musings on music and life

September 9, 2016

The rise and fall of Theranos

Filed under: Philosophy — sankirnam @ 11:30 pm

I’ve been meaning to write something about Theranos for a while, and seeing this rather dramatic article in Vanity Fair yesterday spurred me to action.

Theranos is a Silicon Valley company that was started by Elizabeth Holmes as a 19-year-old undergraduate student at Stanford. I don’t have any personal involvement or interest in the company, but the story of Theranos is reflective of the biotech industry as a whole, and as a rather large company with a multibillion-dollar valuation, all eyes are on it as well as the other large startups. Back in 2014, when it was around the time of my graduation, people were telling me to look up Theranos and apply there since “it was hot” and “Liz Holmes was going to change the world”. In hindsight, I’m extremely glad that I dodged that bullet.

I remember reading this New Yorker article shortly afterwards and feeling a great deal of skepticism. One of the things that tipped me off was this passage:

One day, in her freshman year, Robertson said, she came to his office to ask if she could work in his lab with the Ph.D. students. He hesitated, but she persisted and he gave in.

[…] That summer, at the Genome Institute, Holmes worked on testing for severe acute respiratory syndrome, or SARS, an often fatal virus that had broken out in China. Testing was done in the traditional manner, by collecting blood samples with syringes and mucus with nasal swabs. These methods could detect who was infected, but a separate system was needed to dispense medication, and still another system to monitor results. Holmes questioned the approach. At Stanford, she had been exploring what has become known as lab-on-a-chip technology, which allows multiple measurements to be taken from tiny amounts of liquid on a single microchip.

Over the years, I have worked with many high-school students and undergraduates in research, and I also did “research” myself in an organic synthesis lab while in high school. The one thing in common that all new researchers have is this: they don’t know anything. I’m not saying this to be mean, but to lay the reality – working in a research lab is a vastly different experience from doing coursework. For instance, all undergraduates will study diazotization of anilines  and learn the variety of transformations they can undergo (Sandmeyer and other reactions). But carrying out one of these reactions yourself is vastly different from simply drawing the structures and reaction arrows on paper; you wouldn’t know just how explosive diazonium salts can be unless you have actually worked with them before. One of the key things you learn in research is humility, which is why getting any kind of research degree is often described as an ego-shattering process; 99.99% of the time, when you think of something, chances are, it has been done before.

Here’s an interesting story that illustrates my skepticism: There was a high-school student who used to work in my lab when I was doing a PhD. We all knew that this student had no interest in science, beyond getting some “research lab experience” to bolster her CV and improve her chances for admission to an Ivy league university. She would come and “work” for only 2-3 hours once a week every Friday. Anyone who has any kind of experience doing research or any kind of lab work knows that you can’t get anything done on that schedule. This student had never set up a single reaction from start to finish (which involves setting up the reaction, monitoring it, quenching it when complete, working it up, purifying the crude, isolating and weighing the product(s), and finally characterizing the product(s)). And yet somehow she managed to win first place in the state science fair, presenting a chemistry project with practically no self-generated data!

That’s why I’m skeptical about “child prodigies” in science, because it takes a long time to develop the foundational knowledge required to make serious contributions, or even to understand the subject matter properly. I’m highly doubtful that after doing basic “research” for a few months, one would have the necessary domain expertise to be able to start a company. I’ve been studying chemistry for 12 years and I feel like I don’t have the necessary expertise! To put things in perspective, one of the criticisms about Theranos is that “finger-stick blood tests aren’t reliable for clinical diagnostic tests; because the blood isn’t drawn from a vein, the sample can be contaminated by lanced capillaries or damaged tissue“. This is true, and anyone with a proper understanding of high-school biology would be able to tell you that. Another issue is statistical – when your sample sizes are smaller, your error bars are going to be correspondingly larger, and this is an important consideration when you’re trying to do measurements on vanishingly small concentrations of analytes (oftentimes ng/L). I guess this would be an instance of people succumbing to groupthink. I mean, the premise of Theranos is awesome, don’t get me wrong. Miniaturizing diagnostics is a huge challenge, and is on the cutting edge of science, engineering, and medical research. George Whitesides (Harvard) is actively working in this area, as are many others. But is it really possible that a 19-year old could solve a problem that the smartest people in the world are struggling with? Color me skeptical.

I remember I was once watching the lectures from Stanford’s Intro to Chemical Engineering class a few months ago, and I stopped watching in disgust once I realized that the instructor, Channing Robertson, was now on the board of Theranos.

Also, I remember my father asking me multiple times about how Theranos was able to secure so much funding if the scientific foundation was so shaky. This article explained everything:

“[…] none of the big V.C. outlets invested in Theranos. When the company raised an additional $200 million in early 2014—which gave Theranos a $9 billion valuation and made Holmes “the world’s youngest self-made billionaire,” worth about $4.5 billion (on paper, a point that few stories ever noted)—that money largely came from private equity.

You couldn’t find Michael Moritz, John Doerr, or Peter Thiel on the Theranos board. And while Marc Andreessen has repeatedly come to Holmes’s defense—blocking Twitter followers who have questioned her and even implying that she could be the next Steve Jobs—his firm, Andreessen Horowitz, did not invest in Theranos. (And even those V.C.s who did are now trying to distance themselves. Theranos is no longer listed among Draper Fisher Jurvetson’s “featured investments,” even though its logo was there this time last year.) When I’ve asked V.C.s why they didn’t pour millions of dollars into a company that appeared to be changing the world, I was told that it wasn’t for lack of trying on Holmes’s part. She met with most top venture firms. But when the V.C.s asked how the technology worked, I was told, Holmes replied that it was too secret to share, even to investors. When they asked if it had been peer-reviewed, she insisted once again it was too secret to share—even to other scientists.

But that Vanity Fair article was eye-opening. I didn’t know that Theranos’ chief scientist ended up committing suicide due to the pressure and unreasonable expectations put upon him. Yikes. That scenario can be traced back to Holmes’ lack of scientific training; as I mentioned before, a proper experience in scientific research and a proper scientific education will teach you humility, as well as the fact that the laws of nature bend for no one.



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