SAN FRANCISCO — Jan Garfinkle is not your typical VC founder, and not just because she’s a rare woman running a venture capital firm she founded nearly two decades ago. Though she hails from the Bay Area, she started Arboretum Ventures, a health care VC firm, in Ann Arbor, Michigan. She also serves as the chairwoman of the National Venture Capital Association.
Garfinkle worked at two medical device startups — both of which were bought by Eli Lilly and then spun off in an initial public offering in 1994 — before leaving California for the Midwest. She shared her perspective on medical innovations and the disgraced blood diagnostic startup Theranos in a recent interview with The Associated Press.
Q: What it’s been like to be outside of the VC hubs like Silicon Valley and New York?
A: The biggest advantage of being in the Midwest is that we can develop companies here for about a third less dollars than what it takes on the coast. And that’s because of salaries and rents and vendor costs and all those things combined. We are able to develop the company to the same point to have a successful exit, but it takes us a third less dollars.
Q: You started out in the Bay Area, what happened?
A: My husband had moved to California to marry me because that’s where the startups were. But after a couple of years he was unhappy so I said OK, find another job in the Bay Area or Seattle. Well, he found one in Ann Arbor, Michigan. Around that time we had three little girls. I couldn’t do everything. I had a baby and then 18 months later I had twins. It was just really crazy.
I did not want to leave. But I had to, or get divorced, and I didn’t want to get divorced. This is one of the challenges of two-career families, that someone is always compromising. My husband had left a great job in Chicago. So it was my turn to move for him.
I did consulting for seven or eight years, then tried to work at the two medical venture funds in Ann Arbor at the time. It didn’t work out. So after leaving an interview with one of them, I went home and went to IRS.gov, filed for a tax ID number and started Arboretum. I just decided to jump right into it, which was extremely naive. I had no idea what to do on the venture side. What I knew was how to help early stage health care companies.
Q: What big trends did you see then that are still happening today?
A: I was starting to feel both as an employer and an employee that we were starting to bear more and more of the costs of health care. And I had a fundamental belief that through innovation we should be able to drive the cost out of the health care system but still provide great clinical care. Back then, health care spending was 12 per cent of the GDP. Now it’s 18 per cent.
Q: How does that work in practice?
A: We target trying to reduce 20 per cent of the episode of care. We’ve invested now in 50 different companies and they on average they hit that that milestone. One company, Inogen, is an oxygen concentrator. Inogen developed this little 5-pound, now 3-pound portable oxygen concentrator that replaces both the tanks and the stationary devices used by people who need oxygen who’d normally be tethered to these big, heavy devices.
Q: Theranos. From your perspective, how did something like that happen?
A: I think the biggest mistake that happened there was that there was nobody on the board who had ever invested in or run or been part of a health care company. So the oversight, the governance, the ability to really question what the company was doing was not there because the board, while they were all very famous people, didn’t know the right questions to ask and the right diligence to ensure that nothing shady was going on.
Q: Where do you think the most interesting new inventions are going on right now in health care?
A: Genomics is one of the big ones. Look at cancer as an example. Cancer is going to become a chronic disease, primarily because there is now this ability to take a biopsy of a tumour and you can do genomic sequencing on it and identify what gene mutation happens that caused that tumour and then you can give a drug that targets that mutation. The other is a wave of new technologies called digital therapeutics. These are essentially using your phone to provide therapy. We are an investor in a company called Pear Therapeutics that has FDA approval for cognitive behavioural therapy for addiction.
Q: How might the elections affect the venture space?
A: When there is so much regulatory turmoil like there is now and such division between Democrats and Republicans, it makes it hard. The entrepreneurial ecosystem is somewhat fragile. So if I had a wish list, it would more regulatory certainty. Sometimes startups aren’t thought about. We’re not Google and we’re not Facebook, they have all these issues that they’re trying to address and people forget about the little startup companies that may get caught up in something that was not intended for them.
Barbara Ortutay, The Associated Press
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Your daily look at late-breaking news, upcoming events and the stories that will be talked about today:
1. MORE INFORMATION ON THE PRESIDENT’S ACTIONS
A second whistleblower has come forward with details about Donald Trump’s dealings with Ukraine, adding to the impeachment peril engulfing the White House and potentially providing new leads to Democrats in their unfurling investigation of Trump’s conduct.
2. KEY CHANGES IN MIDDLE EAST CAMPAIGN
U.S.-backed Kurdish-led forces said American troops began pulling back Monday from positions along the border in northeast Syria ahead of an expected Turkish invasion that the Syrian Kurds say will overturn five years of achievements in the battle against the Islamic State group.
3. WHO WAS LOOKING FOR BUSINESS DEALS IN UKRAINE
As Rudy Giuliani was pushing Ukrainian officials last spring to investigate one of Donald Trump’s main political rivals, a group of individuals with ties to the president and his personal lawyer were trying to install new management at the top of Ukraine’s massive state gas company and steer lucrative contracts to companies controlled by Trump allies.
4. TWO AMERICANS, ONE BRITON SHARE NOBEL
The 2019 Nobel Prize for Physiology or Medicine has been awarded to scientists William G. Kaelin, Jr, Peter J. Ratcliffe and Gregg L. Semenza for their discoveries of “how cells sense and adapt to oxygen availability.”
5. NO END IN SIGHT FOR GM WALK OUT
Contract talks aimed at ending a 21-day strike by the United Auto Workers against General Motors have taken a turn for the worse, hitting a big snag over product commitments for U.S. factories.
6. ENVIRONMENTALISTS WANT CHANGES
Activists with the Extinction Rebellion movement blocked major roads in Berlin and Amsterdam on Monday at the beginning of what was billed as a wide-ranging series of protests demanding new climate policies.
7. EXPERTS SEE U.S. ECONOMY SLOWING
The nation’s business economists think President Donald Trump’s trade war with China will contribute to a sharp slowdown in economic growth this year and next, raising concerns about a possible recession starting late next year.
8. TOP JUDGES TO DECIDE ON CRUCIAL ISSUES
The justices are returning to the Supreme Court bench for the start of an election-year term that includes high-profile cases about abortions, protections for young immigrants and LGBT rights.
9. ROCK LEGEND GINGER BAKER DIES
The volatile and propulsive drummer for Cream and other bands who wielded blues power and jazz finesse and helped shatter boundaries of time, tempo and style in popular music died Sunday at age 80.
10. BASKETBALL AND POLITICS IN UNEASY MIX
Houston Rockets general manager Daryl Morey tried Sunday to defuse the rapidly growing fallout over his deleted tweet that showed support for anti-government protesters in Hong Kong, saying he did not intend to offend any of the team’s Chinese fans or sponsors.
The Associated Press
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CARSON CITY, Nev. — Elizabeth Warren was greeted by Republican activists chanting “Stop impeachment!” as she strode toward baggage claim at a Nevada airport. There were more protesters at a Carson Center rec centre where she spoke, including one atop hay bales yelling “Trump 2020” until he was hoarse. And during her speech, Warren was interrupted by a man screaming “you’re all socialists!”
Warren wasn’t in Manhattan anymore.
The Massachusetts senator has proven she’s popular in Democratic strongholds, perhaps most memorably when she filled New York’s Washington Square Park last month. But as she’s rising in the polls and sitting on a fresh pile of campaign cash, Warren is also frequently hitting places where she might be less welcome. That includes Nevada’s capital, a conservative area with a proud cowboy streak that’s a seven-hour drive from the glitz of Democrat-friendly Las Vegas.
These trips test whether the progressive message that has fueled Warren’s rise can resonate in all regions. It’s an important hurdle for Warren to clear to prove that, if she were to become the Democratic nominee, she could win back voters in areas that sided with President Donald Trump in 2016.
Her trip last week to Carson City gave reason for optimism. Warren drew more than 1,000 people on a Wednesday night. And some of the loudest applause followed Warren’s most progressive pronouncements, especially when she declared: “I don’t want a government that works for giant multinational corporations.”
“It’s easy to think everything here is Reno,” said Jonathan Byrnside, a 38-year-old federal employee who came to see Warren from nearby Silver City. He was referring to the better-known locale famous for casinos — and, in a bygone era, lenient divorce laws — about 25 miles away, where Warren’s airport run-in occurred. “But there are a lot of people with progressive values who live in rural areas.”
It was Warren’s third visit to northern Nevada and she’s not the only Democratic presidential hopeful venturing into Republican areas. Sen. Bernie Sanders of Vermont came a few weeks ago, while former Vice-President Joe Biden visited Reno the same night Warren was in Carson City. California Sen. Kamala Harris was on the campus of the University of Nevada at Reno the following day.
Still, Warren’s crowd was larger than any of the others. The complex’s floor was so full that some attendees dragged metal benches to climb atop for a glimpse of the distant stage.
“This is huge for Carson City,” said 74-year-old Jim Woods, a retired construction engineer. Added his wife, Dianne: “This is red territory. It doesn’t look it now.”
Others aren’t so sure.
“Working-class America isn’t swayed by one stopover in Carson City,” said Rory McShane a Nevada-based Republican strategist who said the area’s ranchers are threatened by policies like Warren’s signature “wealth tax,” because it would potentially hit families with property worth millions even if they themselves are barely scrapping by.
Some supporters of her Democratic presidential opponents have grumbled, meanwhile, that any well-known Democrat can stage large rallies in reliably blue areas featuring $6 lattes and craft beer that outsells Budweiser. They question whether Warren’s core message of remaking the political system to empower everyday people may get lost in hipster-heavy locales that suggest she’s too elitist to appeal to the very working-class voters she’s most trying to excite.
“She’s trying to create the image that she’s getting these big crowds so she knows where they’ll play best,” said Ed Rendell, a former Democratic Party chairman and Pennsylvania governor who called Warren “unelectable” because of her vows to do away with private health insurance for a single payer “Medicare for All” plan.
Warren’s campaign notes that she’s spent months travelling to often deeply conservative areas, holding 139 town halls nationwide, including in West Virginia, Arizona and Alabama.
“The American people know the government is not working for them,” said spokeswoman Saloni Sharma. “She’s building a grassroots movement in red states and blue states — cities, suburbs and rural areas — to take on the corruption in Washington and make our country work for every person.”
Still, the criticism by those backing her Democratic White House rivals highlights what sometimes seem to be Warren’s dual personalities. The senator says in her heart, she’s the daughter of a poor Oklahoma family that clawed its way back from economic ruin who wants to help others now facing similar circumstances. But she’s also a former Harvard professor comfortable lecturing to the intellectual set and appearing in the likes of director Michael Moore’s anti-big business documentary “Capitalism: A Love Story.”
A night after her swing through Carson City, Warren held a rally that was more to type. She addressed a crowd that her campaign estimated at 8,500 that thronged a grassy park in downtown San Diego, buffered by swaying palm trees and cool breezes off the Pacific. The second-largest city in the largest blue state isn’t a Democratic stronghold but sports many a neighbourhood famous for hipster prowess, and locals welcomed Warren adoringly as expected — with lines snaking for blocks, thunderous cheering and some attendees leaving home more than three hours before the event to be sure they could get in.
Even in San Diego, however, Warren’s progressive side shone through. She was introduced by California state lawmaker Lorena Gonzalez, a longtime labour leader who endorsed the Massachusetts senator on behalf of “working Californians.”
Matilda Mclaughlin, a 67-year-old retiree from Carlsbad, California, said Warren’s message runs counter to the idea that big crowds in places like San Diego will breed resentment among would-be supporters elsewhere.
“Her manner is approachable, it’s understandable and it’s decent. It’s not vulgar. She’s not looking to make enemies,” Mclaughlin said. “She’s looking to really draw us together, and why shouldn’t we? It’s time for the United States to grow up.”
Will Weissert, The Associated Press
The biggest cases before the Supreme Court are often the last ones to be decided, and the focus on the court will be especially intense in June, just a few months before the 2020 election.
A look at some of the high-profile cases the court will hear in its term that begins Monday and runs through early summer 2020, and when the cases are being argued, if a date has been set:
LGBT rights (Tuesday)
Title 7 of the landmark Civil Rights Act of 1964 prohibits discrimination in employment on the basis of sex, among other categories. The question for the justices in two cases is whether that provision protects people from discrimination in the workplace because they are gay or transgender. The sexual orientation case involves a fired skydiver in New York, who has since died, and a fired county government worker in Georgia. Aimee Stephens, a fired funeral home director in suburban Detroit, is at the centre of the case about gender identity. The Trump administration has reversed the Obama administration’s support for the workers.
Protections for young immigrants (Nov. 12)
President Donald Trump first announced his intention in 2017 to end the Obama-era program that protected from deportation and gave work permits to roughly 700,000 people who, as children, entered the country illegally or overstayed their visas. The Deferred Action for Childhood Arrivals program was never authorized by Congress. At issue before the court is whether the way the administration has tried to wind down the program is lawful. There seems to be little debate that Trump has the discretion to do so, as long as his administration complies with a federal law that generally requires orderly changes to policies.
Abortion (no date set)
Louisiana’s law requiring doctors who perform abortions to have admitting privileges at local hospitals is virtually identical to a Texas measure the court struck down in 2016. What’s different is that Justice Anthony Kennedy, part of the majority in 2016, has retired and been replaced by Justice Brett Kavanaugh. Both appointees of President Donald Trump, Justice Neil Gorsuch and Kavanaugh dissented in February from a decision to keep the Louisiana law on hold. Now they will hear their first major abortion case. The outcome could reveal whether the justices are willing to uphold more state abortion restrictions.
Religious school funding (no date set)
The Montana Supreme Court struck down a state program that provided tax credits for contributions to a private school scholarship fund because religious schools were included in the program. The state court said the program violated a state constitutional ban on sending public funds to religious institutions, even indirectly through the scholarship program. Montana parents are challenging the ruling as a violation of their religious freedom under the U.S. Constitution.
Juvenile sentencing (Oct. 16)
The issue of life with parole sentences for juveniles is back before the court in the person of Lee Boyd Malvo, who as a teenager terrorized the Washington, D.C., region in 2002 as one-half of a sniper team. At issue for the justices is whether Malvo should be resentenced in Virginia in light of Supreme Court rulings restricting life-without-parole sentences for crimes committed by juveniles. The case gives the more conservative court the chance to put the brakes on what has been a gradual move toward more leniency for juvenile offenders.
“Bridgegate” (no date set)
Bridget Anne Kelly is the aide to then-New Jersey Gov. Chris Christie whose email — “Time for some traffic problems in Ft. Lee” — led to the Bridgegate scandal: lane closures on the New Jersey side of the George Washington Bridge to punish a local officeholder. Kelly was convicted of fraud. The justices have agreed to hear her argument that her actions must be viewed in the rough and tumble of politics and did not constitute a crime.
Insanity defence (Monday)
Kansas is among five states that have abolished the insanity defence in criminal cases. Lawyers for a Kansas man who has been sentenced to death for killing four members of his family argue states must allow an insanity defence under the Constitution.
Non-unanimous juries (Monday)
Oregon is the only state in the country that still allows for criminal convictions in some cases even if the jury is not unanimous. Louisiana voters did away with the practice starting this year, but the court will hear from a Louisiana defendant who is serving a life term for killing a prostitute after being convicted by a 10-2 jury vote while the old rules were still in place. The Supreme Court previously decided that while federal trials require a unanimous verdict, states could set their own rules. The justices appear likely to set a uniform rule on unanimity, just as they did in a case last term when they held that the Constitution’s ban on excessive fines applies to the states as well.
Guns (Dec. 2)
A case from New York City could be the court’s most significant word on gun rights in a decade, or it could go away altogether because of changes in local and state law since the justices agreed to weigh in. At issue is a New York City ordinance that prohibited licensed gun owners from carrying their unloaded weapons to shooting ranges or second homes outside the city. New York has amended the ordinance and the state also has passed a law requiring local governments to allow licensed gun owners to transport their weapons. That could make the case go away, even if the justices often frown on an effort by one party to end a case after it has been accepted for review.
The Associated Press
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NEW YORK — Telling half-truths and outright lies. Manipulating media coverage. Pushing legal boundaries. Pressuring subordinates to do the dirty work. Believing in the force of his own personality. Accepting no personal responsibility.
The playbook Donald Trump has used as a real estate developer, celebrity businessman and political candidate has, for the most part, proved effective through the first two-plus years of his presidency.
He has shown an uncanny ability to wriggle out of jams that might have doomed just about any of his predecessors.
That M.O. may finally be catching up to Trump amid the House’s impeachment inquiry. The tactics that helped win the White House have jeopardized his hold on it, ensnaring him in accusations that he enlisted a foreign government to investigate a political foe and, so far, leaving him flailing against a rapidly escalating investigation.
“He’s arrived at a very different place right now. He’s being held to account in a way that he never had before and is running into the limits of what he normally does,” said Tim O’Brien, a Trump biographer and frequent critic. “The Trump we’re used to seeing is someone whose visceral feeling to survive is to plow through public criticism to just push forward. His behaviour hasn’t changed, his circumstance has.”
It was Trump’s ability to get out of one predicament that led him getting into this one.
The investigation by special counsel Robert Mueller into Russian election interference shadowed the White House for two years before ending with a whimper on July 24, when the former FBI director’s faltering testimony seemed to close the book on the inquiry. Mueller told Congress that he could not exonerate the president on obstruction of justice, and Trump told the world that he had been completely cleared.
Trump’s approval ratings have remained at about 41%, but his grasp on power and his hold over the Republican Party have been unshaken.
A day after Mueller’s congressional appearance, an emboldened Trump leaned into foreign election interference again, this time asking Ukraine to investigate potential a leading Democratic rival, former Vice-President Joe Biden.
The speed of the story has stunned a capital already used to a relentless Trumpian news cycle. In barely two weeks’ time, under an avalanche of disclosures in news stories and Trump’s damaging admissions, House Democrats called for an impeachment inquiry, posing the gravest threat yet to his presidency.
To this point, Trump appears foundering in how he’s reacted. With no formal response team and with many in his party keeping quiet, Trump has turned into a one-man war room. He’s raged at news conferences, berated aides and directed epithets at critics.
“He’s being erratic and inflammatory,” said Douglas Brinkley, presidential historian at Rice University. “It’s not a strategy designed to garner new voters. Who wants to buy into an act of a man screaming in chaotic fashion? Instead of trying to work his way out of the whole, he’s digging himself deeper.”
In many ways, Trump has lived a life free of consequences.
His two divorces were marriages from which he wanted to escape. He turned the separations into tabloid gold. His early financial struggles were resolved by his father. His bankruptcies mostly impacted his lenders. He never apologizes, moves to win that day’s — really, that minute’s — news cycle, and trusts that his supporters will believe and follow him.
“He is facing the ramifications of his actions in a new way,” said O’Brien. “What is so striking about this Ukraine story is that the anger that his closest allies would only see behind closed doors has burst into public view. I think he’s going to continue to lash out and burn things down around him. He’ll try to throw more people in his close circle under the bus if he needs to.”
His upstart presidential campaign was riddled with gaffes and blunders that should have ended his candidacy. Each time, he pushed forward and survived.
He broke norms at every turn. He insulted Republican stalwart John McCain, a former prisoner of war, for being captured. He derided a beauty pageant queen for being overweight. He accused an American-born judge of Mexican descent of being incapable of impartiality on immigration. He had his fixer, Michael Cohen, pay off women with whom he had affairs.
Every time he was wounded, he would strike back, and even harder. The best example came at the most perilous moment of the campaign, the October 2016 weekend after release of an “Access Hollywood” tape in which Trump is heard boasting about sexually assaulting women.
After holing up in Trump Tower for 24 hours as rumours swirled that he might be replaced on the ticket by his running mate Mike Pence, Trump emerged on a Saturday afternoon and plunged into a crowd of supporters gathered outside, as if drawing strength from the unshakable loyalty of his base.
The next day, in the hour before second general election debate with Hillary Clinton, he held a surprise news conference in St. Louis with women who accused former President Bill Clinton of sexual impropriety. It was a jaw-dropping moment in a campaign full of them.
Trump had changed the conversation and a month later, he was elected the president. And that is why some of the closest supporters believe he can escape this crisis too.
“It’s not planned strategy, really, it’s just who he is,” said Sam Nunberg, a former campaign adviser. “The president is trying to take control of the narrative. Releasing everything. On the attack. And what he has been able to successfully do, as of now, is control the Republican Party, keep them in line. His supporters, and small donors, and are still with him.”
“If this was any other president, they’d be one foot out the door,” said Nunberg. “He’ll survive this. He always does.”
EDITOR’S NOTE — Jonathan Lemire has covered politics and the White House for The Associated Press since 2013.
Follow Lemire on Twitter at http://twitter.com/@JonLemire
An AP News Analysis
Jonathan Lemire, The Associated Press
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