Ahahaha, this book pissed me off so much! I just could not believe how bad the whole Theranos debacle was. I mean, I wasn’t entirely unfamiliar with the subject before going in – I knew that, by and large, most of the companies claims were fraudulent. But there was still plenty of room to be surprised at how bad the damned thing actually was.
Fair warning – this review is going to be a bit rant-like at points. I developed a lot of pent up frustration listening to this book, and I will be making no apologies for it.
The author, John Carreyrou is better placed than most to write a comprehensive review of the rise and fall of Theranos and its founder and supposed wunderkind, Elizabeth Holmes. It was his investigative work in the Wall Street Journal back in 2015 that really called the beginning of the end for Theranos, and this book is a comprehensive expansion of his articles that exposed the scandal.
For those of you that aren’t familiar with the whole affair, the aim of Holmes and by extension, Theranos, was to offer a whole battery of blood tests using a single drop of blood. Their idea was that by using such a small volume, they could do away with intimidating and painful blood draws, thus making people less reluctant to get tested. The wide panel of tests they were willing to offer was also meant to reduce turn around times and eliminate multiple doctors visits. There was also talk of automating the process as much as possible to reduce human error – something that really appealed to the Silicon Valley crowd. And on top of all that, they were offering it all in a compact unit that could easily be installed in supermarkets for convenience – or even sent to the military to revolutionise battlefield medicine.
Unfortunately, the whole thing was cooked from the start. In my opinion, after reading the book, one of their biggest problems stems from Holmes approaching it all backwards (That, and her ego). Rather than taking either a patient-centred approach or even an engineering one, she seems to have gotten herself fixated on aesthetics instead- she wanted her little lab to look all iPod-y and sleek. Very Jobs-ian. Everything else was engineered around that. And this is where things really get frustrating because they took what could have been a semi feasible idea – improving certain blood tests and better integrating them – and turned it into a bloody Sisyphean task. Their original prototype, the Theranos 1.0, was actually promising – it involved a cartridge system dependant on microfluidics. This could have possibly gone somewhere if they were willing to spend maybe 7-10 years on it. And it could have been good. But they couldn’t be arsed with that timeline, so they pivoted to a new machine – the Edison.
This new machine was not much more than a pipette-in-a-box and an utter disaster. Things kept on falling off the damned thing, it couldn’t be calibrated correctly, and it couldn’t properly regulate its own temperature. Far from being more accurate than a pipette-wielding lab monkey*, the tests gave out wildly inaccurate results. One memorable one, which was for syphilis, had a false positive rate of around 20%. You simply could NOT roll that out to the public in good faith!
Again, things were being made more difficult by self-imposed restrictions; the company was still absolutely fixated on the idea of getting everything done with blood a single fingerprick. Another really great marketing idea, but that’s about it really, because you can’t obtain accurate results from such small volumes.
So when it came to the crunch, what did Theranos do? Confess that these things take time and they might have to modify their timelines a bit? Nah, too ethical. Instead, they just decided to not report test results that didn’t look right. They then started running tests on competitors machines and didn’t disclose it. Since these tests were not meant to run off just a drop or two of blood, they decided to dilute their patient samples instead, which further screwed with the accuracy. They also lied about their pharmaceutical contracts and gave false information to the FDA. Any stupid decision that could have been made, they made it – my face was little like Edvard Munch’s The Scream while reading through it.
I came away from it with utter contempt for Elizabeth Holmes, her company’s former president Ramesh ‘Sunny’ Balwani and half the damned fools in the Silicon Valley venture capitalist bubble. Holmes and Balwani were disastrous heads of the company. Balwani had a background in software engineering, and probably had less knowledge about the field of medical testing than Holmes. Both were pretty bad – Holmes showed just how out of her depth she was with her memorable ‘a chemistry is performed’ explanation of her own technology; while Balwani would exasperatedly ask why his engineers couldn’t just stack multiple testing units on top of each other to make them more compact. (Hardware engineering is not software engineering folks. Think of the heat dispersal!)
To top it off, they were also horrendously bad at managing people. Their management style was almost cartoonishly dictatorial and over the top; it’s like they took the stereotype of a hard-arsed 80’s style CEO and said ‘Hey mummy, I want to be THAT!’ But this style of management is not good for peoples well-being, and it really screwed with company dynamics. The people who could leave often did, leaving gaps in projects and screwing progress. But some people couldn’t leave – there were a lot of Indian nationals who were worried about losing their visas and just had to cop it. It could be argued that their bullying style resulted in at least one suicide. While I firmly blame Holmes for most of her missteps, this is the one aspect where I think Balwani was actively a bad influence on her.
But they never could’ve gotten where they did without the venture capitalist types. I have toyed with the idea of going into consulting if working as a lab monkey doesn’t work out for me, but if this book has taught me anything, it’s that there’s no point trying to sell such services to these kinds of people. The thing about rich dickheads is that they only trust the opinions of other rich dickheads. Holmes managed to solicit money from some very wealthy people; as well as recruit a board of very powerful men, including George Schultz, James Mattis and Henry Kissinger. The Silicon Valley types seem to love the fact she was a college drop-out (very Maverik); her ‘disruptor’ attitude to business; and her supposed protestant work-ethic. The older folks were probably recruited by playing up to their fear of missing out: if there was going to be a new dot com boom or a new Jobs, they wanted in. And the more famous names and faces that ended up linked to the company, the more others wanted to give. Hey look, if she roped in Kissinger, it must be good right?
(Kissinger knows sweet FA about medical testing, and I wouldn’t classify him as good, either.)
But what they failed to note was that that there were no biotech hedge funds or anything else of the sort fronting any money – and that should have been a giveaway.
You might have noticed that I have not mentioned much about John Carreyrou himself up until this point. This is because he doesn’t enter the story until quite late, and when he does, he doesn’t try and make himself too intrusive – despite the fact he was the one that blew the company-wide open. Writing that first article was not a simple task; it took a long time for him to coax some of his sources into talking to him on the record. They had plenty to fear – Theranos was not above using intimidation and hiring surveillance. Theranos’s legal counsel even tried to threaten Carreyrou’s employer, The Wall Street Journal, with potentially spilling trade secrets, to try and get the story canned. But they also had plenty of motivation to speak out as well – people were going to be hurt if these fraudulent tests were allowed to go ahead. The whole account is both gripping and exhausting; I came away from listening to it emotionally drained, but thankful for each of those people who spoke out.
Now back to the angry-making: I don’t know whether or not Carreyrou meant for this to be one of the stronger massages of his book, but one of the main things I took away was how easy it was for incompetent boobs, high on their own hubris, to piss away shit-tons of money. The whole thing is just obscene. Just think of all the research that could have been funded using all that VC cash. But nope, it’s all down the drain now, with very little technological progress to show for it. What’s worse is that due to the fact Theranos was allowed to get to the commercial testing stage with very little oversight, there are people out there who have been given misleading information about their health, and we aren’t even sure how much harm was done there.
Also, I think that Carreyrou gets a little too compassionate towards Holmes near the end, thinking that deep down, she probably started off wanting to help others. I am less compassionate. I think she wanted to be GirlBoss famous. While she definitely spoke a lot about helping others, I think her actions betray her.
Do I recommend this book? Absolutely. But I also recommend a good strong drink afterwards. I’m popping this under True Story for Bingo, and then I’m walking away from it. This story is so damned frustrating, and as I discovered in the last few weeks, it’s not going to be the only story of its kind – check out what’s going down at the MIT Media Lab