Of triumph and tragedy

I first saw Arthur Jafa’s haunting and devastating Love is the Message, The Message of Death more than two years ago at SF MOMA.

Saisha Grayson, a curator at the Smithsonian American Art Museum, as quoted in Smithsonian Magazine, describes my experience of watching it best: “I cry every time,” she says. “I cry at different parts, for different reasons, but I’m never not profoundly moved.”

Two years later, I still feel that way.

Since that day, I’ve been scouring the Internet to see if it would move beyond gallery walls so I could share it more broadly. I think it’s an incredibly important film to watch and sit with, and I want everyone in my life to see it. In 7 minutes, set to the Kanye’s epic gospel Ultralight Beam, Jafa summarized for me the complicated, contradictory relationship that our culture has with Black identity, how easily our culture can idolize and villainize Black identity in the same breath. All at the expense of Black people. The film also forced me to reflect on the ways that I’m complicit in this culture.

I finally found a watchable bootleg! Please, please watch. And if you do, you might enjoy chewing on this great conversation between Arthur Jafa and Virgil Abloh, previously a creative director for Kanye West.

P.S. Special shout out to Radha and Dinika, who saw it with me the first time, and the many times afterward. We couldn’t just see it once. Thank you both for making the space to take it all in.

Tackling the opioid epidemic

Addiction impacts over 23M people across the socioeconomic spectrum, but few have access to quality, evidence-based treatment programs. Nearly 19M of people who struggle with addiction go untreated each year.

Beyond access, addiction treatment in our healthcare system just isn’t designed for longterm recovery. Our system affords you a 30-day inpatient stay, and, if you’re lucky, you’ll find a good AA program afterward. For those that do receive treatment, the relapse rates were nearly 50%. The outcomes are much poorer for low-income patients.

And then, a beast of its own magnitude: opioids. Devastating millions of families and hundreds of communities across the US. People dropping from overdose in grocery stores and gas stations across the country. Yet, deep stigma is associated with the gold standard of opioid treatment, and so few providers are available to deliver this care.

We looked at several companies looking to drive innovation into the space. Many of the models we found looked to force fit an addiction treatment program into an old, broken payment paradigm, which meant patients still didn’t get the care they needed to successfully recover. Or patients had to self-pay to get a quality program. I had seen enough GoFundMe campaigns, heard enough stories of people taking out second mortgages to fund treatment, and I wanted to see something different.

When I first met with Stephanie Papes, the CEO of Boulder, and then the team soon after, I sensed that they’d build something different. They had a vision for long-term, comprehensive, dignified and patient-centered care, and they wanted to bring opioid addiction treatment to underserved communities in dire need of support. And they deeply understood the system they were building in, and knew where they could push the envelope. This meant finding the right customers and not compromising on the components of care that enabled successful recovery.

Early feedback has come in, and patients love Boulder.

I feel so lucky that Acumen is a part of their journey, and that I have the opportunity to watch a CEO and team with such vision and moral leadership. We captured some of this magic in a recent conversation with the CEO, where we discussed what led her to launch Boulder, despite the payment and regulatory environment, and, most exciting to me, how Boulder is pushing forward a care delivery model and standard of care that may actually work.

Even when the world is burning around you

Toni Morrison passed away last week. With the Administration’s hateful rhetoric, and three mass shootings in the span of a week and a half,  I found hope in re-visiting her 1993 Nobel Prize speech.

She begins her speech with a story about a wise, blind woman, who is asked by a group of children if a bird that they are holding in their hands is dead or alive. Dead or alive —  the blind woman thinks this is a trick, a cruelty, the fate of this poor creature in the hands of the children. As a part of this story, Morrison uses the bird to illustrate her fear of how language can enable oppression and violence, which feels so timely in our political climate: “The systematic looting of language can be recognized by the tendency of its users to forgo its nuanced, complex, mid-wifery properties for menace and subjugation. Oppressive language does more than represent violence; it is violence; does more than represent the limits of knowledge; it limits knowledge. Whether it is obscuring state language or the faux-language of mindless media; whether it is the proud but calcified language of the academy or the commodity driven language of science; whether it is the malign language of law-without-ethics, or language designed for the estrangement of minorities, hiding its racist plunder in its literary cheek – it must be rejected, altered and exposed.”

But alas! The children are ultimately not cruel. They wish to tap into the women’s wisdom and experience to understand life — all of it — and death. I love that Morrison uses the vulnerability of language to build up our own sense of vulnerability for the bird and the power of the children. I can viscerally feel the cruelty, or the anticipation of it, from the children. I imagine the myriad times when I, as I get older, with all my rhyme or reason, look into the eyes of children and feel sheer terror for not knowing what’s behind them.

And then Morrison quickly reverses our expectations of how the story should go.

Reading this was a reminder of how vulnerability and fear can make it easy to build up walls and false narratives, and I need to fight the desire to judge and close down. Especially during times like this, and even when the world can be so, so ugly. And it was a reminder to have faith that we will have a path toward shared prosperity if we approach these difficult moments without judgement and with openness.

“Finally”, she says, “I trust you now. I trust you with the bird that is not in your hands because you have truly caught it. Look. How lovely it is, this thing we have done – together.”

Mapping the stages of intimacy to levels of digital security

I’m trying to Marie Kondo my digital life, and I’m starting first with messaging apps. tl;dr: It’s really hard to figure out what needs to go. I tried to create a decision framework to help me, and I ultimately ended up with a map that (for the most part) links level of friendship to level of security and privacy. Funny, right? Ok, well, I think it’s funny.

Reddit DM / Discord: Anonymous strangers that know you better than some of the people around you — you are who you want to be, and they are who you need them to be

Twitter DM: Strangers that you may collide with out and about in San Francisco. The more prolific they are, the more it *feels* like you know them. So there you are, the both of you standing in line for ice cream at Bi-Rite, and you say hi only to realize they have no idea who you are. Hi, I’m awkward!

Instagram DM: Strangers, mostly, and, acquaintances becoming strangers, your relationship held by a delicate thread of responding to each other’s Instagram stories with emojis

Messenger: Acquaintances, mostly. Why do people still use Messenger?

WhatsApp: Friends, mostly

iMessage: Friends that have remained friends because you’ve been in the same group thread forever. And Mom, who recently discovered emojis. 🥰💫🎉

Signal: Good friends, which include fellow activists, whose connection to you cannot be described in words. Includes friends that have upgraded to better friend status because they think you’re annoying, but like you enough to listen to you preach about Whatsapp metadata, and, uh, Facebook. Also includes your significant other, who you hope will one day respond to your eggplant emoji. He won’t, but you’ll keep trying anyway, and Signal is your best bet.

Privacy is also more than just encryption. As you design your personal threat model, consider physical risks, which include social engineering. Triple check that you trust the recipient or you could unwittingly become Internet content.

(Thanks Ryan for consenting to my shenanigans!)

Telegram: Best of best friends. You convinced two of them to join during one of your fits about encrypted messaging, privacy, and big Tech. They won’t switch to Signal because they love you enough to not give in to all your demands.

Anyway, that exercise basically got me nowhere. Back to the whiteboard. For now, I’ll just stick to asking myself what sparks joy as I stare at the 20-30 tabs that I have open at any given time.

While you’re here, here are a few related reads floating around in my head:

An ode to unspoken stories

What are the words you do not yet have? What are the tyrannies you swallow day by day and attempt to make your own, until you will sicken and die of them, still in silence? – Audre Lorde, The Transformation

What I read this weekend: I’ve experienced the power of great storytelling in all of its forms: from exceptional journalism that broke my heart and opened my eyes wide, poetry that spoke intimately to my consciousness, to the chic Glossier ad that sold me the promise of feeling chic, effortless, and free when you sport skin as smooth as a baby’s ass.

I wish I could tell good stories. I suck at telling good stories. I never seem to get the pacing right, I don’t give enough context, my punchline is only funny or compelling to me, and I focus in on all the wrong details.

I suck in part because I’m not practiced. I’ve mostly stayed silent. Perhaps to appear normal, or because of fear and trauma. Or because I didn’t see a space for my stories.  Last weekend, I sat on a panel with a Vietnamese woman that grew up in my neighborhood. In hearing her frank and unsentimental account of her life, I realized that I had never shared my own. With friends, even! I realized that I’m not afraid of vulnerability; I’ve kept silent in fear of being cast as “other”.  And for so long, I’ve adopted versions of stories, allowing other people’s narratives set the bar of what is OK to share.

It feels comfortable to say storytelling isn’t my jam, shrug it away, and move on with my life. But I need to learn. My story is so important, and so is yours. We further our collective consciousness in deep and meaningful ways when we tell our stories.

So how do you begin? For me, it starts with getting my stream of consciousness into clear, concise, and digestible writing. I also want to use a variety of tools, including data and strong imagery. Think Matthew Desmond.  Here are the resources I’ve started with:

Interview with Negotiating the Terms

I wish Nikita Singareddy‘s Negotiating the Terms existed when I looked to enter VC. There were few female role models from diverse backgrounds, and I didn’t know of the unique range of career pathways into the industry. NTT is that resource, and I hope it inspires and helps more women enter the industry. Even as an investor now, I turn to NTT to see how other women think about our work.

I’m so excited to share my own path to venture capital on Negotiating the Terms. Who knew that starting a little online shop with Janet Nguyen in high school would spark my love of (and career in) entrepreneurship and beyond… Big thank you, also, to Miller Center for Social Entrepreneurship at Santa Clara University, Melissa Richer and The Ayllu Initiative, and more!

Originally posted on Linkedin.

Hidden costs

I went down a rabbit hole of research to understand the skyrocketing costs of insulin after reading this op-ed in the New York Times. Written by Dr. Danielle Ofri, a practicing physician at Bellevue Hospital in New York, she begins the piece by walking through the dizzying experience of managing her patient’s insulin for Type-1 diabetes: near-constant changes on what is covered, and how much is covered. As a result, her patient’s out-of-pockets expenses changed month to month, making it difficult for the patient to budget on a fixed income. This doctor was willing to go above and beyond to work with the pharmacist to figure out what was going on. Sadly, they had little success, and it struck me how few patients have advocates like Dr. Ofri on their end.

In my research, I felt the same dizzying experience as I navigated the pharma value chain, generics, drug patents, and the system of rebates and coupons that pharma manufacturers, distributors, PBMs and insurers play with to get drugs covered and drive up costs. All of this, at the devastating expense of their patients: people unable to pay the $1,000+ a month for their medication, people missing doses, people rationing their doses, and the black market, from people donating their doses once a loved one has passed away to people seeking alternative providers beyond our borders.

This research also led me to reflect on a company I recently reviewed. The company wanted to help low-income consumers access drugs at a more affordable cost, and a big piece of its model was using this system of rebates and coupons. That sounds promising at first glance, right? Lowering the cost of drugs means it’s more accessible, and then improved adherence, then improved health outcomes. But maybe not: the story behind insulin was a reminder of how some fixes can cover up the underlying dynamics that created these unjust systems in the first place. And exploiting a loophole (or something broken) here may mean something else must break down in another part of the system. Someone always pays. Sadly, it seems like it’s usually the consumer that has the least power in the system.

Also, related, I’m currently reading Elizabeth Rosenthal’s amazing An American Sickness. I don’t know why it took me so long to pick the book up, but I highly recommend if you’re interested in or working in healthcare.

Operating as if Beijing de facto called the shots

What I read this weekend: The Economist has a fairly rosy outlook on China’s ability to lead the world in science and innovation. An over simplification of their position, but essentially:

  • Advances in science require collaborating with the international science community, and China will not become the super power that it wants to be if it doesn’t abide by the community’s standards and conventions.
  • Rather than shunning their Chinese counterparts, Western scientists should carefully collaborate such that they can promote accountability and transparency.
  • At some point, Beijing’s grip on critical thought may hinder their ability to foster innovative thinking.

With my own Western bias, this line of reasoning makes a whole lot of sense. I find myself wanting to be as optimistic as the authors. But how does our own biases shape how we right size China’s ability to realize their ambitions? In 2016, China surpassed the U.S. in peer-reviewed science and engineering articles published (although the Economist claims these papers were lower quality). Combined with research coming out of the E.U., the West still leads but China’s growth rate suggests they could catch up.

The first question I have is perhaps the easiest to answer: what’s the timeline for the West to exert our influence, when Beijing has invested such significant money and brainpower behind the effort?

Then: how much soft power do we have, really? Are we preaching to our own? Meanwhile, Beijing has demonstrated its own form of influence in other ways, as it’s tried to do so with the Internet. And also, this. Basically, find other ways to set the rules, and then everyone has to play your game.

And are we thinking correctly about capability? Perhaps there are different ways of thinking and reasoning that lead to advances in science, and the West has just demonstrated one way that works. Also, I’d like to think that we all have access to our god-given human ingenuity, and this potential is free from the political system that govern our lives. We shouldn’t let our faith in our capitalist democracy become blind hubris. The Economist speaks a bit to this:

“But the idea that you can get either truly reliable science or truly great science in a political system that depends on a culture of unappealable authority is, as yet, unproven. Perhaps you can. Perhaps you cannot. And perhaps, in trying to do so, you will discover new ways of thinking as well as fruitful knowledge.”

Would it be more prudent if we just operated as if China will become a dominant power in science and technology? We could then be proactive about the potential implications. Meanwhile, we should continue to deliver and set standards for high-quality research. This includes more transparent and reproducible research. And finding alternative sources of funding: we frequently fund research through grants from organizations that may have a special interest in the outcomes, leading to conflicts of interest and questions the credibility of the outcomes. And we should invest much more in science and math education.

Emergent behaviors

I enjoyed this wide ranging conversation between Marc Andreessen, Ben Horowitz, and Tyler Cowen, which covers their partnership, how Marc and Ben thought about a16z’s differentiation when they founded the firm, how VC has evolved, and what’s next for [insert your favorite tech or industry here]. There’s several gems in this episode (which somebody painstakingly captured on Breaker) and worth a full listen. Here’s one that I found particularly useful…

From Marc, in response to Tyler’s question, “Did you invent the tweet storm?”:

“I literally couldn’t shut up, so it sort of catalyzed. The big lesson for these internet platforms is […] emergent behaviors is incredibly important. The really successful platforms let users surface the behaviors that the creators of the platform could have never thought of. Twitter has had issues over the years, but […] the compelling ways people have used Twitter have been invented by users. […] It’s not just Twitter. It was true of the personal computer. It was true of smart phones. It’s been true for many of these Internet platforms. It’s a useful principle for product design: let the users innovate.”

Emergent behavior extends far beyond product, and is a useful principle across a number of domains. For me, top of mind are community building, advocacy and organizing, but I do wonder how one tracks and responds to these interactions in an offline environment. You’re operating in an environment wherein the data isn’t (1) readily available, and (2) as responsive, so how do you know when that behavior is indicative of a larger group behavior? What is real and what is noise? If you want to co-create with your community, how do you set up a response system for that kind of interaction?

In any case, as a person that’s constantly holding everything in her head, planning everything from A to Z, I appreciate the reminder to let go, enjoy the magic of improvisation, and make it up as I go along (with co-conspirators, if possible).

(P.S. I just realized that my blogs ask a lot of questions but rarely suggests a hypothesis or attempts to find the answer. I’m going to try to do that more in 2019.)

A case for optimism

What I read this weekend: I feel such heaviness from the vicious cycle of bad news and bad forecasts, from immigration policy, deteriorating social safety net and world order to climate change and automation. It feels like we’re only going backward. And some days, this weight compounds because these problems feel insurmountable. This Shouts & Murmurs piece does a great job of capturing the manic hum of doom and gloom.

I found this hopeful article that makes a case for progress, and in turn, optimism. The author cites Steven Pinker’s Enlightenment Now book and a few other notable thinkers on this topic, and an observation that really stuck with me is that this pessimism could ultimately affect the policies we choose to support and how we vote. I also listened to an interview with Vitalik Buterin (the founder of Ethereum), who believes that the most popular delusion or irrationality should be our belief in progress. I’m now thinking of ways to actively flip these negative scripts in my head, and to find scripts for hope, optimism, and progress even in trying times. I shared this reflection with my team and some friends, who shared their own awesome life hacks:

  • Don’t get caught up in the minutia of day-to-day news. It’s OK not to hear every update. Know the key themes.
  • Subscribe to articles about new discoveries and innovations in science.
  • Check out Gap Minder, which provides you with raw data about the world to react to,  rather than hearing about an issue from a news outlet that may have distorted the data to fit a specific narrative. Also, see Outlier’s series on data storytelling, where the team explores how data can mislead you.
  • Find and follow people that start from an empty whiteboard to re-design the world, such as Jeremy Rifkin and his thinking around a zero marginal cost society.

(Thanks Eliza, Larry, Ryan, and Markeze.)

So: what does give me hope? People that show up, as much as they can, like these wonderful humans that came together for the Families Together demonstration. We walked from Dolores Park to Civic Center to protest immigration policy in solidarity with our neighbors.