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“I know dozens of diplomats who have lost out on getting assignments to China, Hong Kong and Vietnam,” said Yuki Kondo-Shah, a diplomat in London who successfully fought an assignment restriction banning her from Japan.
Although the employees praise Mr. Blinken’s statement in March announcing a softening of restrictions, they worry about another limit still in place: the provision called assignment review, in which counterintelligence officers can recommend bans after a routine investigation of employees with offers for posts that department officials assert have special intelligence threats.
“It’s really problematic,” said Tina Wong, a vice president of the U.S. Foreign Service union.
The list of posts is classified, but The Times learned that in addition to China, it includes Russia, Vietnam and Israel, which is a U.S. partner.
Stallion Yang, a diplomat whom the State Department once banned from working in Taiwan, has gathered data for the Asian American Foreign Affairs Association, an employee group, about officials up for postings to one of the special intelligence-threat countries. Since 2021, he said, he has tracked 22 cases of employees with ties to Asia who were under investigation for longer than the standard period of one month.
The association sent a letter to Mr. Blinken raising concerns. Last month, John Bass, the under secretary of state for management, replied in a letter obtained by The Times that of 391 assignment-review investigations in the last year, only nine had resulted in a recommendation of rejection.
But diplomats say the number does not take into account employees who moved on to other jobs after the investigations dragged on.
And beyond those concerns, there are aspiring diplomats who were cut out of jobs much earlier, even failing to get security clearance approval.
One China-born American, Ruiqi Zheng, 25, said the State Department told her she would be denied a security clearance even though she had begun a selective fellowship there. After a clearance process lasting almost two years, she was rejected in 2021 because of ties to family members and others abroad, she said.
“Everyone I knew told me that it was too good to be true, that America would never accept foreign-born Chinese Americans like me,” she said. “But I chose to trust the process.”
False claims and risky trades at the Silicon Valley start-up HeadSpin were part of a pattern of trouble emerging at young companies that lacked controls.
After Manish Lachwani founded the Silicon Valley software start-up HeadSpin in 2015, he inflated the company’s revenue numbers by nearly fourfold and falsely claimed that firms including Apple and American Express were customers. He showed a profit where there were losses. He used HeadSpin’s cash to make risky trades on tech stocks. And he created fake invoices to cover it all up.
What was especially breathtaking was how easily Mr. Lachwani, now 48, pulled all that off.
While HeadSpin had raised $117 million from top tech investors — including GV, the venture capital arm of Google’s parent, Alphabet; and Iconiq Capital, which helps manage Mark Zuckerberg’s billions — it had no chief financial officer, had no human resources department and was never audited.
Mr. Lachwani used that lack of oversight to paint a rosier picture of HeadSpin’s growth. Even though its main investors knew the start-up’s financials were not accurate, according to Mr. Lachwani’s lawyers, they chose to invest anyway, eventually propelling HeadSpin to a $1.1 billion valuation in 2020. When the investors pushed Mr. Lachwani to add a chief financial officer and share more details about the company’s finances, he simply brushed them off.
These details emerged this month in filings in U.S. District Court for the Northern District of California after Mr. Lachwani had pleaded guilty to three counts of fraud in April. He is set to be sentenced next month, with a maximum penalty of 20 years in prison for each count.
The absence of controls at HeadSpin is part of an increasingly noticeable pattern at Silicon Valley start-ups that have run into trouble. Over the past decade, investors in tech start-ups were so eager to back hot companies that many often overlooked reckless behavior and gave up key controls like board seats, all in the service of fast growth and disruption. Then when founders took the ethos of “fake it till you make it” too far, their investors were often unaware or helpless.
FTX, the cryptocurrency exchange that collapsed last year, had a three-person board with barely any influence over the company, tracked its finances on QuickBooks and used a small, little-known accounting firm. Theranos, the failed blood-testing company, had no financial audits for six years. The founders of those companies have been convicted of fraud.
Now, amid a start-up shakeout, more frauds have started coming to light. The founder of the college aid company Frank has been charged, the internet connectivity start-up Cloudbrink has been sued, and the social media app IRL has been investigated and sued. Last month, Mike Rothenberg, a Silicon Valley investor, was found guilty on 21 counts of fraud and money laundering. On Monday, Trevor Milton, founder of the electric vehicle company Nikola, was sentenced to four years in prison for lying about Nikola’s technological capabilities.
“Governance got a bit loosey-goosey during the bubble,” said Healy Jones, vice president of financial strategy at Kruze Consulting, a provider of financial services for start-ups. Lately, Mr. Jones said, he has noticed venture firms doing more due diligence on potential investments, but “they probably shouldn’t get a gold star for fulfilling their job description.”
Through a lawyer, Mr. Lachwani declined to comment.
Rajeev Butani, who took over as HeadSpin’s chief executive in 2020, said in a statement that the company’s board took immediate action after Mr. Lachwani’s conduct was discovered that year and cooperated with the government investigation.
“We are grateful to our customers who have supported us through the journey,” Mr. Butani added.
Mr. Lachwani started HeadSpin in 2015 in Palo Alto, Calif., after selling his previous company, Appurify, to Google. Businesses use HeadSpin’s technology to test and monitor their apps across various geographies and devices. The start-up quickly attracted money from investors including SV Angel, Felicis and GV.
There were soon red flags. HeadSpin’s financial statements often arrived months late, if at all, investors said in legal declarations. The company’s financial department consisted of one external accountant who worked mostly from home using QuickBooks, a basic system designed for small businesses. HeadSpin had no human resources department or organizational chart and wasn’t audited.
Around 2015, Mr. Lachwani saw an opportunity to profit on HeadSpin’s cash reserves. “It is extremely sad to see money reaping really low interest,” he wrote in an email that year to Karim Faris, an investor at GV who sat on HeadSpin’s board.
Mr. Faris advised Mr. Lachwani to keep the cash in “very conservative and liquid instruments.” But over the next few years, Mr. Lachwani used HeadSpin’s cash to buy stocks and options in tech companies including Snap, Roku and Tesla, according to bank statements filed as part of the case. At one point, he sent Mr. Faris a bank statement that showed the money was in cash and cash equivalents, according to Mr. Faris’s declaration.
By 2017, Mr. Lachwani was overstating HeadSpin’s revenue to investors by including income from customer contracts that had not been finalized and one that had been canceled, he said in his plea agreement.
HeadSpin’s investors tried and failed to assert influence. Mr. Faris and Nikesh Arora, HeadSpin’s chairman, each provided a list of candidates for chief financial officer to hire, they said in declarations. Iconiq pushed Mr. Lachwani to add more controls, according to claims made in a presentation included in a court filing.
Mr. Lachwani resisted Iconiq’s demands, resulting in “a rift between them” that led the founder to want to return Iconiq’s investment, the presentation said. Mr. Lachwani never hired a chief financial officer.
Iconiq and Mr. Arora didn’t respond to requests for comment.
HeadSpin’s accountant, Sana Okmyanskaya, said in a declaration that Mr. Lachwani had directed her to add income from new contracts to the company’s books. When she asked to see the contracts, he ignored her.
“He seemed very busy and seemed often to work late into the night,” she said in the declaration.
Mr. Lachwani sometimes sent Ms. Okmyanskaya invoices that he had altered to include money that was never invoiced, his lawyers said in a filing. Ms. Okmyanskaya, who did not respond to a request for comment, said in her declaration that he had also lied to her about the details of contracts to explain inconsistencies.
In 2019, Mr. Lachwani cashed out $2.5 million of his own shares in HeadSpin, selling them to an investor.
Investors poured more money into HeadSpin in 2020, valuing it at $1.1 billion. By then, Stefanos Loukakos, a tech executive, had joined the company as a senior vice president and discovered Mr. Lachwani’s pattern of misrepresentations.
That March, Mr. Loukakos shared his concerns with Mr. Arora in a 16-slide presentation, which was later filed in court. Mr. Lachwani had claimed HeadSpin had more than 20,000 devices on its network, for example, but Mr. Loukakos had found that the real number was closer to 2,000. When Mr. Loukakos asked an engineer about the discrepancy on Slack, the engineer responded, “lol ask manish.”
Mr. Loukakos’s presentation also included text messages that showed Mr. Lachwani cursing at employees and firing them abruptly, including one worker who was in the middle of a video call with a client.
HeadSpin’s board launched an investigation. Mr. Lachwani stepped down in May 2020 and agreed to return $1.9 million of the $2.5 million that he had cashed out. The company restructured its finances and returned money to investors that wanted out.
HeadSpin continues to operate. In March, it announced new funding of an undisclosed amount from Atlassian Ventures. An outside accountant placed the company’s valuation at $302 million, more than 70 percent below its 2020 valuation.
Ahead of his sentencing next month, Mr. Lachwani’s lawyers made the case for a lesser sentence. Despite Mr. Lachwani’s misrepresentations, they said, none of HeadSpin’s investors actually lost money.
“Mr. Lachwani did not need to say false or misleading things in order to create a successful company,” his lawyers wrote, “but he did.”
For a relatively green, relatively unheralded (but very ambitious) member of Congress, Representative Ro Khanna, a Democrat from California, has managed to position himself squarely at the intersection of competing, if not outright contradictory, interests and ideas that could shape his party’s future. The 47-year-old, whose district includes parts of Silicon Valley and who served in the Department of Commerce under President Barack Obama and later as a co-chairman of Bernie Sanders’s 2020 presidential campaign, is trying to cast progressivism in a more economically focused light. He calls his approach “progressive capitalism” and “new economic patriotism,” and he believes it is the key to broadening the progressive coalition to include the struggling middle of the country and those who might otherwise associate progressivism with economic redistribution rather than growth. That shift in emphasis is also what he thinks is crucial to President Biden’s re-election chances. “We can’t just have a triumphant ‘Look at all the great things we’ve done’ message,” says Khanna, who is often mentioned as a possible 2028 presidential candidate. “Meet people where they are. They don’t think we’re in a great place.”
Where do you see the greatest tension between the two parts of a term like “progressive capitalism”? The core progressive animating idea has largely been redistribution: We’ve got to tax the wealthy. There are challenges that I would pose to that. I’m for taxing the rich more, but there has to be a focus on economic production — on how do we grow the pie? Not just redistribution, but giving more people the opportunity to create wealth. That has to be part of the progressive vision, and that has to involve the private sector. You can’t build new steel factories in this country in Ashtabula, Ohio, or Johnstown, Pa., if you don’t work with the private sector. So on challenging the progressive side: Have a focus on production, and be open to a partnership with the private sector. On the capitalism side: You have to care about place. You can’t just say let’s have all this macroeconomic growth and not focus on every district in America. Make sure that you understand that it is a bad thing for America that my district has $10 trillion of company value and other districts are totally in despair.
When you talk about manufacturing and economic concerns, do those ideas resonate for voters who feel culturally alienated from the Democratic Party? Joe Biden talks about those things, and if you look at polling, it doesn’t seem like voters give him credit Where is the disconnect? I’d say two things: One, we have to start by acknowledging people’s anger, a sense that the system is not working for them. The president can say: “Look, for years we’ve had this offshoring globalization debacle. We’ve had working-class wages decline. We’ve had communities hollowed out.” Don’t try to tell them that they should think that we’re in a great place. The second thing is: Let’s ask people in these communities what they want. I’m proud of having co-authored the CHIPS Act but if you go to Johnstown or Warren, Ohio, they’re not saying, “We want semiconductor factories.” They’re open to it, but they want steel. Can you imagine if Joe Biden was in Warren, Ohio, saying, “I’m the president who’s bringing back steel to America”? So the two things are: recognizing people’s anger, and doing it on a bigger scale in every district.
And your feeling is that Biden is not doing that? I think he could do more. He won South Carolina
Why not convene a summit in South Carolina and invite the H.B.C.U. leaders and every tech leader in America. They’d all show up! Have an economic summit and say: “Only 1 percent of venture capital is going to Black business leaders, and Black women and men are underrepresented in tech. I want you to pledge to have technology jobs created for this state.” Every person in D.C. loves Lyndon Johnson’s record, right? They’re always like, “He did Medicare, Medicaid; he did the Voting Rights Act; he did the Immigration Reform Act.” But every street in this country is named after John F. Kennedy, because Kennedy captured the public imagination. What we have to do as Democrats is not just think legislatively, but think, How do we capture the public imagination?
I want to stick with the idea of how progressives might capture imaginations. Your messaging is pretty different from high-profile progressives like Alexandria Ocasio-Cortez or Ilhan Omar
It’s inarguable that they have captured people’s imaginations.How do you think about what you’re trying to do in the context of what they do? My aspiration is to inspire not just progressives but a majority of this country. My argument is that the central concern people have, including progressives, is that the American dream has slipped away, that people don’t think that their lives or their kids’ lives are going to be as good as the lives of their parents. So how do we capture the economic imagination of the country to believe that their prospects are going to be better? Having a perpetual economic-development council at the White House — which we don’t have — is important. Then doing things in communities that have lost steel; say, look, we’re going to put up new steel plants in these communities. That would go a huge way in capturing the imagination and getting the working class that has been left out to say, “We’re going to be part of this economy.” The downside is, OK, this is not necessarily going to speak right away to maybe the emotional sense of the traditional progressive, the progressive slogans. But it is a way of framing the goals that we all share in a way that can attract majoritarian support.
Do you think the majoritarian aspirations that you have are possible if the more fiery members of the progressive caucus remain its face? You have a way of asking very provocative questions in a very sober — like, “What did you eat for breakfast?” [Laughs.] I think you can’t have a majoritarian progressive coalition without the fire and without some of the extraordinary members of Congress who are reaching young people and mobilizing them. But it has to be broader than that.
You got your start in politics on Obama’s State Senate campaign.7
7
As a student volunteer in 1996. Khanna attended the University of Chicago.
From Barack Obama to Bernie Sanders: That’s a path that moves left. Have your fundamental ideas about politics also moved? I think that Barack Obama is the greatest modern political figure. He changed the definition of political leadership in this country and what the face of leadership looks like. That said, I have become increasingly aware of the challenges of wealth disparity, income inequality, the sense that we need much stronger progressive policies. We need higher taxes on the very wealthy. We need Medicare for All and free public college. These are ideas that are much more progressive than where President Obama was. I believe that we now have a mobilized constituency in this country that makes those things much more plausible to achieve than when Obama was president. So I’d say my politics are probably in between Obama’s and Bernie Sanders’s.
Is that just sophisticated triangulation? When you look at my record, it is deeply progressive, but I also believe that we have to understand the importance of the multiracial coalition that President Obama built and have humility as we are talking to Black and brown voters. Too often they have not been sufficiently part of the progressive coalition. There’s not going to be anyone who’s going to articulate the blueprint of a multiracial, multiethnic democracy better than Obama, but to get there maybe we start with the economics. Say we can build things together: immigrants and people who trace their heritage back to the Mayflower, people of color and people of the white working class. Americans love money. They love economic opportunity. Maybe economics is one way of starting to unify this country.
You said that Black and brown voters have not sufficiently been part of the progressive coalition. People have noted minorities moving to the right.
What needs to change about the progressive message to those voters? We can’t have people going down to the Black South and telling them what it means to be progressive. So one is to pay appropriate deference and understand where those communities are coming from, and not just go there with our message and say, “We figured it out.” We need to have more of an effort to listen organically to the Black community, to the members of the Congressional Black Caucus. There’s got to be a humility about it. Going to the right? There I think we need an economic message. OK, wonderful, we’ve appointed one of the best Supreme Court justices, Ketanji Brown Jackson. What are we doing for the economic empowerment of these communities? Are we funding small businesses? Are we providing tangible relief on student loans? We have to deliver on the economics.
When people have asked you recently about the lack of a Democratic challenger to Biden, you’ve pointed to the power of incumbency and the fact that no challenger is going to have the name recognition that he has. I don’t hear you making arguments that have to do with enthusiasm for Biden’s ideas or achievements. Is that telling? The president has done a good job. It’s a challenge, because we have to say he has done a good job while acknowledging that people don’t feel good about the economy. That’s hard. But when you look at what he promised when he ran, he has delivered a lot of that. On foreign policy, I think he has restored the NATO alliance; he stood up to Putin. He has, in my view, gotten China policy pretty right. I would push a little heavier on reducing trade deficits, but he is standing up to China while not pushing us into a cold war. He has a lot of experience for the volatile times we’re in. I guess there’s no one in our party right now — in the absence of Barack Obama — who I would say, “Put that person in,” and they would do a better job to lead this nation.
I was reading your first book and saw a blurb from Elon Musk.I suspect that you didn’t send him your most recent book for a blurb. What do you make of his political turn? Well, I still keep in touch with Elon, so here’s what I say: As an entrepreneur and innovator, he is unparalleled in genius. The fact is, he thought about electric vehicles and made that work. He figured out how to get rocket launches to be far cheaper. He figured out how to get Starlink into places of conflict. If you spend 15 minutes talking to him, you’ll realize his brilliance. But I wish he would pay more attention to issues of the role of the government that enabled him, and I wish we had insisted, when the government gave the loan to Elon for Tesla, that it have labor neutrality for unionization. I wish he realized that there has to be a more inclusive benefit to innovation. That’s where we have philosophical differences. He can be schizophrenic, as a lot of entrepreneurs are. I had an hourlong conversation with him, with Mike Gallagher, chairman of the China committee, on A.I., and he was incredibly thoughtful. Then you see his tweet that’s like a seventh grader. It’s a lot that you can’t defend.
Did you read “The Techno-Optimist Manifesto,” by Marc Andreessen? I did. I know Marc.
He and guys like him have a pretty unadulterated belief that government has to get out of the way. What are the counterarguments that you can discuss with him, or thinkers like him, that suggest common ground? I make two arguments to tech leaders. The first one is that Silicon Valley emerged because of government investment in ARPA, in DARPA, in the N.S.F.Thoughtful folks realize the role that government investment had in making Silicon Valley possible. They realize it today in defense technology, how much the decisions of the Pentagon are going to matter in terms of the adoption of some of the new technology. So as a base line, I say, “Look, government investment was critical.” The second point I make is, I know everyone in Silicon Valley thinks they’re self-made. But most of them didn’t have to worry about health care. Most of them never had to worry about massive credit-card debt. They got to go to the dentist. They had enormous advantages. I say, “Why can’t we have that for everyone?” The third point I make, which is probably the most compelling to them, is: “You don’t need me to make more money. You need me to tell a story of America so there is not a massive populist backlash in this country. It is not sustainable in this country for my district to have $10 trillion and places in the rest of America saying, ‘What’s going on with the American dream?’ If we don’t solve this, the tech backlash is only going to increase.”
Is it possible that a little more populist backlash in that regard might be helpful? If you look at the polling on Amazon, on Google, on Apple, they’re much more popular than Congress.
It doesn’t take much. It doesn’t take much, no. But they’re actually pretty high approval brands. I think that there needs to be pushback on technology in terms of taxing the wealth, in terms of requiring labor standards, in terms of making sure they aren’t violating antitrust law. But I don’t think a reflexive “We hate everything about tech” is going to create the economic opportunities in places that are left out.
How do you understand the aggrieved sense that seems to emanate from people like Musk or Andreessen? Society’s winners railing against how broken everything is. It seems profoundly blindered. It can be offensive to people in the working class who are actually struggling. I have no patience or tolerance for it, but I explain it by saying that a lot of these folks had a chip on their shoulder. They weren’t accepted by the San Francisco bankers and the lawyers and the standard finance companies. These folks were outsiders and underdogs in the ’80s and ’90s, and they took huge risks, and some of them don’t realize that they’ve won. The introspection that needs to happen is to say: “OK, now you’ve become the system. You’re no longer fighting the system. Look at the people who are really struggling in this country. It’s not you.”
If Andreessen is a supporter, if you’re able to have conversations in Silicon Valley, if you keep getting re-elected in Silicon Valley, might that suggest that people see you as fundamentally nonthreatening or malleable? Look, I’ve taken them on with the Internet Bill of Rights. I supported Senator Amy Klobuchar’s antitrust legislation that some of them had issues with. I would point to my labor record. Then you start adding it up, and you say, “Why are they supporting you?” I think one of the reasons they’re supporting me is that I am a technology optimist. I do believe that we can use technology in ways that are important to reindustrialize the country and create economic opportunities. So they like the work I’ve done in co-authoring the CHIPS and Science Act. They like the fact that I understand and take the effort to be curious about technology.
The notion of you as someone willing and even eager to find compromises is notable. We’re in this political moment where compromising is seen as weakness. I mean, there are two different frames for me. The more positive frame is: I’m very consistent in my progressive values, but I want to build a majoritarian coalition for these progressive values, and I want to do so with a hopeful, unifying vision and the recognition that I don’t have a monopoly on the truth. We need this temperament to make progressivism not just 20 to 30 percent of the party but a majoritarian part. The negative spin would be: This is opportunistic or not pure enough. I may end up upsetting both the progressives and the moderates, or I may succeed. That remains to be seen.
Winston, an older silverback, is getting enviable medical treatment. Now his keepers must confront an issue that vexes doctors and older humans, too: How much intervention is too much?
This month, as the patient lay anesthetized on a table, a cardiologist made a half-inch incision through the skin of his chest. She removed a small implanted heart monitor with failing batteries and inserted a new one.
The patient, like many older males, had been diagnosed with cardiac disease; the monitor would provide continuing data on heart rate and rhythm, alerting his doctors to irregularities.
Closing the incision required four neat stitches. In a few hours, the patient, a gorilla named Winston, would rejoin his family in their habitat at the San Diego Zoo Safari Park.
“Winston, at 51, is a very old male gorilla,” said Dr. Matt Kinney, a senior veterinarian at the San Diego Zoo Wildlife Alliance who led the medical team through the procedure. With improved health care, new technology and better nutrition, “we see animals living longer, and they’re healthier for longer, too,” he said.
In “human-managed care” (the term “in captivity” doesn’t fly at zoos anymore), gorillas may live two decades beyond the 30- to 40-year life spans that are common in the wild, and longer than zoo gorillas did in decades past.
As with their human relatives, however, aging also brings chronic illnesses that require testing, diagnosis and treatment. Gorillas are prone to heart disease, the leading cause of death for them as for us.
So now the questions for Winston’s caregivers resemble those that doctors and older human patients confront: How much treatment is too much? What is the trade-off between prolonged life and quality of life?
Geriatric wildlife care “has gotten more and more sophisticated,” said Dr. Paul Calle, the chief veterinarian of the Wildlife Conservation Society, based at the Bronx Zoo. “The medical and surgical knowledge of people can be directly applied.”
It looks more like human geriatric care. To keep gorillas healthy, zoo veterinarians not only turn to technologies and drugs developed for humans, but also consult with medical specialists like cardiologists, radiologists, obstetricians and dentists.
Winston, for instance, takes four common heart drugs that people also take, though at different dosages. (He weighs 451 pounds.) The heart monitor he received, smaller than a flash drive, is implanted in humans as well. Winston received his annual flu shot this fall, and he is undergoing physical therapy for arthritis.
“We’re looking to provide comfort to these animals later in life,” Dr. Kinney said.
That doesn’t come cheaply: There were nearly 20 doctors, technicians and other staff in the operating room when Winston received his new monitor. But the San Diego Zoo Wildlife Alliance, parent organization for the zoo and the safari park, covers Winston’s care through its annual operating budget. Donors and partners offset some additional expenses.
“None of our animals have insurance, and they never pay their bills,” Dr. Kinney noted.
Several of Winston’s longtime caregivers, called wildlife care specialists, have retired. But Winston, who has achieved silverback status with age, remains on the job, managing his “troop” of five gorillas, keeping the peace and intervening in squabbles when needed.
“He’s such a gentle silverback, an incredibly tolerant father,” said Jim Haigwood, the curator of mammals at the San Diego Zoo Safari Park. “His youngest daughter, he’ll still allow her to take food out of his mouth.”
The zoo has twice introduced females with sons to the troop, which in the wild might lead to infanticide. But Winston’s caregivers believed he would be accepting, and he was.
“He raised those males as though they were his own sons,” Mr. Haigwood said. (Once they became rambunctious teenagers, however, they were resettled in their own habitat, an option that human parents might occasionally envy.)
Winston, a western lowland gorilla native to Central Africa, arrived at the San Diego Zoo in 1984. He enjoyed robust health until 2017, when his caregivers noticed “a general slowing down,” said Dr. Kinney, who arranged Winston’s first echocardiogram.
The test showed only “a couple of subtle changes, nothing alarming,” Dr. Kinney said. Everyone was relieved. Normal aging.
Then in 2021, the whole troop contracted the coronavirus, probably transmitted by a human. As in human patients, age mattered.
“Winston was the most severely affected,” Dr. Kinney said. “He had a cough, pretty significant lethargy, lack of appetite.” He began holding on to objects as he walked.
After an infusion of monoclonal antibodies, Winston recovered. Now the whole troop has been vaccinated and boosted against the virus.
But while Winston was being treated, the veterinarians and human doctors ran other tests that found concerning health issues. Winston’s heart had begun pumping less efficiently; that led to a daily regimen of blood pressure and heart drugs hidden in his food, and to the implanted monitor. He also takes ibuprofen and acetaminophen for arthritis in his spine, hips and shoulders.
More worrying was a CT scan and biopsy showing a cancerous tumor damaging Winston’s right kidney. That prompted the kind of risks-versus-benefits conversation that should inform decisions about invasive treatment for older patients, but that is often skipped for humans.
“Do we do a surgical procedure?” Dr. Kinney recalled wondering. “The big concern was, what would the recovery look like?” After considering Winston’s age and life expectancy, and determining that the tumor wasn’t growing, “we were comfortable with continuing to monitor him,” he said.