Theranos: What can Silicon Valley learn from the troubled health care startup?

What Can Silicon Valley Learn From the Troubles of Health Care Startup Theranos?

What Can Silicon Valley Learn From the Troubles of Health Care Startup Theranos?

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Oct. 28 2015 11:32 AM

What Can Silicon Valley Learn From the Troubles of Health Care Startup Theranos?

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NBC News’ Maria Shriver, left, and Theranos founder and CEO Elizabeth Holmes speak onstage at the Vanity Fair New Establishment Summit on Oct. 6, 2015, in San Francisco.

Photo by Mike Windle/Getty Images for Vanity Fair

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Answer by Ramzi Amri, M.D.; Ph.D.; postdoctoral fellow, surgical oncology:

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The Theranos story could become the poster child of the obsession of technophiles who don't know what they are talking about with “disrupting” health care, and the greed and hunger for buzz that fuels this. Stop trying to disrupt my health care, folks; this is not a sandbox.

Seriously, though, Theranos is yet another example of what happens when a lot of excitement arises about something that is alleged to be industry-changing without first passing the scrutiny of science; that is: open, peer-reviewed testing and validation, the gold standard if you want to introduce anything that will be used in patient care, and actually the scientific backbone that should stand behind any claim.

The story usually goes like this: A semi-informed technophile who is tangentially interested in health care but has no (completed) formal education in the field has an innovative idea that at first sounds great, even revolutionary, and most importantly buzz-worthy. The idea gets picked up by media and completely overblown by grandiose claims, catalyzed by masses of semi-informed technophiles who are tangentially interested in health care but have no formal education in the field. These early adopters of these stories eat it up and regurgitate it with even more superlatives. Soon enough, the investors who are tangentially interested in health care but have no formal education in the field come in, hoping to make big bucks. Reading story after story about how awesome and revolutionary this is, in increasingly trustworthy sources, they take this at face value. In a game that involves politics and power, the investors pull in an armada of important and recognizable faces who are tangentially interested in health care but have no formal education in the field into the startup's board of trustees. In the end we have a product that hardly lives up to the buzz. People are disappointed, the buzz turns to outrage when someone who did his homework bursts the bubble ... until the next big clickbait “this will disrupt health care” story comes up. I'm just happy patients are safe and there's still a medical community and a Food and Drug Administration that tells you in your face when your science is bad and you should feel bad, and sends you back to make something that is actually reliable and safe to use with patients.

Every step of the way, some of the people closely involved will undoubtedly have thought about the possibility that the whole thing might just be not that revolutionary. Perhaps some of the claims are even just plain baloney. But nobody wants to be that guy. Besides, he's not the expert, right? But who in that board room actually is? Oops.

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Worries about return on investment come up behind the scene, and while the grandiose claims remain as they are at the core of what got interest and money in, the business plan is subtly nudged toward less revolutionary but feasible plans. Eventually, the product is quite different from the world-changing story parroted years ago, and investors wonder if this will ever get their money back. Involved parties hope the story will just die out and an average medical testing company will eventually arise from this “disruptive” company. But this time, someone called them out on their overblown claims, and as it seems rightly so.

Grandiose claims need grandiose proof. If they are attached to an idea that to any practitioner of this field is hardly original or feasible, it will and should be considered baloney until proven otherwise in the court of science. If you do want to play a very dangerous game and inject billions into the idea, be my guest, but do realize that medical technology is hard, and most projects fail because if there really were an easy way to improve health care, you would think that somebody that spent 12-plus years training in the field and actually works in the field would have. As a doctor, I have lives in my hand, and I will only use tools that have been validated time and time over. If a startup goes bust, everybody packs up, and investors move on. We don't work that way, and even though the daring get the prize in startup land, in medicine we take every claim one step at a time, and nothing comes close to our patients until it has been extensively validated and shown to be safe. Until then, it might as well not exist. But hypes come and go, and we're often just too busy caring for patients to call each and every overblown story out. As I know from experience: Going against the stream costs a lot of energy, of which we have little after a regular working day.

Another example: Remember Jack Andraka, the teenage wunderkind with his so-called revolutionary test for pancreatic cancer? We're now years past the hype, and his “disruptive” innovation is questionable. Back then, the hype had no limits, but in practice anyone in the field sighed and knew this was very likely overblown, but nobody wanted to be the asshole that calls out a 15-year-old kid who just won the big science fair. In his case, I guess investors were smart enough to check the viability of the idea before investing billions, perhaps because he was just a kid. But the funny thing is that Jack knew more than the average Silicon Valley health care disruptor, and he actually spent time in a lab to develop his idea. Now he has a book out, and he's an advocate for young LGBT people in science. I'm happy for him, but let's be candid here: The reason he became famous is a claim to which the scientific reality did not live up to the hype.

With Theranos, it's nearly the same story, except billions of investor dollars might potentially go to waste. So much is wrong with the very premise of its core idea to do everything with a finger prick that any life-science graduate would immediately be very skeptical. Yet when the investors stormed in yelling, “Shut up and take my money” and the advisory board got filled with big names (and little formal education in the field), no one dared to say, “Where's the proof?” There's the problem of contamination, sampling error, the very simple issue that some tests just inherently need a certain volume or noncapillary blood, the fact that different tests need different reagents in very particular ratios. I'm in no way a medical genius or an expert in medical technology, but having worked with patients and having a basic understanding of the tests I order, I immediately had my questions and doubts. But as many people like me I suppose I didn't want to be the cynical asshole who calls out the Silicon Valley wunderkind.

Let's just all remember that the upcoming demise, fizzle, or at least serious downgrading of Theranos' great plans is what happens when masses of investors ride on a bandwagon while they know little about the actual science behind it. That's what scientific scrutiny is for. Grandiose claims coming from Silicon Valley should not be exempted just because they have a buzzworthy story behind them.

Lastly, I want to call out reporters and anyone propagating these stories about health care disruption that just putting them out there isn't harmless. Please never forget that patients and sick people are your audience. Every time these big promises come with fanfare about how they will change the world and they don't check out, you end up giving false hope to a vulnerable group of people. Your stories can cause disillusion and distrust in the medical establishment at large, and might even push people away from health care or to quacks and snake-oil salesmen.

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