Theranos: Could The Company Have Been Revolutionary?
To write that Theranos was a disaster is no longer a controversial opinion — The Inventor and Bad Blood both convey how risky it once was to speak out against the company. Theranos had a threatening team of lawyers and private investigators that did everything in its power to stop the whistleblowers. The company once had a valuation greater than that of Uber, and Elizabeth Holmes appeared on the cover of Time Magazine. Today, the company’s deception and illegal actions are so well-known that it is difficult to imagine how so many people fell for it.
From Bad Blood:
Balwani [former CEO] had tasked a Theranos software engineer named Michael Craig to write an application for the miniLab’s software that masked test malfunctions. When something went wrong inside the machine, the app kicked in and prevented an error message from appearing on the digital display. Instead, the screen showed the test’s progress slowing to a crawl…Michael Craig’s app wasn’t the only subterfuge used to maintain the illusion. During demos at headquarters, employees would make a show of placing the finger-stick sample of a visiting VIP in the MiniLab, wait until the visitor had left the room, and then take the sample out and bring it to a lab associate, who would run it on one of the modified commercial analyzers.
— From Bad Blood, by John Carreyrou, emphasis mine
Theranos is relevant to the software industry for a few reasons:
- The excerpt above demonstrates how the company used deceptive software; it can be argued that the excerpt also shows how faulty demos can be
- The company casts Silicon Valley in a negative light. A common refrain now is that this is where the valley’s “Fake it till you make it” mentality fell on its face
- Many software engineers dream of working at a healthcare company for the same reason doctors and nurses are interested: To help as many people as possible. This is a cautionary tale
Instead of writing the 1000th article about how Elizabeth Holmes should be ashamed of herself, I wanted to take a slightly different angle and write about blood. This should be interesting.
What Could Have Been
The motivation behind Theranos was simple — blood work is very expensive, and Holmes was promising a cheaper and more efficient alternative. This could have been more than a convenience; this could have been revolutionary. Millions of Americans do not have health insurance. Diagnostic blood tests are hugely important, but the American healthcare system consists of going through an insurance company (if there is one), not always knowing up front what the cost will be, as Holmes describes, and having large amounts of blood drawn.
What this company claimed to be creating was a small device that would prick your finger, then provide you with an enormous amount of diagnostic data. The cost would be fully transparent. It could be done at a local Walgreens.
What Diabetics Do
Glucose meters have existed since the 1980s, but they are still something of a scientific feat. Though not as reliable as a lab test like the A1C, they allow diabetics to purchase a comparatively cheap testing kit over the counter or on Amazon, test themselves hundreds of times with instantaneous results, and do their own science, so to speak. The CDC writes that regular glucose tests are the most important thing a diabetic can do. By administering their own tests and by obtaining their metrics, individuals are empowered to make life decisions about when to eat and what to eat.
A full testing kit that provides 100 tests can be purchased for about $30; though this is not a substitute for the A1C, Walgreens charges $35 for a single A1C test (it should be noted that the A1C measures the average across three months, but this is still just one data point). If it were not so easy to use glucose meters, diabetics would either lack a critical resource or require huge amounts of money to compensate.
Theranos might have been a little bit like this: A simple finger prick test.
Could This Actually Have Worked?
According to “practicing atheist” Tomaz Vargazon…um, let me use a different source, actually. The number of upvotes this Quora post received makes me think it is probably credible, but I find it kind of funny that the bio just says “practicing atheist.”
According to Chemical and Engineering News, finger stick blood tests are useful, but at-home testing is not universally trusted by doctors, the act of pricking runs the risk of contaminating samples, and results tend to be much less consistent. Does that mean that Theranos’ core idea is dead in the water? In a sense, no. The CEO of Seventh Sense Biosystems, for example, suggests pricking the skin with microneedles and drawing the equivalent of two drops of blood. Ryan C. Bailey, of Genalyte, suggests a very different approach of using silicon mirror resonators, or using light waves to detect diseases.
“Does not violate the laws of physics.” The Quora discussion above was more damning. Still, even with the added obstacle of the Theranos story, some biotechnology companies are pressing on.
Theranos was a Major Setback
HBO’s “Silicon Valley” was a TV series that parodied the cliche industry desire to “make the world a better place.” But at its core, in the very first episode, was a billionaire who was quirky and mean, but who had unquestionable integrity. Minor spoiler, the actor for him died tragically and the writers had to do without him. Without that character, and without that actor, the series took a very dark turn that it may not have taken otherwise.
The most fascinating contribution “The Inventor” made to the discussion was the die experiment. In this study, participants were given the choice to lie or be honest about the result of a dice roll, and they would be compensated accordingly. In a twist, participants were told that the money would go to charity. When participants believed lying was for the greater good, their lies became unnoticeable on a lie detector.
Did Elizabeth Holmes think that if she kept lying, eventually the technology would write itself and the world would become better because of it? Is it hard to say, but the trial will speak for itself.