
Theranos Founder Faces a Test of Technology, and Reputation - jbae29
http://www.nytimes.com/2015/12/20/business/theranos-founder-faces-a-test-of-technology-and-reputation.html?_r=0
======
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.

~~~
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.

~~~
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.

------
robbiep
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').

~~~
laarc
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.

~~~
robbiep
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!

[0]
[https://en.wikipedia.org/wiki/Korotkoff_sounds](https://en.wikipedia.org/wiki/Korotkoff_sounds)
[1] [http://www.visimobile.com/](http://www.visimobile.com/)

~~~
laarc
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.

~~~
robbiep
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

[http://www.racgp.org.au/download/documents/AFP/2011/November...](http://www.racgp.org.au/download/documents/AFP/2011/November/201111nhf.pdf)

[http://www.australianprescriber.com/magazine/20/1/18/20](http://www.australianprescriber.com/magazine/20/1/18/20)

[https://en.wikipedia.org/wiki/Ambulatory_blood_pressure](https://en.wikipedia.org/wiki/Ambulatory_blood_pressure)

------
jerryhuang100
_> 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].

[1] [http://individual-
contributors.insidegov.com/d/c/Christian-H...](http://individual-
contributors.insidegov.com/d/c/Christian-Holmes)

[2] [http://www.corporationwiki.com/Texas/Houston/christian-r-
hol...](http://www.corporationwiki.com/Texas/Houston/christian-r-
holmes/34634412.aspx)

[3]
[http://www.ruf.rice.edu/~eesi/scs/Holmes.htm](http://www.ruf.rice.edu/~eesi/scs/Holmes.htm)

[4] [https://www.usaid.gov/who-we-are/organization/christian-
holm...](https://www.usaid.gov/who-we-are/organization/christian-holmes)

~~~
mikesickler
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!

~~~
laarc
An accusation this serious should be accompanied by evidence, or dismissed.

~~~
RockyMcNuts
He wrote about it in his book -

[https://en.wikipedia.org/wiki/Bill_Frist#Medical_school_expe...](https://en.wikipedia.org/wiki/Bill_Frist#Medical_school_experiments)

[http://web.archive.org/web/20021101052043/http://www.boston....](http://web.archive.org/web/20021101052043/http://www.boston.com/globe/magazine/2002/1027/coverstory_entire.htm)

~~~
laarc
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.)

Thanks!

------
klenwell
_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._

Less so, I guess, visionary entrepreneurs.

~~~
joelS
Another Feynman quote that comes to mind:

"For a successful technology, reality must take precedence over public
relations, for Nature cannot be fooled."

------
dbcooper
The Washington Post's article about Thernos and the DoD was probably the most
interesting thing published about them since the original WSJ articles.

[https://www.washingtonpost.com/news/wonk/wp/2015/12/02/inter...](https://www.washingtonpost.com/news/wonk/wp/2015/12/02/internal-
emails-reveal-concerns-about-theranoss-fda-compliance-date-back-
years/?postshare=3491449147304325&tid=ss_tw)

I found General Mattis joining their board, after supporting them within the
DoD over internal objections, to be particularly interesting.

------
Asparagirl
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.

[https://www.twitter.com/eholmes2003/favorites](https://www.twitter.com/eholmes2003/favorites)

#narcissism

~~~
bane
That's pretty weird. I didn't believe you until I checked it out myself.

I wonder how much of Theranos is a long-play effort to create a "brand" around
Holmes?

Perhaps years later, long after Theranos is dust, she'll point to it as a huge
success that made her into the billionaire she became.

------
Gatsky
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....

------
mikexstudios
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?

~~~
Naritai
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.

------
RockyMcNuts
An author of one of the gushing cover stories on how he feels he was misled -
[http://fortune.com/2015/12/17/how-theranos-misled-me-
elizabe...](http://fortune.com/2015/12/17/how-theranos-misled-me-elizabeth-
holmes/)

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.

------
xkcd-sucks
Why are all these articles about Holmes' personality?

~~~
danso
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.

~~~
revelation
Also, have you looked at Theranos website? She is just.. everywhere.

~~~
BinaryIdiot
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.

~~~
revelation
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.

------
bane
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:

[https://www.youtube.com/watch?v=A8qgmGtRMsY](https://www.youtube.com/watch?v=A8qgmGtRMsY)

[https://www.youtube.com/watch?v=MBs-
oj7U-bo](https://www.youtube.com/watch?v=MBs-oj7U-bo)

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.

~~~
adevine
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.

------
danso
> _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.

[0] [http://www.wsj.com/articles/theranos-has-struggled-with-
bloo...](http://www.wsj.com/articles/theranos-has-struggled-with-blood-
tests-1444881901)

[1] [http://www.newyorker.com/magazine/2014/12/15/blood-
simpler](http://www.newyorker.com/magazine/2014/12/15/blood-simpler)

~~~
daveguy
"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-...](http://www.nytimes.com/2015/06/04/upshot/bill-gates-college-
dropout-dont-be-like-me.html)). 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.

~~~
colmvp
> 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.

~~~
Asparagirl
That "unless" is looking more and more likely by the day.

------
mrnismo92
Who picks the pictures for these articles?

------
cft
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.

~~~
late2part
When you hear hoofbeats, you don't think zebra.

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).

------
swingbridge
It's really put up or shut up time for this company. There's been so much hype
around this, but things are starting to smell funny.

------
FussyZeus
This company is 12 years old and has never once made an honest dime. How the
hell is she or it succeeding in any capacity?

------
revelation
Why are there random pictures of tools in this article?

~~~
xkcd-sucks
Because they're the only functional pieces of instrumentation to be found
within the Theranos building

------
tronreg
Is Elizabeth Holmes breaking the law?

------
chvid
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.

------
hvo
If i post an article on Hacker News,it wont make front page.But if someone
else posts the very same article many hours later,it will
[https://news.ycombinator.com/item?id=10764636](https://news.ycombinator.com/item?id=10764636)

Talk of double standard.

~~~
lmitchell
Or you just posted mid-afternoon in the Americas and fairly late evening in
Europe, instead of hitting American prime time right on the nose... :)

