Ethics in Medicine

Theranos: Lab Testing as Mission!

Kristen Sparrow • December 16, 2014

Elizabeth HolmesI had heard a few things about Elizabeth Holmes and her company Theranos.  It has all the makings of the modern day tale of derring-do: a young brainy genius drops out of Stanford (daring!) to start a world changing company.  In this particular case it’s particularly riveting because of the extreme youth of the founder (she has been running the company for 10 years and is just 30) and the fact that she is, well, a she.
So when I saw that she was profiled in the new New Yorker I read every word. In this profile she comes across as the classic business founder in hyper drive. She’s an impressive, amazing, vegan, loner genius.  And she stresses more than once that she wants to live a life of purpose. I guess that’s pretty typical of Silicon Valley start up founders, that they see themselves changing the world.  And, hey, great!  But the story becomes a bit more, er, nuanced when it turns out that she has a few thugs on the board of the company like  Henry Kissinger and Paul Frist (!!).  She has former Defense Secretary William J Perry, Sam Nunn, former chair of the Armed Services Committee…..  The story has taken a very corporate insider turn extremely quickly.  The technology is secret so that they won’t be copied, which is, I guess, okay?  Except that these are medical tests, and everything should be under strict oversight.  So the presence of all of these heavy hitters on the board, really sets off a lot of alarm bells.  So the business model is not just the scrappy start up, disrupting an industry.  It may be part Uber model.  Step in, side step regulations, get market share fend off law suits and go from there.
Holmes seems extremely sincere, her technology allows blood testing with just a few drops of blood instead of tubes and tubes.  So from what I gather, she’s changing the world for people who don’t like syringes (not snark, she actually says that). But for this to really be profitable the plan is to have it in the VA administration, Walgreen’s etc…  The plan is that patients customers can order their own tests, and this will improve preventative care.  Her example is people who are prediabetic.  The customer would order the test themselves and then forward it to a physician.  This is problematic for a jillion reasons.  Law demands that physicians follow up and address abnormal blood tests.  So will Theranos be legally required to do the same?  Another basic problem is that, as Andy Ellner, physician and co-director of the Harvard Medical School Center for Primary Care says,  there is “very little evidence” that paying more attention to blood tests or doing more tests over all will have an impact on people’s health.  Even in prediabetes.  In this blog, in the “First Do No Harm” category, I have tried to put a spotlight and some of the excesses in traditional medicine.  Some of those excesses come from too much testing.
So it will be interesting to watch Elizabeth Holmes and Theranos.  I can’t help but cheer her on, since women at the helm are so rare.  But I also wonder if that board of directors with such a cohort of chin stroking, back room types is really benefiting the mission even as uninspiring a mission it seems to be.  Holmes insists she needs a purpose driven life, one that “has changed people’s lives.”  I guess it’s hard for me to see more lab tests as being a real game changer, but maybe my imagination is weak. On the other hand if Holmes’ purpose is to make a ton of money, she seems to be doing just fine.  With that I have to file this blog post under “follow the money” as well as “first do no harm.”
Addendum: (to an already long blog post)
Part of what irks me here is that this is part of a pattern, not only in Silicon Valley, but in Finance.  People are developing businesses and gadgets that are terrific at attracting funding and selling products (real and financial) and getting really rich.  They are clever and have mastered the game and yay capitalism! But to then claim that you are changing the world is kind of lame.  You’re making money and that’s not easy, so enjoy!  But don’t tell me that you’re a Paul Farmer or an Elizabeth Blackburn.  Real  science is extremely hard, tedious, and often not remunerative.  And by the way, Jonas Salk never made money from his polio vaccine because he thought that would be corrupt.  Real heroes, like Paul Farmer, are changing the world.  I don’t think lab testing qualifies. Rant over.