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At Theranos, Many Strategies and Snags (wsj.com)
131 points by srunni on Dec 28, 2015 | hide | past | web | favorite | 125 comments

>In April 2014, she got a long email from another employee. The employee alleged that Theranos had cherry-picked data when comparing Edison machines to traditional lab machines to make the Edison look more accurate, according to a copy of the email.

>For one test, the device’s accuracy rate increased sharply after some information was deleted and manipulated, the employee wrote. Edison machines also allegedly failed daily quality-control checks often.

>Ms. Holmes forwarded the email to Mr. Balwani. He replied to the employee, who no longer works at Theranos, denied all the claims and questioned the employee’s understanding of statistics and lab science.

Oh man. If you read through Theranos' reviews on Glassdoor [1] this anecdote seems totally legitimate. Multiple reviews talk about the toxic culture and how management does anything to cover their behinds. Quite a few of these were written before the scandal broke so I think they're quite honest about what's going on.

[1] https://www.glassdoor.com/Reviews/Theranos-Reviews-E248889_P...

Here's some fascinating things I came across above and beyond lousy management kvetching and nepotism complaints:

- complaints about poor pay, minimal benefits, no options, no 401(k) matching, no wellness benefits, no gym

- not allowed to post Theranos on your linkedin profile...that's crazy goobers

- lots of acknowledgement by reviewers that many of the reviews of Theranos are fake, including a couple that say there's regular pressure to post fake positive reviews on the site. Reading the positive reviews that sound like press releases, I can believe Holmes probably wrote them herself.

- long work hours, minimal work from home, regular weekend work

- incredibly high turn-over rate (no surprise)

- complaints about lack of domain knowledge up through the management chain, from product development to medicine

- very heavy involvement by the COO in everyday employee's work, complaints about the COO's temper and lack of domain knowledge (he, Ramesh "Sunny" Balwani appears to be Stanford CS dropout who went on to get an undergrad and MBA elsewhere)

- descriptions of the assay preparation not being particularly unique...which feeds my previous notion that they're main innovation is subsidizing blood tests with VC money to drive the price down

- employees with experience in the regulatory environment are ignored

- no protocol "if you stick yourself with a needle" (written by a current Phlebotomist)

Interesting thing about Balwani is he already had an IS/CS degree from UT Austin in '90 and a MBA from Haas in '03 - the CS degree from Stanford is from '04.

Glassdoor actually removed a few of the more scathing negative reviews about working there. I think Theranos advertised on Glassdoor so they removed some of the even worse reviews... there used to be some even more negative ones.

So I was on Glassdoor just yesterday and saw a little note "Your trust is our top concern, so companies can't alter or remove reviews."

Is that just a flat out lie?

It's not a lie but it's not necessarily the whole truth. Companies can't alter reviews, but Glassdoor definitely can and does. We just don't know what criteria they use.

Glassdoor seems like it has the same business model as yelp- "Buy our advertising and we will make your good rankings rank higher and your worse reviews be filtered or lower."

Maybe not outright extortion but certainly not what they claim of being a truly independent forum.

That allegation against yelp has never been proven. I'd be surprised if either yelp or glass door is outright deleting reviews for money.

What would you consider a proof? does a a sales rep asking her friends to post fake negative reviews count?


The fact that they need to have friends post fake reviews suggests to me that this is not sanctioned activity or a systematic fraud.

An environment where salespeople feel they can do stuff like that is a problem, but no, it is not proof that "yelp deleted bad reviews for money"

I was looking for chimney sweeps in the DC area and found one of the top-rated chimney sweeps on Yelp on about page 4 or 5 after the 2 and 1.5 star rated companies. The companies on the first page were all those that paid Yelp. I talked to the owner of the company that I hired and he said that Yelp wanted him to pay $300+ / mo to get his placement on the search pages higher and he said he didn't want to because he was so busy from so much work he didn't need any more visibility (he ran and operated it with maybe one or two other assistants). For a lot of companies, this could be viewed as extortion to hide well-rated companies so far down the list that most users wouldn't look to go there.

Yelp definitely hides a lot of reviews that are completely legitimate supposedly due to their review validity system filtering them, but in a lot of cases I've seen the only crime these disenfranchised reviewers had was that they didn't want to go make a full-blown Yelp profile with pictures and everything to make really serious, very well described complaints. This artificially inflates review relevancy ratings for companies that have Yelp reviewers that skew towards younger demographics. There's a ton of stores where I live that are frequented primarily by 50+ year olds but they have almost zero Yelp presence since nobody operating or visiting the store are much into technology / social media enough to care.

True not not, Yelp certainly wants you to believe it helps to buy from them. It's how they make money. It doesn't need to be written in the contract to work.

I know companies that have tried to get their reviews removed or edited, and offered considerable bribes for it. All have been turned down. My impression is that Glassdoor does uphold their stated policy. It's possible that their bribes were not high enough, or not presented to the right people, but at the least, it is not easy to get a review removed.

No- but glassdoor can remove reviews on companies' behalf :)

i wonder if we can find them? or an archive of them?

Can someone post those reviews? I'm curious to read them. Hopefully there is a daily cache of glassdoor that we can look at.

The couple I remember reading that have been deleted were about how the CEO and the COO park their Ferraris/crazy racecar sports car in 2 designated spaces directly in the front entryway (like literally exactly in front foyer the building) whereas the actual handicapped spots were about 150 yards away down the parking lot away from the entry of the building compared to the CEO/COO spaces.

There were also complaints about ridiculously high security to the point where people didn't even know their own exact job descriptions/workflows because of "competitive secrets" and that they couldn't talk to people working in other departments due to paranoia/culture of fear.

Finally there were a couple about how they interview and act like your job will be at the fancy building on Sand Hill near Stanford but really the bulk of the employees are relegated to annexed buildings far away in EPA or in Mountain View, yet they don't tell them this until their start date - during all their onsite interviews up through the offer letter it seems like they'd be working at the HQ on Sand Hill.

The kicker is right after your quote:

He added: “This is product development, this is how startups are built.” The reply ended with an edict that the “only email on this topic I want to see from you going forward is an apology that I’ll pass on to other people.”

Just FYI for anyone clicking this link, this is a link that sets it to show the worst reviews on Glassdoor, not a random sampling. I wasn't that familiar with GD beforehand it and confused me.

You kind of have to. The vast majority of them are obviously fake. If you look at the wording / grammar there is a lot of similarity (uses of the word "Great", etc)

Good shout on the glassdoor reviews, it's amazing how even the most rudimentary internet searching seems to elude journalists!

Also, can this be our last Theranos thread before the company officially implodes? I get no small amount of freude out of this schade, but it's becoming the new bitcoin in terms of endlessly rehashed HN topics.

I wrote a parody of Theranos as a TV pilot that is increasingly becoming true: http://www.pricks.com/

(I'm sharing this here because the Hacker News community seemed to enjoy my Season 3 premiere of Silicon Valley [https://news.ycombinator.com/item?id=10179894], but apologies if others feel it detracts from the discussion.)

Great stuff Blake.

I can imagine an entire episode dedicated to trying to get Pricks onto Product Hunt. The double entendre's and puns write themselves.

I was just thinking that someone needs to write a novelization of this Theranos nonsense & turn it into a screenplay and voilà:- Silicon Valley's "Wolf of Wall Street" or the next "The Social Network" ... I'm sure someone is already writing it up.

I thought Arrested Development has been parodying the tech scene well.

Seasons 1-3, which aired during the Bush era, showed the lives of incompetent and corrupt property developers + military contractors.

Now the main running gag is a BS non-existent app.

Don't forget what Parks and Rec did in it's last season. We've seen a lot of great comedy about tech recently.

To be honest, I'm just waiting for the company to collapse for Aaron Sorkin to start writing a screenplay about it.

I'm thinking JLaw for Holmes. Like a Joy that doesn't suck and ends on a different note.

Well, if nothing else, congrats on acquiring that domain name.

It definitely wins my award for Most Esoteric, Timely Use of a Six-Letter .com Domain Name that Can Be Found in an English Dictionary.

Hey. Are you the original dev for firefox?

Via the about page: http://www.pricks.com/about

> Blake "Blade" Ross has been working in tech since he began programming for Netscape at 14. When he was 17, he left Netscape to start the Firefox web browser with some colleagues. After Firefox, Blake attended Stanford for a year and then went on leave to build a new company. In 2007, Facebook purchased that company as its first ever acquisition. Blake spent 6 years as a Director of Product at Facebook. He has been featured a number of times for his work in tech, including on the cover of Wired and Spectrum magazines, and in the 2013 Forbes 30 under 30 list.

Like Holmes, Ross also ditched Stanford after a year to start a company :)

No matter how this story ends (whether they eventually ends up with having a fully functioning product or not) this should be a cautionary tale to anyone wanting to actually change the world in healthcare.

Science speaks for itself and does not care how much you raised at what valuation. It requires a rigorous approach to testings and facts and data or it will be merciless if you aren't living up to your own claims.

So hopefully next time someone has a great disruptive idea in healthcare, they will spend a little more time getting the science and tech right before they start worrying about becoming a unicorn.

"For a successful technology, reality must take precedence over public relations, for nature cannot be fooled" - Richard Feynman

how about reality distortion fields?

It is a common, romantic view of how science works - but it is only compatible with reality on a 30-50 year timescale, and probably only because of survivor bias.

The science of Dan Shchetman, J. Robin Warren, Barbara McClintock and many others spoke for itself, and for a long time "science" essentially didn't listen. I put "science" in quotes because "science" doesn't speak or listen - scientists do - and the scientists shunned those luminaries (eventually to recognize them with one of the highest honours - the Nobel Prize).

Warren had to use himself as a test subject for others to notice. Shechtman was a cast out for years (and then it turned out that he wasn't the first to notice 5-fold symmetry - he was just the only one for a long time to insist it's real; the other "scientists" who noticed it cared too much about their status, rather than the science). McClintock was shunned by her peers and essentially lost her job -- though evidence for how badly she was treated by "science" for her radical ideas (now mainstream and assumed true) is being whitewashed.

I keep wondering how much progress we have lost because "scientists" (unlike "science") does care how much you've raised, how much you've published, and who your friends are.

> anyone wanting to actually change the world in healthcare ... Science speaks for itself

The belief that modern healthcare is nothing but the application of science is also romantic and misguided. In the US, healthcare is a business and not even a free-market one. It is informed by science, most definitely. But e.g. no doctor will recommend the single most effective treatment for type 2 diabetes early in the disease[0] (calorie restriction whether directly, by direct fasting or intermittent fasting). In fact, it turns out that the American Diabetic Association recommendations are the everything but science, and possibly the worst you could do.

[0] - http://www.theguardian.com/lifeandstyle/2013/may/12/type-2-d..., see http://www.ncl.ac.uk/magres/research/diabetes/reversal.htm for references

I agree that good science often doesn't get recognized because it happens to rub some established scientists the wrong way.

However, the issue with Theranos is the opposite: it is getting recognized, even though we don't know whether it's good science or not, because there isn't any visibility into what they do and how they do it. The scientists you mention all published their work for the world to see; they didn't hide behind "trade secrets".

> The belief that modern healthcare is nothing but the application of science is also romantic and misguided.

I agree with this too; but again I don't see how it applies to Theranos, because they are explicitly claming that what they are doing is science. So they should be judged by scientific standards, even if the rest of the health care industry can't live up to those standards.

I was not remarking about Theranos, but rather to ThomPete's statement.

Rigorous science is not sufficient (e.g. the Shechtmans/Warrens that we don't know about -- it is pure hubris to believe that all those were eventually vindicated), nor is it required (e.g. Vioxx, Thalidomide, ADA recommendations, baby peanut allergy recommendation, dietary cholesterol recommendation, dietary sodium recommendation).

If Theranos is a lesson to entrepreneurial scientists it is probably: "Don't waste your time failing quietly and cheaply, when you can fail extravagantly and retire rich"

Not sure what you mean.

Their product is scientific. It's not just a health app or some nutriment recommendation which can be claimed successful without any scientific claims to back it.

Theranos has a very a scientific product with a binary output and so it's claims will stand up to that (i.e. being approved by passing a number of tests)

My lesson was for those who wanted to change the world via healthcare, not those who wanted to get rich.

> Their product is scientific. It's not just a health app or some nutriment recommendation which can be claimed successful without any scientific claims to back it.

So was VioXX[0]. Read the Withdrawal section, especially the last paragraph. As someone who was following the case closely while it was happening, I can tell you that everyone involved looked guilty as hell, even though the court found only the marketing people "overzealous".

You see, "science" doesn't lie. But scientists do. Some liars are better than others, though.

Also, the standard US medical advice about things like nuts that might cause allergy are "delay introduction as much as possible" (e.g., do not introduce peanuts before age 3 or so, for fear of allergic reaction). You will hear this from doctors and find this in official manuals, although there is no science to support this (never was), and in fact, there's data indicating that early exposure to nuts reduces allergy.

> Theranos has a very a scientific product with a binary output and so it's claims will stand up to that (i.e. being approved by passing a number of tests)

Output is not binary. Most (often all) data used to evaluate medical products is provided exclusively by manufacturer, who is able to massage data to yield specific desired results, see e.g. VioXX.

> My lesson was for those who wanted to change the world via healthcare, not those who wanted to get rich.

Well then, they shouldn't look to Theranos - those guys obviously care more about getting rich than about changing the world (well, changing the world for the global good, anyway).

[0] https://en.wikipedia.org/wiki/Rofecoxib

They might have also learned that lesson with Solyndra in 2011.

I recognize your point in showing scientists whose data were initially discounted. The Theranos case is different, however, as they have not attempted to publish their methods. If they had tried and been rejected, it might begin to be fair to compare them to the distinguished researchers you mention.

> no doctor will recommend the single most effective treatment for type 2 diabetes early in the disease

How do you know this is true? Dietary counselling is recommended as part of the treatment of newly-diagnosed T2DM, per UpToDate[1], a reference for this kind of thing.

> American Diabetic Association recommendations are the everything but science, and possibly the worst you could do.

I'm not sure what you mean here. What are the guidelines and how are they deleterious?

1. http://www.uptodate.com/contents/nutritional-considerations-...

> If they had tried and been rejected, it might begin to be fair to compare them to the distinguished researchers you mention.

I might have been misunderstood. I am not defending Theranos or claiming they deserve any accolade or even sympathy. I am just pointing out that the romantic view that "science triumphs" is not, historically, supported by evidence on time scales shorter than a few decades. As most people's careers -- scientists included -- are on that time scale, it is a bad idea to assume that "science triumph" for any specific person or company.

> How do you know this is true?

I've been following these issues for a while. To borrow Gary Taub's analogy - the guides ("eat this much or that much, mostly carbs, low fat, moderate protein") are similar to an advice about how to make a nightclub popular: "get more people in". Yes, if you manage to do that consistently and with sustainable effort, then everything will be fine - yet the compliance rates are ridiculously low (as your link points out). But now we have the people, rather than doctors, to blame for non-compliant behavior, so the ADA and medical institution is not to blame.

However, there are studies (no time to look for refs right now, sorry), showing that people on low-carb, high-fat, medium protein (i.e. "keto" style) have a much, much higher compliance rate, and much better outcomes (in term of controlling blood sugar and reversing type 2) -- yet the recommended ADA (IIRC, can't find it right now) is 60% carb, 30% protein, 10% fat. That's high fat, mind you - not high protein.

Science and results don't care about secrecy and PR either. As far as I can tell, the only purpose of this company is to provide the media with a steady stream of glamour shots of the CEO so they can fawn over her and promote the never ending "pretty Stanford dropout founds a company and is like Steve Jobs" narrative.

Well that's all very moral, but what Theranos is doing is mostly engineering. So while "hype the fuck out of it, raise big money, and fake it 'till you make it" might feel all icky, it's not a unique plan.

Will we be saying the same things about Palantir? Maybe, maybe not. There's not that much difference between Palantir and Theranos. What has Palantir got that others don't? Answer: The ability to raise money at incredible valuations. Both are living off a mythologized ("PayPal has great fraud detection" and "you don't need an incompetent phlebotomist poking holes in your arm") advantage. We'll see if they can turn all that money into a real advantage.

But you can't count on science to spank these people.

That's what I thought at first, but $400M and 12 years should have been enough to put together a pretty solid uTAS seeing as microfluidic integration wasn't exactly bleeding edge back then either. But they seem to have drunk their own kool-aid and created a working environment so toxic that they sabotaged their own chances to fake it till they made it. They might still get there, but even if they do there's a lesson to be had about expectation management.

EDIT: to clarify, I'm not the source of downvotes. Before the recent media explosion I believed exactly as you did.

Anyone working in microfluidics would've been skeptical at the time and is probably not surprised now. Microfluidics is amazingly hard to make work properly, and the history of the field is littered with great ideas which proved to be much harder to execute reliably.

Somehow the ability to spend money scales pretty well relative to the ability to raise it.

Palantir is not making binary claims which can be proven right or wrong. Palantir is making tools which can be used and interpreted different ways. They are much more like vitamins.

This is a very important point in favor of Palantir. While there is much to be said for the placebo effect in medicine, Palantir's customers can more readily convince themselves Palantir works. On the other hand, you've either got herpes or you don't.

Agreed! And confidence in theories is needed to persevere to get true evidence. But if the evidence disproves the theory - adapt.

To ignore this is hubris.

Should Bill Gates have spent a little more time actually writing an operating system before selling one to IBM?

Fake it 'till you make it is often an important part of success.

I think the point is you can't fake it till you make it in medical science, and if you can, the outcomes usually aren't great.

But he did license them an OS that like worked, not a promissory note that may be like near Star Trek technology.

Does the composition of Theranos' board strike anyone else as very weird? It seems much more like the board of a foreign policy think thank than a biotech start up. There are three former cabinet secretaries (state and defense), two former very senior military officers, two former senators (one regarded as a foreign policy expert), a bigshot DC lawyer, and the former CEOs of Bechtel and Wells Fargo. The only physicians are former Senator Frist and a very credentialed epidemiologist, but it's not clear to me that either would have much knowledge about laboratory testing.

I'm really curious what the rationale for this board composition is. [Edit: I'm curious if this is connected to Holmes' father's experience in the foreign policy establishment]

I think they wanted a bunch of Washington power players because their real money grab was pushing regulation changes so that patients could go and do their blood tests themselves, without a doctor's order. Surprisingly, they were actually successful in getting this passed in 1 state already- Arizona. If they were able to push that through it would be a HUGE gamechanging cash cow, because people could either self pay or even try to get Medicare to pay for it if they wanted to run their own bloodwork without seeing a PCP and getting an order.

Physicians groups, insurance companies and biomedical ethics groups aren't really hip to this idea because patient self-testing bloodwork may open pandoras box to a lot of unnecessary expenses, especially if the patient is trying to bill this through their insurance. False positives can and do happen, and they lead to unwarranted appointments, specialist visits, exploratory surgeries, etc. Other reasons physician groups are opposed to it is because they view it as profiting off people who are hypochondriacs, and a huge amount of the customers would probably be drug abusers and steroid users. Most likely, people who would go and do their own blood work are the system's "super ultilizers" and they are the ones who are already costing the insurance companies and the states $3-4 million per patient per year in healthcare expenses. It's not uncommon to have a fibro/rheumatoid arthritis/hypochondriac patient who bills $10 million per year. If these people go to the ER and cost 3k per visit every time they can't fall asleep and have anxiety (~12x per month), imagine how often they might want to go and run their own bloodwork.

Not being able to order our own labs as patients is the reason there are moral objections to for-profit hospitals selling "full body scans" and dermatologists doing unwarranted full body mole checks. Generally the proper guidelines is to only administer testing when you suspect that something is wrong.

> Physicians groups, insurance companies and biomedical ethics groups aren't really hip to this idea because patient self-testing bloodwork may open pandoras box to a lot of unnecessary expenses, especially if the patient is trying to bill this through their insurance.

Yes, and this concern is justified. If I have to pay for your lab tests, I'm not going to let you just decide to run whatever tests you want. That would be foolish.

The solution to this is to allow people to order their own tests if they pay for them themselves. A company like Theranos could then profit by making tests cheap enough for ordinary people to afford them, which would bring much-needed competition to the health care testing industry. But first they need to be able to show everyone, by ironclad evidence, that their tests are reliable.

Will you please link to a source for the $3-4 million per patient per year figure or the $10 million per year figure for certain diseases?

It's just from what I see at work, we're consultants who do strategic case management for high acuity cases- patients who spend more than $3million per quarter (or whatever levels that specific client establishes with us) get kicked over to us.

I'm working with a guy right now who has a blood clotting disease and his meds alone are $800k yr before all the inpatient stays and procedures.

Generally once the patient starts spending and hits certain level of cost they get assigned a case manager through their insurance to 1. see if they're getting proper treatment 2. try to streamline them to the correct care first (rule out needless and repeat visits) 3. make sure all procedures and drugs are medically necessary. The people that go beyond these case managers sometimes go to a different organization for medical management.

Some states are getting even more strict, in Alaska right now if you have Medicaid and go to the doctor too much for what they view as needless visits you actually get cut off from ALL providers and then can only see certain approved providers for certain approved types of visits, can only get prescribed specific drugs and you have to "graduate" from that program after a year in order to get out of it by keeping ER visits to less than 1 every 6 months. I'll try and find you a link with more info about that program but they're trying to keep it on the dl because obviously all the patients who get put on that program are pretty outraged & they don't want the bad press about it, the perception of denying care etc.

Also everyone in the AK medicaid who is on opiates has to abide by a "pain contract" including random drug testing and med count checks and if they screw up too many times they will get banned from certain doctors/facilities, put on a stricter program (like the above) and can get kicked off Medicaid. Unfortunately this just leads to more homeless heroin addicts, so I can't really say that program has been a success.

Edit: link http://www.adn.com/article/20140703/state-aims-curb-overuse-...

Thanks for the expanded answer! I found it hard to believe because I was remembering when most insurance had a lifetime payout between 1 and 5 million, but of course that was pre-ACA and never relevant to Medicaid.

If you were trying to get military contracts that might be pretty helpful. The military has a huge healthcare system. So does the Department of Veterans Affairs.

Their early strategy was to get military contract but it didn't go too far because they needed to get FDA approval or something.

I suspect that Holmes is the "front" for someone connected to her father (who is a "civil servant" -- dunno why the article isn't more specific). Probably someone connected to military, government, etc.

Her father has a high-level job at USAID. https://www.usaid.gov/who-we-are/organization/christian-holm...

> Holmes worked in the field with USAID missions in Pakistan, Bangladesh, Indonesia, Egypt, Yemen, Ghana, Haiti, Liberia, Kenya, and Ethiopia

> Holmes served in the U.S. Army, Second Lieutenant, Civil Affairs, receiving the U.S. Army Soldier’s Medal for Heroism.

Want to guess who he really works for?

It seems unlikely that a covert operative would take job as CFO of the EPA, but what do I know.

Maybe they'd do it because it's a good cover (e.g., you find it unlikely)?

Hah! Maybe Theranos and Palantir have more in common than I thought.


Civil Affairs actually tend to be in the field quite a bit.

Well Dropbox has weird board members as well.

I like how Holmes' recollection of meetings is always different than the other attendees. Only one machine had an error message, not all three. She didn't abruptly walk out of the meeting. She didn't refuse to answer a question due to "trade secrets". And so on.

I can't help but be impressed by the spokesperson as well. It's clear the reporter didn't buy a word of it, and I don't either. But I wish I could have seen the discussion; that was a lot of impressive tap dancing.

Every article I read about this company sounds like a recap of Rashomon. No two participants ever describe the same events.

Interesting, Theranos' funder's behavior is what you would expect from someone who knows nothing about Science:

- make bold claims

- avoid going into details ("trade secrets", sheesh)

- make investors believe in your "vision"

- give talks about successful entrepreneurship to polish one's image

And still nothing reliably demonstrated.

What amazes me the most is how clueless investors are. If they don't care about Science, what do they care about when it comes to providing new Healthcare solutions? What's next, a new take on homeopathy ?

> What's next, a new take on homeopathy ?

Not too far off, actually:


Hehe, I really like Derek's sense of humor:

> A few billion years of blind evolutionary tinkering gives you a mass of insane, irrational, tangled interwoven systems with no documentation in sight. Crazy new things keep getting uncovered all the time (siRNA! Who knew!), and the number and scope of the crucial things we have no clue about is just another one of the things that we have no clue about. If your worldview has been formed by using human tools to make human-designed applications for humans, you are in for quite a shock.

Many in SV find it hard to grapple with traditional startups not penetrating health care to a greater degree; in Rise of the Robots (one of the Financial Times and The Economist books of the year) it's lamented for an entire chapter.

Traditionally the level of fundamental research and development displayed by Theranos - in areas of health or national defence - are done for years behind closed doors and then slowly rolled out to the public to mitigate any questioning of the underlying tech since the standards are understandably higher (i.e - it has to work from the start). This stands in contrast to the "move fast, break things" attitude pervasive in start-up culture.

I don't think there's anything necessarily fraudulent about Theranos, from what I've read, which seems to be the not-so-subtle undercurrent in much of the commentary. Rather they flipped the model startups should use in health, which is establish a business model that works and then work on preparatory tech in the background until it's ready to be rolled out. This seems to be largely what Theranos has done, but not what it's purposely chosen to articulate to the public and investors as it surely would have garnered less attention/funding. At this point Theranos seems to be playing the waiting game; waiting for their technology to reach a point where they can make a more transparent case for their business model and change the narrative once they've reached a point that's more aligned with the aspirations that have been articulated by Holmes for the past decade.

Once again, Peter Thiel's approach with Palantir looks to be extremely well executed and one that perhaps Theranos should have emulated.

Stating that your company has tech it does not have in order to lure investors and obtain contracts would be fraud. Whether that's in fact the case with Theranos will become clear eventually.

Yes, operating under the assumption early stage rounds were predicated on the technology existing and being sufficiently robust to carry out a certain percent of tests, that would be fraud.

Thing is, the approach your describing is fundamental dishonest... Leading investors to believe that you have technology that will be ready in 2011 when in reality you expect it to be ready in 2016 is not flipping a start up business model... It's just lying to get investor money

The latter half of that paragraph is articulating what I think Theranos is currently doing, not what I think they should have done.

What I said they should have done is described to their investors the business model that would act as a stop gap measure (gain market share and revenues by using existing technology) while allowing them to develop their proprietary technology to a point where it can get regulatory approval and can replace the already existing tech they're currently using.

> Leading investors to believe that you have technology that will be ready in 2011 when in reality you expect it to be ready in 2016 is not flipping a start up business model... It's just lying to get investor money

I've not seen any indication that rounds were predicated on certain delivery dates of the tech (what tech? what is the "success" percent? can the tech be augmented with more traditional tools?). If terms did get that specific, then there would be grounds for potential fraud.

The strategies being played by Theranos's executive don't look like Silicon Valley, IMHO. They look like outsiders cargo-culting the startup process: outside-looking-in Silicon Valley.

It's seems like there has been enough deception of investors, employees, partners and customers over the 12 years with little/nothing to show that "fraudulent" is probably the correct word.

Without knowing the term sheets and early investor negotiations that were held, I shy away from using the term fraudulent in the strict legal sense of the word.

Certainly you can argue more broadly that Theranos statements to the public over the past decade go beyond being disingenuous about their implementation of difficult technology and enter into fraudulent territory.

Would you please qualify Peter Thiel's approach here? and why it would have been a better model? Palantir is pure software company. Theranos is a suite of biomedical tests. This has a major lab/hardware component.

Theranos exists in a regulated industry where at a minimum as a lab developed test you have to abide by CLIA regulations. In addition you have to have validation, verification, design history and a whole bunch of documentation to prove that what you developed does what it should do and actually works.

The thing about Theranos is that the rules are well established.. You just have to follow them. If you don't know the rules you have to be a quick study or you have to hire experienced folks who know the rules and how to guide you through the process.

I'm not equating them absolutely, however I'm pointing out the Planatir began utilizing existing tech to make in roads into national defence while using that cash flow to create more proprietary technology that, once released, allowed the company to grow much quicker and that tech became it's mainstay. Presumably initial funding rounds and contracts were predicated on this being the strategy, not novel tech being utilized immediately (which is inline with what Theranos has done). The comparison stops there, at a macro level not micro level as you're describing, thus why only a sentence was devoted to it.

> Sunny Balwani is an entrepreneur and a computer scientist. Sunny joined Theranos after dropping out of the Computer Science program at Stanford University. He received his MBA at UC Berkeley and undergraduate degree from UT Austin.

Honest question, can you claim to be a Computer Scientist if you drop out from a computer Science program ? To me it sounds like calling yourself a Doctor after dropping out following the first year of Medicine Studies.

Needless to say, this smells of arrogance more than anything else.

Sounds like he dropped out of a graduate degree from Stanford. If his undergrad degree from UT Austin he might have a plausible fig leaf to go around calling himself "a computer scientist". Though I certainly wouldn't call somebody who with just an undergraduate degree a "scientist" in any field unless they've proven themselves by practicing such science in a credible manner for a reasonable period of time.

I prefer an operational definition: a scientist is somebody who does research using the scientific method. But then again, this eliminates a bunch of CS people, since they're mostly doing math and engineering.

Me too. Hence the "practicing such science" part in my comment. University degrees such as Master of Science/Doctor of Philosophy etc. are meant to provide validation from universities that the holder of such degrees has had some training in the discipline but it's by no means a requirement to be a scientist (Leonardo da Vinci certainly didn't have a PhD).

In theory, yes. But when it comes to highly specialized topics, there are a number of things that are very hard to learn on your own (at least for now) without going through an academic path. Chemistry, Biology, pretty much require hands-on experience as part of your education - and you can't do that kind of things from home or simply by reading books.

You can teach an 8-year kid the scientific method so they can "do science" with household chemicals. Probably they won't discover anything novel, but assuming they don't look at the internet it will be new to them and that's the important bit: reasoning about truth on the basis of experimental observation.

> Honest question, can you claim to be a Computer Scientist if you drop out from a computer Science program ?

Yes, absolutely. Plenty of luminaries in computer science don't have actual CS degrees.

I would think many computer scientists without a CS degree would still hold a degree in a field that would provide a solid basis for CS research (engineering or mathematics, possibly other sciences that require higher maths to be completed). There are probably a few that have little to no classical education but these exceptions are likely outliers.

> He replied to the employee, who no longer works at Theranos, denied all the claims and questioned the employee’s understanding of statistics and lab science.

> Quality-control failures were due to the “newness of some of our processes, which we are improving every day,” Mr. Balwani wrote.

> He added: “This is product development, this is how startups are built.” The reply ended with an edict that the “only email on this topic I want to see from you going forward is an apology that I’ll pass on to other people.”

I would rather question Balwani's understanding of Lab Science and Statistics as someone who has never had a remote experience of lab science in the first place. And about his understanding of Statistics, I have no idea where he thinks he has any authority either. MBAs are not particularly known to be very good at grasping probabilities.

I'm honestly getting kind of annoyed with seeing stuff about Theranos, since everyone writing about them is beating about the bush, and only ends up describing how Theranos communicates with a startling lack of earnestness.

Example from the video, paraphrased:

Mod: "What prick tests are you able to do, using no commercially available lab equipment?"

Holmes: "[lots of waffling] We're currently only doing the Herpes test. [proceeds to not answer the question]"

Mod: [accepts the non-answer and moves on]

This kind of reporting is entirely useless, unless it's some kind of attempt to subtly out Theranos for being dishonest.

A media interview is not a police room interrogation, nor a courtroom cross-examination. The interviewer (most probably) realises the question has not been properly answered but understands that they have to keep the interview moving. Also, if they go in too hard, it can have a backfiring effect of causing the audience to start sympathising with the person being interviewed (even though that person is clearly waffling and dissembling).

The interview is still effective in that hard-headed people watching the interview who need concrete answers and actual information will still draw their own (likely negative) conclusions.

Yeah, i understand that interviewing follows specific rules, since it's a realtime setting. However, what i failed to make clear in my original post: The mentioned exchange is not addressed seriously in the article either.

The media was caught off-guard after years of writing puff pieces, and it's only now that they are doing any investigative journalism. The only thing they have to go off of right now are hype-filled interviews, sources, and he-said / she-said conversations.

I'm sure the major newspapers are all preparing full investigative pieces, but those take time. In the meantime we'll get articles full of circumstantial evidence and insinuations.

You are just used to confrontational rating grabbing interviews. The fact that someone does not answer a specific question is valuable, just not as entertaining. The more questions the interviewer can deliver, the better. She dug her own grave.

Huh? Sounds like she did answer the question -- only Herpes.

They're currently, as I understand it, doing the herpes test commercially (sometimes, apparently). The question was what they are able to do, not just in a commercial sense.

For awhile, I kept seeing job posts at Theranos, which is how I know the name. I didn't know whether they were expanding or just had high employee turnover. The WSJ articles and the strange Glassdoor reviews (either totally love the company and CEO or extremely negative about the company and its ethics) leads me to believe that the WSJ is correct. The latest article with the video interview of the CEO, makes me think that she is incredibly smooth at spouting the BS, to the point of being a pathological liar. This company will be VERY interesting to watch during the coming year.

I'd be interested to be the results from a bot monitoring/archiving the Glassdoor page. I'm sure Glassdoor has some ability to audit or approve the review statements before they posted publicly which would provide some degree of damage control, but given the negative reviews it seems some would get through.

Theranos = Pets.com of this decade's bubble, which will once again be defined by founders, often young ones, having no clue what they are doing.

Investors can you please get better at realizing that sometimes experience and know-how can help?

Should they get better at that? I mean, I'd like them to. But they're after return, not virtue or value.

I can certainly say I don't like what they're doing, but I'm not sure I can say that they won't make money on this.

As the article says, "blood tests sometimes provide life-or-death answers." If these allegations of fraudulent testing are true, then the executives belong in jail.

The key questions that needs to be addressed, is how homogenous or heterogenous are blood markers at the level they want to measure at? The machines may be reporting results accurately, but a pin-prick-sized droplet may simply not be a large enough sample size for the tests they want to run.

There was a recent publication on this subject in the American Journal of Clinical Pathology (http://news.rice.edu/2015/11/17/blood-test-results-vary-from...):

> Bond and Richards-Kortum found that averaging the results of the droplet tests could produce results that were on par with venous blood tests, but tests on six to nine drops blood were needed to achieve consistent results.

>prick-sized droplet may simply not be a large enough sample size for the tests they want to run

This was always the main criticism of Theranos. Finger-stick blood tests have never been considered reliable for clinical diagnostic tests because you don't get enough blood and the blood you do get can be contaminated.

I wonder if you could apply some substance on the skin or needle so that after the prick it doesn't heal up instantly? Keeps the blood flowing for a few seconds.

How does the blood become contaminated?

For one thing, it's almost impossible to get your skin perfectly clean. Any test that uses a single drop of blood will be very sensitive to even the slightest amount of soil or contamination on the fingertip where the drop is extracted.

Couldn't this be alleviated with a finger prick method that prevents the droplet from sitting on the surface of the skin before it is collected? (i.e. a tiny needle that reaches below the epidermis to extract a drop of blood)

The needle breaks the skin and moves through any contaminants that were on the skin's surface--potentially mixing the contaminants with the sample regardless of whether the blood sits on the surface of the skin or not.

Isn't it common practice to wipe the skin with a disenfectant to prevent this very thing? A 60-70% alcohol-based solution will kill the vast majority of germs on the skin.

Contaminants don't have to be alive to confuse results. Also many contaminants we're talking about were never alive in the first place.

Stuff on your fingertips.

Holmes' backstory is getting so redundantly covered. It's like how every Superman movie has to walk us through how he was sent to Earth when Krypton was destroyed.

I suppose if the author didn't talk about Holmes' history, though, they wouldn't have half the damn article. Certainly nothing interesting to talk about with that company by itself, were it not for the headline grabbing founder.

That said if I read about how this "inspiring" person dropped out of Stanford when she were only 19 one more time I might lose my mind.

How can I short Theranos?

I suppose you could go long LH and DGX. They might outperform if a potential major competitor fails to make an impact.

This is yet another downside of unicorns ;). Though I doubt investors need much help at this point to realize how overvalued it is. Theranos will never raise at anything close to a $9B valuation again.

It's a long shot gamble funded by some people who maybe should and maybe shouldn't know better - I don't pretend to be in a position to judge the science in this case. So, who cares? I don't mean that in a derogatory sense, I mean it in the sense that you might set yourself a limit of a few hundred pounds for a game of poker one night. If it pays off, great. If it doesn't, no biggy. If they're committing fraud, then there are regulatory mechanisms in place around that - how far you trust those is an issue, but it's a much larger issue than one company.

The big sin that you mustn't commit, and that many do anyway, is to trust a private company's data where a potential conflict of interest like this exists. Run your own trials.

though not yet proven, I believe we may have found the Enron of our decade

The company's name sounds vaguely like "tear anus". What did they expect?

Is it just me or WSJ increasingly is behaving like apologist for big business?

They probably always were, just now I am noticing.

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