COVID-19 and the international response is likely to impact every healthcare startup’s financial and clinical plans. There is considerable uncertainty about how much. But unlike the last fiscal crisis, this is a one-two punch that may require startups without inexhaustible cash reserves or a COVID-19 related program, to shelter in place for the foreseeable future.

The financial crisis of 2007-2008 had a chilling effect on venture investing. In October 2008, Sequoia Capital sent a warning to its portfolio companies and its presentation went viral among investors as a harbinger of the downturn. Venture investing plummeted in 2008 and 2009 and many Venture funds allocated more of their capital to keep their existing portfolio companies going.

A week ago Thursday, Sequoia Capital sent a letter to its founders warning that the coronavirus was a “black swan” event and startups should “brace themselves for turbulence” by considering if they have enough cash and preparing to face supply chain disruptions. The letter also warned they could have a harder time fundraising, similar to the market downturns of 2001 and 2009. (https://techcrunch.com/2020/03/07/vcs-warn-coronavirus-will-impact-fundraising-for-the-next-2-quarters/)

This market downturn is far more rapid than in 2008. It has yet to play out fully and with markets down 30-35% this past month, the drop is only about half of what was experienced in the bear market of 2007-2009, although that bear market was over 17 months and took many months to reach the half-way point. It is possible that we are still far from the bottom and early in this bear market and the effect on investors’ willingness to make new investments in non-COVID-19 healthcare startups will be very negative.

However, there is another area of perhaps greater concern. Unlike the economic downturn in 2007-2009, this pandemic severely impacts the healthcare system upon which life science startups depend to develop and clinically test new products. These same medical systems and healthcare practitioners are expected to have tremendous stress placed on them as they are on the front line responding to the pandemic. The effect on clinical studies may be severe in the short run which includes next flu season in the fall and winter when a second peak is possible. This is likely to significantly delay the initiation of new clinical studies as well as affect the enrollment and data gathering in ongoing studies except for trials of COVID-19 treatments or vaccine candidates. Travel restrictions, supply chain disruptions, emergency hospital containment procedures affecting patients’ and sponsors’ access to trial sites, and study personnel or patients contracting the disease, are among the anticipated impacts. Closing of trial sites and temporary halting some trials is contemplated.
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What to do now?

1. Maximize your runway – reduce all non-essential expenses unless you have at least 18 months of cash.
2. If you have clinical studies underway, work closely with your staff, clinical research organizations, principal investigators and/or study sites to understand what will change in the ability to conduct existing studies and/or start new studies. You may need to change timelines for the studies and this may affect clinical trial supplies, stability studies and other related activities. Postponing what you can extend your cash runway.
3. Virtual startups have an advantage right now – natural social distancing. So much of life science product development can be done remotely and collaboratively with contractors. If not already doing most of your business this way, now is the time to transition.
4. Notify investors and shareholders – they need to know changes in plans in a timely fashion. No one will be surprised that this pandemic is affecting the business. You may need their support if a bridge financing is necessary to reach the other side of this crisis.

What about the future?

1. This will eventually pass or become a new status quo to which we adapt. Regular financing and clinical study conditions will return. How fast is anyone’s guess but we all hope it will be measured in months. When things improve, the survivors will be able to re-emerge and resume activities aggressively.
2. This may be the time to consider China and Korea or other places where clinical studies can actually get done in the next year because they got control of the pandemic earlier and will potentially be back to normal operations sooner.
3. The growth of video conferencing and remote work will cause startups that operate from offices and labs to rethink how much being together was essential and how much can be saved by being more flexible.

Keeping your business alive is mission one. Figuring out how to conduct clinical testing is mission two. If both are managed well, your business is likely to prosper when the inevitable improvement comes. But until then, startups may have to hunker down just like citizens.
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About the Author: Dr. Weickert works in the service of medical innovation, with entrepreneurs and companies ranging from large public pharmaceutical and medical device companies to small private startups, and the investors who cultivate them. He is CEO of a pre-clinical oncology startup and has been CEO or acting CEO of 4 other medical startups, CBO of three, and advisor to scores of others. Whether consulting on business or financing plans, or providing executive leadership, his focus is on providing the vision for how breakthrough products will improve medicine and patient care. His blog, “Musings on Medical Startups”, and work examples are at his web site: www.witcreek.com and on LinkedIn www.linkedin.com/in/weickert.

A note at the beginning; what I say below applies to startup companies in the regulated industries supporting health care, where I work. These require approval, compliance, patient focus, and operate in a complicated economic ecosystem. I cannot say whether everything below applies to startups in other industries.
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The startup founder was looking for a CEO with professional experience running startups or growth companies in medical devices. He had brought the technology and company to a point where a significant proof of concept was achieved, had several other team members with technical and product experience, but indicated it was time for a “professional” CEO. Everything seemed good: the prototype seemed to work very well, the technology principles were sound, IP was filed and some claims had issued, and investors were already interested and performing technology diligence. Some conversations with potential strategic partners had even occurred.
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So, with this successful start, why were they looking for a CEO? “Because investors said we needed a professional CEO”, said several founders. At a spinout of a larger company, the spinout execution was dependent on the founder recruiting a credible outsider as CEO. In all these cases it was clear, an independent CEO was key to founders getting the capital, the buy-in, to proceed with bringing their idea forward. None of them said “I am out of my depth” or “I don’t know what it takes to develop medical products or a business” or even just “we need business help” even though one or more of those was certainly true for each. The motivation for recruiting a CEO was someone else with money and/or leverage telling them they needed one. They needed to check this box before capital could move forward. I call this being a checkbox CEO.
                                                                                  _______________________
The difference between a startup checkbox CEO and a real CEO is whether everyone recognizes the company needs an experienced business decision maker or someone with money said the founder(s) needed an outside CEO.
                                                                                       ___________________
On the one hand, you have to admire a founder who is so committed to their vision, their invention, their baby, that they are willing to step down from that founding CEO role and put the reins in someone else’s hands. On the other hand, you have to be an incredible optimist to think that is really what will happen, particularly with first-time founders. Having been a checkbox CEO more than once, and having heard similar stories from others, the checkbox CEO is not really viewed by the founders as the key company decision maker, particularly if the founder or founders maintain a majority of shares after the first or second investment round. They are for show and for advice, making the routine business decisions and managing the non-interesting, non-technical work, while the founders drive what they see as the key to the company, the technology, and expect to have decisions about their baby made their way.

Some clues about whether you are dealing with this type of founder is whether their top priority is avoiding any significant dilution; at least any that would reduce them to a minority stake. If dilution is the worry, rather than execution, a major conflict is likely down the road. Is staying on the Board permanently and naming other Board members so they have a majority a priority? Bad sign. Is the R&D budget and top prioritization of technology development their only interest? That may not change. Do they express concerns about security and keeping everything secret because someone is likely to steal their ideas, even though one or more patents describing them have been filed and published? Something irrational may be driving these concerns.

If you are leading a startup and face one or more of these situations, you may have unwittingly become a checkbox CEO. You might experience tension from the founders when other management team members are brought on board. It may prove difficult to get the founders to tell you what they are doing and why, especially if timelines slip (and they will). You might find the founders continuing to engage with potential investors or partners on their own without you, or independently engage with potential collaborators or even clinical sites without having you in the loop. One set of founders insisted on collaborating with a clinical site without any contract or agreement even though the collaboration meant the company would give the clinical site access to their IND, and supply devices, consumables, the clinical protocol and training. It can get worse. At another company, three weeks after management team members started a systematic investigation into why technology progress was stalled and appeared to be headed backwards and timelines had been completely blown, the company’s founders went directly to the Board with wild accusations of mismanagement. The Board investigated and didn’t see it their way and later these accusations evolved into lawsuits that killed the company.

If you suspect you may be a checkbox CEO, you need to mitigate your risk as soon as possible. The most drastic mitigation is resignation and depending on the situation, you may need to use it. I have. Hopefully things are not that dire, and there are still steps to take to improve the situation. Directly engaging and listening to the founder concerns is the most important first step. Make sure you dig deep enough to know what the issue or issues really are; often the initial founder’s description is the one they believe to reflect positively on them and suggest unselfishness, but the real concerns might well be personal, selfish, and harder to extract. Selfish motivations are OK; who doesn’t expect a company founder to be rewarded financially and with recognition? In fact, knowing exactly what a founder ultimately wants from the enterprise they founded is a key thing to learn before joining the team.

You don’t have to do everything to evaluate or fix a checkbox CEO situation on your own. An active Board Chairperson can be very helpful to learn more about the founders’ issues and motivations and calibrate what you have heard or sensed. They can also help the founders by having a separate direct line of communication with them through which she can listen and coach them on what is necessary for them to have a success. Often independent information on the transitions companies go through and why those are necessary can help support situations in which changes are being introduced that founders are resisting.

If you are considering a situation that you suspect might be a checkbox CEO, you don’t have to abandon an otherwise sound ship. There are a number of steps to consider that can make it a great opportunity for everyone.

1.      Founder motivations. Understand the founder motivations, such as how much money do they personally want to make at the end of the day, what kind of recognition and visibility to they hope to receive? Answering these questions can make an individual feel vulnerable; questions of finance and ego are sensitive topics. These topics have to be approached in a thoughtful way, sensitively and in circumstances where the founders can be themselves, without fearing judgement.

2.      Dilution vs. execution. It is rare that control and dilution are not an issue, especially for first time founders. They have all heard horror stories about startups where the founders were diluted to nothing and cast aside. It is important that founders have a realistic understanding of the multiple funding steps required to get a company to an exit stage, the dilution likely to accompany those steps, and the absolute requirement for superb execution in order to be successful. Without execution, the funding plan and dilution does not matter since the company will crash and burn. Minimizing dilution is not the key to founder success; great execution overcoming the risks ahead will bring success and it rewards. Keeping founders focused on execution not dilution is the challenge.

3.      Coaching. Can you coach the founders to be the best they can be at their positions? The best will feel vulnerable that the company will outgrow their skill set and they will lose a seat at the management table. The most difficult founders don’t realize that is even possible. Frank conversations about expectations and how to set them up for success, as well as what is unrealistic, are essential.

4.      Allies. Make sure you have allies on the Board who appreciate what the business needs to succeed and what the CEO needs to drive. Good outside or investor board members can help keep the business focused on the right things and avoid being driven by the founders’ agenda. They can also provide other voices articulating the business priorities, reinforcing the CEO’s agenda.

5.      Written agreements. Are all the agreements in place with the founders? Written employment, IP assignment, stock and voting agreements and more should be in place and the Board should be disciplined about documenting resolutions. If there are informal arrangements, make them formal if possible. Ambiguity or the absence of agreements can become a wedge that can tear a company apart if founders’ priorities deviate from those of the rest of the team.

First time startup founders in medical enterprises usually fall into two categories, 1) academics who want to continue their full-time appointment and 2) full time founders, often working and funding the initial efforts on their own. The academic founders who don’t plan to join the company full time are rarely responsible for the challenges described above. It is usually founders who have been nurturing their baby with some significant personal sacrifice or plan to take the full-time plunge and abandon the safe harbor of their current employment, who have the most on the line and therefore the greatest need for control. Recognizing that this sacrifice and/or loss of security may be a driver for behavior is helpful to both the founder and the potential CEO.

To first time startup founders. If you are a startup founder and believe that you really don’t need an outside CEO but are only thinking about or doing it because investors or someone else is telling you to do it, stop. Your job is to convince those people you are right for the job and can do it. If you can’t do that, then you should acknowledge that maybe they are right and perhaps your company does need a CEO. But if you believe you are the right CEO for this stage, fight for it. It is much better to give that your best shot than accept a CEO only to regret or second guess it later. Here is your program:

1. Understand why others are proposing an outside CEO. There are a number of questions you can ask. What do they see as the gaps in the company’s team? What do they think the CEO needs to be able to do at this stage?  How do they map your skills and experience to the company’s needs? Why don’t they view you as a potential CEO?
2. Be brutally honest with yourself. Can you describe what a CEO’s main roles are? Does this resonate with your investors or partners? If you were the company Chairperson (and you might already be), would you hire yourself as CEO even with outside candidates to choose from? If so, why? If not, why are you trying to get or hold onto that job? If you would hire yourself, what features and experiences make you the top candidate? Are you communicating these clearly to the parties advising you to look elsewhere?
3. Consider a stage-specific CEO. Perhaps at the early stage of a startup, the need for an experienced CEO is lower than when regulated development, partnering or commercialization is on the agenda. Where would you place yourself on the spectrum of CEO skills necessary as the company grows? Consider a conversation with your potential investors or partners about whether you might fit on the early/founding/SEED/Series A CEO part of the spectrum with a later transition to a more experienced CEO that you would support.

If you cannot convince your counterparts that you are right for the job, you have two main choices: 1) find potential new investors or partners that share your vision and believe in you as the leader to take your company there or 2) reconsider whether the potential new investors or partners have a point and genuinely embrace trying to find the right CEO partner for making your company a success.

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Despite these experiences, there are many great ideas out there and many great founders. I remain optimistic about what I call the Life Science Diamonds in the Rough, genuine breakthroughs invented by people outside the mainstream and marquee institutions. These need help and nurturing from those with experience, otherwise they will never reach the patients they are intended to help. But founders and the CEOs brought in to help their enterprises, need to be on the same page about the roles and responsibilities and expectations in order to realize success.

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About the Author: Dr. Weickert works in the service of medical innovation, with entrepreneurs and companies ranging from large public pharmaceutical and medical device companies to small private startups, and the investors who cultivate them. He has been CEO or acting CEO of 4 medical startups, CBO of three, and advisor to scores of others. Whether consulting on business or financing plans, or providing executive leadership, his focus is on providing the vision for how breakthrough products will improve medicine and patient care. His blog, “Musings on Medical Startups”, and work examples are at his web site: www.witcreek.com and on LinkedIn www.linkedin.com/in/weickert.

Startups are risky. Statistics on failure indicate most industries only have around 50% of their new companies operating after 4 years (http://www.statisticbrain.com/startup-failure-by-industry). Others suggest 3/4th of Venture backed companies go out of business (https://www.wsj.com/articles/SB10000872396390443720204578004980476429190). The latter does not account for those companies failing to get Venture backing, which is easily a majority of Medical Device and Biotech startups. And therein lies one of the least understood risks of startups, the risk they will not access capital at some point along the path to profitability, or the terms of that capital will be so onerous that early investors will be wiped out.

I recently had a rude reminder of how a successful exit for a Medical Device company can still wipe out early investors. Over several years, as part of a well-known and experienced Angel group, I made three investments in a Medical Device company. They produced a product, brought it to market and gained market traction. Lawsuits with competitors consumed more capital than planned and generated uncertainties which created difficulties with fundraising. Though the company ultimately prevailed, the circumstances in which the last capital was raised resulted in a large venture debt and a 2x preference for the last equity investors. So despite a substantial exit, all the net proceeds went to the last investors in, and early investors as well as common shareholders (founders, executives) were left with nothing. Millions of dollars wiped out while others got a 200% return. While this does not seem fair, this is not uncommon and is one of the key concerns of early investors and Angel groups. First money in often gets buried if things don’t go perfectly along the way. Even a “success” can bust early investors.

Most entrepreneurs recognize that early equity investors will assign a low valuation to the initial startup enterprise. While opportunities may be large, they require success in the technology and product(s), perfect execution by the team, and frequently clinical and regulatory success. The products must have protectable intellectual property and not infringe on IP for which the company does not have a license. The product(s) must fit clinical practice in a way that promotes adoption and must be superior to other solutions available at the time of launch. The market and uptake must support a significant return on the capital required to achieve product commercialization. All these risk hurdles must be cleared in order for investors to recoup their investment and earn a return. All these contribute to the discount in valuation investors require for early stage startups.
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In addition, the ability of a company to obtain additional capital at various “value inflection points” throughout the company’s product development and commercialization cycle is an additional risk. Circumstances related to execution, that are within the company’s control, as well as market circumstances outside the company’s control, both impact the availability and terms of capital at future points of need. The obstacles to raising capital during development are underappreciated. There is often a time pressure, where opportunities will be lost or diminished if capital is not deployed to meet them in a timely fashion. Interruption of funds for operations can compromise contractors and teams, resulting in cascading delays. The pressure to accept onerous deal terms can be substantial. If there have been hiccups in execution, funds may not be available at all. In either of these circumstances, early investors suffer. That’s why they demand a valuation that will reward them handsomely those few times when everything goes right.

The good news for entrepreneurs is this can be mitigated to some extent by having a very clear and well thought out funding plan that coincides closely with key development milestones but provides sufficient time for data to drive funding decisions and closing on new capital. There is a reason that you hear many companies talking about Bridge financing; they had delays or didn’t plan enough time from milestones to closing on capital, to keep operations going. Doing a good job of laying out the financing strategy and milestones over the life of the company will improve the confidence of early investors and mitigate some of your financing risk.

This month I attended the 2016 BIO International Convention and one panel in particular discussed a topic of great interest to me: "The Newest Bright Shiny Thing -- The Challenge Of True Innovation".  Working as I do with drug and device startups on the cutting edge of medical innovation, the panel’s thoughts on innovation were of great interest. The focus turned out to be on finding more effective approaches to creating and sustaining innovation at incubators, Universities and larger companies. The discussion elaborated on creating an environment promoting innovation at those institutions already well endowed with advantages and resources, and expanding on the areas for innovation beyond significant medical advances. Innovators who were not at an incubator or company or prominent university or medical school were, as is often the case, left out of the conversation. So during the Q&A, I asked the panel about the true innovation that is not a bright shiny object, but is instead a rock dug up by someone you don't know, and is a diamond in the rough. How do we do a better job recognizing those and bringing them forward? 

The response was generally that if the discoverer can't get their innovation brought forward on their own, despite their personal shortcomings, scarcity of early non-academic funding or the institutional resistance to change in the field of medicine, then maybe it will come around again and be rediscovered in the future. This is actually congruent with history in which medical advances which have been initially rejected or failed to gain traction eventually were rediscovered and brought into conventional practice. For example, the breakthrough in understanding that Heliobacter pylori caused most gastric ulcers and could be cured by antibiotics led Barry Marshall and J. Robin Warren to a Nobel Prize in 2005 and revolutionized how we diagnose and treat gastric ulcers. Their discovery was preceeded by a Greek physician, John Lykoudis, more than 25 years earlier, who successfully treated his own gastroenteritis with antibiotics in 1958 and received a Greek patent in 1960. He subsequently treated an estimated 30,000 Greeks with antibiotics, curing their ulcers. His attempts to publish his findings in JAMA were rejected and he was fined by Greek medical authorities in 1968 for malpractice. But his discovery eventually arose again.

The status quo seems to be a natural selection model of medical innovation in which breakthroughs may be extinguished for many different reasons but if the niche (need) is still open, other versions of solutions will arise again and may become established in the right circumstances.

The right circumstances very often depend on who is originating or representing the idea. Coming from a well-recognized lab like Bob Langer's at MIT almost assures support, attention, funding and acceptance. Many of the most recognizable institutions like Stanford have numerous startup programs. I participate in two at Stanford, SPARK sponsored by the Medical School and iFARM sponsored by the Office of Technology Licensing, and there are many more like StartX that are very well known. This past week, Obama even participated in a Global Entrepreneurship Summit at Stanford. Bright shiny Institutions like these produce the bright shiny objects pursued by investors and companies alike. But other innovations are overlooked.

Bright shiny objects pursued by everyone are not necessarily the problem, but our inability to discover or, perhaps more painful, readiness to discard the diamonds in the rough.  The status quo and the quest for perfect vehicles for investment drive decisions costs lives. To say we will wait until they come around again is to postpone a cure for sepsis or Alzheimer’s or drug resistant infectious diseases,  keep sticking people with needles and catheters to get drugs through the skin, and replace lost tissues or organs only with ones harvested from others requiring immunosuppression and accepting a high failure rate. Each year we postpone a sepsis breakthrough, 8 million people die worldwide.
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Breakthroughs are out there – the repurposed drug that might cure sepsis, the plant-based artificial skin that costs a fraction of the current products, the drug delivery device that cures MRSA and necrotizing fasciitis infections in 5 minutes, the sensor that measures IV drugs in real time to catch mistakes, the simple cap to cover and sterilize IV ports and prevent infections. What is missing? For many it is polishing and cutting the diamond to make it sparkle. For others, the breakthrough is still buried in the soil of inexperience or conflict that hides the potential.  If the originator knows how to polish and cut, then she can make it a bright shiny object. But if the entrepreneur is new to the game and does not have the resources to do the initial trial, engage the regulatory specialists, file the broad IP and recruit a “world class” team, all without outside capital, and the talent to create a business vision with a quick return for investors, then there will be no polish, no shine, and no funding. And I understand more than most how entrepreneurs can be their own worst enemy. But isn’t it worth giving some of these diamonds in the rough the attention they need to shine? Don’t our patients deserve it?

In this age of virtual companies and constant connectivity, collecting thousands of people in one place to rub elbows and share stories seems as archaic as riding horses. Why spend the money and time to exhibit or attend CES or JP Morgan Healthcare or any of thousands of meetings and conferences each year? Why fly across the country to meet your counterparts when Skype will cost you nothing? Not only are human beings generally social animals, but there are some things you want to know that just don’t come through over email or phone calls the way they do in person.

Passion. When a person really cares about something in a dedicated and passionate way, the face, body, eyes and gestures are part of communicating. The words that are said matter but the expression, focus and involvement of the whole person communicates so much more. When someone has a joyous expression and is full of energy when talking about their company, their product, their breakthrough, it is infectious. I still remember being riveted by a lecture in graduate school where the visiting Harvard Professor paced the stage with a big smile while he told us about his lab’s studies in Sigma Factors. He made everyone care because he cared so much in such an infectious way.

Credibility. Just like body language and facial expression can tell you about a person’s passion and dedication, it can also signal reservation, mistrust, or disinterest. Whether consciously or not, most people read whether another person is open and trustworthy by their actions more than by their words. How many times have you come away from a conversation and thought or said “I just don’t have a good feeling about that person”? That was your subconscious signaling you that their non-verbal signals were telegraphing: “don’t believe what I say”. This is why important contracts are seldom signed before the parties actually have a chance to meet with each other. The more important the contract, the more meetings may be necessary and the more members of the team they will involve. This is also why people want to do business with people they already know – the credibility has been established.

Serendipity. In gatherings of colleagues trying to gain attention, unexpected connection and amazing experiences can occur. At a satellite conference during J.P. Morgan Healthcare week, I had just such an experience. An innovator seeking investors for a breakthrough in drug delivery, one of my specialties, described dosing someone at the conference the night before with one of their investigational products. She was in serious pain and he reported she experienced rapid relief. While I found him believable, the conference setting offered me the chance to immediately and personally verify this story. I quickly found the woman who was part of the team supporting the conference with catering and refreshments (i.e. with no vested interests). She had been experiencing severe neck and shoulder pain for two weeks and it had been affecting her sleep. She said on a scale of 1-10, it was an 11. She was skeptical of his offer the night before but wanted to be a good sport. Within 15 minutes of a topical dose of a nonsteroidal anti-inflammatory, her pain was down to 7 and after an hour it was gone. She had slept great and was ebullient and delighted to talk about her experience the next morning. Then she shared that another member of the circle the night before had received a dose. I followed that chain to a gentleman who was both a company executive and investor. He was used to being skeptical about unusual medical claims. He dosed both his sore knee and back and commented: “while I can’t say conclusively that it worked, I can say the pain is gone”. And he seemed awfully interested in helping the company get capital.

This experience follows a long line of medical innovators dosing themselves and others to prove something they really believed in. Dr. Barry Marshall gave himself a gastric ulcer by drinking Heliobacter pylori, to prove it was the causative agent, then was cured with antibiotics, leading to the change in the paradigm for treatment as well as an eventual Nobel Prize. As a startup executive, I had dye injected by a prototype nanojet device to show how it gets into the skin and diffuses just like a drug dose would. These kinds of personal demonstrations and observable, unorchestrated results are anecdotal but powerful validation that an entrepreneur is willing to put everything on the line in a situation they don’t control because they believe in what they are doing to the core. That is what face-to-face and gatherings like this week in San Francisco allow you to learn. You can’t email that.

The gravity of the J.P. Morgan Healthcare Conference draws thousands of worldwide healthcare investors to San Francisco each January. Around the Westin St. Francis and Union Square orbit satellite Conferences catering to Companies and Investors outside the scope of JP Morgan’s analysts and bankers. That’s where the large universe of early stage companies and microcaps find the stages on which they can tell their stories and connect with investors. Biotech Showcase, OneMedForum, the RESI Conference, StartUp Health Festival, and the Non-Dilutive Funding Summit each seek to establish a niche in which to attract and transact. Each had a different way of getting attention, or distinguishing their offering.

Mini-JPM: Biotech Showcase™, in its eighth year, is working hard to become a mini-JP Morgan. But it is mini no longer. It’s web site touts 306 company presentations and almost 2,500 attendees, putting it on a company presentation footing comparable to J.P. Morgan with about half the estimated JPM attendees. They also created two one-day tracks dedicated to connecting medtech and digital health companies and investors.   With so many companies and attendees, this has become the Jupiter of the J.P. Morgan satellites.

Rising star: This is only the second year for the one-day RESI conference (Life Science Nation’s Redefining Early Stage Investments) during JP Morgan week but they reported the week prior to the conference that they had more than 288 confirmed companies. Among the companies were 30 chosen and spotlighted as part of the RESI Innovation challenge. These 30 were deemed most innovative by Life Science Nation’s internal scientific review board and their technologies were on display in the exhibit hall throughout the conference. Conference attendees were invited to participate in a virtual investment contest in which each attendee could invest up to $500,000 in “RESI Cash” in 1-5 companies whose technologies they were most impressed by. 

Rock stars: The StartUp Health Festival was the furthest from Union Square but they packed their venue offering an opportunity to hear startup luminaries such as Vinod Khosla, Dean Ornish and Craig Ventner in “Fireside chats”. They report that over 1,000 investors and participants registered for their two-day event, and enough showed up that the StartUp Health Café was packed and the “intimate Fireside Chats” were standing room only. 

Non-Investor conference: In contrast to the rest of the conferences, the 11th Annual Non-Dilutive Funding Summit provided a one-day focus on non-dilutive funding. Panelists and participants included representatives from NIAID, NIBIB, NINDS (all NIH) and NCI and DoD. This conference is organized by the FreeMind Group which specializes in helping life science companies secure non-dilutive funding from US Federal Agencies and Private Foundations, and it features mostly panels and opportunities to meet with these representatives to discuss company projects rather than presenting company pitch decks. 

Focus on Fundamentals: Also in sharp contrast to the Biotech Showcase and RESI, the OneMedForum conference was a much less crowded event with far fewer companies participating, and only a single presentation track throughout the three-day event (including China Forum on Wednesday). The new location was extremely convenient - half a block from Union Square, yet sessions and partnering tables were uncrowded. Unlike other conferences, OMF did not offer any panel sessions Monday or Tuesday, focusing instead exclusively on the business of connecting companies with investors. Unlike other venues, service providers were scarce. The lower density of participants did not seem to impair the ability of determined companies to make many investors connections. Several companies I spoke with reported 20 or more high quality investors meetings so perhaps the no frills model has a niche too.

It will be interesting to see if all these events are still in orbit around JPM next year and how each morphs to try and grow and stay relevant to companies and investors alike.

After months of networking, research, interviewing and analysis, you have two job offers. One is a small startup with a team that has really impressed you with their intelligence and grasp of the job ahead - creating a major disruptive technology. They still have their first major funding event ahead of them so things will run very lean for a while but you will have substantial equity. The second is a company that is already profitable with a strong growth potential and a solid team where you will probably stand out. With less risk, salary is secure but you have a lot less upside. Both really appeal to you and you can contribute a lot to both situations but the offers are expiring and now you have to make up your mind.  Today!  Try flipping a coin!

You are going to take whichever job the coin flip lands on. Assign job one to heads and job two to tails. Now flip. Its heads! Now, do you feel happy that it landed on heads or disappointed? That’s the real answer you are looking for – how you feel about the outcome. That was inside you all along but hard to put your finger on with all the analysis. That intuitive and emotional input to your decision is the “gut” to add to the analysis of the “head” and really learn where you should go. The coin flip does not tell you what to do, but it does help you tell yourself.

The coin flip test can be useful for other binary decisions as well, professional and personal. Any time we are in a dilemma where we have to make a decision with the information we have, our intuitive / emotional brain can be a powerful ally. But it is often suppressed by the doubts of our analytical minds wanting a clear, logical best choice. In many circumstances, not making a choice is the most harmful thing to do. So toss a coin and learn how you feel inside about your choices; how your subconscious has processed the options. Learn what you really want to do when analysis paralyzes your decision making apparatus. If you are happy it came up tails because that means you are going to skip visiting Aunt Shirley for Christmas this year or hire that very energetic marketing candidate, then it is the right decision for you and move ahead without regrets.