I listened to a podcast about this, and one other thing that struck me was all the Silicon Valley magical thinking. Like just having an Idea, a Vision, was enough - there was no need to ask someone who actually knew something about blood, about testing for diseases etc. Kind of a modern version of faith moving mountains.
Oh yeah, totally. Whenever an actual scientist weighs in on the story, they're like, "Sure, fingerstick testing is the holy grail of lab testing, and if it were solvable, it would open up an avalanche of breakthroughs." Holmes' approach is more or less, "Let's just will a solution into being through sheer force of obstinance, and I'm the special smarty because the real breakthrough is that no one else has thought of fingerstick testing."
Worth noting that her (horrible) boyfriend was not white - another breakthrough for equality in the fraud sector!
One of the things that stuck in my mind from the book was, yes, the role of the lawyers. Boies even had himself paid in Theranos stock, to the extent he became a director of the company! And interestingly some of the more successful whistleblowers seemed to be the ones who didn't know they were meant to be afraid of him.
Also, something really emblematic about the whole "two highly respectable families have an incredibly vicious feud over patents that don't really exist" thing.
and a weaponized legal system functioning as institutionalized thuggery
#makelawyerspublicservants
Are you picturing all lawyers being employed by the state? Or that public representation is always available, if you're being sued?
The secret of the FDA is that they use SAS for almost everything. That's the sign of someone who knows how to live.
I thought Carreyrou wrote for the Wall Street Journal, not the WaPo.
And is this basically the Elizabeth Holmes of NGOs in Africa?
Except Bach was not a doctor. She was a 20-year-old high school graduate with no medical training. And not only was her center not a hospital -- at the time it didn't employ a single doctor.
Yet from 2010 through 2015, Bach says, she took in 940 severely malnourished children. And 105 of them died.
Now Bach is being sued in Ugandan civil court.
11: The way that story is written sort of exemplifies the NPR ethic: all of the damning facts are there, and it's made quite clear that Bach behaved monstrously, but there's very little emotional language about this (pretty, white, Christian) woman who was culpable in the deaths of scores of infants, and absolutely no examination of the culture that created her and countless more just like her.
I mean, there's that quote form the one guy, and a paraphrase right after, but the actual story is poisonous American Evangelical culture. IOW, it's factual enough to convince listeners that NPR has told them a shocking truth, but anodyne enough that nobody outside the Bach family will feel the least need to question their own behavior.
4: thinking about it, it's really hilarious that Boies paid himself in *stock*. you can't cheat an honest man.
For sure. I'm pretty sure that a good-hearted Evangelical could listen to that story and conclude, "But what was the alternative? Condemn the children to die?" and not have their savior-mentality challenged by it.
Oprah also had a charity aimed at impoverished African kids that ended badly. In fact, many charities are ineffectual for a whole bunch of reasons, not all founder delusion or inattention. I don't know that there's a good way to concisely and completely describe the story of any failed charity trying to intervene in an environment with lots of deep problems. Too big a topic. But silence is also a bad response.
I damn sure don't have ideas for whether and how there are great ways for individuals in the rich world to make any difference. I guess I see a difference between unreasonable optimism, even from an evangelical, and clear fraud (Holmes). I think discussing how difficult it is to distinguish those is worthwhile. But that's a broad topic, pretty disconnected from real suffering, and not really suitable to a radio quickie.
That book is so so entertaining. The woman at Stanford who saw through it all immediately is the best. It never ceases to amaze me that the whole time they had literally nothing, like I can imagine getting too excited about a promising idea that doesn't pan out, but here there was never even one scientific idea. The whole thing is just "wouldn't it be cool if we could magic instead of science" from day one.
I damn sure don't have ideas for whether and how there are great ways for individuals in the rich world to make any difference.
Spending a few years becoming significantly informed from people who have knowledge is a good place to start. Learn how to distinguish different sorts of authority - who you should look to for advice and who you shouldn't. Learn about the moral complexity of the field you'd like to go into. Then spend a few years being part of an organization that you think you might admire, and learn from the inside if you really do admire it. Gain experience. Then try to move on to another organization that seems to address some of your criticisms from the last place. Eventually, when you understand why the existing organizations are not seeing the problem as clearly as you do, with your novel way to solve it, then feel free to strike out on your own.
Avoid arrogance of thinking that you are instantaneously the wisest person to tackle the topic, particularly where other people's health and wellbeing are at stake. Save your creative disruption for new groundbreaking Angry Birds apps.
17 gets it right. It makes it clear how many of these startups are just "We're going to be the company that does [thing that has so far never happened]". Is that thing physically impossible? We'll find out!
There should have been an incredible number of red flags from the fact that Theranos existed in a totally parallel universe to the existing diagnostic lab companies, and those companies pretty much just ignored Theranos after a cursory inspection. No interest in getting in on the ground floor of this technology that would supposedly replace their technology. Also no interest in trying to attack and undermine this newcomer that would theoretically put them out of business. They just ignored them. And in Silicon Valley that was just more evidence that the incumbents were lazy and ripe for DISRUPTION.
It sound like it was kept afloat for years by the credulity of the Walgreens executives - specifically the ones whose only motivation was fear that if they didn't do something CVS would.
The woman at Stanford who saw through it all immediately is the best
It must have been a surreal experience to be that person and watch the whole train wreck unfold.
It sound like it was kept afloat for years by the credulity of the Walgreens executives
I dunno. The political prestige of the people on the board is breathtaking. Dumbasses, sure, but their names kept massive amounts of venture capital rolling in.
Why aren't stupid rich people giving money to me?
Smart rich people are making me work.
It's wild that people think boards provide meaningful oversight, as far as I can tell they're totally useless.
22 I actually know the answer to this. It's two things, both of which are required: you're not pretty enough, and you're not telling them you're going to make them richer while doing great things for humanity.
karma seems dedicated to ensuring that every time i go to an elected official town hall i end up sitting next to a fellow citizen on the opposite side of whatever i'm there to rant about, lately autonomous vehicles. i'm pretty sure the dude next to me at the wiener western addition town hall on saturday is an av engineer. every single "problem" he proposed avs would solve within our city is i replied a "problem" already solved by taking the bus plus better paratransit for elderly and disabled folks.* avs not completely theranos-esque, they are crawling all over the city for sure, but avs as an answer to anything inside a walkable, bikable city are strongly theranos adjacent for sure.
*also was super fun to watch him trying to process my ambiguous age presentation (acting like his mom and yes that is bc totally old enough to be your non-teenage mom, young man; but not looking like his mom ... dude was totally confused ha ha ha).
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27: I noticed that too, but as soon as I saw your comment, it had reappeared.
25: As long as you're sure it's not my LinkedIn posts about how to make sure your bowel movements are billable.
19 is correct but understated. This is a holy grail of analytical chemistry research. There were two profs in my grad program working on exactly this topic. It's an area of very active research! AJ listened to Bad Blood, and I had two questions: how did this get funded, and why did anyone believe Holmes could deliver? Part of the answer is that they were turned down by basically every biotech VC in existence, so they pitched to tech VC instead, where a 19 year old disruptor in a field they didn't understand and didn't hire outside consultants to vet, seemed less incredible than in biotech.
Funny story: AJ's PhD advisor used to tell stories from his consulting gigs in similar circumstances. He returned from one such trip and told his students about this man who applied for funding to develop bacteria (isolated from muck somewhere very exotic-sounding) that he claimed generated electricity in a battery-type closed system with (basically) no user input in perpetuity. He called the bacteria "Nanos." Smart man that he was, the advisor requested a sample for his lab to evaluate. The grad students had so much fun with their Nanos.
isolated from muck somewhere very exotic-sounding
The floor of the men's room of a Flying J.
Theranos is way outside of my area of expertise, so I had no opinion until it became obvious to everyone that it was a scam, but inside my area of expertise I see people raising money for ideas that can't work all the time.
Usually the red flag is not just that they have a bad idea, but that the lead technical people appear to have no idea what they're doing and make statements that an undergrad who's taken a course in the area shouldn't make. Most of the time, these companies shut down after burning through funding for a couple of years, but sometimes these companies succeed and get acquired for mind boggling sums of money.
Don't VCs bother having experts review the companies they're funding? Maybe some do, but it's clear that many don't. Maybe they don't because they know that these companies can have successful exits via acquisitions, but that just pushes the question back one level. Don't acquiring companies bother to have experts review the companies they're acquiring?
There are some point of care tests. You can do an A1c, for example. I don't know what they cost or what Theranos claimed was possible.
Part of the answer is that they were turned down by basically every biotech VC in existence, so they pitched to tech VC instead, where a 19 year old disruptor in a field they didn't understand and didn't hire outside consultants to vet, seemed less incredible than in biotech.
That is hilarious but not surprising from the sorts of people who brought us Juicero.
It's great that the name was bought by a Fleshlight competitor.
33 I suppose it's like subprime lending. All you have to do is not be holding the bag when the music stops. With this one, I suppose the "quality" of the people fooled by the thing could be considered indicator enough of a longer than usual run of music.
13 Back in the mists of time, I would suggest to my big law colleagues that it seemed to me that the prospect of getting paid in stock might create a conflict of interest, when it came time to tell the client what it could or could not do. If anyone had taken me seriously, I'd have been pretty unpopular among the transactional set, but they knew better than to pay attention to a mere litigator, stuck on quaint notions from the past. I don't know, maybe it's no different from any contingent fee engagement . . .
34: Their big claim was that they could do a ton of point-of-care tests using a tiny blood draw. Like, a single drop of blood to do full panels of bloodwork. That was what was sort of beyond belief. They'd have to have some amazing (and unprecedented) special sauce to amplify signals from tiny samples while maintaining reliable (medical quality) outcomes. It's not so hard to do some kinds of tests (like blood glucose) on small volumes, but this would require a huge advance in existing technology.
35: I actually found it vaguely reassuring that biotech companies turned them down!
33.last, see 32.last. I'd love to be an outside expert on this stuff just for the stories, but then again, I wanted to write a check for $25K I don't have when a grad school acquaintance told us about his revolutionary new wound care device (developed in a garage, even!), so maybe I'm a sucker, too.
Bold prediction: At the time of her criminal trial, Ms. Holmes will be visibly pregnant.
Ironically, because that's the medical thing where a small drop can contain so much information.
I'm so glad I'm no longer working for a non-profit in Silicon Valley whose board and some key people in executive positions were enamored with disruption and scale. "How can we become a global institution and reach billions?" is kind of an absurd question when it's not clear you can plan for more than a year or two at a time, build basic infrastructure for what you do, or avoid laying off 14% of the staff because you failed to prepare for the consequences of a bunch of short term funding running out all at once, with no VC waiting in the wings to fund your by-definition nonprofitable enterprise.
I'm not going to read the whole thread, but in comments 2 and 4, Nathan and Knecht were prescient (I was entirely credulous).
http://www.unfogged.com/archives/week_2014_09_28.html#014094
Don't acquiring companies bother to have experts review the companies they're acquiring?
Short anwer: Nope.
Longer answer: many have pointed out that big companies are not very good at doing R&D these days. They buy startups instead. And the big companies focus on ...well, being "sales-driven companies". This isn't ridiculous, b/c a company that isn't sales-driven will die when it doesn't pay attention to its customers. But the inevitable consequence of being a sales-driven company, is that all layers of the company get permeated with salesfolk, everybody's selling to everybody else, and real technical expertise flees .... because when you have a choice between buckling down and learning something, or faking it, the latter is always a faster way to your next bonus.
So inevitably, there's nobody left to vet those acquisitions. I saw it myself at IBM: in the 90s acquisitions were often of decent technical quality, and IBM just degraded the tech to the point of worthlessness over a number of years. In the nougties, the tech was shitty and worthless, and nobody could tell. By the teens, heh, not merely was the tech awful, but the businesses were often awful too. E.g. the stuff that's been published about Watson and various health acquisitions that were basically impossible-to-integrate-into-IBM's-business, and eventually led to massive layoffs.
It's an inevitable progression.
I spent doing years doing devops on IBM WebSphere Portal. The shittiness of that software was just mindboggling. But at least is was extremely expensive.
40: I suppose I should have expected that "pleading the belly" was still a valid concept in US law.
17, 20: The woman at Stanford who saw through it all immediately is the best
"Alien is a movie where nobody listens to the smart woman, and then they all die except for the smart woman and her cat. Four stars."
Woman at Stanford (whose name I wish I could remember):Ellen Ripley::Elizabeth Holmes:Alien Queen::Gen Mattis: Lt Gorman::Ramesh Balwani:Carter Burke::David Boies:Ash.
Woman at Stanford == Chelsea Burkett? Reading the book now.
OT but we should probably stop talking about Knifecrime Island: the US has a 50% higher rate of knife homicide than the UK! (Though I wonder how much of that has to do with superior emergency medicine saving the lives of stabbing victims?)
https://www.euronews.com/2018/05/05/trump-s-knife-crime-claim-how-do-the-us-and-uk-compare-
We're just better at stabbing people.
51: That article/graph really only covers knifemurder, not all types of knifecrime. It's perfectly reasonable to believe that Americans demonstrate higher lethality in their knifecrime even as the Brits are committing knifecrime at a higher rate per capita.
Our schools may not teach sex education, but that's because all of health class is about where the important arteries are and how to reach them with the blade.
53: true, but homicide's the only fair basis for international comparison, otherwise you get into problems about definition - "assault" vs "grievous bodily harm" vs "attempted murder" vs "pointy shoving" vs "non-consensual incisive massage".
55: the way to a man's heart is through his stomach.
This just reminds me that I can legally own a sword-cane, but still don't.
I can legally own a sword, but shouldn't.
Right. Unless you make it an every day carry item, it's just nerdery.
Speaking of performative nerdery while armed, I bet the guy who took his rifle, pistol, and body armor into the Walmart in Missouri gets off. The state enacted a law to protect gun assholes and it looks like they did a great job with it.
Their big claim was that they could do a ton of point-of-care tests using a tiny blood draw. Like, a single drop of blood to do full panels of bloodwork. That was what was sort of beyond belief. They'd have to have some amazing (and unprecedented) special sauce to amplify signals from tiny samples while maintaining reliable (medical quality) outcomes.
This is correct. Just based on, like, probability and sampling there simply shouldn't be enough molecules in that small of a volume to accurately reflect the blood when it's subdivided into that many different tests.
And it wasn't just a tiny blood draw. It was supposed to be from a finger stick. Which adds ADDITIONAL complications because you are getting capillary blood that has been diluted by interstitial fluid, instead of venous blood that reflects the bloodstream better.
60: also, when I need one for the day, I can get one. No point in actually buying (or indeed forging) my own.
Nothing looks as rented as a rented sword.
It is quite odd that "forging a sword" could mean "making something that is a sword" or "making something that isn't a sword".
62: If you shake the patient hard enough, even the finger blood will be the same.
Clearly, Theranos should have considered blood draw via a simple stabbing process.
While you studied microbiology, I studied the blade.
With a name like Theranos I was honestly surprised the product wasn't system-on-a-swordblade.
In my head, I keep reading it as "Thanos."
65: I enjoin you from forging a sword, but enjoin you to forge one.
70: It is a combination of three very strong brands: Thanatos, implying "this will make you long for death"; Thanos, implying "this is the most destructive thing you can imagine"; and Thera, implying "this will blow up in your face".
The knife subthread reminds me that back in high school a student got expelled for pulling a switchblade on another student. It seems so anachronistic and 1950s in retrospect somehow. Are switchblades a thing anymore?
61. Believe it or not his story is that he was running an experiment to see if Missouri law really meant that he could wander around a supermarket looking like a terrorist with impunity, or whether somebody would do something about it. Believe it or not.
I believe it. The law appears to have been written exactly as he thinks.
The whole thing is obviously nuts, but not at all hard to believe.
74-76: What he did was legal -- and yet if a cop had shot and killed him, it's more likely that that cop would be viewed as a hero, than disciplined in any way.
Still he was probably right to think that as a person with light skin, the odds were in his favor.
78: Sure. That was the best case scenario.
He was arrested for causing disorder, or a panic, or something like that. Which, true, he certainly did, but what he did does seem to be entirely within the limit of the law as written. Which is asinine, of course. It would be better if what he did was explicitly illegal, instead of implicitly based on second-order effects. Are there many laws that criminalize actions based on how other people react?
We had a random daytime knife murder a block from my office last week. The cop was talking to the victim and a dude came up and stabbed her throat. Initially reported as a hate crime, but seems to be random. Anyway, uh, yeah, go USA, I guess.
Shooting the guy on sight would just be rational, right? Asking police to do anything else would unfairly endanger police officers. I don't doubt the people of Mississippi will recognize this and amend police guidelines accordingly.
But the police do shoot black men with guns in Walmart, even when the gun is a toy.
Police are more reluctant to shoot white guys. Or at least, the majority of white spree shooters are arrested unharmed. (Our local one was wounded by return fire--I don't think most shoot at cops.)
Anyway in states that allow open carry and body armor (?!?!) the laws appear to be entirely inconsistent with reducing murderers' ability to get the jump on you. But apparently even in those states people don't like having the consequences their batshit laws waved in their face. Maybe this'll lead to some rationalization.
Oh, yes. Of course. Apparently the sense I meant is "chiefly British," so let's call it rationalisation of the laws.
I wasn't sure if I was Standpiping.
@37 Like subprime I assume the dynamic is that back end of the funding is actually the input of some other process that needs constant feeding.
Additionally a number of startups pivot - often multiple times, and plenty of semi-cogent ideas sell. so I assume at some point it just becomes a numbers game of throwing the right amount of money at people who look vaguely credible and managing the risk.