how theranos could’ve saved itself, and why it didn’t

Perhaps the worst thing about Theranos is not the lies, the fraud, or the failure. It’s that the company and its portable lab could have been salvaged and improved lives if its CEO didn’t drown in her own hype.

blood hand pattern

Proving that you can’t fool all of the people all of the time, Theranos finally collapsed under the scrutiny of scientists, regulators, and investigative journalists, fueling countless post-mortems, mea culpas, and questions about how our institutions let us down by not catching the fraud until dogged reporting from John Carreyrou and data from whistleblowers, who were hounded by the company’s legal goons, finally reached the public. I bring up the mea culpas because I’m also guilty of giving Theranos the benefit of the doubt on their FDA filings, chalking up their lack of transparency to a combination of paranoia and greed instead of outright criminality because lacking any proof of unseemly actions, I didn’t want to assume the worst.

But it appears that Theranos’ vagueness had nothing to do with protecting trade secrets. It was meant to hide the fact that its disruptive and revolutionary lab-in-a-box simply didn’t work, and it’s the look into how the company’s Edison machines were handled that really caught my eye in the HBO documentary on Theranos’ collapse. While the main story here is one of fraud, there did seem to be very genuine efforts to make the machines do what they were meant to do. It’s not that Holmes set out to defraud powerful investors by pretending she had a revolutionary device when she really didn’t. She really did have a vision for something truly innovative, even though it ended up being a pipette dream and defective electronics covered in biohazards.

Set aside the fact that Holmes blithely ignored the engineers’ warnings that the laws of physics were simply not going to let all the technology she wanted to cram into a small metal box work in such confined spaces. Forget about her attempt at a fake-it-till-you-make-it ethos with people’s lives on the line, and, if you can, ignore the “we’re focused on solutions, not problems” snippets of execu-speak favored by scammers like Billy McFarland of Fyre Festival fame. What seems downright tragic is that it’s actually not completely impossible that her machines would’ve done wonders for personalized medicine if she scaled down her ambition a bit.

where theranos went wrong

Basically, it seemed that there were two key problems with Holmes’ idea. The first is that you can’t do hundreds of tests on a few drops of blood. There just isn’t enough organic material for testing without violating the laws of science, and diluting the samples to process them in their Edison prototypes or conventional machines — to which Theranos resorted when it was clear their technology was just not going to cut it in the real world — means your tests become wildly unreliable and inaccurate. The second problem is that the Edison machine was just too small and no amount of warnings from engineers would make Holmes consider a larger one. In her mind, she pitched a machine the size of a toaster on steroids and that’s the size it had to be.

Now, imagine an alternative world in which Holmes listened to reason and said that while she does hope to do every test with a few drops of blood, the company isn’t quite there yet and will need to start with small blood draws. Instead of trying to offer 100 tests, she could start with a few dozen extremely important ones that can signal serious chronic problems like blood sugar levels, cholesterol, kidney function, and so on. Her small labs could have used less blood and done fewer tests, but if those tests were accurate, easily accessible, and cheap, it would’ve given patients something to discuss with their doctors about their basic health.

Likewise, she could have allowed the engineers to double, if not triple the size of the box for the Edison machine. It would’ve still been quite portable, and very importantly, it could have been made to work accurately enough to for serious clinical use. More space meant fewer gears got stuck, fewer vibrations to disturb samples, more accurate testing, and fewer breakdowns. With fewer tests to do, there would be less internal motion and shocks to the critical parts holding the samples and analyzing results. Instead of spending hundreds on lab tests, patients could come to a pharmacy with such a device, get their blood drawn, and receive quick and accurate results about their vitals. This would already be a huge step and no one else was doing it.

when you can’t take no for an answer

Unfortunately, evolution was not what Theranos pitched. They were committed to delivering a revolutionary product capable of doing up to 200 tests on a drop of blood because that’s what they told everyone from their investors to their first customers. Coming back and saying they want to scale down their ambition a bit could have spooked those giving them money, which would have been temporarily embarrassing but survivable, especially if framed as a desire to make sure every step of the process is done right and the patients are taken care of properly. It might actually attract more investors because they would see a responsible business instead of a flashy shot in the dark at something experts viewed with heavy skepticism.

But again, it seems that pride wasn’t going to let that happen and fawning profiles calling the company the brainchild of a genius on par with the discoverer of fire and the creators of sliced bread and perforated toilet paper went straight to Holmes’ head. It wasn’t enough for her to be the face of a major improvement in medicine. She had to be the genius everyone made her out to be and upend the current order once and for all, by any means necessary. It’s a cliche, but pride truly came before the fall, and she really seemed to believe that she could intimidate and silence her critics while she bought just a little more time to make the machine she was being told couldn’t work do the impossible and finally live up to her own and the media’s hype.

Ultimately, the fall of Theranos, the bankruptcy of Mars One, and yes, the Fyre Festival, all have one thing in common: leaders who desperately wanted to change the world, honed stories that promised the future right around the corner, found credulous journalists to tell those stories, and eventually bought into their own hype while either ignoring or rationalizing away the problems they kept having realizing those wild dreams. Then, when the problems piled up, they resorted to lying and cheating to buy more time to make that dream happen, until finally, their scams collapsed under their own weight. When experts, scientists, and engineers talk about being skeptical and urging people to ask critical questions, this is exactly what we’re trying to prevent.

the dangers of feeling entitled to your own facts

We live in a world ruled by confirmation bias, and it’s enabling people so lost in it, they believe they can do the impossible and refuse to listen to reason while calling every criticism fake news with thinly veiled — if veiled at all — disgust. From music festivals that physically can’t happen, to groundbreaking portable labs that have the accuracy of tarot cards, to political careers based on nothing but the exploitation of people’s worst instincts with tsunamis of fear-mongering bullshit, we’re allowing our societies to develop their own alternate realities and lock themselves in them instead of accepting the limitations and facts of the one we should be sharing.

In this environment it’s not that big of a surprise that we’re unearthing so many scammers who are getting so far with their scams. All they need to do is tell people what they want to hear and let those people tune out any information to the contrary. They’re being given the tools to do so by social media and permission by their leaders. And as they eagerly lock themselves in their echo chambers, where every day is warm and sunny, and their homes are about to be powered by the magic of unicorn farts, the scammers who have their full attention will encounter very little resistance as they keep lying and cheating. Of course, the problem with denying reality is that you can only do it for so long before it returns with a vengeance, and the hustles fail.

The really sad part of this is that all those cries of fake news and built-in tools to enable life by confirmation bias let these scams drag on for longer, do more damage, and ensnare far more victims. Right now, as we speak, at least a dozen more Theranoses and Fyre Festivals are gaining momentum, and mods are busy purging unbelievers from their social media timelines. We might be just a few years away from documentaries in which we explore their collapse in grim and stark detail, asking how it could’ve gone on so long. And until we re-embrace the need for nuance, skepticism, and a shared set of facts, we’re going to keep getting scammed and asking the same question.

# health // medical experiments / medicine / skepticism / theranos


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