
Blood-Testing Firm Theranos to Dissolve - mudil
https://www.wsj.com/articles/blood-testing-firm-theranos-to-dissolve-1536115130
======
sharkweek
Highly enjoyed _Bad Blood_ and recommend it to anyone interested in some fine
investigative journalism.

I think the most disappointing thing about this whole saga is that (in theory)
the Theranos technology was supposed to be a major healthcare game changer. It
could have revolutionized testing, and would surely have saved countless
lives.

But instead... here we are.

~~~
erentz
> think the most disappointing thing about this whole saga is that (in theory)
> the Theranos technology was supposed to be a major healthcare game changer.
> It could have revolutionized testing, and would surely have saved countless
> lives.

This reads like such a weird statement. It never existed. It could’ve never
have revolutionized testing because it was entirely imagined and not based on
reality.

It’s like watching Star Trek thinking tricorders are real then being
disappointed when told they’re a fiction.

~~~
mifreewil
So, I’m one of Theranos’ biggest critic, since I’ve had a weird fascination
with the company since someone on HN pointed out the bizarreness of its BoD
back in 2013.

I think if Theranos hadn’t gone all-in on its fraud it still could have had an
impact. One area was that it was actually pushing to change laws (I know it
did this in Arizona) to give individual control over blood testing instead of
requiring people to go through doctors and corporations. Another area was
price transparency. Much like the Surgery Center of Oklahoma
([https://surgerycenterok.com](https://surgerycenterok.com)), it was listing
all the prices for its tests right there on its website. These 2 things alone
would be a major advancement in the US. Forget the mini blood tubes.

~~~
prepend
The law change for direct access to lab ordering and results is really
independent of Theranos. HHS changes rules in 2014 to allow patient access [0]
that goes back almost 20 years.

The price listing was pretty cool though.

[0] [http://www.labtestingmatters.org/direct-access-to-test-
resul...](http://www.labtestingmatters.org/direct-access-to-test-results/)

~~~
arcticbull
It’s also not clear that it’s a good thing; false positives lead to serious
negative consequences which is why tests aren’t ordered in the first place.
It’s why you don’t get a colonoscopy at 25: chance_of_false_positive *
harm_of_false_positive > chance_of_detection * treatment_success until much
later in life. You as an individual are not qualified to make that aggregate
decision.

------
hcknwscommenter
The one thing I am very surprised so few people bring up is that finger sticks
hurt like heck compared to a venous puncture. I give blood all the time, so
much that I have scars from giving blood (and donating plasma in my youth).
The only thing about giving blood that hurts is that darn finger prick to
check your hematocrit. Sometimes I can't type the whole rest of the day. I
would never choose a finger prick over a regular sample.

~~~
peteretep
Your experience is not mine, and I'm not sure it generalizes.

~~~
thaumasiotes
In my experience, getting shots or blood draws does not hurt. A finger prick
might or might not. But I'd prefer the finger prick anyway because it's much
less creepy than having a long needle stuck into your vein.

Antivaccination movements historically pop up in all kinds of different places
and contexts for different nominal reasons, and I'm pretty sure a big part of
what gives them steam is that people just aren't comfortable with the physical
logistics.

~~~
anyfoo
Interesting. I’d echo the original commenters sentiment. I have given blood a
few times and was never really bothered about the long needle sticking in my
arm, nor the process in which it got there, but the two times or so where I
got the finger prick for a small amount of blood were a painful and
inconvenient experience.

~~~
nojvek
Finger pricking and typing don’t go well together. One is a really annoying
experience. One is like, “ooooh that didn’t hurt as much as I expected”

------
madrox
It is hard to remember a time when Theranos wasn’t a byword for scamming, but
if you have 15 minutes it’s worth searching HN for Theranos articles and look
at comments from the very beginning.

~~~
THE_PUN_STOPS
Here’s two examples:

[https://news.ycombinator.com/item?id=7951019](https://news.ycombinator.com/item?id=7951019)

[https://news.ycombinator.com/item?id=6349349](https://news.ycombinator.com/item?id=6349349)

~~~
JauntyHatAngle
It seems from those comments there that a lot of people on here were quite
sceptical to their methods from the start.

There are a lump of people who appear excited in general, sure, but the people
who appear to have know-how in the area are more subdued and questioning, even
then. There are a fair few comments calling it garbage.

Many people seem to have called it.

~~~
tinbad
“It seems from those comments there that a lot of people on here were quite
sceptical to their methods from the start.”

This is no different for literally every HN post.

~~~
TeMPOraL
It's cynicism, but that's hard not to contract these days. If you've been
around the Internet long enough and know something about anything even
remotely scientific or technical, you quickly learn that:

\- You can't trust scientific press releases at face value.

\- You definitely can't trust science reporting in media, or any kind of
reporting for that fact (see: [https://en.wikipedia.org/wiki/Gell-
Mann_amnesia_effect](https://en.wikipedia.org/wiki/Gell-Mann_amnesia_effect)).

\- You can't trust companies not to oversell themselves, in particular
startups like this, you never take them at face value.

People are much less cynical when a company is open about what it's going to
do and how, talking science and engineering instead of marketing & PR
bullshit.

------
msmith10101
Bad Blood is an awesome book. Really disturbing. There's a story about a naive
stanford grad who joined Theranos and tried to blow a whistle internally when
he realized that the "Edison" (a Theranos-based testing equipment) was BS.
Holme's right-hand-man destroyed the kid, fired him, and even turned his
grandfather against him (who was an investor - these Stanford fucktards and
their legacies). Of course that stanford person is now pursuing his own
startup...

Bad Blood has not had the impact in SV that it should have. The stock market
needs to crash and the myth of steve jobs needs to die :-(

~~~
nikdaheratik
> The stock market needs to crash and the myth of steve jobs needs to die

It's not all about myths. The interest rates are still very low especially for
the rate of growth. Decent returns are hard to find and people are willing to
chase just about anything. Ofc, her decision to copy alot of Jobs' style made
for some easy pickings.

------
a-dub
In seriousness, internet business culture makes everything look easy. Internet
things have outsized impact due to the global reach of a revolution in
communications technology. Smartphone things have outsized impact due to good
UX finally reaching the masses when they were ready for it.

I think the lesson here is that doing anything that interfaces directly with
the physical and natural world is much harder, and those problems that have
high impact have had a lot of very smart people working on them for a very
long time.

It's easy to think that the formula for internet media or smartphone IT
success can easily translate to these domains, and it seems that the reality
is "no, it doesn't.". There is no low hanging fruit on the hard problems, as
there was with the internet and smartphone revolutions.

~~~
mrtksn
I like your approach but I disagree with your conclusion. Just recently Pepsi
Co bought SodaStream for $3.2B. AFAIK, SodaStream is essentially a company
that innovated with the UX outside the Internet-based technologies, not
solving some hard problems.

Theranos claimed to have been doing something similar but failed due to their
choice of UX improvement approach being based on technology that does not
work.

An analogy in the internet-based business would be promising to improve the UX
of customer support using AI and then not delivering on the AI part.

I think that your "Outsized impact" concept is interesting but I think that
there is no such thing, it's just an illusion due to the speed differences of
the delivery of the impact. Should Theranos was not based on pseudo-science,
the eventual impact could have been no smaller than your average internet
unicorn.

~~~
a-dub
tldr;

internet/smartphone success comes from low hanging fruit made possible by
revolutions in communication technology. it does not translate to hard domains
like biomedical science. these problems are legitimately hard. and quite
orthogonal to soda and chatbots.

~~~
mrtksn
Theranos' was not about making something previously impossible, possible.

Theranos doesn't have anything to do with biomedical science, they were
supposed to improve the experience of blood testing both for the patient and
for the medical professionals. Their problem was that they choose to try to do
it by a method that was not technically possible at this time.

Another company might try to improve the experience by improving the needles
and redesign the machine to look like less offensive and scary and they might
succeed in it.

It's exactly like the difference between SodaStream's success and chatbots
failure, that is, betting on UX improvement using a tech that's not there.

Chatbots, SodaStream. Theranos - they don't do anything new that wasn't done
before. Chatting with customer support was around since a while, Carbonating
water to make soda was around since probably the industrial revolution and
testing blood samples were around since modern medicine.

All these companies tried to improve the experience and reduce costs,
regardless of the nature of the business being internet or manufacturing
based. It's not about the domain.

EDIT: I'm not defending Theanos and I'm not going to comment about the motive
of the people involved as I don't know them and I was not involved with
Theanos at any time.

~~~
zbentley
> All these companies tried to improve the experience and reduce costs,
> regardless of the nature of the business being internet or manufacturing
> based.

No, Theranos did not do that. They _claimed_ that's what they were trying to
do, but they were, in reality, _marketing a fraudulent product that did not
work_.

This is very simple. It is also a very important distinction, and it's
worrying that many people here seem not to get it. This is not a "they tried
and failed with the best of intentions" situation. This is not a typical
failed-startup situation. This is not a product-market-fit issue.

This is a company that claimed to be improving the state of the art but was
actually engaging in a deliberate deception.

You don't have to know the "motive of the people involved" to understand that
Theranos' situation is _fundamentally ethically different_ from that of a
well-intentioned company that was unable to deliver on its promises. This
isn't a difference in degree (of money involved or people defrauded or
whatever), it is a qualitative difference. It's deeply disturbing to me that
yourself and many others seem unable to see that.

~~~
mrtksn
I don't know about the details of the case so I'm trying not to claim that
somebody did something in bad faith. I find internet lynches distasteful.

Did an actual investigation found out that these people scammed the investors?

What was their end game? Live a life of fame for a few years until people
start asking questions and end up broke and labelled as frauds for the rest of
their lives?

------
maxxxxx
I just finished Bad Blood and one thing I have noticed is that how much you
can get away with if you have mastered the art of talking to powerful people.
It seems they could have figured out much earlier that Theranos was a fraud if
anybody had ever bothered to take a closer look. Even when some people started
having doubts Holmes always was able to take herself out of it. Instead the
whistleblowers got treated badly. The Shultz situation was especially
frustrating to read.

This reminds me a little of a situation at work. We have a director who
everybody outside management knows he is full of sh.t. He never delivers
anything and when you get the chance to talk to VP or CEO they agree that he
needs to go. But then they talk to him and he always gets a second chance.
This guy gets much more face time with our CEO then anybody else I know.

------
kstrauser
I really, really wanted their tech to be real. It could have been
transformative. I've seen a lot of glee over their (well deserved) failure,
but I'd much rather be celebrating their success.

------
DubiousPusher
Did anyone ever follow that $100 million a hedge fund dumped into the company
like a year ago, well into the crap htting the fan? What was that about? Why
would you do that?

~~~
rrdharan
It was for their patents - as one of the other commenters mentioned, in the
event that they fold, i.e. now, the hedge fund gains ownership of all their
patents.

~~~
DubiousPusher
Did they hold any valuable patents? As I understand the FDA came out and said
the device didn't work and beyond that any evidence suggesting it did was not
just misguided but fraudulent.

------
godzillabrennus
They basically sold the patents their investors paid for when they took out
the last loan and didn’t meet the requirements to keep getting funded.

It seems that the only question remaining is how long Elizabeth and Sunny go
to prison for after this brazen heist they pulled off.

~~~
myth_buster
Well, white collar crimes are not punishable offense.

~~~
peteretep
If you have some legal insight, I'm sure the Manafort team would love to hear
from you.

~~~
URSpider94
While GP's comment is somewhat tongue-in-cheek, the Manafort conviction is so
newsworthy because it is such a rarity that white-collar criminals get
prosecuted to this extent. It's the exception that proves the rule. Keep in
mind, after the 2008 global financial crisis, in which several prominent
financial institutions failed and millions of people lost their homes to
foreclosure, only one banker was sentenced to jail time, and only for 30
months.

~~~
joering2
Why would you want to jail innocent people?

Sorry to be a devils advocate but past administration loosened up rules based
on which you were or were not supposed to be eligible for a loan to an extent
which it should never be.

Unless you want to jail George Bush or some of his staff members, there is not
so much fault around to put on people working in financial sector.

~~~
TheOtherHobbes
I would love to jail George Bush and some of his staff members.

Interestingly, you have just implied that ultimately no one can be held
accountable for these failures.

Isn't that a bit of a problem?

~~~
peteretep
> you have just implied that ultimately no one can be held accountable for
> these failures. Isn't that a bit of a problem?

Yes, but not one to be solved by retroactively classing behaviour that wasn't
a crime then as a crime now. The right solution is to criminalize the
behaviour moving forward.

------
kornish
Fitting that this article is posted by John Carreyrou.

~~~
unmole
I guess it just makes sense for him to handle all of WSJ's Theranos coverage.

------
samstave
Serious question, even if the answer is fairly obvious; What does the future
hold for Elizabeth?

I mean, how will a person who has done that and basically become a digital
leper, recover or work again in any meaningful way? Change her name, learn a
new language and move to another country?

~~~
Fnoord
Jail-time, surely? She has deceived investors. She's already not allowed to
lead a company for the next 10 years.

~~~
chadcmulligan
> She has deceived investors

Maybe the investors deceived themselves. If I was investing millions of bucks
in a startup run by a 19 year old I'd be doing a large amount of
investigation. Doesn't seem like anyone did

~~~
Fnoord
How many investors _did not_ invest after they investigated? We'll never know.
Theranos HR and legal dept. were fierce against any whistleblowers. One person
even committed suicide because of the involved stress.

~~~
chadcmulligan
I had not heard that - very distressing

~~~
Fnoord
I read about it in Bad Blood, it was perhaps the most disturbing fact from the
book. Especially given the suicide was in direct consequence of Theranos'
scam, and also because I lost my uncle to suicide related to his work (which I
suspect was related to ethics). There is a Wikipedia page devoted to the late
Ian Gibbons [1] (I didn't verify the content of the entry though). I can
highly recommend the book Bad Blood.

[1]
[https://en.wikipedia.org/wiki/Ian_Gibbons_(biochemist)](https://en.wikipedia.org/wiki/Ian_Gibbons_\(biochemist\))

------
CptFribble
I hope I'm not becoming "that guy," but I feel like everyone is still missing
the point on Theranos. Even if they hadn't defrauded investors, the company
would never have had the impact they claim, because Theranos' entire finger-
stick idea just doesn't fit into the lab industry.

I spent a bunch of years in labs, working for the tech companies that made the
"state of the art machines" that did the actual testing. Theranos wasn't only
competing with LabCorp and Quest, they were also competing with the testing
machine companies like Beckman-Coulter, Roche, Siemens, Bio-Rad, and many
others.

So many tests get ordered for a CMP (comprehensive metabolic panel, the most
common battery of tests), that you would need like 30 finger sticks to get
enough blood. Theranos never clarified if they could do 30 tests on 1 drop, or
1 test per drop. That little misdirect actually matters a lot to the patient
who might have to get stuck 20+ times for all the things the doctor needs.

I'm quite familiar with the way the state of the art systems work. A modern
system is already testing microliters of plasma (your blood goes through a
centrifuge) per test. Comparing size of blood draws is misleading. The several
tubes that get drawn are for logistical reasons that don't go away if you
switch to finger-sticks. For example, the law requires that a lab keep some
blood on hand for emergency re-testing if it turns out you have a critical
level. Maybe a tech drops your sample. Maybe the machine has a problem right
when it's doing your test (happens all the time, no reason it wouldn't happen
with the Theranos instrument, had it existed). How many finger sticks are
required to keep some extra on hand?

Theranos was also misleading about the test time, but that doesn't get
mentioned either. They claimed 4-hour test time, but compared it to the
24-hour turn around time of a major lab like LabCorp. In reality, modern
systems take 8-15 minutes for most tests, depending on what it is. Large
molecules (hormones, etc) and whole-blood tests can take longer, sometimes up
to 1.5 hours on older machines. Nothing approaching 4 hours, though. A 4 hours
test time is atrociously long.

And after all that, you still need a doctor to look at the results. Let's say
the dream happened, and we all started going to Walgreens to get Theranos
tested. Even if we got 30+ tests on a single finger-stick drop, we'd still
need to wait 24-72 hours for the doctor to look at the results and call us.

Maybe I'm beating a dead horse at this point, but I think from the very
beginning, Theranos didn't have a serious business model. I also would like
anyone on HN reading this, who's interested in the medlab space, to understand
that there's a lot more going on than just testing on fingerpricks and fraud
here.

If any of you out there actually _do_ have a revolutionary one-drop testing
device, don't try to partner with Walgreens and open your own labs. Just
sell/lease it directly to doctors and hospitals.

~~~
mirimir
Could it have worked with standalone systems, running in hospitals, doctors'
offices, etc? That would be impossible with current (or vaguely conceivable)
technology, of course. Some years ago, I was seeing a doctor who did
urinalysis in house. I figured that he was money grubbing, and maybe insurance
companies eventually decided the same.

~~~
thaumasiotes
No, it could not have worked as desired with any system, because it is
fundamentally impossible to use a drop of blood to detect chemicals which are
present in the circulatory system from which it was drawn, but are not present
in the specific drop being tested.

Blood is not a homogeneous substance. In order to be satisfied that you can
detect substances that are present in the person, you need to extract more
than a drop of blood.

~~~
URSpider94
To be more specific, most tests are designed around venous blood samples.
Theranos' finger-prick would gather blood from capillaries in the finger,
where the vessels are very narrow (changing the balance between blood cells
and plasma) and also where diffusive processes into and out of cells are
extremely active - and so assays like blood glucose level may be significantly
off from what you would see in a venous draw, if for example your finger is
curently burning a lot of energy ...

------
aj7
The big auction was on July 19. All the Mazaks are gone.

------
theshadowknows
I can’t help but wonder if Theranos’ tech really was that good and they got
crushed by big medicine? It really doesn’t seem all that far fetched to me.

------
ryan-allen
Paywall free link [http://archive.is/gEktW](http://archive.is/gEktW)

~~~
godzillabrennus
Outline is more optimized:
[https://outline.com/kRrnNH](https://outline.com/kRrnNH)

~~~
Operyl
The Outline is missing some of the text it looks like? The text "according to
a shareholder email. Theranos" is nowhere to be seen in the outline link.

------
adiusmus
Pardon my ignorance but what are the issues as to why something like what
Theranos was proposing was so difficult?

Is it that the underlying tech is too hard or is there some basic engineering
that doesn’t exist yet?

(Ignoring the fact they didn’t have a real solution / the whole thing was a
scam etc)

~~~
bootlooped
My impression was that at least one issue is the sample size of blood needs to
be large enough to be representative of the whole system.

If you pick 5 skittles out of a bag, no amount of technology can make it so
you can reliably determine the frequency of each color over the whole bag.

There are other issues another comment describes well.

~~~
adiusmus
Good analogy.

I’m not a medical person so I’m not sure about the statistical sample volume
required for typical tests. I do know that I’ve had comprehensive testing done
and they took 5 tubes the length of my finger. That’s pretty far from the drop
of blood that Theranos were after.

The future has a way of returning to these things. We’ll see if there’s even a
partial approach that could work soon enough. Or not.

------
a-dub
That's a shame. But hey, it doesn't take much solvent for one drop of blood!

------
Chris2048
When you give blood they usually hide the bag, I suppose for the squeamish.
But that drives me mad, just waiting there not knowing how much more to go -
It's a natural progress bar!

------
godelmachine
Alright.

So, can anyone answer the question, what’s gonna happen to Ms Holmes and what
are the possible career trajectories she may take?

Just wanna know what a brilliant person like her could do.

------
ptman
How does the competition compare?
[https://nightingalehealth.com/](https://nightingalehealth.com/) ?

------
ChuckMcM
And poof goes the unicorn. Also enjoyed _Bad Blood_ its really well done.

------
jedberg
I'm sort of sad about this. I liked having a well known company headed by (and
founded by) a woman to hold up as an example for my daughter. There are other
billion dollar companies headed by women, but I think this was the only
"science" one other than 23andme?

~~~
DoreenMichele
Does Jessica Livingston of Y Combinator not count? Is being one of the co-
founders of a $100 billion tech incubator not sciency enough for you?

~~~
jedberg
Jessica is already on my list, but she’d be the first to tell you she’s not
sciency. :)

~~~
DoreenMichele
Silly question: How sciency was Holmes? Did she personally help develop her
(completely fraudulent) blood tests? Or was she merely a business woman in
charge of bringing this bag of hot air to market?

(Hint: I don't really care if she supposedly helped develop it. It didn't
actually work. She's not some kind of genuine scientist.)

I'm just gonna leave this here and suggest that most of whatever tech was
developed by these 1000+ still active companies likely wouldn't have made it
to market without YC:

[https://yclist.com](https://yclist.com)

(Also, this isn't intended as snark. I'm just cranky at the moment and
seriously cannot see why it matters that Jessica "isn't sciency." My
crankiness is for wholly unrelated reasons and has nothing to do with this
discussion.)

~~~
dreamcompiler
How sciency was Holmes? Not very. She dropped out of college after one year.
Although many people have had great success in software with this level of
education, it's kinda hard to imagine somebody making major contributions to
the life sciences without even a bachelor's degree.

~~~
hcknwscommenter
I would say not at all.

------
anigbrowl
It's really worth reading through historical HN threads on Theranos to get a
feel for how the media was content to serve as a PR outlet for such a long
time, and how people were so taken with the narrative Holmes and her allies
pitched..

------
pfdietz
This is my surprised face. :|

