
Scientists skeptical about Theranos blood test - walterbell
http://www.businessinsider.com/science-of-elizabeth-holmes-theranos-2015-4#ixzz3YO784nGj
======
learc83
So the CEO dropped out of Standford at 19, started this company, and now she's
a billionaire? I can see dropping out to found Facebook, but a biotech
company?

What skills did she have that allowed her to do this, and where did she get
the money to hire all the needed PhDs and get through FDA testing? How would
she have even gotten access to the equipment and test subjects to prove that
her idea was worth investing in outside of an academic setting? The whole
thing sounds crazy.

Edit:

I read Elizabeth Holmes Wikipedia page and it says that when she was a
sophomore at Stanford, her Chemical Engineering professor encouraged her to
found the company. But I can't find anything about about any breakthroughs she
made that warrant the millions in early investments. No one seems to want to
talk about what exactly it is they're doing, and they're board of directors
has a former Secretary of State, a former Secretary of Defense, and a former
Senator. The fact that she's also been able to maintain 51% of this company is
also astounding.

~~~
burritofanatic
The New Yorker had a good article that covers her background.
[http://www.newyorker.com/magazine/2014/12/15/blood-
simpler](http://www.newyorker.com/magazine/2014/12/15/blood-simpler)

~~~
vinhboy
> Although she can quote Jane Austen by heart, she no longer devotes time to
> novels or friends, doesn’t date, doesn’t own a television, and hasn’t taken
> a vacation in ten years. Her refrigerator is all but empty, as she eats most
> of her meals at the office. She is a vegan, and several times a day she
> drinks a pulverized concoction of cucumber, parsley, kale, spinach, romaine
> lettuce, and celery.

Every time I read about these ultra successful people, I just think they are
freaking machines... and I don't mean that in a derogatory or mean way.

I am genuinely amazed people can operate like that. I know I can't.

------
jacquesm
What stops the skeptics from doing their own tests by walking into a service
center and having their blood analyzed for all tests possible and doing the
same with their blood for conventional tests? Or an even large scale test?

If their concern is genuine (rather than a way to get a look under the hood of
a competitor for the current sellers of such services) there are multiple ways
in which they could get their verification without inside information on how
Theranos does its thing.

~~~
sowhatquestion
Exactly. This is what I was hoping for from an investigative piece on
Theranos. Even an n=1 sample where the author had his or her blood tests done
with Theranos and a competitor would be worth more than all the speculation in
this article.

~~~
jacquesm
Especially if such a test gave different results than the accepted competitors
test.

~~~
sobkas
But they would have to spend money on tests, wait for them to finish and there
might be a possibility tests won't show what they hoped for(even if their
hypothesis is true). While speculation is cheap, fast and always trueish
enough to warrant an article.

~~~
jacquesm
You mean they to hope that the tests would work as advertised? After all we're
all in it for the best of the patient and a decrease in healthcare costs or an
increase in quality for the same price, right?

------
josephpmay
I'm kind of perplexed why Apple needs FDA approval for their watch to measure
blood oxygen, yet Theranos can develop a completely novel blood testing
technique whose results could impact major medical decisions without having to
conduct a single study.

(note that I'm not saying that Theranos hasn't conducted studies, rather the
FDA doesn't require any)

~~~
toomuchtodo
FDA testing regulations loophole.

------
XorNot
The composition of the board has always bothered me. It's not at all clear
what business value a lot of those people bring. Maybe opening certain doors,
but I would've thought in such an area, as the article suggests, you would
want more medical expertise.

That should be a little bit of a red flag to anyone - since the history of
scientific fraud is full of lone specialists who couldn't brook explaining the
technical details to anyone else qualified to understand them.

~~~
hackuser
It's also interesting there are so many foreign policy heavyweights, and many
in a certain range on the political spectrum. I'm not suggesting some
conspiracy, I just wonder why.

~~~
minthd
One big problem in the healthcare in africa, is the cost and complexity of
blood tests. And we know lab-on-chip technology can fix that, but nobody is
working on that, because of "business model" problems.

But that's one thing a successful theranos could do, and foreign policy is
important at that.

~~~
XorNot
This is complete misdirection though. It has no relevance to a biotech
company. If the test is cheap and easy, then charities and governments will
carry it into Africa. There's no fiscal reason to pay people with foreign
policy experience, because it has nothing to do with foreign policy. Its miles
away from being relevant to the central technology, and African charity is not
how one achieves a multi-billion valuation.

------
Gatsky
It is interesting to look at their test menu at:
[https://www.theranos.com/test-
menu?ref=our_solution](https://www.theranos.com/test-menu?ref=our_solution)

You can see here that they have replicated most of the routine blood tests out
there. Interestingly, they have also replicated some of the archaic and pretty
useless blood tests like Rheumatoid Factor. They also offer Erythrocyte
Sedimentation Rate (ESR). This is pertinent because ESR is actually a physical
property of blood, it is performed by measuring the rate at which red blood
cells fall to the bottom of a tube. Perhaps they have developed a microfluidic
method to measure this, but it wouldn't be a 'chemical process'.

But at the end of the day, they are offering the same tests that are currently
available. If someone said to me we can now do the same old blood tests faster
and cheaper, I would say that this is going to have very little impact on
people's health. None of these tests are truly useful in prevention or
screening unselected patients.

It does really seem that Theranos is a case of packaging the existing blood
diagnostics and trying to capture a large part of the market. Exciting for
investors I guess, but for patients or healthcare workers probably not so
much. I wish they were doing something like cheap, easy and reliable
comprehensive circulating DNA analysis, or proteomics, or something with
immune cell function profiling...

I hope with all this cash they have a program for giving this technology to
places that can't afford the usual lab infrastructure, that would be a very
good thing.

~~~
tel
_> If someone said to me we can now do the same old blood tests faster and
cheaper, I would say that this is going to have very little impact on people's
health. None of these tests are truly useful in prevention or screening
unselected patients._

Are you kidding? I'm not completely familiar here, but I'd love to see a
comparison of the current SOC for time between measurements of each of these
endpoints and then a clinical judgement that genuinely nothing interesting
happens in these levels at timeframes shorter than SOC.

A person I'm familiar with has a severe endocrine disorder which has
eliminated nearly all of his natural hormone production. Instead, he must
self-administer all hormones in proper dosages. In order to survive this way
he has become _vastly_ more familiar with his own blood panel than most human
beings ever would dare. On insurance dime he takes far more regular blood
tests than you usually can get access to and understands, even very roughly,
how events in his life, diet, exercise, stress, weather, etc begin to affect
his blood chemistry and, subsequently, his life. In his, of course anecdotal,
experience these are things that he cannot converse with doctors about because
they're not able to speak confidently so far outside of SOC. It's not
necessarily surprising stuff, but there's comparatively little real-world
evidence to give it a bite.

Theranos could make similar analyses achievable for far more people. It opens
an entirely new branch of clinical research---blood chemistry fluctuation at
the level of perhaps up to multiple times per day over months at a reasonable
cost in both testing and human time (given adequate distribution---Walgreens
or, even, eventually, a home edition). You can't pretend that Phizer and GSK,
known partners, aren't all about that.

 _> Exciting for investors I guess, but for patients or healthcare workers
probably not so much._

Only if you assume SOC doesn't change under the influence of massively more
available quantitative data.

~~~
Gatsky
I am assuming that SOC won't change under the influence of massively more
available quantitative data, or at least any gains would be both slight and
only applicable to a very small number of people. I think it is probably a
misconception that humans are simple enough that measuring something (on
Theranos' current testing panel) which is produced in ten different ways in
five different organs from millions of cells and then diluted in 7 litres of
blood is going to tell you anything revolutionary.

Certainly happy to be proven wrong, but there is a risk of harming people
(financially, psychologically and perhaps medically) if you convince them that
relentless tracking of their serum sodium tells them something useful.

~~~
tel
I think the difference here comes in use. I agree that misinforming people
about the meaningfulness of their blood chemistry is dangerous and low value.
My target users are not Quantified Selfers (although my anecdote example might
have thrown that off) but instead large scale clinical research sponsors.

------
rustyconover
Let us not disregard the intelligence value the NSA or another other
government entity gathers by doing a low resolution DNA sequencing all of the
blood that goes through these machines for future reference. This covert use
wouldn't be outside the bounds of proper skepticism with the involvement of
ex-DoD members on the board.

Without proper auditing and disclosure of development processes and the new
implementation of the diagnostic tests on chips (rather than disposable test
media) it raises the question of how can anyone be sure exactly what and what
not the machines are testing and recording? Slot machines in Las Vegas have
their code more closely audited and monitored than this technology.

This situation just yells out for government regulation, peer review and
reverse engineering.

~~~
jacquesm
Let me get this straight: because you're afraid that the NSA gets the hand on
their data you want government regulation?

That's _both_ the government.

When you're giving blood to some entity and you want to safeguard what happens
to the result regulation won't get that for you, but independent oversight,
sample anonimization at the source (insofar as this is possible with a blood
sample, your DNA _is_ your identity), decentralization of test locations
(preferably as close to the source as possible), proven sample destruction and
no keeping of data post sample destruction would be the way to go. Government
oversight pretty much guarantees government access, the opposite of what you
wish to achieve.

It will be very hard to create a service like this without a loophole that can
be used to sneak such data out.

The best way in which this could be done is by having the tests made so
foolproof that they can be done directly in the hospitals without centralized
laboratories.

As for the board, you could say something similar about DropBox but I don't
see them giving three letter agencies access to your account either without
proper process and a court order.

Anything less could sink the company and given the amounts of money at stake
here you can bet their competitors would love to do just that.

And who is to say that their competitors are not already acting in a similar
manner anyway, they are after all processing about 100x more volume today.

~~~
_up
Microsoft, Google, Apple are all NSA PRISM program participants! And nothing
happened to them. Why should that be different with Dropbox? And isn't Dropbox
using Amazon to store its data. It would probably be sufficient, if Amazon
participates.

------
learc83
After a bit of digging I found another article that discusses the skepticism a
bit more. The comments are worth reading as well.

[http://pathologyblawg.com/pathology-news/new-yorker-
theranos...](http://pathologyblawg.com/pathology-news/new-yorker-theranos-
founders-description-chemistry-process-comically-vague/)

------
al2o3cr
The article seems very confused - if the process is "patented", then surely
the details aren't a secret? That's kinda the exact POINT of the patent
system...

------
streptomycin
I don't understand. The article talks about how there is nearly no publicaly
available proof that these tests actually work, yet they're selling them in
drug stores and hospitals all over the country? And all we know is that
supposedly "Theranos' labs have been evaluated and deemed acceptable by drug
companies, hospitals that work with them, Walgreens, and others"? Why is this
legal?

------
netrus
A little off-topic:

The famous Forbes-List estimates her wealth to be 4.5b, because she owns half
of a company that has raised 200m. If she is somehow reasonable with the
finances of her company, it is likely that her actual bank-account (or real-
estate etc) is well below 10m - which is a hugh difference to all the old-
money people far below her in the list.

------
webreac
many scientific revolutions have occurred after improvement of measure
instruments. If we start to have a continuous measure of our blood, there may
be revolutionary discoveries about health.

~~~
lotsofmangos
ADR scanning could probably do this non invasively, it can even pick up prions
in blood -
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2008164/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2008164/)

------
lotsofmangos
Hey, can we test your blood? We are making blood tests more accessible. No, we
won't tell you what we are doing with your blood or how we are doing it or
even if it works. What do you mean how does this make blood tests more
accessible? Look, don't worry, just trust us, after all we have Henry
Kissinger on the board, so we must be on the level.

------
DannoHung
This title seems kinda weird. Can a mod make it more about the fact that the
test method is in question rather than that someone got rich because they
invented it?

~~~
dang
Now that you point it out, I agree. We changed the title to make it more
neutral.

~~~
jacquesm
I suspect the 'billionaire' was thrown in there as clickbait regardless, for
some reason large numbers attract clicks.

~~~
dang
It's surprisingly dismayingly automatic what attracts clicks, including on HN.

