Jun 9, 2023

6 – What Sequoia’s Breakup Tells Us About VC Markets | Behavioral Health Chatbot Goes Rogue | Other News Updates

Featuring: Vic Gatto & Marcus Whitney

Episode Notes

Vic Gatto and Marcus Whitney discuss the Sequoia Capital split, the NEDA Chatbot mishap, Optum’s bid for Amedisys, and more.

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Episode Transcript

Marcus: [00:00:00] So I honestly don’t know what episode this is. What are we on? Is this six?

Vic: I’m not exactly sure.

Marcus: It

Vic: probably is a good cold open.

Marcus: Yeah, uh. Welcome, this

Vic: is episode blank.

Marcus: I mean, I think it’s a good sign that we’re starting to do it every week. And it’s just, it just is what it is.

Vic: Right, exactly.

Marcus: It is what it is.

It’s uh,

Vic: five or six or seven. I

Marcus: think we’re beyond five. I think we’ve done five already. Um, the pair one keeps sticking out. I actually got a, um, I have, I have a friend. Who, uh, who asked if I was up for talking to, uh, Corey McCann.

Vic: Oh, really?

Marcus: Yeah. From, from, from pear.

Vic: I think you are. You should be. Of course.

Of course.

Marcus: But after we bring on our friend. Yeah,

Vic: yeah, yeah. We already, we already agreed with him, but that that’ll be a good set the table. What’s coming next. We’re going to start today talking about VC.[00:01:00]

Marcus: Um, we always talk about VC. So what we are, what we do, that’s what we do. Um, so big, big

Vic: news today.

Marcus: Yeah. And this week, yeah. Big, big story this week is about, uh, Sequoia and. It’s um, it’s, it’s a story that’s a global story. So it’s riding the wave of the whole U S China tension thing that’s going on. It’s, you know, it’s sort of an easy time to put that out, um, that you’re going to separate your global fund into three different funds, correct?

There’s three. That’s right.

Vic: Yeah.

Marcus: All right. So, all right, break, break it down. What’s going on?

Vic: They’re splitting their fund in three different. Independent groups. Um, I think it’s a smokescreen for what’s Sequoia needs to do anyway. But the, but the, the message was, we are concerned about the U S China relations.

It’s important for our Chinese affiliate to be able to work independently. And [00:02:00] therefore we’re going to break, break into three parts. And that, I, like you said, that fits with the narrative of U S China relations are.

I’ve been following Sequoia for a long time because they are the best brand in venture. Maybe one of the top two or three brands. And of course, we’re, we’re trying to build a brand. And they have a lot of things that we I want to copy and they have some things I want to avoid. And so I just see this story from a different perspective and I think it’s worth it to sort of dig in because there’s a lot of lessons about what VCs can be great at and what they need to stay away from.

Marcus: All right. Let’s, let’s just quickly give them benefit of the doubt before we start digging into other things. Yeah. So, well, I mean, specifically around the, around the China stuff, right? So it does, feel like we are in a, [00:03:00] uh, in a time where, you know, there’s a lot of questions around where your money is coming from.

So just to completely get out of VC, um, this has been a really big week in the sports world of just two, two stories. Um, one, the, the live golf merger with the PGA, right. And the, the, the, both of these stories are Saudi related. Right. Um, and the other one is messy. Uh, Lionel Messi coming to major league soccer, which is

Vic: great.

Marcus: Yeah.

Vic: At least I thought it was great.

Marcus: Yeah. No, trust me. It’s amazing. Right. It’s amazing. Um, you don’t know how many texts I got from people asking already for next year’s natural soccer club match against, uh, Miami, but, but in both cases, the Saudis, I think really were the catalyst, right. For, for both.

Situations because

Vic: I didn’t know they were behind the soccer.

Marcus: Yeah. So let me, let me just walk through that. So, so on the, on the soccer one, um, They have been making Ridiculous. We’re talking like billion dollar offers to the top players in the world Okay, the top [00:04:00] players and they’ve already got ronaldo.

Yeah, right So, you know the next name you think of after ronaldo is is obviously messy, right? Um, and he reportedly turned down You A billion dollar deal to come to Miami. So anyway, the point is, you know, and I’m sure it wasn’t just whatever the standard deal was, right? I mean, you know, there’s reports about Apple.

Um, and indeed is collaborating with Major League Soccer to make the deal happen. And, you know, there may be some things were messy, prefer to be associated with Major League Soccer versus the Saudis, but but also to Pass up a billion dollars, you know, you have to sweeten that deal. So in, in that case, we know the Saudis really made major league soccer step up their game, right?

No question. In the, in the case of, um, in the case of live golf, I mean, this is just crazy, right? I mean, you know, the whole Storyline, the PGA was, was pushing around nine 11 and all this other kind of stuff. And now, I mean, this is going to be some strong reputational damage that the PGA is commissioner, as well as, you [00:05:00] know, a lot of key players who were involved.

It sounds like the only person who’s coming out smelling like a rose is probably Roy, Rory, uh, uh, McElroy, because he was sort of stood his ground the whole time. I think most people are sympathetic to what’s happened to him because he didn’t go for the buyout. Right. Anyway, the point I’m just making is that global capital allocation, especially when it’s dealing with countries where we’re misaligned, meaning the U.

S. is misaligned. It’s now becoming like a public eye kind of thing. And I think it’s probably also starting to show it’s show up in diligence and capital allocation. It’s, it’s probably, you know, a real diligence concern.

Vic: I think it is. And I think there’s a lot of concerns, maybe not in the public eye, but, but if I were Sequoia getting my money out of China would be a big concern.

The other thing that you didn’t mention, but it’s where I immediately went to his FTX. They were the middle of the FTX thing, Sequoia, Sequoia, Sequoia was in the middle of FTX is fiasco. They [00:06:00] put a bunch of money into FTX with, with. Uh, not very much to diligence

Marcus: and that also has sort of a branch of a storyline this week as the SEC has gone full court press against crypto suing both finance and coinbase this week.

Yes. So, so again, you know, and it’s very, very clear there’s a nationalistic edge to what’s going on there, right? So, you know, there probably was some relativity to the FTX, um, situation tied to this. I mean, obviously. You know, the guys at Sequoia are very tapped in. Um, but anyway, I guess I’m just making like

Vic: China was the.

Like the best place to go for venture capital assets in 2000, 2005, 2010, 2015. And Sequoia really led the way there. And they’ve led the way in a lot of venture things. And I think it’s clear that music has stopped.

Marcus: Yes. Yes. So. [00:07:00] I just wanted to give them benefit of the doubt in terms of like, it might be the right time to separate.

Oh, I think it’s

Vic: definitely the right time to separate. I think there are other reasons besides a purely China play.

Marcus: I think that’s probably true. Alright, so what do you think?

Vic: So I think that they have gotten too big. Their performance is not what it once was. And I don’t think they have the, the talent, the deal flow, the, the ability to, to sort of manage this size apparatus globally.

And this was a good opportunity to sort of pull back to where they. You know, our headquartered and get up, get slightly smaller. It’s still gonna be really big.

Marcus: There’s so much to unpack here. Um, I mean, I think we’re, we’re gonna, we’re going to talk about maybe there. I mean, I, I’m, I’m not a total Sequoia historical expert, but I think we’re going to talk about what it looks like to us from our pitch book [00:08:00] research is their best ever performing fund, which when we looked at it, like the numbers are unbelievable, the returns on this funder.

I mean, there’s a reason

Vic: that Sequoia has the brand they have. They at least were world class. And

Marcus: then we’re going to look at, um, a 2010 fund. Um, which, which is not like a terrible fund at all, but it does show a stark difference in a, the assets under management in that fund be the way that the fund actually performs in terms of distribution of the assets, right?

And the returns generated per asset. Um, and then I think there’s probably. Some important, uh, respect we need to pay to what time these different funds happened in and as well as what time we’re in right now, right? Because you have this, we’ve already talked about the international issues. We talked about the FTX issues, which was a total black eye, which is no question about that.

Um, when you combine those two things with just the general. Downgrade of VC assets. That’s you know, that’s that’s happening in [00:09:00] material of how talented you are or anything else That’s just across the board. We’re all suffering that Um when you combine all those things, I mean, that’s that’s not a great recipe

Vic: Yeah, it’s it’s not of course i’m completely biased because i’m making a living in venture I think there are different strategies that need to be deployed based on what the exit markets are like.

Marcus: I think that’s right

Vic: Yeah, and so that some Some funds like hopefully like jumpstart can be successful in all kinds of environments, but I think if you raise, uh, over a billion dollars. In order to deploy it in the investment time horizon and then build something of value and exit, you need a certain kind of exit market or it doesn’t work.

Marcus: That’s right. You’re highly dependent on what’s going on in the macro when, when those are your inputs, you know, billion dollar plus fund, a 10 year window, you know, five years to deploy it, you need. the markets to [00:10:00] move in your direction very quickly. No question.

Vic: And I also, I mean, I, I think there’s a, there’s a talent and alignment of incentives thing that we should talk about too.

Marcus: Okay. All right. Well, let’s, let’s, let’s start by looking at, um, a couple of the Sequoia funds. So, uh, first one we’re looking at is Sequoia capital seven. Um, this fund was from 1996. Yeah. It’s 96. Okay. Right. All right. So lay it, lay out the blueprint on this fund. How is it structured?

Vic: Yeah, so there are five partners that are all experienced.

This is fund seven. Their first fund was in 1981. Okay. And there are five partners, 150 million to be deployed. Uh, Sequoia is already the best venture capital firm in the world. Maybe Kleiner. At this point? At this point. Okay. They are the best. And the market got much bigger in the early nineties. So Yale published their, their [00:11:00] results in the late eighties.

They had great results. They were the first institution, first university to really go heavy into venture. They started doing that in the seventies and eighties, they published. Their results and every other university in the world realize, gosh, we, we should do that. And so in the nineties, there’s a lot of capital started coming into venture.

Sequoia was the, was the dominant, very strong firm. And in 96, they raised 150 million with five partners. And so you have, you know, 30 million each to invest and they, they invested in, in mostly tech and other, other things in silica Valley. And of course, uh, Netscape went public in 95. And so this was just at the dawn, the very beginning of the internet.

Yep. The first time you [00:12:00] had a browser and could actually do things that were graphic and Sequoia was in the middle of that. And you know, they had fun six and fun five that were also investing in these things. So they’re in the middle of the deal flow in Silicon Valley. And it’s a, I think, uh, I would have said that 25 million today in our funds, we kind of model around 25 million per partner, because that’s what a mortal can deploy in early stage capital where you’re doing fairly small investments.

And that’s what they put together.

Marcus: All right. And we we’ve got this, uh, screenshot of the results from this fund. This is, these results are absolutely legendary.

Vic: And there’s a bunch of acronyms that are inside baseball. So let’s just quickly define it. So internal rate of return. Most people will know that 174 percent it’s an annualized number.

CVPI is the total value to what’s paid in fund, [00:13:00] right? So that’s like ratio of how much they have in total value versus what they paid in. A little over 16 times. The investor capital. Yeah. Now this next one is the, this is the one. So the DDPI is the distributed what they sent out to investors. And so they sent 15 x out dude.

So for every dollar you put in, oh my God. And there were $150 million they sent 15 x and it’s unbelievable. Obviously the carry, they got 20% of the profits. There are a lot of profits. It’s a bad ass fund. That’s a great fund. They are known for this fund and another other fund. Their earlier funds were good to the funding.

Nine in 92 was a hundred million and it was 110 internal return. And I don’t have the, the. DPI, but the TV PI was [00:14:00] 15. 7. So like they’re a great, great firm. And it

Marcus: was,

Vic: it was a lot of really talented people, but there are five main partners. And of course, you know, as you were sort of mentioning that this was at the beginning of the internet.

So a lot of these sales. We’re into the. com craziness, God bless. I mean, that, that was a market that was available and I don’t know what you have next, but I, I wanted to talk about like some of their, I think their best when,

Marcus: well, we, we, so let’s talk about this. Yeah. Yeah. So. There’s a, there’s a really great graph that pitch book provides called batting average by deal type.

I love that. Yeah. Um, because it shows you the distribution of performance based on multiples, um, based on where they invested, right. Right. Um, you know, early stage, later stage seed round, but they stack them in these [00:15:00] bars based on performance. So you can also get a pretty relative sense of like how many things returned any money at all.

Versus how many investments return any money at all versus how many were total zeros because they’ve got a category called bankruptcy out of business. So that’s that’s that. And also they got a zero to one X, right? So,

Vic: yeah, just a quick aside Kleiner 10, which 99. Yeah, I know it because I talk about all the time.

They had 20 investments. Most were under five X and then Google. Yeah. Right. Right. So, so that, that’s an example of kind of the opposite of this, where they had a bunch of strikeouts, but they hit a grand

Marcus: slam times 50 home run. And, and that Kleiner example, I think is often referenced when people are trying to tell you how VC works.

And I’m saying that in air quotes, right? When VC is a power law business and you’re like, just assert that that is what it is. Well, when we look at this, Particular graph here.

Vic: This is not power law. It [00:16:00] wasn’t power law in the 80s. It wasn’t power law in the 90s It has become that right because of the way they design the funds and they staff the funds, which is too much

Marcus: and really quickly for anyone who doesn’t know what the power law is, it basically is, it’s kind of like a version of the 80 20 rule where, where it says, you know, most of your returns are going to come from one or two assets out of, you know, 10 to 15, you know, in your portfolio,

Vic: I say it’s a 90 10 rule.

So 10 percent of your investments. We’ll deliver 90 percent of the return.

Marcus: So when we look at this graph that that’s up here, you can just visually see the vast majority of assets that they invested in return something. And the highest percentage of the overall base, 30 plus percent. Returned 50 X like that is incredible.

That’s unbelievable. I

Vic: mean, just for frame of reference, the chart that I used to raise money, it stops at 10 to 20 X [00:17:00] because I don’t have the 50 X and I aspire to get there, but they didn’t have one, they had multiple and then they have a whole, Another group of companies in 10 to 50. And so this was a stacked portfolio where everything did well.

And that’s how you get to

Marcus: a huge return. So anyway, I just thought this was, this was impressive. And one thing that we, we need to just emphasize is the fund size. The fund size here, you, you talked about it, that 30 million per partner kind of number, right? The fund size was 150 million. Right. Okay. So, you know, we’re not talking about crazy fees.

Yeah. Not when you have five partners. That’s not crazy fees. It’s really not.

Vic: They’re in Silicon Valley. Five partners. We showed the picture of the office. That, that’s the office that they had. Yeah. And it’s on Sand Hill Road. So, three million dollars a year. Yeah. They’re paying themselves salary, but they’re not, they’re not flying [00:18:00] around in a private jet.

And no, no, but they did well in the carry.

Marcus: Yeah. Carrie’s unbelievable. So anyway, you kind of look at this and you would say, you know, the incentives are aligned and that drove incredible performance. And they were very focused, not on just one company winning, but, you know, an entire portfolio delivering.

Right.

Vic: And then the other thing that I want to talk about is that these were not unicorns. No. Right. So we, I looked at just one of those 50 X’s cause they have several, there’s like seven or eight. It was

Marcus: plum tree was the one. Right.

Vic: And so they got a 50 X or more return. They were the first investor. I think they might’ve been named.

Yeah. Yeah. Yeah. And they sold the business for 211 million, I think. Yeah, 211 million. And so, that made me smile because, like, that’s something that, that, uh, that’s our game. Right. We’re trying to get in early and help these companies make progress and then sell it to our customers. You know, existing fortune [00:19:00] 100 company for 150, 200, 250.

And that’s repeatable. We can, I think we can do that in healthcare and a repeatable way, getting to a unicorn, uh, where you, you know, somehow get to a billion dollars. It’s possible if you hit the right market inflection, but it’s, it’s not always repeatable. And so anyway, they, they, they assembled this. Of course it was in the.

com area, but. But this wasn’t like ton of huge market caps that went to zero. I mean, there were, there were a whole bunch of really solid companies.

Marcus: Okay. So now we’re going to look at Sequoia capital 2010. Sorry. I want to start here. Yeah. Um,

Vic: they called it 20 tanks. It’s a 13th fund.

Marcus: So

Vic: they’re superstitious.

They didn’t want to Sequoia 13. Right. Yeah.

Marcus: Makes sense. Um, so this fund, first difference we need to point out is fund size. It’s almost 10 X the fund seven [00:20:00] that we looked at. Right. So, so six funds later, they’ve gone from 150 million size size fund to 1. 36 billion. Now I think we need to acknowledge once you have a fund, that’s.

Sending out 15 times the value paid in 15 times your demand. You can raise any amount you want. Your inbound demand is going to be out of control. Right? So I don’t want to say, you know, look what they did here. They now they stepped up to raising a billion and that’s when everything that’s kind of ridiculous.

Of course, everybody was beating down the door saying, you know, please let us place money with you.

Vic: Yes. But I’m not sure that they have to take it if they can’t deploy

Marcus: it. No, you don’t have to. I’m simply saying their result, their results generated significant demand. And it’s very easy. If you never had that demand to say, you should not take the billion dollars because the dynamics changed drastically in terms of the, [00:21:00] the, the, um, the management fees.

Yeah, I

Vic: don’t blame the Sequoia partners. No, no, no. I blame the LPs. Yes. Okay. So, well, the LPs didn’t. So this is the beginning of us all learning, right? Like, okay. But if you’re, if you’re investing a billion dollars or you’re a piece of a billion, you’re investing a hundred million in a VC firm need to do some damn due diligence.

I mean, the incentives are different. The five people that drove that return, only one is still here. And so I just think that the LP community, I believe. That the brand power drove people to invest in the brand Sequoia and not look so much at all of the inputs that made the original several Sequoia funds really successful.

The fund size, the alignment of incentives, the team. I think you’re right.

Marcus: [00:22:00] And I think that there have been, there’s been a story about how venture capital works that only until recently are we starting to see it challenged, like for the longest time, it was not challenged now for you and I. We’re here in Nashville, right?

We’ve always been the underdogs. We’ve always been the outcasts. It’s like we’re scrappy. We’re used to this market. We’re the underdogs and the outcasts, right? I mean, like we’re not the establishment. Okay. But for the longest time, the story has been, uh, you know, VC lives in Silicon Valley. It is about networks.

It is about access and no one’s got better access than Sequoia. So that’s been the narrative around it. And you know, the LP community has sort of run with that. Um, I’m not saying it’s right. I’m saying now we’re, you know, now after 13 years after this particular fund, you know, was launched, [00:23:00] we’re now hearing, Oh, we think there may be some negative You know, incentives of raising a fund that large.

We think there may be

Vic: 20, 20 million a year in fees and fees.

Marcus: Yeah. We, you know, we think there may be some negative correlations between super large fund size and performance. I mean, but these are, you’ve been in this world longer than I have, but these are new things. I, I don’t feel like I heard these when I first got in the, got in the game.

Vic: I think it depends on what LP you’re talking about. There, there are LPs that are just trying to get into any, any company, any, any company with this track record in Silicon Valley. There, there were entire firms that their strategy was to follow Sequoia around and do the next round and they were successful at raising money.

And so there’s lots of LPs out there. I just think that it would have been possible to see that these are different [00:24:00] animals. 150 million with a five person team is different than over a billion. And, but the reason we chose this one is that this is not a new fund.

Marcus: No.

Vic: It’s 13 years old. And then also importantly, This was a pretty good time to invest.

Yeah. You had plenty of opportunity to build and sell assets. This, this wasn’t like coming into the great recession. I mean, it, it wasn’t a, I mean, it was a normal time.

Marcus: Yeah. I mean, it was coming out of the coming out of that. Yeah. It was coming out of the GFC. Yes. Yeah. And we, you know, we, we briefly looked at the deals in this fund.

One of the deals in this fund was WhatsApp. Yeah. So I think that was the signal to us. Okay. This is a legitimate fund. Right. You know, it’s,

Vic: it’s, yeah, they’re, they’re good assets. There’s too many.

Marcus: Yeah. Yeah. Now I’m not sure that I, we, we, we reviewed it. There was some, there was some funny business with like all the capital wasn’t called this DPI of zero.

There’s just some things there. I’m not sure. I [00:25:00] totally like find correct. But when we look at the batting average for this particular fund, One thing we do pretty clearly see is a much higher percentage of bankruptcy out of business, uh, businesses in the portfolio, right? So we’re moving into 30 plus percent, whereas the last one, it was sub 10%.

Um, so, so clearly they’ve shifted much more to a power law type of model, you know, as they got later, later on in the business.

Vic: My opinion, and I don’t have the inside scoop. So it’s just my personal opinion is that in order to deploy 1. 3 billion with people that are coming into the firm and they’re really smart people in Sequoia can hire the best people in the world.

They have to deploy it pretty quickly, and they’re, they’re swinging for home runs on every deal. And sometimes that works, they have a few big wins like [00:26:00] WhatsApp, but they also struck out way more than the early funds, and that impacts the, the total return, impacts the IRR, so it’s, it’s much more risky.

Marcus: I was at a, I was at a mixer last week that, uh, some folks from launch Tennessee kind of put together and, uh, I ran into a person who’s a, who’s a VC moved here from LA during the pandemic.

And we were talking about, about venture and she was mentioning that, you know, she basically just doesn’t think VC is, is that, is that difficult. And I was like, Hmm, let’s, I mean, let’s, let’s, let’s talk about that. Right. And what she, what she brought up was the strategy you talked about, which was, uh, she never leads.

Um, and everything she does is based on network and access, you know, her ability to get into deals and she places capital and she never leads. And there is a [00:27:00] radical difference between that VC strategy and the VC strategy that we have, right. Which is lead as often as possible, take a board seat, you know, be actively involved in governance and really, you know, see ourselves as a key player in the success of the company, right?

You know, actively being shoulder to shoulder with our, with our founders as partners. I say all that to say that, um, there are different ways to do VC for sure. There’s different ways to do VC. I don’t think I could be comfortable doing this version of VC. Um, the only word just because I don’t, it’s just too much of the chance, right?

Market timing

Vic: thing. So yeah, that strategy works really well if there’s a huge exit. Opportunity within two to four years of when you place that follow on investment. Yeah,

Marcus: but the idea that it’s repeatable, right? It’s

Vic: not repeatable. [00:28:00] I just can’t get comfortable. I mean, it’s repeatable when the market gets chaotic and and hot.

It’s not, uh, you can’t make money in every market that way. And so I, I agree with you. It’s why we’re partners. I would much rather really understand where’s healthcare going? Talk to Emily about where the regulatory environment’s going, and then take a view. This space needs to be improved. Partner with a set of entrepreneurs and really try to lean in, help them make progress, help create value, and then we’re gonna exit whenever the team wants to exit.

But there’s, we have creative value. So yes, I would love to have a super hot market and have people bidding on my asset, but either way I’ve created value and it’s going to be sustainable and repeatable.

Marcus: I mean, all of this just begs the question, what is the value of a [00:29:00] VC brand? Right? Because one of the things we’re, we’re highlighting is over the course of 10, 20 years, 30 years, The brand stays the same.

The partners change, the strategies radically change, the geographies change, right? So what does it mean to invest in a VC brand? I mean, this, this

Vic: is a, well, I mean, this is my life for the past 10 years. So like we are, you and I are trying to create a VC brand in jumpstart and it, it, of course, at first we were the first two employees and there were other employees that the advantages we’ve created.

Are intentionally designed to be outside of our personal pattern recognition. And so, so for instance, we created jumpstart foundry, which is a different way to sort of seed start support. Foster help [00:30:00] very many 30, 40, 50 startups in healthcare every year. And it is, it’s done with algorithms and a standard term sheet.

That’s only one. And then this, this, uh, online learning thing that’s run by university professors and our internal team. And they’re great people on the team. But they’re not the personalities that are driving all the returns. They’re, they’re making it work for the entrepreneurs, but you could find another person that really cared about entrepreneurs to help.

And that’s one of several assets that we are building that if I, you know, passed away, went down in a plane crash, it would still exist. And forever venture was this kind of gatekeeper in between, cause there was no internet. So pre internet the VC value person was, we have access to the money and we have access to the entrepreneurs [00:31:00] and those two pools of people.

Didn’t know each other. And the VC was this kind of like a toll booth that like you came if you wanted to access to entrepreneurs or you wanted access to money and they were the gatekeeper there. And that was a really valuable service because they couldn’t find each other. They don’t travel in the same circles and they couldn’t find each other.

And that’s over now. And so, I mean, I spent, I mean, I recruited you too. I spent 10 years in traditional venture and loved the idea of investing in healthcare tech because healthcare is a late adopter of technology and it’s really fun to invest in stuff that’s old, but the model of how venture works.

Hadn’t changed since 1975 to 1985 when Sequoia and where I was working and a bunch of early, early firms created the model in 2005, 2008, 2010, when we were playing [00:32:00] with this, there was a lot more technology, a lot more data, a lot more capabilities. And so I think we’re trying to invent it right now. But, but the idea that my personal deal networks or someone that moved here from LA’s her personal deal networks, her relationships that get her access to a deal is going to be sustainable.

If she leaves, that’s not real. And those people that invest with her may not want to work with someone new that they don’t know. And so it becomes this, um, it’s just like your personal. investment strategy. It’s not a business, right? So you might invest with that partner for that fund, but it’s not fair to say Sequoia was great in 96, and so the same platform is going to be great in 2010.

Now Google or tech based Apple, Amazon, they are not, I [00:33:00] mean, certainly there are personalities that help create that, but there are software assets, private asset network effects that make a difference.

Marcus: There were also extremely, I mean, that, that last class of companies you just named, they’re also extremely productive businesses.

Right. I mean, I think one of the things we’ve been talking about across different episodes in different ways, but never sort of putting a super fine point on The difference between financially engineering, a great return in a deal and investing in and growing up a great company that is productive in the economy and actually makes things in whatever your industry is better.

Right. Um, and I’m not saying like, we, we’ve never participated in a deal that didn’t actually generate, you know, um, meaningful outcomes for patients or for workforce or any of those kinds of things. I would say I don’t think we ever set out to do that [00:34:00] though. Um, you know, I think we’re always trying to build companies that are actually going to work , you know?

Yeah. That’s not the easy way to go about it, I don’t think. I don’t think it’s the, it’s not the easy way to go about it. It’s, it’s not the easy way to go about it. Um,

Vic: momentum following deals only is the easy way.

Marcus: Yeah.

Vic: The reason I like to do it the way we do it is. It’s more resilient, but if you’re a momentum or financial engineering firm, there are times when the debt markets are where they are now, or the public markets are where they are now with that doesn’t work.

You have to just stop and go home, right? And that’s not that fun.

Marcus: Yeah. And it’s not clear when this one’s going to end, um, because it’s, it’s, it’s playing out so slowly right now. Um, and there’s so many geopolitical aspects to it. Yeah. That it’s not, it’s not clear when it’s going to end. So, so it does feel like this is the time to really be focused on building real companies, um, [00:35:00] in the early stage.

Right. I mean, that’s kind of where the equity can be appropriately priced and. You can work shoulder to shoulder, and you can try to make meaningful progress in the company.

Vic: I agree. That’s why we do what we do. Our salaries would be bigger if we raised a billion dollars. Not that we could. But raising a really big fund and doing a momentum play or financial engineering, you have more management fees.

You have less risk. I think it’s less fun. It’s less resilient, less sustainable. My wife would be happier.

Marcus: All right. That’s probably a good segue. Uh, we’re going to take a quick second to, uh, remind you again about our fund that’s available for, uh, Institutional, uh, sorry, um, for accredited investors out there as individuals, jumps are foundry.

Doug Edwards: Thanks guys. For the opportunity to talk about our pre seed fund [00:36:00] jumpstart foundry. My name is Doug Edwards, CEO of jumpstart health investors, the parent company of jumpstart foundry. We’re so excited to be able to talk about, uh, early stage venture investing, certainly the need for us to change the crazy world of healthcare in the United States.

We are spending 20 percent of our GDP north of 4 trillion a year on healthcare with suboptimal outcomes. Jumpstart Foundry exists to help us find and identify and invest in innovative companies that are going to make a difference in healthcare in our country. Every year, Jumpstart Foundry invests a fund, raises a fund, and deploys that across 30, 40, 50 assets every year, allowing ease of access for our limited partners.

to invest to help us make something better in healthcare. Some of the benefits of Jumpstart Foundry is there’s no management fees. We deploy all the capital that’s raised every year in the fund. We find the best and brightest typically around single digit percentage [00:37:00] of companies that apply for funding from Jumpstart, and we invest in the most incredible, robust, innovative solutions and founders in the United States.

Over the last nine years, jumpstart Foundries invested in nearly 200 early stage Pres precede stage companies in the country. Through those most innovative solutions that Jumpstart Foundry invests in. We also provide great returns and a great experience for our limited partners. We partner with AngelList to administer the fund, making that ease of access, not only with low minimums, but the ease of investing in venture much better.

We all know that healthcare is broken. Everyone deserves better. Come alongside us with Jumpstart Foundry. Invest in making the future of healthcare better and make something better in healthcare. Thank you guys. Now back to the show.

Marcus: All right, we’re back. Um, this is a story that when you pointed it out to me, Vic, it made me chuckle because I literally had a conversation with a great founder and investor, uh, who I’m not going to name, um, who was [00:38:00] talking about this very opportunity, which is leveraging AI specifically generative AI, um, for mental health purposes and trying to make up for the fact that we have a shortage In therapists, um, with AI so that people can at least reflect or have some place to go when they need to talk.

So when I saw this literally was like the thing I was concerned about when we were talking about this opportunity, uh, we’ve talked a lot about how AI in the clinical setting is fraught, um, lots of problems because we’ve already seen. You know, being GPT four and Bard and all these things like. They’re super flawed already.

Right. I mean, you know, and in a clinical setting, you need real precision. Um, and there’s real liabilities attached to failure to be precise. And, uh, this is a, I think a perfect example of [00:39:00] why we should be very, very careful about bringing generative AI into the clinical setting.

Vic: Yeah. So I’m, I’m a little more optimistic, but what I would say is you, in a clinical setting when, when human life or real patients are involved.

I think it’s not appropriate to not have a human in the escalation path. If something is needed, you need to have a button or something you can hit to talk to a real person now that it may be that I would say you could help a smaller number of clinicians treat more patients more effectively, give them more support, but there has to be a way to escalate to a person.

Marcus: All right, so let’s let’s talk about the story because you found it.

Vic: Yeah, so, uh, this company. It’s called, I forget what the stands for it. NEDA. There it’s, it’s been around for 20 years. The

Marcus: National Eating Disorder Association, I

Vic: think. So for 20 years, they’ve [00:40:00] had a support help desk where if you have an eating disorder or you think you might, you can call and get support, get referred to somewhere.

They’ve been around for a long time. They have a group of volunteers, a few employees. They started using a chat bot in partnership with a San Francisco based, uh, By an AI firm called CAS. If I made up this story in a fictional book You would not believe it, but it all broke this week. This is from the Wall Street Journal, but there’s lots of news stories, social media exploded.

And so just to, to, I’m going to give you like how I learned about it and then we’ll go back and re look at a timeline. So this all broke. Uh, because somehow the chatbot that was not supposed to be using generative AI began using generative AI and it began giving anorexic people in crisis advice that they [00:41:00] could lose weight more effectively.

If they did A, B, C, and D. Oh my gosh. And giving them advice on how they could measure their body fat with a fold of skin. And you should consider changing your diet to get to a calorie deficit. The exact opposite. Opposite advice that one should give. And so I thought that it’s really bad and how could that happen?

Right, right. And so kind of dug into it, and there’s two really problematic parts. The first is that they signed up in the fourth quarter for this, this chatbot service, they went with the free version. So the San Francisco company casts, um, of course they caused the problem, but they also were offering this to nonprofits as a free service.

And so I think which is noble, which is noble. Yeah. They needed to be maybe a [00:42:00] little more careful with it, obviously, but I can hear what am I portfolio companies saying, Hey, we should offer this to nonprofits. Totally. It’ll be good for them. Good for us. We’ll learn anyway. So they offered this, this service.

And when they signed up in the early fourth quarter 2022, they were not using generative AI. It was a text based scripted service and was approved by the leadership at NEDA. And there were only certain chat paths you could go down, and then it referred you to the number to call. Okay, so that’s, that’s how this whole thing started.

Seems pretty safe. And what happened at first is the employees, employees and volunteers got really frustrated because their front line, their ability to interface directly with the people in need was diminished dramatically. There are five employees and a bunch of volunteers, they tried to form a union, um, [00:43:00] and in March they, I think they did form a union, and then were fired five days later.

One thing that occurred is all the humans were let go. Then the second thing that happened is sometime between when they turned it on and last week. Cast decided they would add in a journey of AI tool set, which was allowed under the terms and conditions of the agreement, but obviously was not a good idea.

And so they they turned it on. They didn’t tell an A. D. E. N. A. D. A. They just turned it off. And so there are no humans monitoring this, and it started generating what the A. I. Thought was appropriate responses to people saying, I feel. I feel overweight. I look in the mirror, whatever. I don’t know the anorexia story totally well, but I think their [00:44:00] body image is such that they do feel like they’re overweight, even though they’re clearly not right.

And so they’re, they’re chatting with the AI. And I think it pulls from, you know, wherever it’s pulling from the whole internet of diet advice. And gives diet advice to someone that is, like me, 20 pounds overweight and needs to lose a little weight, so I should maybe eat less carbs. And, unfortunately, there are no people In the escalation path, there’s nowhere to go because the whole union busting, let go of people thing.

And so it was, it was terrible. A lot of people were really, I don’t know, scarred, but hurt by it, upset by it. Of course, after several days, any day turned it off, but there’s a lot of examples of, of a lot of lessons about how we need to be cautious with just rolling this stuff out. [00:45:00] And maybe free is worth where you’re paying for it.

Marcus: There’s a couple of things that we need to unpack here. I actually like to start with like the labor focus, right? So because, uh, we haven’t really seen this come to healthcare yet, but we have some

Vic: great fear of AI.

Marcus: Yeah. Well, well, but we’re already seeing it play out in other, in other areas. Right. So for example, um, the writer’s guild.

Yeah. Right. I mean, there’s no question that AI is a massive component of, you know, That whole, it would already be settled. That’s right. That’s right. AI is a massive component of that, of that issue. And the problem, of course, is that, you know, much of Hollywood has shifted to this streaming model. Oh, oops.

The streaming model is not working. The content costs too much and there’s too much of it. There’s no way AI is not going to make its way into this whole situation. Right? So there’s going to be a diminishing of that [00:46:00] profession. It’s like, and, and it’s, it’s a, it’s a macro level issue. The problem is the whole media landscape.

Is upside down. It’s, it’s not profitable, right? So, whenever we have these, these issues where an entire industry And the reason why it’s relevant is because we’ve been talking for weeks about how healthcare, Specifically delivering health services from hospitals, is not profitable. Especially if you’re doing a ton of Medicare and Medicaid, right?

So that’s the analogy. It’s like the streaming thing, it just doesn’t, it doesn’t work. It’s losing money, okay? And the Writer’s Guild folks, they’re like, They are up against a very long, hard battle. I think it’s going to be very, very tough to get these production houses to agree that they’re literally going to not use AI.

I mean, it’s not going to work. I can’t see that happening. I

Vic: mean, they may delay it. That’s the best case.

Marcus: Uh, the next one business insider, right? You know, all of their writers basically said, you know, we’re, we’re, we’re striking don’t test our resolve. And it’s like, I think this is going to be really, really difficult.

[00:47:00] So, so this is the first instance I’ve seen of something that we’re seeing in the media landscape, right? The content, the media landscape happening already. It’s that’s already happening in that space. We’re now starting to see it happen in, in, in healthcare. This is, this is where you might expect it to happen first, right?

In mental health, right? Where we have a shortage, but amazing that this organization just as a union busting. You know, method has used AI and just immediately proactively fired people putting themselves in this kind of situation. I mean, that’s,

Vic: that’s the, that’s one of several lessons, right? Like I would rather an EDA decide we have this chat pod.

Let’s now reach out to 20 times more. People and from a triage perspective and reach everyone and then yes, when they need more help, there’ll be triage and they’ll get to one of our volunteers and then triage further to one of our full time [00:48:00] employees, right? And instead of keeping the same volume of patients and cutting their staff, let’s reach out to more patients.

There’s a lot of patients that have need mental health. That I think is viable. There’s a lot of complications to make sure he’s done right. But the idea that you don’t need the people because you’re going to replace them with a bot, even if it’s a well done bot, which this wasn’t. It’s still not right.

Like it’s not, it’s not appropriate in my mind to have healthcare tools that have no humans involved.

Marcus: Yes. And we’ve been talking thematically about how AI is going to be this ruthless weapon that organizations that believe they cannot navigate the durable rising cost of labor. And then otherwise challenged market, right?

You know, spending is down revenues down everywhere, but somehow my cost of operating is going up. I don’t know what the right or wrong thing is here. I totally agree with what you just [00:49:00] said, but I’m saying we’re going to see this dilemma continue to play out, right? Organizations feeling like they’re pinched.

And moving way too quickly in the AI space, quite frankly, because there’s such a lack of a roadmap. There’s no regulatory apparatus in place. So there’s nothing to stop them from making these kinds of decisions.

Vic: Yeah. There’s nothing to stop them, except that, I mean, I, I believe that the culture of the nonprofit or the culture of a health system, the culture of a Is what makes it really work well and grow people want to work there.

They feel part of something bigger than themselves. And I think it’s possible to leverage AI as a part of that culture and use it to do something that’s more impactful than you could do without artificial intelligence. It’s not appropriate to use the [00:50:00] technology tools to, to kill the culture and send everyone home.

That’s just not the right approach. That

Marcus: sounds good. If you’re not burning cash, I, all, all I’m, all I’m saying, all I’m saying is that the economic scenario that we’re in right now is going to continue to present situations like this, where people in positions of authority, they’re under pressure, under pressure, their balance sheets are going upside down.

The P and L’s look like a disaster. Labor is the place where they’re getting hammered hardest. And they’ve got these new fancy AI things that they can just quickly swap, you know, people out and AI in. So anyway, I’m just, I’m just saying this has been, this is something new that we didn’t have in, in previous, you know, cycles like this, like, you know, we didn’t, I mean, maybe, maybe we had machines, but this is a completely different beast.

[00:51:00] This, this, this ability to, to swap AI in for a person. And even if it’s going to do less good work or whatever, it doesn’t change the fact that you can make that decision. So I anticipate, unfortunately, more of these stories coming up, because I think more leaders are going to, to make what you could argue is the wrong look to me.

This is clearly the wrong decision, right? I mean, you know, as bad as it, as it is for the people who lost their jobs, it’s really, really bad for the person who’s suffering with anorexia to get, you know, Absolutely. The opposite message they’re supposed to get. Right. So just from a compassionate, um, perspective, this is, this is very, very bad.

However, economics are real. The burning cash scenario we find ourselves in is real. And I think we’re going to see more and more of this, which should put a flame under our lawmakers to actually do something to put some type of regulatory framework in place.

Vic: I have no confidence that they can do that. [00:52:00] I think, I think the genie’s out of the bottle and there’s nothing regulators can do to stop AI.

Marcus: Well, stop, stop. It is. I’m not saying stop it. I’m saying you gotta be able to say something like, Hey, software developer, you cannot just add generative AI to your product without, and without properly informing your customers. So this, this, this is a perfect example. This organization needed, didn’t even know they were using generative AI.

Right. So there are things that we can put into place that can, um, you know, look, I, I think about it kind of like smoking, right? You know, people still smoke all the time, but at least there’s a warning on there, you know, search general warning, smoking, this will do blah, blah, blah, blah, blah. Are we even properly getting warned about all the downsides that can happen from AI?

I don’t think we’re getting warned at all. So look, there are little things that we can do that. Look, they’re not stopping it, but they can be speed [00:53:00] cushions at a minimum, slow you down enough to like, really make sure you’re doing the right thing here, you know, before you decide to fire people for generative AI, that’s going to literally tank your organization’s reputation.

Vic: Well, I mean, I think there’s a lot of industries that. Are going to be a lot more difficult, like the screenwriters guild than health care.

Marcus: Yeah.

Vic: So in our space, I mean, I think that there are so many needs. The right question for someone at a, at a health system or a payer is what is the highest and best use of my human talent?

And then where can I make them more effective, more efficient and offload some of the mundane mind numbing work that has to be done, but is not really necessary for human. For me, empathy. is where humans outshined machines. It’s not that, uh, AI can’t be trained to [00:54:00] project empathy in a fake way, but it’s not the same as a nurse.

You know, kind of holding your hand and helping you understand what treatment you’re going under, obviously

Marcus: not the same.

Vic: It’s not the same. And so what can we do in health care that sort of allows the humans to do what they can do that? No machine can do and then take away some of the duties that are not necessary.

I think in health care, there’s plenty of work for humans to do because a lot of empathetic care is needed. There are other industries where I think they’re going to have a bigger challenge. They’re not going to need many people, uh, but someone else can worry about that.

Marcus: All right. Um, we want to review a couple of stories from previous episodes, um, that have had new developments this week.

Um, one, I think we’ll just kind of quickly mentioned. We, we regularly talk about, um, that we read Axios and, and, uh, you know, this, this story from, uh, Aaron Brodwin about a fertility startup bunny that had, uh, A lot of promise, um, shuddering after [00:55:00] failing to secure funds. I think what was so crazy about this story is they had a lead.

The lead was willing to invest seven 50, right? But they would not close unless the founders could find another two 50. So they had 75 percent of the round done. They have a lead. You know, how many people say, oh, I need is lead. Right, right. All they need is another two 50 and they couldn’t get the two 50 to get to a close.

And so that’s the end of the startup.

Vic: They shut down and they literally are not doing it anymore. And the, the takeaway for me is it, it’s, um, it’s really difficult. It might, it might be, um, the hardest time to raise money that I’ve seen in 23 years. There’s no clarity of what type of deals can get done before this story.

I would have said there are very few lead investors. [00:56:00] But they found a lead, they found a lead and it’s crazy. They couldn’t get the

Marcus: two 50

Vic: most mean I’ve led a lot of deals. You’re a little ideal. I can’t think of a time that I was willing to do seven 50 and I wouldn’t close on the round and go right.

And so I, I don’t know what the lead was looking for in the other two 50. But it is, I have not seen, I mean, this is similar to oh one, oh two after the. com crash, but I don’t remember a deal like that. I mean, so the leads go away first, everyone kind of runs for cover, but you still have to deploy some money.

So you wait for someone else to lead and do all the work. But this is the first time in my career I’ve seen a lead deal fall apart when you have three quarters of the money.

Marcus: Yeah, so, I mean, look, I think the only thing we’re just sort of bringing up here is continuing to talk about [00:57:00] the difficulty of the capital markets, continuing to talk about being much more vigilant in your capital conservation, your capital efficiency, and much more conservative in your projections about how successful you’re going to be in raising money.

I mean, This is a, this is, this is a brutal story to me, um, you know, to have a founder working on, on an important company, um,

Vic: yeah, they went through an accelerator. Yeah. They got out of the accelerator, they get a lead investor, and then three months later, it’s all over.

Marcus: Yeah. But by the way, the name of the company is bunny B U N N I I.

Um, you know, I, I hope this founder takes another run at something. I mean, it’s, uh, It’s, it’s, it’s sad, you know, it’s, they really never got a chance to show us what they had, you know, uh, and, and the, the conventional wisdom is if you get a lead, you’re good. Um, so clearly they should apply a jumpstart foundry.[00:58:00]

I, well, we should have been able to talk to them before they decided to shut their doors. Um, all right. And then, uh, final thing, and this was a total left field, unexpected, uh, development, which is, um, Optum. Uh, made an offer to acquire a medicines. Uh, so there was already, it was already an offer on the table from option care health.

We talked about it all stock deal, basically a merger of this large, you know, uh, infusion based company to merge with the medicines. You know, seem like that negotiation and conversation was going well, we’ve already talked about the landscape in home health, how lots of large players, especially payers are combining with home health entities because they don’t want to have anything to do with, with hospitals.

Um, but, but the home is certainly in many people’s opinion, the future of where health care is going to be where the

Vic: patients want to be. It’s less expensive.

Marcus: It’s hard to better, better, better outcomes if you can deliver the care correctly. Right. Um, and, uh, Optum has [00:59:00] already acquired, not just made an offer, but acquired LHC.

Vic: That’s what surprised me is, um, I mean, you can see from this chart people, I, I got a couple of comments last week that we need to describe what’s on the image. We have five, six different big platforms and just the breadth of nationwide coverage. LHC and Optum already have a lot of the country covered.

Sure. They’ve already acquired LHC. Optum is part of UnitedCare group, which is the largest player complex. And now they’re trying to, in addition by Emeticis, um, all cash offer, all cash offer, so that it’s pretty much the same enterprise value. Yeah. The difference is cash or stock. Right. And I

Marcus: don’t know.

And hold on. And by the way, we presented. When we talked about a met, uh, uh, when we talked about this whole home health consolidation thing that was going on, we [01:00:00] talked

Vic: about

Marcus: this, we, we showed him as a stock performance. So, you know, um, I, I think very good move by Optum to make an all cash offer because I’m sure many of the medicines investors are probably, you know, taking that very seriously thinking, Hey, listen, you know, it would be nice to go ahead and redeem now, you know?

Vic: Yeah. I mean, I, I think, um, At first I was pretty surprised because They already have LHC, which is a great platform, but as I was preparing for the show and kind of thinking about it, it’s kind of a brilliant move by Optum. They’re pretty smart. It’s kind of like a heads we win, tails you lose thing. If they get the asset and it passes regulatory scrutiny, which I don’t know how that’s going to go.

But. Um, then they have a, a really dominant position even more so, and there’s also a chance that, um, option care is going to have to up their offer and pay more, which also is fine for them. That’s [01:01:00] right. They kind of, um, I don’t know, it was a pretty smart play,

Marcus: I think. Well, so we, we, we’ve talked in the past about how fragmented healthcare is.

And I think, you know, we were talking about how making analogies between Facebook. And, and what their position is in advertising versus UHG. Yeah, it’s, it’s not an analogy because even as, as large as UHG is, um, well capitalized as they are, it’s still a very fragmented industry and they still only have a certain percentage of all these different things.

I think if you combine LAC and a medicines are the largest home health providers. In an unbelievably fragmented market. So I think if you combine the two of them, I don’t think it makes up 20 percent of the, of the overall, I think it’s less

Vic: than 15.

Marcus: Yeah. So, so Optum, Optum slash UHG is track record on these acquisitions so far.

They’re shooting the lights out. Yeah, they’re shooting the lights out. So I think they’ve, they’ve done the diligence and they’ve sort of figured out one way or another, as you said, either drive up a, you know, a larger [01:02:00] price from option care or, you know, acquire it and combine that, you know, the, the two best of breed home health providers in the country.

On their platform, uh, you know, just incredible, incredible scenes, incredible move. Uh, and it’ll be interesting to see what the, uh, what the shareholders of, of a medicines move towards.

Vic: Yeah. Either way, I think for entrepreneurs, it’s the same story. And for VCs as a couple weeks ago, there’s a lot of consolidation happening in this space, home health and primary care are reasonably coming together and we need to build tools to make those.

Big buyers, more effective.

Marcus: I think one other thing I’ll just sort of point out, uh, I’ve been having a couple of conversations with folks lately. Um, we’re, we’re going to have to scale the home health infrastructure to really deal with what we used to call the silver tsunami. Um, you know, our growing population of, of, uh, senior citizens [01:03:00] that are, you know, going to need more and more care.

And we don’t have the facilities to take care of these people. I mean, I mean, literally we don’t have the brick and mortar facilities. To take care of these people. And we certainly don’t have the labor force in these brick and mortar facilities to take care of. The growing number of seniors that are going to need care.

So people don’t want to go to those facilities. I don’t want my parents going to those facilities. Right. So what I want is I want the home health ecosystem and the platforms to advance and evolve and get stronger. And, uh, such that I have an option to keep my parents in their home, um, as they continue to age and, and issues will come up.

They, you know, we’re all moving in that direction. So,

Vic: and I think there’s a lot of innovation that can make That more feasible. Yep. Maybe more feasible for longer at first, then make it more feasible altogether.

Marcus: Yeah. So it definitely feels like there’s, there’s a, there’s a large demographic play here over the next, you know, 10 years that says we need a lot of.

Growth and, you know, the consolidation [01:04:00] probably makes sense because that’s the one where you’re going to get the growth efficiently. But I think the amount of innovation that can be created in the venture space to enable, to empower, to grow, to make it better, more precise, this whole home health, um, you know, movement, I think there’s a lot of opportunity there, a lot of opportunity, just kind of getting, just getting started feels like.

Vic: I mean, to me in an ideal market, consolidation is. Getting to kind of five to seven players.

Marcus: Yeah.

Vic: If there’s only two, it makes it really hard for me to sell into it. But if there are 60, then no one has enough power to really spend any money or, or do innovation. That’s right. And so I think this is healthy for,

Marcus: for

Vic: us and for innovation in general.

I

Marcus: agree. I think, I think it’s good. And also, you know, the more that this gets. Connected into payers, the better the pathways for reimbursement and other things will, will be. And that’s, that’s also something that’s needed in this case. And

Vic: they’ll, they’ll sort of pull it together where they have [01:05:00] the entire risk book so they can, they can add home health in a way that someone who doesn’t have that whole view of the patient can.

Marcus: Yep. So I think it’s positive. All right. Uh, another fun show. Yeah. Busy week. We’ll see what happens next week. As always, see you next week.

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