The dish

Bad Blood.

Theranos was one of the hottest tech startups of the last fifteen years, at least in terms of the breathless coverage afforded to the company’s putative blood-testing technology and young founder and CEO, Elizabeth Holmes. As you know by now, the entire thing was a giant fraud: the technology never worked, the company ducked or lied to regulators, and Holmes in particular lied to the press and investors who plowed a few hundred million dollars into the company before it collapsed. That implosion came about thanks to a few whistleblowers from inside the firm and the diligent reporting of Wall Street Journal journalist John Carreyrou, who tells the entire history of the scam in his book Bad Blood. The book is thorough, gripping, and infuriating: how did one inexperienced college dropout manage to con so many ostensibly intelligent people into believing her bullshit?

Theranos’s claim was that they could run over a hundred tests on just a single drop of blood drawn by a fingerstick by using a relatively minuscule device, first one called the Edison and later one called the miniLab, that could live in a doctor’s office, a pharmacy clinic, or even a patient’s home. This included routine tests like those for blood cholesterol levels as well as more complex tests that would ordinarily require a lot more blood, which would have to be drawn from a vein. None of this ever worked, and Theranos hid the fraud by taking blood samples back to its headquarters and running the samples on larger machines made by Siemens, all the while making increasingly grandiose claims about its technology, forging nine-figure partnerships with Walgreens and Safeway, and continuing to solicit investments at valuations that eventually crossed $5 billion, making Holmes a paper billionaire.

The media coverage of Theranos in general and Holmes in particular was willfully credulous, none more so than the Fortune cover story “This CEO’s Out for Blood,” a fawning profile that bought all of Holmes’ lies wholesale with what appears to be no attempt to independently validate any of her claims. (The writer, Roger Parloff, eventually admitted he’d been duped.) Holmes appears to have had a strategy for executing this con by co-opting the reputations of powerful, older men: she managed to pack her board with major political figures, including George Schultz and Gen. James Mattis, who all tended to be old white men with zero scientific or technical background, but whose presence carried a lot of weight with the media. She also hired attorney David Boies, eventually giving him shares in the company and a board seat, to stage scorched-earth attacks on anyone who dared criticize the company, which included intimidating former employees who might reveal that Theranos’ technology didn’t work. She even landed a spot as an Ambassador for Global Entrepreneurship for the Obama Administration, only stepping down months after the fraud was revealed.

Carreyrou didn’t buy it, and he didn’t back down, all of which shows in his WSJ articles that dismantled the company’s house of lies and again shows in Bad Blood, which is meticulous in reconstructing the genesis and perpetuation of the fraud, with information gleaned from over 150 interviews with employees and others close to Theranos. He particularly benefited from information from Tyler Schultz, George Schultz’s grandson and a Theranos employee for about a year, who realized that Theranos’ technology didn’t work and that they weren’t properly verifying their results (but were still making the same claims of accuracy to the public), and who reported the company to regulators despite intense pressure and outright threats from Theranos, its lawyers, and his own family. (Schultz, who will turn 99 later this year, was a true believer in Theranos and in Holmes until well after the fraud was made public.) Bad Blood is full of details of internal interactions from Theranos that depict Holmes and COO Ramesh “Sunny” Balwani as vindictive, paranoid bullies who didn’t care that the technology didn’t work, or simply refused to accept that it didn’t, and thought they could steamroll anyone who tried to get in their way – and for about a decade, it worked.

The overwhelming sense Bad Blood gave me is that so very many of the people involved in the scam belong in jail. Holmes and Balwani, who was also her boyfriend when she hired him, come across as sociopaths who relentlessly bullied employees and the media; both are still facing criminal charges, while Holmes settled SEC fraud charges while Balwani is fighting them. They had many allies in their scheme, from Boies (whose behavior seems unethical, at least) to the various marketing and PR flacks inside and outside Theranos who helped perpetuate the con. Does Chiat Day, the major advertising agency Theranos hired to build its image, bear any responsibility for helping disseminate untruths about the company? What about Theranos’ marketing employees or in-house attorneys, the former repeating the lies Holmes and Balwani told them, the latter using dubious tactics to intimidate former employees into signing agreements against their own interests? If Holmes and Balwani actually serve jail time – I’m skeptical, but there’s still a nonzero chance of that – it may deter some future mountebanks, but the biggest lesson of Bad Blood seems to be how many people happily went along with the scheme because they thought Theranos was going to make them rich, and because there was little direct cost to them. Patients could have died from errant medical directions that came from Theranos’ inaccurate test results, yet just about every person involved in promulgating the swindle walked away with nothing worse than a bad name on their resumes.

Carreyrou raises the most salient point that investors and reporters missed during Theranos’ days as a high-flying simurgh: the venture capital firms backing Theranos focused on high tech, but not on biotech or medical devices. The VCs with expertise in medical investments were absent. Carreyrou argues that that should have set off alarm bells for other investors or for reporters racing to laud the company or its female founder/CEO, who benefited from the media’s desire to find a rare woman among Silicon Valley leaders, from her photogenic looks, and from her overt attempts to channel Steve Jobs (which come off as delusionally creepy in the book). Con artists will never lack for marks, but when the people who would ordinarily be most interested in backing a venture head in the other direction, it should serve as at least a prompt to ask more probing questions before putting the CEO on your magazine’s cover.

Next up: I’m preparing for the upcoming amazon series by reading Terry Pratchett & Neil Gaiman’s novel Good Omens.

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