[n0us]

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.

[nostrademons]

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.

[ZanyProgrammer]

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.

[aj7]

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.

[madaxe_again]

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.

[n0us]

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.

[madaxe_again]

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.

[pain_perdu]

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.

[wavefunction]

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.

[aj7]

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.

[cant_kant]

ie: Family friends of one of the Kleiner Perkins founders.

[jaskerr]

PAMPA? Sorry.

[ZanyProgrammer]

Palo Alto, Menlo Park, Atherton.

[jaskerr]

Aha. Thanks. Very SV, said from the wilds of upstate NY.

[panic]

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"?

[n0us]

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.

[pkaye]

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.

[steven2012]

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.

[srunni]

> It would also be a huge win for premature babies, some of which only have 2oz of blood in their entire system.

Take a look at Baebies, which is doing exactly this (neonatal screening): http://www.newsobserver.com/news/business/article28910089.ht...

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.

Unlike Theranos, their work has been published in peer-reviewed journals. For example, here's a publication from 2004: http://pubs.rsc.org/en/content/articlelanding/2004/lc/b40334...

[dikdik]

If you look at CEO's and other higher ups of healthcare companies, a significant number have absolutely no science training.

[daveguy]

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?

[xyzzy4]

Martin Shkreli is an example. Criminal allegations aside, he founded Retrophin which currently has a $750 million market cap.

[trimbo]

My understanding is that Retrophin is an M&A company. They did not develop any drugs that they sell.

[seehafer]

For current public companies, you're right, because public company CEOs outside of recent tech cos are rarely founders.

Healthcare founders almost always have either medical and/or science training.

[dikdik]

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.

[awl130]

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.

[specialp]

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!

[CamperBob2]

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.

[specialp]

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.

[CamperBob2]

That does not make them "free." Somebody's paying, even if you aren't.

[pkaye]

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.)

[DanBC]

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.

[rokhayakebe]

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.

[pbreit]

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.

[ksherlock]

SPOILER ALERT

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).