The idea of rapid disruption in the healthcare industry makes me uncomfortable for some reason. I admire Holmes's ambition and in interviews I've watched she seems competent and well guided but something just doesn't seem to add up.
How was a college dropout able to get a break in the healthcare sector? Becoming a doctor requires years of education and training and along comes this young woman who just decides "I'm going to change all of this." What? I don't understand how a person with no experience, no vetting, no medical training, no engineering training, and frankly a product that I find to be of questionable value ends up getting millions in funding and at the head of a multibillion dollar company.
Perhaps I just don't understand the phobia that some people have around blood tests but it is my understanding that you get a blood test as a way to gauge your health, not because it makes you feel nice. The hold up doesn't seem to be that tons of people are afraid of needles otherwise they would be getting tested all the time. The hold up to people getting blood tests all the time is that doctors don't order them, presumably because doctors don't think people need them.
As long as the test isn't extremely uncomfortable for the patient, I would think that accuracy is really the only measure of quality for a test and it seems to me that they are willing to sacrifice accuracy in favor of making people feel comfortable.
Also, why would I ever get a blood test at a grocery store? Why would I ever trust some random employee at a food store to respect my privacy and be medically competent enough to administer a test like that. What exactly do I have to gain by getting one in the first place?
Correct me if I'm wrong on any of this because this is just my viewpoint as an outsider. I would however never get a blood test from Theranos and if I wanted one I would call my practitioner and have them administer one at a doctor's office, not at the local grocery store.
FWIW when I saw Safeway was giving flu shots (which apparently is because of an aborted partnership with Theranos), I thought "WTF would I get a shot at the grocery store?" But then my doctor recommended that I get routine vaccinations there because it's apparently about 1/2 the price of getting them at the clinic. And I tried it, and it's actually a lot more convenient than going to the clinic. The shots are given in a private room by a licensed pharmacist who's trained to know about any possible adverse reactions, and there's usually no lines and little waiting.
I was a skeptic, but a doctor's suggestion turned me into a believer. It's just that Safeway's the beneficiary of this rather than Theranos now.
Workplaces have also given flu shots for a while now - they had a yearly flu clinic at Google the years I was there, but I always found it more convenient to go into Safeway at my leisure than drop my work during the day and get stuck with a needle in front of my coworkers.
She comes from a very, very privileged family with the kind of connections most of us can only dream about. Alas that still counts for a lot, even amongst the VCs (especially amongst?) in PAMPA.
Yes, and she is apparently unmatched at creating reality distortion fields. And her minions just played the oldest game in technology. When people come over, and you don't want to show them anything, show them the machine shop. The Times was mystified by a dial indicator and chips (garbage) from a milling machine.
This whole episode is the best justification for the thesis that that VCs are successful, not from adding value, but simply being presented with the best deals. Perhaps that bull at the Dallas Morning News could do as well.
Also, she doesn't work in health care. Theranos is a pr/investment vehicle. The products are overhyped, she's a figurehead, the entire idea is to get investors to part with their cash for as long as possible - and then when it all goes wrong the pretty face in charge stays out if jail. It ain't her business.
I see her and Shkreli as fundamentally doing the same thing - just she's doing it not like an idiot, like him.
This is a true point. When you have a lot of money available to invest and you already have a diverse portfolio of high risk-reward investments I suppose it isn't such a big deal to spend 1m on an intelligent family friend. Still... they didn't get to be that wealthy by being careless with their money so I suppose we/I just don't know the full story.
It's the other way around. They will have approached her, as they smelt an opportunity to use her, as they are still now. Egoistic people are really easy to manipulate, and you only have to stay one step ahead of the wake of your reality distortion field to pull it off.
The house of cards will come tumbling down at some point, but it won't matter, there won't be consequences.
I know this because I've spent enough time in the world of the mega-rich, had enough passes made at me by apparently well meaning robber barons, to know that this is how this works.
The story as it was explained to me (by Tim Draper) was that Elizabeth grew up with Tim's daughter, Jesse, and asking for her first million from him was thus relatively easy.
I don't know, it seems like many people with a lot of money can afford to be frivolous and end up bailed-out by the government.
See the Wall Street melt-down in 2009. These are supposedly finance professionals who "lent to the wrong sorts" but that's their only job, determining who and who not to lend to, right?
There's a lot of "boys will be boys" among the upper-middle class and wealthy, whether those "boys" are boys or girls of these families.
I see a lot of old men, who once wielded a lot of power, being assiduously ego stroked by a young master, whose upbringing served to hone that skill to perfection.
Becoming a doctor requires years of education and training and along comes this young woman who just decides "I'm going to change all of this."
You don't need to be a doctor to hire doctors. Aren't startups supposed to be all about this kind of disruption by outsiders? People who come along and decide "I'm going to change all of this"?
Perhaps not, and perhaps she has a gifted eye for talented medical professionals/chemists and/or is able to put people in place who do but it's still a company being built by someone who doesn't really have the deep domain specific knowledge that would be required to make truly informed decisions. How many tech companies were founded by people with literally zero experience in tech? probably not many except medicine is even harder to learn. While you can spend all day reading Stack Overflow and writing apps to become a reasonable programmer it isn't like you can do the same thing with Web Md and become a reasonable doctor.
Theranos was founded in 2003, so it is a 12 year old company. So it is a long time to come up with a disruptive technology even for the healthcare industry. And she comes from a wealthy family with the right connections.
This is an ignorant viewpoint. It's not just phobia. If a fingerprick blood test were actually possible it would make a huge win for children. One of my kids needs to get his blood tested for lead ( standard blood test for his age). Good luck trying to get him to hold still while he's screaming and fighting and drawing enough blood for a test. It would also be a huge win for premature babies, some of which only have 2oz of blood in their entire system.
The sell of Theranos was that you could do a thousand blood tests on a few drops of blood. If you could go to Safeway and get an accurate fingerprick blood test, then you wouldn't need a trained specialist to draw blood and collect the blood samples anymore. That's a huge win as well.
It seems less and less likely that is actually possible but if it were and you could get reliable and accurate results, it would really make a difference. It's not just people being scared of needles.
The cofounders previously founded Advanced Liquid Logic, a diagnostics company using microfluidics technology developed in a Duke research lab that was subsequently sold to Illumina for $96M in 2013. Baebies is now licensing that technology from Illumina.
Citation please. My experience is that there are a lot more MDs and PhDs in biotech than other tech fields. I would like to see where you got the information that a "significant number" have absolutely no science training. Also, when you say "significant number" do you mean less than other fields at a significant level or do you mean less than some number you are defining as significant. If the latter would that be only 5, 10, 15, 20, 49.9% without science training and is that less than average or other tech fields?
I don't think it's necessarily a bad thing. There is a whole new crop of start-ups in the healthcare space with founders coming from Google and Facebook (ie Flatiron Health). I think this is great for bringing innovation to an industry that is hurting for it.
how can you not understand the convenience factor? do you mean, why would you buy a home pregnancy test at Walgreen when you can just schedule an appointment at a doctor? are you kidding me? because it saves time and money, that's why. how is that a difficult concept to understand. I would certainly choose a quick blood test from Walgreens rather than going through my HMO to schedule a blood test if i suspected something was wrong. if i received a positive result, then that would factor into my decision to see the doctor.
Theranos changes none of that. Unless a test is CLIA waived, it needs a prescription to be done. They are trying to make it easier to take samples by requiring less blood to be drawn but it is silly for those in the field. Most chemistry tests take only several microliters of blood so yes the "nanotainer" would work for that. But most tests need venous blood, so it is irrelevant if you take a tube vs a ml when you have to take a vein draw anyway!
Perhaps I just don't understand the phobia that some people have around blood tests but it is my understanding that you get a blood test as a way to gauge your health, not because it makes you feel nice. The hold up doesn't seem to be that tons of people are afraid of needles otherwise they would be getting tested all the time. The hold up to people getting blood tests all the time is that doctors don't order them, presumably because doctors don't think people need them. As long as the test isn't extremely uncomfortable for the patient, I would think that accuracy is really the only measure of quality for a test and it seems to me that they are willing to sacrifice accuracy in favor of making people feel comfortable.
Couple of potential issues: one is that blood tests can be extremely expensive. They are run by delicate, temperamental, and pricy analyzers that have to be babysat by reasonably well-trained personnel. Some tests need costly reagents. Still others aren't readily automated at all and require a lot of manual inspection and interpretation, again by people who don't work for free. Meanwhile, doctors are under external pressure to keep costs down, sometimes to a fault. I think these are the pain points that Theranos is trying to address.
The second issue is the real elephant in the room: statistics. Accuracy is not a simple concept in this business. If Theranos succeeds in commoditizing a large number of blood tests and making them available to people without medical supervision, there will be some unintended consequences. I think these are positive goals -- don't get me wrong -- but the fact is that the traditional medical priesthood is still going to be needed to follow up on the tests. If you run enough lab tests on a sample of your own blood, you will get some positive results for diseases you don't have. A test that's 99.9% accurate for say, HIV, is going to report a lot of false positives if you give the test to people who were never in a high-risk demographic to begin with.
So when a physician decides which tests should be ordered and which ones should be skipped, they aren't just being financially stingy. They're also trying to get at the most likely diagnosis without wasting time on laboratory snipe hunts. I don't think anyone including Theranos can do much about this problem. It's just too hard to come up with a perfect medical test, let alone a perfect machine to execute it.
Basic panel of blood tests is reimbursed $8 from medicare. That is pretty darn cheap. I know here we always think that industries are ripe for disruption, but the lab industry is mature, highly competitive, and has a high barrier to entry that is not possible to circumvent (FDA/CLIA approval) for tests.
Blood tests are not all that expensive. You can get the most common 25 blood tests done for a total $50 (including drawing blood and paying middle man costs with no insurance.)
It's useful to try to understand what's going on with the blood testing stuff, because it shows how hard it is for people in public health to get accurate messages across.
Some people think more information is always good. We see healthy people without any symptoms will sometimes pay for "whole body MRI scans".
Some people think that if you have an illness it's going to be seen in the blood.
Frequent traditional blood tests are time consuming and not that pleasant.
Theranos claims that they don't need that much blood; that they can do a blood test with just a drop.
This means people don't need to see a phlebotomist nurse to have blood taken, they can just blot a drop of blood on a stick.
So, the claim goes that people can have very many blood tests all the time, and that will give us more data, and that data is always good.
Theranos plays into some deeply entrenched stuff, so while it's alarming they got so much money it shouldn't really be that surprising.
Medical knowledge is no prerequisite to shaking up Healthcare.
Prior experience is no prerequisite to start and grow a business into several billions in valuation; ask Mark, Larry, Bill, Steve and 'em.
Making blood tests super easy to take is extremely important. For example such a system could run tests daily and inform you a long time before something terrible happens. It's like cars, before they existed it wasn't very easy to understand how they will impact societies.
I hate the sentiment here in pretty much each of your paragraphs. I don't mind rapid disruption too much but Theranos is 10 years old so not sure where that comes in. College drop-outs: Gates, Jobs, Ellison, Zuckerberg, Branson, Dell, Ev, Kalanick, Koum. It's not uncommon for "outsiders" to be able to create breakthroughs that "insiders" never saw. You're completely missing what quick, cheap blood tests could enable. It could revolutionize all of medicine. Because grocery stores are convenient. Even if Theranos was proven effective? Take your head out of the sand.
There is no Theranos. It's a marketing campaign for a sci-fi movie being released in 2016. (Look at Elizabeth Holmes' (an actress, btw) dress code. Look at their website. Try to find a reference to the company before 2015. It simply doesn't exist!).
After the surprising success of Soylent, MGM decided to cash in with an updated version of Soylent Green. In the future, instead of eating food, people just insert their finger into a machine which analyzes their blood chemistry and makes a delicious beverage optimized for your individual needs. Of course, it also scans your calendar (final exams? Add some ritalin. Important business presentation? Add some xanax. Hot date? Add some viagra).
I don't want to give away any more of the plot, but it stars Elizabeth Holmes and Will Smith (note this is the second remake where he replaces Charleston Heston, the first being Omega Man/I am Legend).
There is so much ... hype around this technology. But some of their use cases aren't all that useful, and their technology (while supposing to be cheaper) is often done on handheld units at the moment in isolated regions.
Let me explain:
Use cases outlined in this article that have minimal real medical benefit, but sound great:
- Home blood testing (why? there are only 2 types of people who may find this useful: patients on Warfarin, and patients on dialysis. Dialysis patients (if not on home dialysis) get tested 3 times a week when they go to dialysis. INR is usually stable once established, ceteris paribus)
- Field blood testing (Mostly pointless. Clinical signs are much more useful in a casualty situation. Arterial blood gasses are useful in resus rooms in emergency departments but in the field you want to keep them breathing, not go reversing exotic blood gas abnormalities)
For the majority of tests (EUC, CMP, LFT, FBC, Coagulation studies) in rural/isolated places, the i-stat machine is used in australia. This is priced ok... around $40 per cartridge for around 6-10 results.
The i-stat works with not much more than a couple of drops of blood as well, although it needs to be drawn from a vein, not a finger-prick.
Other tests, like lipids, or antibody markers, etc, are rarer and much more expensive. It would be great to have them cheap (but again, we don't really know how cheap theranos is saying tests are going to be)
which may make them more common, but again there just isn't much benefit in taking them regularly.
Theranos may well be a white elephant. which is unfortunate. The promised technology (fingerprint testing) would be great. But I can't comprehend how they could go for 12 years without a product. And as a doctor, I would be very suprised if the technology works as advertised.
There is unfortunately too much hype surrounding this product for me to believe that we will get what has been promoted, but you never know and I would love to be pleasantly surprised.
I wonder how popular this viewpoint will be here on HN - the home of lifehacking and microanalysis of bodyfunction (often without the corresponding knowledge to go with it, but prefaced with a view that 'more data will always be better').
My biggest concern with Theranos, which I haven't really seen acknowledged in any of these articles, is that multiparametric panels on asymptomatic individuals will lead to a proliferation of false positives. Running hundreds of tests whenever a patient decides to do so doesn't make sense unless that ultimately enables better clinical outcomes for patients. And this is true regardless of whether the underlying measurement technology that Theranos has developed actually works or not.
It's discussed in a journal article from earlier this year by a pathologist:
> panel profiling, which was introduced in the 1970s as a way of identifying early biochemical changes of disease in asymptomatic individuals, had been abandoned in the 1980s, not so much for the cost. It has long been realized that with multiparametric testing, approximately 5% of results will be false positives, i.e., test results outside the reference intervals, in otherwise normal subjects. This is due to the definition of reference intervals, as being values between the 2.5 and 97.5 percentile of a reference (normal) population. The high cost of investigating seemingly abnormal results in normal people, and the added anxiety of patients, has led to the complete replacement of such biochemical profiling with what is now known as “discrete testing”. In the latter, tests are performed by the testing laboratory, only if requested specifically by the physician.
This is a really valid criticism. I often send patients home from the emergency department with values outside of the normal, usually without discussing that finding with them (ie, it is not useful for a patient with some level of kidney failure to know that their sodium is 130, and has been on every presentation they have had for years). Trying to have a conversation with every second patient about why this value is slightly outside of reference and how the reference ranges are actually calculated is not productive and will likely only lead to confusion and obsfucation of the actual reason they presented
The medical community should reconsider the standard policy of not having that conversation. While it may be medically sound practice, the insurance industry takes these reference values as Gospel Truth. Your life insurance premiums and coverage are predicated on how much deviation you exhibit from the reference ranges.
Only in countries that are allowed to differentiate on the basis of lab tests. Which is not the case where I practice.
If a lab result is outside the normal range and a patient has a reason for it to be outside the normal range, that's fine. If a patient has a deviation that is related to their presenting complaint, that's fine too. If a patient has an unexplained deviation which is not related to the presenting complaint, well, there's a 1 in 20 chance that the variation is statistical only. So you use your clinical judgement. is this a patient who requires outpatient follow-up and repeat, or is this an abberation?
I have several people in my family who demonstrate various levels of hypochondriasis. Imagine the nonsense over gluten-free and every other fad diet of the last 30 years, non-specific symptoms, alternative "medicine" and that's two or three people in my immediate family. Now let them start ordering their own blood tests and it'll make the anti-vaxing movement look like a cultural blip.
Most people simply aren't smart or informed enough to understand things like "false positives".
> I wonder how popular this viewpoint will be here on HN - the home of lifehacking and microanalysis of bodyfunction (often without the corresponding knowledge to go with it, but prefaced with a view that 'more data will always be better').
This would be what I see as the fundamental flaw behind Theranos, even if their technology worked (works?) as promised: the idea that more data will always be better is sophomoric (and I select that word judiciously, considering the founder). Evidence-based medicine clearly shows that more data does not, in itself, lead to a better outcome.
My startup facilitates at home testing of PT/INR levels (for coumadin/warfarin patients). In general, yes, INR levels stabilize, medicare won't pay for at home testing until the patient has been on warfarin for 90 days. However, it is surprising how many critically high or low results we get in an average week.
Studies [1] show that weekly INR testing results in a 55% reduction in strokes, 35% reduction in major bleeds and 39% reduction in deaths.
I was hoping the product would pivot to passive blood pressure monitoring. I want my blood pressure to be recorded every few seconds, logged and cross-referenced against what I did, ate, and drank. For correlation purposes, knowing those things can be as simple as snapping a photo.
Smart people apparently claim that blood pressure is one of the most reliable indicators of how long you'll live. If so, then it's always seemed strange it's (almost) never measured.
Now that would be a cool product. Lots of datapoints.
I'm skeptical about the claim - yes, it's important, but there are so many variables that feed into it, and I need to be convinced that constant, 24 hr monitoring of BP would enable better management than spot tests, home BP management and the occasional 24 hr ambulatory monitoring.
It's a very consumer-targeted technology, although it would certainly find a place in emergency departments and ICUs.
I am at a loss to think of ways as to how we would actually capture the data, although better minds than mine I hope come up with ways.
The problem is that to get a good read on arterial pressure you either need to do it the old fashioned way (occlude the artery and record that pressure, then slowly drop it until it's constantly flowing again - see [0]) - or you need to stick a cannula into an artery, as we do in ICUs, and measure pressure using a transducer.
Even technologies that stress their 'passivity' (see [1]) and try to capture this market use the old fashioned way. I don't see that changing anytime soon - you could try and somehow monitor the stretch of a small artery maybe using some variation of current o2 saturation sensors, coupled with advanced computer models of flow rate and variation in small arterioles, but that is a world away and would seem to me to be highly subject to variation/sensitivity.
My prediction is that this won't be possible until we are commonly implanting biometrics in people, but I guess we will wait and see!
It seemed promising to do some experiments with sewing a BP sleeve into a shirt, then setting up an Arduino to trigger it to inflate/deflate. It should be possible to record the result digitally. It'd be slightly uncomfortable, but even if it's only once per hour, it's still better than zero per hour. The noise would be annoying, but I have some ideas for how to make it quiet. But would anyone actually want such a thing?
Thanks for batting around the idea with me, and for the valuable references. I didn't know there was any other way to measure BP than the old-fashioned way.
You're describing creating an ambulatory blood pressure cuff. I've had one attached to me and you get used to it fairly quickly, although it failed to measure blood pressure when I was active (I was cycling for a few of the readings, which you think would keep your arm fairly still and not cause a problem) Cool to make it yourself though! Have a look at these further links. The australian prescriber article you may find particuarly useful
My mom is terminally ill and recently started experiencing orthostatic hypotension, so I just picked up an Omrom armband blood pressure monitor that is trivially easy to use and stores the last 100 measurements for two people.
It's still not what you want, but it looks like things are moving in the direction you suggest. That said, I'm wondering if it is even possible to do what you suggest without being inconvenient to the user. Having an armband inflate and tighten around my arm every few seconds with become infuriatingly annoying. Are there alternatively ways to measure blood pressure that are imperceptible?
What I'm looking forward to seeing is conductive textiles making their way into compression clothing so we can measure heart rate all the time. i.e. a wearable EKG shirt. The use case would be older people at risk for a heart attack and heart fail so we can detect problematic heart abnormalities that are predictive of failure.
I'm guessing I got downvoted for linking to the product on Amazon. What's the appropriate way to link to something like that so that it doesn't get downvoted?
You know, when I saw your original comment, it was so helpful that I wanted to respond to you and say thank you, but I suppressed my instincts because I thanked someone else, and it felt like the community would react badly to me saying "Thank you so much!" to every single person.
But now I see that the community actually downvoted your comment rather than rewarded it. Darn.
For what it's worth, and even though this reply is very late: Thank you so much for your time and for the thoughtful and helpful reply. The links, specifically, were the reason it was helpful to me.
I think your comment was informative, your manner of linking was fine, and that you should ignore the downvote(s) in this case. I guess it might be slightly clearer to use the full "amazon.com" in the URL, and I suppose someone might argue that it's safer to indent it two spaces so it's plain text rather than an active link, but seems good to me as it is. Maybe someone clicked the wrong button, didn't like something else about your wording, or was just in a bad mood.
Here's what England's NICE say about diagnosing hypertension. COmpare the difference between ambulatory measurement, and home measurement.
We know that most people can't even take their medication properly (many organ transplants fail because people don't comply with the medication regime, for example) so easier blood pressure monitoring would probably be useful. Especially if you combine it with something that can lower blood pressure.
> If the clinic blood pressure is 140/90 mmHg or higher, offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. [new 2011]
> When using ABPM to confirm a diagnosis of hypertension, ensure that at least two measurements per hour are taken during the person's usual waking hours (for example, between 08:00 and 22:00).
> Use the average value of at least 14 measurements taken during the person's usual waking hours to confirm a diagnosis of hypertension. [new 2011]
> When using home blood pressure monitoring (HBPM) to confirm a diagnosis of hypertension, ensure that:
> for each blood pressure recording, two consecutive measurements are taken, at least 1 minute apart and with the person seated and
> blood pressure is recorded twice daily, ideally in the morning and evening and
> blood pressure recording continues for at least 4 days, ideally for 7 days.
> Discard the measurements taken on the first day and use the average value of all the remaining measurements to confirm a diagnosis of hypertension. [new 2011]
> Dr. Bill Frist, the former Senate majority leader from Tennessee who joined Theranos as a director last year, supports Ms. Holmes and asserts that “the data I have seen speaks.” But he also points out that the Theranos story has taken on the cast of a vicious political campaign and there’s nothing more appealing than watching a front-runner fall from grace.
This is ridiculous. A lifetime politician accuses other clinical scientists and medical practitioners questioning Theranos' basic technology and its secrecy as political campaign? That's not how Science and Medicine work. Even that "a front-runner" statement is questionable. Theranos can not even releases its revenue number to be compared to LabCorp or Quest Dx.
> In the early 1990s, Mr. Holmes moved the family to Texas where he worked for energy companies, including Tenneco and Enron. (Mr. Holmes has since returned to public service and now works at the United States Agency for International Development.)
NOW that gets very interesting! Mr. Holmes [1] was found to be listed as officers in at least four Enron subsidiaries[2,3]. Guess that would be great lessons for some future entrepreneur. Conveniently such Enron experiences are not listed on USAID website [4].
As a med student, Bill Frist adopted cats from animal shelters under false pretenses so he could experiment on them, sometimes fatally. Definitely a good fit!
You know, I didn't expect this to be on his Wikipedia page. My apologies for not doing the most basic of searches. (The topic was uncomfortable enough to want to avoid it, but I still should've checked.)
They [former employees] say she [founder, Elizabeth Holmes] would become angry and sometimes fire people who pointed out problems. She often spoke as though the company’s technology already existed, they said, rather than as if it were still in development.
Funny how that works. I'm just getting into the book Superforecasting: The Art and Science of Prediction by Tetlock and Gardner and came across this passage:
Galen is an extreme example but he is the sort of figure who pops up repeatedly in the history of medicine. They are men (always men) of strong convinction and profound trust in their own judgement. They embrace treaments, develop bold theories for why they work, denounce rivals as quacks and charlatans, and spread their insights with evangelical passion.
So even if Theranos is a complete flop, Holmes may still prove a groundbreaker in her hubris. Tetlock and Gardner sum up the problem by quoting Richard Feynman:
What medicine lacked was doubt. "Doubt is not a fearful thing," Feynman observed, "but a thing of very great value." It's what propels science forward.
Sure, there are people in history who found their own way and we're the better for it, but for every 1000 people that "go against the grain" 999 end up just being people with not enough self awareness and a lack of personal insight.
Have you guys seen Elizabeth Holmes' Twitter favorites?
99% of them are faves for someone saying how inspiring she is. How she breaks glass ceilings. How she's doing something significant. How the press just wants to build people up to then tear people down. How she should run for president. How her speeches were transformative. How she has vision. Her bio. Her story. Videos of her. Press puff pieces about her. Her face. Her.
I've never seen anyone on Twitter use faves in quite this way. It's not faves about anyone else's content or jokes. It's not faves about Theranos, either. It's all. about. her.
In my opinion, Holmes is a fanatic. This is subtly different from being fanatical or obsessive about certain things, which is probably a good or even necessary characteristic for a founder.
She seem to just be a fanatic. She has found a mission, and is pursuing it without any second thoughts. Never mind whether anybody else thinks that the mission is actually that important... Fanatics have the ability to impress those close to them, because of their overriding zeal. From a distance though, they seem crazy and somewhat deficient human beings.
I'm not sure that fanatics do science well, or handle other people's money that well either....
The images in this article are awful: generic shots and captions of a machine shop; a (possibly empty) black box that's supposed to be a testing machine. Where are the actual machines doing the tests? Where's the science?
The main topic of the article is about how Theranos won't share any info about the science or about the machines. So that's probably all the NYT has to work with.
The photo of a couple adjacent "machinist" stations was puzzling. They were pegboards with some carpenter tools like a cordless drill, hammers, wrenches, etc. Not very confidence inspiring.
I know founders sometimes need to create a reality distortion field and sometimes act as if, but as a patient I would also expect transparency to understand exactly what the company is doing and if the tests are accurate.
Puffery and misdirection in a business whose key selling point is accuracy is a bit concerning.
Because she refuses to talk specifics about the technology. And the subtext is that Theranos has been able to attract such a high valuation based on her personality even when the technology isn't apparently there.
The sound of that is almost hilarious so I took a look. There are two pictures of her in the rotating highlights things and one on the company page. I clicked around on at least 10 other pages or so and didn't find any more pictures. Didn't seem like "everywhere" to me unless I happened to visit the few pages without her photo.
There are 3/6 in the rotating thing. She is the first face on Company, actually it's a one minute video of .. just her. Leadership is a jumbotron with a quote of her. Careers has another quote with bonus picture, I love this one:
“The minute you have a backup plan, you've admitted you're not going to succeed.”
Elizabeth Holmes is a category filter on their News page.
What else does a chief-executive have? Number crunching is left to the CFO. Engineering strategy to the CFO. Domain knowledge to the CMO. Operating strategy to the COO.
Theory: They had some early tech that looked promising in some specific clinical circumstances that through dumb luck were the ones that were tested early on. Holmes, as an almost engineer with no particular experience in anything, thinks medicine is just like engineering. It didn't work in the general case or was less accurate than acceptable for medicine, and so now Theranos is basically just doing normal lab tests, but subsidizing the costs with VC money and trying to make it up at scale or a breakthrough in the original technological approach at some point in the future. Holmes is spinning a convoluted web of misdirection, nonspecific, fractured answers and non-answers until either or both of those things happen.
The questions are easy to answer and wouldn't give away any trade secrets, but she pretty systematically refuses to give simple direct answers to very simply questions. If answering these simple questions, like how many tests they can run using their tech, would give away trade secrets then their tech isn't likely very interesting. The copy coming out of the company insists they are able to do the things they claim, but it doesn't appear they have any particularly commercial ready technology to go to market with.
Holmes is caught in a bit of a bind, she used her family's powerful connections to raise absurd amounts of money on nothing at all and now has to deliver or face the wrath of those same powerful connections. She's also managed to fill the board up with big names through her family connections who have absolutely no medical background at all (except for Dr. Foege) in an effort to give some kind of legitimacy.
Here's an example of her answering simple questions to get a feel:
Here's an example of how she answers things, (exact quote) "So we have developed hundreds of tests over the course of the last 12 years that can run on a tiny sample using proprietary Theranos technology..." The critical missing components to this statement:
a) To what accuracy compared to traditional tests?
b) All of the tests on one sample, or one test per nanotainer sample?
c) Are all of those tests current tests that Theranos would run on a sample? (R&D could be generated 10 tests a week, but 90% of those tests could be poor, or could not be clinically useful)
She then goes on about taking the data they've generated for their FDA submission and putting it into the public domain and being a leader in transparency. She goes on to talk about all the various technologies Theranos has developed, but it's only the nanotainer tube that's being tested and blah blah blah it's all very complicated and none of the answers clarify or complete any other answer - it's like getting a good image from a shattered mirror.
Simple yes/no answers turn into minutes of non-answers. This isn't difficult, but she makes it absolutely excruciating.
Here's an exceprt from her bio from theranos.com
"Theranos' breakthrough advancements have made it possible to quickly process the full range of laboratory tests from a few drops of blood - instead of numerous tubes - and at unprecedented low costs, and are now directly accessible to people and their physicians through Theranos Wellness Centers opening nationwide."
Except not a single part of this has been demonstrated to be true in any way.
It's interesting that the only test cleared is one for herpes. Conceptually, a finger prick sample would very clearly work for binary, "you've got it or you don't" tests, like STD tests (e.g. you've been able to buy home HIV tests for years that just require a few drops of blood from a finger).
Most blood tests, though, are about detecting whether levels of a substance are in a particular range - milligrams of cholesterol per deciliter of blood, mg glucose per deciliter, etc. Taking a much smaller sample is pretty much guaranteed to make the plus/minus error range larger, and capillary blood from a finger prick will have a greater percentage of contamination from intracellular fluid.
Even glucose meters you can use at home are much less accurate than glucose readings taken with a venous draw in a lab. In that case, the benefit to a diabetic of being able to do frequent home testing outweighs the loss of accuracy. If you're going to get work done by a lab, though, you are going to want it to be as accurate as possible, and in that scenario I don't see how a finger prick will be able to compare to a venous draw.
> Ms. Holmes said that she needed secrecy to keep others from stealing her ideas, but several former employees say that Ms. Holmes’s steely focus on her mission — an attribute deeply admired by outsiders — made it difficult for her to acknowledge any serious shortcomings in the company’s products. They say she would become angry and sometimes fire people who pointed out problems. She often spoke as though the company’s technology already existed, they said, rather than as if it were still in development.
This seems a little unfair to Holmes. In this one paragraph, anonymous former employees paint Holmes as a megalomaniac -- e.g. she fires people "who pointed out problems" and lies about the existence of technology. She may very well be a megalomaniac, but these assertions should at least have vague anecdotes ("A former employee recalls a 2008 incident in which Holmes fired a senior engineer in a Reply-All email after he replied that he didn't think the machine could be finished on deadline."). The judgment of what is simply pointing out a problem is sometimes context dependent. And nothing else in the story mentions other proof that would affirm that Holmes is a power-freak when it comes to being the CEO. Yes, there are plenty of anecdotes of her being headstrong in negotiations and attempting projects and deals that went nowhere, but that's a different thing than being a vindictive charlatan among her own employees. The NYT sat down with her for a 2.5 hour interview and could have at least confronted her with this and given her a chance to deny it. In contrast, the WSJ, who couldn't score an interview, had actual anecdotes [0] (the hearsay of one of Theranos's chief engineers, who had claimed the technology was a fraud before committing suicide, and emails about fudging the FDA tests).
The parts about her pre-Theranos life were similar to the New Yorker's story from last year [1]...it sounds like she was the real deal in terms of being a passionate engineering student. It makes me wonder if she had spent at least a couple more years beefing up not just her engineering experience, but life experience, that some of the poor CEO decisions she's made would have been mitigated.
"It makes me wonder if she had spent at least a couple more years beefing up not just her engineering experience, but life experience, that some of the poor CEO decisions she's made would have been mitigated."
I think that is a very astute observation. When you are in the top 0.01% of CEOs you don't have a lot of scrutiny. Bill Gates says that he got lucky with his success and that graduating is a much more sure path to success (http://www.nytimes.com/2015/06/04/upshot/bill-gates-college-...). If you do make mistakes or have a failure and you dropped out then that (for better or worse) is a focus and probably makes it more difficult to bounce back. She hasn't failed yet, but the fact that she didn't spend the extra year or two finishing her degree will make it more difficult if she does fail. And lets be honest. We all fail at least once or twice.
> but the fact that she didn't spend the extra year or two finishing her degree will make it more difficult if she does fail.
If she weren't so well connected or known I'd agree with you. But she isn't some unknown dropout who failed fast and hard trying to get into YC or bootstrapping in some random location in SF. Unless Theranos gets revealed as a giant fraud, I doubt she'll find it tough to find another position in the future.
I actually wonder if this is an early signal that there maybe corruption inside the FDA. The goal of recruiting a BoD of this level of influence but of irrelevant skills was an attempt to control the outcome of the FDA approval process, regardless of whether the tests actually work or not.
The purpose of NYT article seems to be to message that while Holmes may get removed from the CEO, the shareholders are still hoping to retain the value.
I'm no fan of Theranos, but the more plausible explanation is that she's blue bood family w/ connections, and they're pulling those in because they can.
I don't accept as supported the assertion that influential accomplished people on your BOD means you're out to corruptly influence process (any more than general business).
I don't quite understand the negativity this company is getting. Sure the product that it is developing may not turn out successfully but that is the risk for any company that tries to innovate.
Ms Holmes seems to be solid leader in the sense that she is well-connected, possesses salesmanship and communicates a clear vision. She has certainly been able to raise large funds.
Sure there might be hr problems but that is the case with any company and surely professional mid level management can be hired in to fix that.
How was a college dropout able to get a break in the healthcare sector? Becoming a doctor requires years of education and training and along comes this young woman who just decides "I'm going to change all of this." What? I don't understand how a person with no experience, no vetting, no medical training, no engineering training, and frankly a product that I find to be of questionable value ends up getting millions in funding and at the head of a multibillion dollar company.
Perhaps I just don't understand the phobia that some people have around blood tests but it is my understanding that you get a blood test as a way to gauge your health, not because it makes you feel nice. The hold up doesn't seem to be that tons of people are afraid of needles otherwise they would be getting tested all the time. The hold up to people getting blood tests all the time is that doctors don't order them, presumably because doctors don't think people need them. As long as the test isn't extremely uncomfortable for the patient, I would think that accuracy is really the only measure of quality for a test and it seems to me that they are willing to sacrifice accuracy in favor of making people feel comfortable.
Also, why would I ever get a blood test at a grocery store? Why would I ever trust some random employee at a food store to respect my privacy and be medically competent enough to administer a test like that. What exactly do I have to gain by getting one in the first place?
Correct me if I'm wrong on any of this because this is just my viewpoint as an outsider. I would however never get a blood test from Theranos and if I wanted one I would call my practitioner and have them administer one at a doctor's office, not at the local grocery store.