Five takeaways about the Theranos broo-ha-ha

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You’ve probably seen by now both that the WSJ’s John Carreyrou has run a well researched hit piece on Theranos and that the company, led by wunderkind Elizabeth Holmes, has somewhat muffed its reply. If you haven’t, best thing is to read the Roger Parloff Fortune piece which summarizes the pay-walled piece so you don’t have to do the painful task of sending Rupert Murdoch money. Now in the spirit of FD I need to let you know that we’ve invited Holmes to speak at Health 2.0 twice and her PR handlers have been unbelievably hard to communicate with. They’ve either flat out ignored us or taken forever to turn us down, even though she’s appeared often at (what I at least consider) much less important or relevant venues. I have no idea if she’s badly advised, wanting to stay away from sophisticated health tech audiences, or if her handlers decided that we and our 2,000 strong crowd are just not cool enough for her. Or maybe simply her calendar hasn’t allowed it. Either way I have no first hand knowledge of her or the product–although Elizabeth our invite is still out there! But I do know five things.

1) Lab business decentralizes & democratizes. Whether or not Theranos is lying, cheating, not using its own tech, or its cool stuff just doesn’t work, the trend towards comprehensive, cheap and soon at home lab testing is clear. More than 5 years ago a company called BioIQ was selling at home fingerstick based cholesterol & glucose tests. In the past year the two stage Nokia Sensing XCHALLENGE (of which we hosted stage 1 at Health 2.0 in 2013) has revealed a plethora of companies taking minute quantities of blood, pee or spit and doing complex diagnosis from them. And it’s not stopping there. The next phase is using light and other sensors to diagnose direct from the skin. Whether or not the locus of activity ends up using Theranos at Walgreens or the kitchen table using something else, the dam holding back continuous, cheap multi-faceted testing is going to burst soon.

2) Theranos and Holmes are not the most important thing in health care. There, I’ve said it. While Holmes has talked a lot about revolutionizing health care access and has given lots of transparency into Theranos’ pricing if not its testing technology, what they’re up to is getting easier access to lab tests. I think this is very important and a very good thing, but no one can seriously believe that this is the biggest change in health care. It’s part of a trend towards consumerism. But I’d argue the most important trend in health care is the redesign of chronic care management, on which we spend a shed-load more than lab testing. I may be wrong but if you insert your pet issue here, I’d bet it’s not cheaper lab testing. The media has been a tad snowed by the “youngest female billionaire” and “blonde Steve Jobs” analogies, but even if she runs the field and takes over most lab testing, it’s an incremental change not a huge revolution in health care.

3) Dirty Digger outsmarts defense hacks. The most interesting and puzzling thing about Theranos is the board. It is packed with very old white Republican men from the national security and defense community. Believe it or not it includes Henry freaking Kissinger, Sam Nunn, former Sec of Defense William Perry (OK these two aren’t Republicans but no one would confuse them with Bernie Sanders), a second former Sec of State (Shultz) as if Kissinger wasn’t enough, and a couple of CEOs from big time defense/gov contractors (Gen Dynamics/Bechtel). One of the two token MDs is Bill Frist who just happens to be former Senate majority leader (and remote diagnostic genius). Who’s not on the board is anyone who knows much about health care. Which tells me that Holmes sees the DoD and other international organizations as big potential customers, and possibly the DTC consumer stuff is a sideshow. There must be an amazing back story here. On a side note, the one easily Google-able public military contract they have is very odd (if the website it’s on is to be believed). Either way their board of old white Republicans didn’t protect them from another old white Republican!

4) Valuations are nuts and irrelevant. Part of the excitement over Theranos is the alleged $9 billion valuation. Somewhere between $88m and $400m has gone into Theranos (depending if you believe TechCrunch or Business Insider) and of course it has client relationships with Walgreens and apparently big pharma cos that bring in revenue. Unfortunately for anyone living in Silicon Valley and trying to hire or buy a house, private market valuations are driven by the incredible liquidity in venture funding. But they’re also fake. $9 billion isn’t really $9 billion and until Theranos has been public for a while the real value won’t be known. Castlight Health raised similar amounts of money at a Unicorn valuation and (despite more or less hitting its numbers) is today trading at a market cap of $430m.

5) This ain’t over. While the FDA has told Theranos to dial it down and stop using its fingerstick technique for all but one of its tests, it’s extremely unlikely that it’s the end for the company. Possibly the technology doesn’t work but given what I said in point 1 above that’s highly unlikely. They just need to work through the FDA to get their tests validated and then need to release some public comparison data of their tests vs. Quest/LabCorps. There’s also a very close analogy of FDA problems down the street in Mountain View where another Unicorn company 23andme’s CEO, Anne Wojcicki, totally lost the plot with the FDA by stopping communicating with them. (Apparently “things slipped through the cracks“). But they’ve since pulled it back, made nice with the FDA, raised another huge round, and most importantly landed some huge client contracts.

Perhaps Anne should give Elizabeth the “it gets better” call. And while she’s at it perhaps Anne might tell Elizabeth to come to Health 2.0. After all she’s been a couple of times and it hasn’t seemed to hurt her company too much!

Matthew Holt is the publisher of THCB and the co-founder of the Health 2.0 conference.

7 replies »

  1. too bad she didnt just stay a little more under the radar and have patience. Also, you know, make something that worked.

  2. Nice work, Matthew. You’ve made what could have been merely an opportunistic undressing of the Empress Holmes into an even–handed clarification of the bigger story in the Theranos affair.

    AND you neatly tied in promos of your various enterprises & events in a way that is not nearly as cheap & greasy as your similar efforts of recent years too frequently were. Win-win!

  3. Thanks for your usual breath of fresh air Matthew! Agree that the whole story has been fishy… but even if it did everything it said it could do – it still is not that big of a deal (unless you are Quest or Labcorp I guess) – it does not solve the real issues we face with illogical reimbursements and legal barriers minimizing our ability to practice team based care; along with non-compliance and lifestyle issues on the patient side.

    And not meaning to pile on when things are rough, but I don’t feel guilty as I actually wrote this about 3 weeks ago in response to another glowing article about Theranos I didn’t understand:
    1. Efficiency and Pain: The actual “blood draw” is a fairly involved and still painful procedure that involves a “trained pricker” who has to prepare the finger for a few minutes with warm towels, and then stick you and get the blood out. Personally- I find finger sticks more painful than traditional blood draws… glad I am not a diabetic! So every “site” still has to have trained people, and still takes 5-15 minutes per patient. Not very efficient.
    2.Timing: the results don’t come back immediately, and I believe it may take 15, 30 or more minutes? most pts will be long gone anyway – so how is that much different from sending to a lab and getting them back the next day?
    3. Point of care: Is “Point of care” hugely valuable for typical primary care docs? As above, the results are not immediate- and even if they were, it would only make sense if the pt came BEFORE the visit to get all the labs. Once I am done with pts and ordered the labs, I need to move on – I don’t have time to deal with all the results right then.

    I think this industry is ripe for disruption, but I think we will need to see a few more evolutions, such as
    1. Non-invasive labs – ideally that can be done almost instantaneously – and are so cheap, that every pt who comes into my office has them done before they see me. Eventually, they will just be able to do them at home or on a continual basis. Maybe Theranos will evolve to that, or maybe some quicker, cheaper company will come along…
    2. Computerized algorithms that clarify what needs to be ordered and how to understand the results and explain to pts (well, I’m working on that part already with healthfinch!)

  4. Yeah, wow, what an article. Ouch. This kind of stuff is red meat to me. I learned my lab precision and accuracy (they’re not the same) QC basics in a forensic-level radioanalytic lab in Oak Ridge in the mid 80’s (lot of the same screening and confirmatory technologies and methods as in regular clinical bioassay).

    I did my grad work on the scam that is the illicit drug testing industry, e.g.,


    Lately I’ve been warning of possible inadequacies in QA within the burgeoning sub-forensic clinical-level “genomics” commercial assay industry, given that there are no federal quality regs in that area. (In Vegas we had this paternity testing company billboard by the freeway near downtown featuring a huge picture of an infant with a Photoshopped Pinocchio nose. Tagline: “Who’s The Daddy?” LOL.)

    This Theranos thing is a whole ‘nuther concern. Far more basic, but equally important. Cheap, “innovative/disruptive” lab testing, well, bears close scrutiny.

  5. Excellent, Matthew. Perhaps the most important point you make here is that Theranos will not beat the biggest challenge in health care. We can quibble over what that is, exactly, but it most certainly isn’t the cost or the technology associated with lab testing.

    And kudos to Dave for pointing out a tried and true method of sticking it to Rupert. There are all kinds of ways to make the world a better place.

  6. Good piece, Matthew. In case you want to get behind the paywall without paying Rupert, the workaround is pretty easy. Copy the headline into Google News. Bingo…you get the full article and the satisfaction of stiffing Rupert. You probably knew this but a few readers might not.