exit. He was let go during one of InSound Medical's internal purges and started Loma Vista Medical in his garage in 2006. He spent months surveying possible problems before settling on colonoscopy: a large market, established clinical value, aging tools and visible waste. The idea fit his experience. The prototypes did not.
Tilson and Scheeff, who joined first as a consultant and then as the first employee, could not make the system work on a benchtop. Their response was direct. If it failed in a controlled setting, it had no business moving forward. They pivoted toward composite balloons for kyphoplasty, believing stronger materials could produce a stronger balloon.
Then the environment shifted. Procedure volumes weakened, the market's confidence changed and Loma Vista found itself pedaling into the wind. Tilson, a serious cyclist, used that image literally: a rider can be strong and still look ordinary against a headwind. Technical merit does not cancel market direction.
We knew that there was no one else who could help us. If we couldn't make it work, we would die.Alex Tilson, on bringing manufacturing inside Loma Vista
The second pivot took Loma Vista into valvuloplasty balloons. A board member connected the team to the emerging transcatheter-valve market. On one compressed day, they drove a first prototype to Sacramento for a test, edited the resulting video over lunch and continued to Santa Rosa to show it to Medtronic. The prospective partner was interested, but did not act. That gap between interest and action would become its own management problem.
Meanwhile, the manufacturing partner struggled to meet Loma Vista's needs. The core process was a side project to the supplier and the deadlines showed it. Tilson's team made an expensive choice: more than half of its funding went into manufacturing infrastructure. They could not outsource the difficult part, so they chose to own it. The burden became a capability. The capability became hard to copy.
Bad news travels first
Tilson and Scheeff built a reputation for “telling good news early and bad news earlier.” It is a clean rule for an engineering organization. A disappointing test result does not become more useful with age. Market evidence will not soften in a drawer. Speed comes from reducing the lag between reality and decision.
Their hiring reflected the same preference for evidence. Loma Vista favored energy and hands-on design experience over pristine grades. It grew carefully. Before launch, nearly everyone was technical or worked in assembly. For a time, the company could not pay employees. Lean was not a workshop exercise; it was the distance between keeping options and losing them.
When acquisition discussions began, Tilson treated the process like another system to measure. He tracked meetings, site visits, shared advisers, personal relationships and whether a potential buyer truly understood the product, intellectual property and manufacturing. Loma Vista kept running its operating plan through the negotiations. Stopping to admire a possible deal would weaken the company and hand leverage to the other side.
CR Bard acquired Loma Vista in July 2013. Tilson's retrospective lesson was not a romantic one. Relationships mattered. A wide field of potential buyers mattered. Low burn mattered. So did asking for meaningful value upfront, because future milestone payments are never the same as money already received. The company was bought because the product worked, met a real need and was difficult for someone else to reproduce.
The long build gets longer
Tilson founded Neptune Medical the following year. The new company returned, in a different form, to the area where Loma Vista had started. Dynamic Rigidization addresses a fundamental tradeoff in flexible endoscopy: a device needs to bend while navigating, then provide stability and control when the operator needs it. Neptune's Pathfinder line moved through multiple FDA clearances beginning in 2021.
In August 2024, Neptune announced a $97 million Series D financing with significant participation from Sonder Capital and Olympus. At the same time, it spun out Jupiter Endovascular, allowing Neptune to concentrate on gastrointestinal robotics while Jupiter pursued its catheter-based platform. Fred Moll, the medical-robotics entrepreneur who co-founded Intuitive Surgical, had recently joined Neptune as chairman. Tilson's career had looped back toward the field he entered as a young mechanical engineer.
The next public marker arrived at Digestive Disease Week in 2026, where Neptune presented results from a 50-patient first-in-human study of Triton. The company reported that the system met both primary endpoints. These were early results, not an ending. Triton remained a development-stage product, and Neptune's own site made clear that it was not available for sale.
What Tilson appears to want is larger than another accessory. He has said gastroenterologists need better tools for navigation, inspection, detection and treatment, and has framed Neptune's mission as leading a robotic shift in endoscopy. The aspiration fits the résumé: more control, deeper in a difficult physical environment.
There is also a revealing continuity in the people around him. Scheeff, the Stanford solar-car collaborator who became Loma Vista's first employee, now sits on Neptune's board. Moll connects Tilson's brief early chapter at Intuitive to Neptune's current robotics chapter. Olympus, an established endoscopy company, participated significantly in the Series D. These are not proof that the next system will succeed. They show how technical careers accumulate through relationships as well as inventions. Tilson reached the current starting line with collaborators from several earlier ones.
Even the company split follows an old Tilson habit: give a promising technical direction room to become its own operating plan. Neptune kept the GI work. Jupiter took the endovascular platform. One financing event produced two focused organizations instead of one company carrying two development stories. The arrangement echoes the decisions at Loma Vista, where acknowledging a changing market early allowed the underlying materials knowledge to move toward a better application.
There is an easy way to flatten this story into grit. Tilson runs far, cycles across continents and persists through pivots. But grit alone is not the interesting part. His endurance is instrumented. Measure the headwind. Keep the team small enough to turn. Bring the bottleneck inside. Share bad news while it can still change a decision. Continue building while someone considers buying.
A 50K rewards the same clarity. The distance is fixed. The pace is visible. Optimism cannot negotiate with the clock. Tilson has spent more than three decades designing within those kinds of limits. His work suggests a practical definition of the long game: not waiting patiently, but building a system that can keep learning before it runs out of road.