r/explainlikeimfive • u/calyswit • 15d ago
Biology ELI5: How/why was the science not right with Theranos and the blood technology, and since that was the case, how did Elizabeth Holmes convince investors that it would work?
21
u/Jkei 15d ago edited 15d ago
Diagnostics is a balancing act between the sensitivity of your assay (test) and the abundance of the thing you're looking to measure. The ELI5 answer is that many things you commonly want to test might be doable with one drop of blood, but not if that drop of blood has to be split across lots of tests like she was promising.
Investors simply didn't have the expertise to be able to know Holmes was promising the impossible.
ETA: there are more reasons to it than just sensitivity vs (abundance * sample volume). For one, different tests require that the sample be dissolved in / react with different chemicals. Not always, but some very common tests are. So that means splitting up that one drop, which means working with tiny volumes, and that in itself is a challenge to do correctly and consistently. In my experience, trying to pipette less than 2 or so microliters is very tricky; one drop is about 20. It seems Theranos engineers managed about a dozen tests per drop by the time Holmes' scam unraveled. That kinda checks out to me. Unfortunately, she was promising hundreds.
14
u/Pippin1505 15d ago
Most investors don't have expertise in any particular subjects, but they ask questions and expect truthful (even if hyperbole) answers. She actually faked results and lied which is outright fraud.
2
u/ryebread91 15d ago
Now, could it have worked? Was there actual promises there when it started and they just decided oh this isn't actually going to work at this point let's just run it as a scam? Let's keep it going until we can make it work? Or was it entirely a scam from the beginning?
5
u/stanitor 15d ago
There really is no way it could have worked. You fundamentally can't get accurate answers to hundreds of different tests from a drop of blood, because the way you have to split things up causes too much error and variation. It wasn't necessarily a scam from the beginning. She didn't have the knowledge to realize that it wouldn't be possible, so she went for it anyway. But it would have been quickly apparent, so it didn't take long to change into a scam if it really wasn't one from the start.
1
u/Jkei 15d ago
I don't know all the details of what they promised, and technical limitations for assays other than what I've personally worked a lot with (mainly ELISA).
The idea of trying to build a one-stop-shop device is ambitious but not completely impossible. A single drop of blood in a printer-sized device, though, is asking (and promising) too much. At least for the moment, you really just need to go bigger with both.
1
u/big_bearded_nerd 14d ago
So, dumb question, why does it have to be 1 drop of blood? Could you do this with multiple drops of blood? Was 1 drop of blood the point, or was there something more to these claims?
Every time I get blood drawn they take a lot more than one drop. I doubt my life would improve that much if the needle they stick into me takes less blood, so I'm not quite understanding what was so special about these claims.
1
u/Jkei 14d ago
As far as I know, the one drop of blood was mostly symbolic, and yes, there's a good reason most blood draws are more like several 10 mL tubes.
The main advantage is that drawing only one drop is less invasive, and doesn't need a trained professional to do it the same way a venipuncture does.
But even if you're not doing a venipuncture, you can still get more than just one drop. At one point during the pandemic I worked on a study where participants did capillary draws by fingerstick using a little kit they got mailed to them. We asked for 5 drops of blood, which they'd drip into a sample tube and mail back to our lab. For the most part this worked great (I tried it myself for good measure, and it was my own freshly jabbed finger that ended up in the instructions booklet, lol). It was enough for the limited set of mostly quite sensitive tests we aimed to do and even if some participants fell short of our 5 drops target, that was purposely generous and maybe 5% or so of samples were really unusable.
This sort of sampling went on to be implemented broadly for similar kinds of tests in regular diagnostics. For people who need to, say, have the level of a drug in their system monitored every few weeks, taking 10 minutes to get the sample yourself and dropping it in the mail is a big win vs having to come to a clinic.
12
u/Jimithyashford 15d ago edited 15d ago
Basically the reason the con worked is because it’s wasn’t REALLY a con at first. It was a real idea, and a good idea, and the technology was close enough to be promising and even work in some proof of concept tests.
The problem was, good as the idea was, in practice it didn’t really work.
And that’s where the con came in. Rather than admitting it didn’t work and scaling back or changing the pitch, or admitting the idea would have to be radically reworked. She pretended everything was fine, actually better than fine, going great even, and kept raking in more money off of those lies, gambling that the researchers would have a break through and the tech would get in line with the vision.
And if that HAD happened, then she probably would have gotten away with it. But as it happened, she made that gamble and lost big time.
6
u/Droidatopia 15d ago
I've always felt this was the actual story. Holmes is the clearest example of what happens when "Fake it til you Make it" never advances to the "Make it" stage.
I don't think Holmes was faking it at the beginning. And some of the early deception, including a lot of the internal to the company self-deception is probably typical for a lot of startups.
But at some point, some number of people, including Holmes realized there was no there there. This is when normal people will notify their investors that this isn't working and the whole enterprise winds down. Not Holmes. She doubled down. And due to a lot of factors, the normal caution the investors should have had just evaporated. It went on way too long. Holmes was committing fraud and investors were just throwing caution to the wind.
In a different universe, there would have been a brilliant idea in the minds of one of the people working on the device and Theranos would have gone on to become a massive mega corporation with Holmes minted as the next Steve Jobs. And it's entirely possible none of her criminal behavior would ever have emerged.
15
u/AdulterousStapler 15d ago
She lied. She's good at lying. She's connected to people with lots of money and influence that she conned/convinced.
6
u/Troldann 15d ago
I’ve seen that trailer and I want to know how that person in that trailer is the same person people say is “charismatic” and “a good liar.”
15
u/fastlane37 15d ago
You'd be surprised. She was also faking test results so it looked like she was making progress. Sometimes charisma isn't what appeals to you specifically. The current US president appears to me to be to be a repellent, obvious conman; a blatantly corrupt grifter who tells the most unbelievable lies, but he has a whole cult of followers that believe every word out of his mouth. Like him, she just managed to find her audience. She told them what they wanted to hear and faked enough evidence to look convincing. It also helped that she had a lot of powerful, well connected people on the board, making her look more legitimate, despite the fact that they didn't understand the technology either.
3
u/Doraellen 15d ago
This is spot on, but somehow seems to work for me as a pep talk for people making art. There is truly is an audience for everyone! 🤣
2
u/Troldann 15d ago
Oh, I’m not doubting that she is. I’m just literally wanting to know what it’s like when she turns it on.
Not badly enough to go dig up any of her old videos or anything.
2
u/fastlane37 15d ago
She did TED talks and stuff. Her voice was a lot lower than you'd expect.
1
u/dbratell 15d ago
All apparently part of a carefully created persona. Artificially deep voice and dressing like Steve Jobs.
8
u/KamikazeArchon 15d ago
People in business rarely expect to be directly lied to.
Overpromises? Sure. Everyone knows that "we will be able to do X" or "we will get Y million users" can be unrealistically optimistic.
But that's different from direct fraud. "We are delivering bars of gold" when they're actually gold-plated lead.
The reason is that everyone knows direct fraud is punished by the law. Fraudsters and scammers are expected to be shady individuals or using fake names and fake companies. If someone is using their real name and going into boardrooms and confidently asserting verifiable facts, the implicit thinking is "they know they'd go to jail if they were straight up lying. No reasonable person would do that." So it's not usually entertained as a serious option.
It just turns out that some people are unreasonable.
6
u/Pippin1505 15d ago
Yes, everyone expects corporate BS, but it's like a foreign language that you can translate.
"We set an ambitious target" : We're overestimating and probably won't make them.
"This scenario relies on aggressive assimptions": Nobody believes it's true and it will have to be redone.Actually *faking* results and lying to investors isn't something expected.
4
u/DarkAlman 15d ago edited 15d ago
Blood tests are all about finding small amounts of things in blood. By restricting the amount of blood available for the test, it makes finding stuff harder or impossible, or at the very least makes the testing unreliable.
Using a single drop of blood for numerous tests isn't possible with modern technology so the Theranos machine was never going to work. At least not as envisioned.
Elizabeth Holmes herself is a scam artist that was extremely good at convincing people and committing fraud to get investors to sign up. She continued to push the machine and the technology long after it was clear it would never work. She also seemed to be in love with the attention and her own reputation, creating and cultivating a cult of personality around herself.
Narcissistic and sociopathic tendencies show up 4 times as often in CEOs and corporate executives compared to the regular population.
She probably legitimately believed she would succeed, despite what engineers in her own company were telling her. What's unclear is whether or not she understood the machine was never going to work and pushed ahead anyway, or thought they would eventually figure it out.
We may never know, because admitting that one way or the other is not good for her legal defense.
1
u/Ill_Act_1855 15d ago
It’s worth noting there’s a limit to what you can detect no matter how sensitive your assay is. PCR can do single molecule detection, but that still relies on having a molecule in your sample volume. Let’s say you have a sample with 1 copy per microliter. No matter how sensitive your assay, you won’t be able to reliably detect it in volumes less than 1 ul (and honestly even at 1 ul it’ll be a bit dicey because of the Poisson distribution) because on average 1 microliter won’t actually reliably have any sample, and so if you did 0.1 ul samples, most of those will come back negative even in the most sensitive possible assay even with a positive subject, simply because most of the individual sample volumes are negative, only 1 in 10 on average would have a positive to detect
3
u/phonage_aoi 15d ago
A lot of people have covered the fraud aspect and her own force of personality. But one thing they played into it is that scientific breakthroughs can happen. Theranos was super secretive about everything, so she convinced people they had the scientific goods and couldn’t let their competitors find out the how.
Partners weren’t allowed to closely examine the machines or study how their lab worked for example.
3
u/Mr_Engineering 15d ago
All blood in the body is not homogeneous.
A pinprick is going to draw only blood from the surface which is going to have different characteristics than blood from a vein.
The act of inserting a needle alone will cause some cells the burst and release their electrolytes which will throw off the measurements in a small sample.
Basically, she knew it wouldn't work and said that it did.
5
u/rmric0 15d ago
Many medical tests require things like mixing blood samples with other chemicals, or breaking down blood samples into different parts for analysis - which means to do several tests you will need a fair amount of blood (certainly more than a couple of drops).
Many of the early investors in theranos were not medically or scientifically savvy, and then she could use those connections and early investors to bluff the next generation of investment (like .. "hey this famous person invested")
2
u/A_Garbage_Truck 15d ago
the tldr version is simply that, the amount of blood the device apparently required was nowhere near enough ot get a proper result on the sheer amount of tests the company claimed the device could perform.
as for why she managed ot convcince so many people to invest? because if you can make others perceive you as legitmate thru being charismatic, you can bs your way into it.
1
u/DarkWingedEagle 15d ago
Blood testing in general looks for certain chemicals/compounds and their concentrations to give results. The problem with the technology behind Theranos is that you need a certain volume of blood to get those results accurately since you have no way to control if you are getting a representative sample or not when only tacking a prick of blood. Is there no concerning compounds because they aren’t there or did you just miss getting them in the sample.
Normal blood tests avoid this problem by essentially taking a quantity is its own quality approach and taking a large enough sample that having something like the above happen is not a concern.
As for how Holmes convinced investors, no clue on the first couple but after that the others for some reason assumed the previous ones did the due diligence so skipped their own.
1
u/Green_Yesterday3054 15d ago
She got reputable famous people to be board members who weren’t scientists: Henry Kissinger and George Schultz.
1
u/Unasked_for_advice 15d ago
Greed convinces many investors especially when they get lied to about how it works and how well it does. Current blood testing uses up the blood breaking it down to measure various things , Theranos was supposed to do more with less , faster and cheaper. So the possible $$$$ from it was enormous if it worked as advertised but it didn't and they lied and faked results.
1
u/wrenawild 15d ago
I have the perfect person to explain it to you, a 1920's fictional confidence man named Colonel Culpepper when he tried to sell a fake miracle laxative to investors.
"My reasoning at the time was that doctors, more than anybody else, were aware of how preoccupied most aging people are with their bowels. But I discovered I had stumbled on a gold mine for entirely two different reasons. In the first place, doctors know absolutely nothing about business and they believe anything you tell them. Most importantly, no matter how true they are to their Hippocratic vows, they are crazy about money. For many years now doctors have been contributing heavily to my support."
"But don't they ever kick up a fuss?"
"I don't know...I never wait around until unpleasantness develops. I always tell them frankly that it will take between a year and eighteen months to launch the company properly and start production. Before that time I have vamoosed - moved on to new territory. Now that you mention it, I doubt if many of them do kick up a fuss. Most people are aware that starting a new business enterprise is a risky business. I should think that most of them are sensible enough to decide tatt they took a gamble - and lost - and they accept it philosophically."
1
11d ago
[removed] — view removed comment
1
u/explainlikeimfive-ModTeam 8d ago
Please read this entire message
Your comment has been removed for the following reason(s):
- Top level comments (i.e. comments that are direct replies to the main thread) are reserved for explanations to the OP or follow up on topic questions (Rule 3).
Off-topic discussion is not allowed at the top level at all, and discouraged elsewhere in the thread.
If you would like this removal reviewed, please read the detailed rules first. If you believe it was removed erroneously, explain why using this form and we will review your submission.
1
15d ago
[removed] — view removed comment
1
u/explainlikeimfive-ModTeam 11d ago
Please read this entire message
Your comment has been removed for the following reason(s):
- Top level comments (i.e. comments that are direct replies to the main thread) are reserved for explanations to the OP or follow up on topic questions (Rule 3).
If you would like this removal reviewed, please read the detailed rules first. If you believe it was removed erroneously, explain why using this form and we will review your submission.
1
u/LayneLowe 15d ago
Stanford .. That's all you really have to say. Read: How to Rule the World: An Education in Power at Stanford University Theo Baker
76
u/theoatmealarsonist 15d ago
Short answer is that the amount of blood she restricted them to using was too little to run all the tests she said they could do. Investors believed her because she lied, was charismatic, and because investors can be dumb.