The world was shocked by the story of Elizabeth Holmes and Theranos, as dramatically depicted in Hulu’s miniseries The Dropout. The apparent wunderkind CEO faked her way to a massively successful healthcare startup in Silicon Valley, wooing luminaries like Rupert Murdoch and Henry Kissinger to her board and dazzling the mainstream press, all while promising a breakthrough that was literally too good to be true. When the walls came tumbling down starting in 2016, many couldn’t understand how Holmes’ smoke-and-mirror show had gotten so far.
Yet it’s the kind of story that’s very familiar to scientific skeptics, and a little bit of doubt would have gone a long way to stopping Theranos before it really got started.
Theranos’ extraordinary claim was that they’d developed a machine called the Edison that could run 200 or more blood tests from a single drop obtained from a fingerstick, rather than the vial of blood extracted from a vein that’s typically needed to supply just a few tests. On top of that, the Edison was somehow small enough to fit in drug stores and even in people’s homes, allowing consumers to essentially order their own bloodwork.
If you ignore the facts that non-medical professionals don’t typically know what to do with a test result once they have it, and that arbitrarily testing for a lot of things can lead to unnecessary worry over false leads, that certainly does sound like a game changer. So it’s in cases like this that you need to ask the most questions.
Where were the intermediary steps? No technology goes from zero to revolutionary overnight. How is it that professional groups like Quest Diagnostics and Labcorp couldn’t even guess at how the Edison was able to do what was claimed? Can it really get enough data from such a small sample? Do simple physics and fluid dynamics even allow for it?
Of course, before you try to explain something, you should check to make sure there’s actually something to explain. Somehow, plenty of investors and pharmaceutical companies believed that the Edison could do what Theranos claimed it could, and even saw it pass tests. How could this be? Simply put, no one was ready for how brazen the company would be in their deception.
A lot of what we see in episode two of The Dropout really happened — the prototype Theranos brought to a demo for Novartis was unreliable, and during a test, a fake result was transmitted to the machine onsite. The HBO documentary The Inventor recounted a separate Edison test that took blood from potential investors, put it into the machine, and then led the investors away while technicians retrieved the blood to analyze on different, workings machines.
The investors had probably never had to deal with this level of deliberate subterfuge. It’s the same reason scientists aren’t always the best people to test alleged psychics and those claiming to have superhuman powers. Nature doesn’t try to fool you, so natural scientists can be easy marks for scammers, as shown by conjurer James Randi‘s Project Alpha hoax, which sent sleight-of-hand artists undercover into Washington University’s psychic research program and fully fooled the researchers.
But besides that, you get the feeling that everyone investing in Theranos, and indeed everyone who worked there, really wanted the Edison to work — whether for massive financial gain, or to legitimately disrupt the medical testing industry and actually help some people. And that’s doubly when you need to ask the most questions. We’re really good at convincing ourselves of what we want to be true, and ignoring contradictory evidence when we’re presented with it. Former Secretary of State George P. Shultz refusing to believe his grandson about what was going on at Theranos, when he actually worked there, may be the best example of cognitive dissonance ever.
Ultimately what sold people on Theranos wasn’t the science, but the story — that of Holmes, the brilliant iconoclast changing the world and paving the way for women in the land of tech bros. It’s hard to call her an outright scammer though, at least early on, because it’s really easy to fool ourselves, too. If the events of the first couple episodes of The Dropout are reasonably accurate, you can imagine someone with a dream being led to believe that in Silicon Valley, as economist Dan Ariely said in The Inventor, putting a goal farther out than you might be able to reach is just what you do.
Holmes’ entrepreneurship hero, Steve Jobs, employed a persuasive technique some called the “reality distortion field” to reach those goals. If his team told him there was no way the new iPhone would be ready in time, he’d convince them otherwise, and through long hours and little rest, they’d make it happen. Sadly for Holmes, science isn’t the same as technological innovation, and no amount of inspired leadership can change the laws of physics and chemistry. Jobs found that out the hardest way possible, when he eschewed surgery for a usually curable form of pancreatic cancer, in favor of “alternative” methods. By the time he came around, it was too late, and Jobs died in 2011.
But as The Dropout continues, you can see Holmes start to buy into her own bullsh*t. She tried to convince her employees that traditional testing companies Quest and Labcorp were taking nefarious action against Theranos, in a paranoid tactic that will be familiar to anyone who studies groups who believe “the government” or some other force is out to get them. At the end of episode 5, Holmes declares to her workers that Theranos is her religion, and we all know that never ends well.
There’s a lot we can learn from the Theranos story, about self-deception and intentional deception of others. Perhaps the biggest takeaway is something we should have already known, although it’s harder to accomplish in practice than in theory — follow the data, and not the story. And if something seems too good to be true, it probably is.
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