One reason you didn’t get that grant is because Theranos

I’ve been tweeting lately about Theranos, a privately held lab testing company, and the troubles it’s been having after an expose came out in the Wall Street journal. When I first heard about Theranos and its superstar CEO Elizabeth Holmes, it bothered me that there was a gap between the over-the-moon accolades they were receiving and my ability to find out details about how the technology behind company was supposed to work. Will Theranos revolutionize medicine, or is it the Emperor’s New Lab Testing Company? I’ve become obsessed with the saga. I won’t do a detailed analysis of the company here, but will explain why the mixture of medical science, showmanship and journalism got under my skin.

Elizabeth Holmes founded Theranos after dropping out of Stanford at the age of 19, and it has made her the youngest self-made female billionaire in the world. At Stanford, she was mentored by the legendary chemical engineer Channing Robertson. Dr. Robertson has a number of claims to fame, including bringing Big Tobacco to its knees. Robertson noted that tobacco companies were the largest consumers of ammonia, and he deduced and demonstrated to the courts that the reason was to increase the pH of the tobacco in cigarettes causing more rapid cellular uptake of nicotine when inhaled. Robertson’s expert testimony demonstrated that tobacco companies intentionally increased the addictiveness of their products, and it cost the four major companies billions of dollars and restricted their activities in the largest class action settlement of its kind. Bravo Channing Robertson! When Holmes approached Professor Robertson with her start up idea, at first he tried to convince her to complete her degree, but then supported her decision to drop out when he realized that he could be looking at the next Steve Jobs– high praise from a high place indeed. There is little doubt that Ms. Holmes is brilliant and there is still a part of me that wants to see her rise triumphant from the specter of suspicion that has arisen recently.

We all admire genius. So…what is her billion dollar idea? To collect tiny amounts of blood from a finger stick rather than traditional phlebotomy and running hundreds of tests using a few drops of blood in “nanotainer” tubes. Thernos technology, it is claimed, will change the face of medicine as we know it because it can be employed not just in the doctor’s office, but anywhere. At Walgreens or the grocery store for example. And for a fraction of the price of standard laboratory tests. And not just by doctors, patients can check their own labs! Bam. Industry upended. How exactly would Theranos run many tests on tiny amounts of blood quickly and accurately? Holmes’ answer was, essentially, “we could tell you, but then we’d have to kill you.” Venture capitalists in Silicon Valley and then the business press ate this stuff up. “Of course..*secret* technology is exactly what’s needed to transform healthcare!” But science geeks and transparency geeks were bothered by the secrecy– no peer reviewed publications, no public demonstrations of any kind. I was born and raised in New York City and my bullshit meter is always set to 11. I couldn’t find any information to convince me that the entire enterprise wasn’t a sham. A colleague recently told me one of his trainees went to work for Theranos on the technical side for a time, and left the company with no idea of how it was supposed to work. It didn’t help that Holmes responded to criticisms by adamantly attributing critical questioning to a lab testing industry conspiracy. Conscientious business reporters continue to give Holmes the benefit of the doubt, but have strongly suggested that she needs to stop bobbing and weaving in response to questions and start revealing. I have a sinking feeling that this has been a con.

What does this have to do with grants? I admire Holmes’ ability to convince people of the brilliance of her ideas–it’s exactly the skill needed to write a good grant. Significance 1, innovation 1. Once upon a time, I assumed that excellent work would transcend the need for clever marketing and charismatic presentation to sell it to the proper audience, but the longer I work in science, the more I see examples of necessary hard work labeled as incremental and dismissed and attention lavished on the well constructed story. The veracity of which appears secondary, or is assumed. I no longer think scientists have a special ability to see past hype and pressures for time make it difficult to tell the difference between working productively and spinning the zeitgeist, but I don’t think this is the case.

Don’t worry about people stealing an idea. If it’s original, you will have to ram it down their throats. – Howard Aiken

In communicating about science we say, “it’s important to tell a story,” and Elizabeth Holmes has demonstrated the power of a story unmoored from underlying reality. As Americans, we love the maverick genius who comes from nowhere to upend a field or industry, and there is desperation in our society obsessed with growth and paradigm shifts to see this narrative fulfilled. But someone should have actually changed the world before getting credit for doing so.

This story would not get under my skin if science funding were not a zero sum game, but it is. It angers me to see hard working scientists be denied money and resources because they aren’t flashy or charismatic enough to spin a fantastical tale. Holmes has some time and millions of dollars to make some magic happen. Not everyone is so lucky.