How can I short Theranos?
This is yet another downside of unicorns ;). Though I doubt investors need much help at this point to realize how overvalued it is. Theranos will never raise at anything close to a $9B valuation again.
At Theranos, Many Strategies and Snags
121–130 of 134 posts
Re: At Theranos, Many Strategies and Snags
#122Earlier quoted context omitted.
Her father has a high-level job at USAID. https://www.usaid.gov/who-we-are/organization/christian-holm...
> Holmes worked in the field with USAID missions in Pakistan, Bangladesh, Indonesia, Egypt, Yemen, Ghana, Haiti, Liberia, Kenya, and Ethiopia > Holmes served in the U.S. Army, Second Lieutenant, Civil Affairs, receiving the U.S. Army Soldier’s Medal for Heroism. Want to guess who he really works for?
It seems unlikely that a covert operative would take job as CFO of the EPA, but what do I know.
Re: At Theranos, Many Strategies and Snags
#123No matter how this story ends (whether they eventually ends up with having a fully functioning product or not) this should be a cautionary tale to anyone wanting to actually change the world in healthcare. Science speaks for itself and does not care how much you raised at what valuation. It requires a rigorous approach to testings and facts and data or it will be merciless if you aren't living up to your own claims.…
It is a common, romantic view of how science works - but it is only compatible with reality on a 30-50 year timescale, and probably only because of survivor bias. The science of Dan Shchetman, J. Robin Warren, Barbara McClintock and many others spoke for itself, and for a long time "science" essentially didn't listen. I put "science" in quotes because "science" doesn't speak or listen - scientists do - and the scient…
I recognize your point in showing scientists whose data were initially discounted. The Theranos case is different, however, as they have not attempted to publish their methods. If they had tried and been rejected, it might begin to be fair to compare them to the distinguished researchers you mention.
> no doctor will recommend the single most effective treatment for type 2 diabetes early in the disease
How do you know this is true? Dietary counselling is recommended as part of the treatment of newly-diagnosed T2DM, per UpToDate[1], a reference for this kind of thing.
> American Diabetic Association recommendations are the everything but science, and possibly the worst you could do.
I'm not sure what you mean here. What are the guidelines and how are they deleterious?
1. http://www.uptodate.com/contents/nutritional-considerations-...
Re: At Theranos, Many Strategies and Snags
#124Earlier quoted context omitted.
That allegation against yelp has never been proven. I'd be surprised if either yelp or glass door is outright deleting reviews for money.
What would you consider a proof? does a a sales rep asking her friends to post fake negative reviews count? https://www.youtube.com/watch?v=C67Lh4LE5LY
The fact that they need to have friends post fake reviews suggests to me that this is not sanctioned activity or a systematic fraud.
An environment where salespeople feel they can do stuff like that is a problem, but no, it is not proof that "yelp deleted bad reviews for money"
Re: At Theranos, Many Strategies and Snags
#125Earlier quoted context omitted.
Will you please link to a source for the $3-4 million per patient per year figure or the $10 million per year figure for certain diseases?
It's just from what I see at work, we're consultants who do strategic case management for high acuity cases- patients who spend more than $3million per quarter (or whatever levels that specific client establishes with us) get kicked over to us. I'm working with a guy right now who has a blood clotting disease and his meds alone are $800k yr before all the inpatient stays and procedures. Generally once the patient sta…
Thanks for the expanded answer! I found it hard to believe because I was remembering when most insurance had a lifetime payout between 1 and 5 million, but of course that was pre-ACA and never relevant to Medicaid.
Re: At Theranos, Many Strategies and Snags
#126Earlier quoted context omitted.
Glassdoor seems like it has the same business model as yelp- "Buy our advertising and we will make your good rankings rank higher and your worse reviews be filtered or lower." Maybe not outright extortion but certainly not what they claim of being a truly independent forum.
That allegation against yelp has never been proven. I'd be surprised if either yelp or glass door is outright deleting reviews for money.
I was looking for chimney sweeps in the DC area and found one of the top-rated chimney sweeps on Yelp on about page 4 or 5 after the 2 and 1.5 star rated companies. The companies on the first page were all those that paid Yelp. I talked to the owner of the company that I hired and he said that Yelp wanted him to pay $300+ / mo to get his placement on the search pages higher and he said he didn't want to because he was so busy from so much work he didn't need any more visibility (he ran and operated it with maybe one or two other assistants). For a lot of companies, this could be viewed as extortion to hide well-rated companies so far down the list that most users wouldn't look to go there.
Yelp definitely hides a lot of reviews that are completely legitimate supposedly due to their review validity system filtering them, but in a lot of cases I've seen the only crime these disenfranchised reviewers had was that they didn't want to go make a full-blown Yelp profile with pictures and everything to make really serious, very well described complaints. This artificially inflates review relevancy ratings for companies that have Yelp reviewers that skew towards younger demographics. There's a ton of stores where I live that are frequented primarily by 50+ year olds but they have almost zero Yelp presence since nobody operating or visiting the store are much into technology / social media enough to care.
Re: At Theranos, Many Strategies and Snags
#127Many in SV find it hard to grapple with traditional startups not penetrating health care to a greater degree; in Rise of the Robots (one of the Financial Times and The Economist books of the year) it's lamented for an entire chapter. Traditionally the level of fundamental research and development displayed by Theranos - in areas of health or national defence - are done for years behind closed doors and then slowly ro…
Would you please qualify Peter Thiel's approach here? and why it would have been a better model? Palantir is pure software company. Theranos is a suite of biomedical tests. This has a major lab/hardware component.
Theranos exists in a regulated industry where at a minimum as a lab developed test you have to abide by CLIA regulations. In addition you have to have validation, verification, design history and a whole bunch of documentation to prove that what you developed does what it should do and actually works.
The thing about Theranos is that the rules are well established.. You just have to follow them. If you don't know the rules you have to be a quick study or you have to hire experienced folks who know the rules and how to guide you through the process.
Re: At Theranos, Many Strategies and Snags
#128Many in SV find it hard to grapple with traditional startups not penetrating health care to a greater degree; in Rise of the Robots (one of the Financial Times and The Economist books of the year) it's lamented for an entire chapter. Traditionally the level of fundamental research and development displayed by Theranos - in areas of health or national defence - are done for years behind closed doors and then slowly ro…
Would you please qualify Peter Thiel's approach here? and why it would have been a better model? Palantir is pure software company. Theranos is a suite of biomedical tests. This has a major lab/hardware component. Theranos exists in a regulated industry where at a minimum as a lab developed test you have to abide by CLIA regulations. In addition you have to have validation, verification, design history and a whole bu…
I'm not equating them absolutely, however I'm pointing out the Planatir began utilizing existing tech to make in roads into national defence while using that cash flow to create more proprietary technology that, once released, allowed the company to grow much quicker and that tech became it's mainstay. Presumably initial funding rounds and contracts were predicated on this being the strategy, not novel tech being utilized immediately (which is inline with what Theranos has done). The comparison stops there, at a macro level not micro level as you're describing, thus why only a sentence was devoted to it.
Re: At Theranos, Many Strategies and Snags
#129Earlier quoted context omitted.
Me too. Hence the "practicing such science" part in my comment. University degrees such as Master of Science/Doctor of Philosophy etc. are meant to provide validation from universities that the holder of such degrees has had some training in the discipline but it's by no means a requirement to be a scientist (Leonardo da Vinci certainly didn't have a PhD).
In theory, yes. But when it comes to highly specialized topics, there are a number of things that are very hard to learn on your own (at least for now) without going through an academic path. Chemistry, Biology, pretty much require hands-on experience as part of your education - and you can't do that kind of things from home or simply by reading books.
You can teach an 8-year kid the scientific method so they can "do science" with household chemicals. Probably they won't discover anything novel, but assuming they don't look at the internet it will be new to them and that's the important bit: reasoning about truth on the basis of experimental observation.
Re: At Theranos, Many Strategies and Snags
#130Earlier quoted context omitted.
I was not remarking about Theranos, but rather to ThomPete's statement. Rigorous science is not sufficient (e.g. the Shechtmans/Warrens that we don't know about -- it is pure hubris to believe that all those were eventually vindicated), nor is it required (e.g. Vioxx, Thalidomide, ADA recommendations, baby peanut allergy recommendation, dietary cholesterol recommendation, dietary sodium recommendation). If Theranos i…
Not sure what you mean. Their product is scientific. It's not just a health app or some nutriment recommendation which can be claimed successful without any scientific claims to back it. Theranos has a very a scientific product with a binary output and so it's claims will stand up to that (i.e. being approved by passing a number of tests) My lesson was for those who wanted to change the world via healthcare, not thos…
> Their product is scientific. It's not just a health app or some nutriment recommendation which can be claimed successful without any scientific claims to back it.
So was VioXX[0]. Read the Withdrawal section, especially the last paragraph. As someone who was following the case closely while it was happening, I can tell you that everyone involved looked guilty as hell, even though the court found only the marketing people "overzealous".
You see, "science" doesn't lie. But scientists do. Some liars are better than others, though.
Also, the standard US medical advice about things like nuts that might cause allergy are "delay introduction as much as possible" (e.g., do not introduce peanuts before age 3 or so, for fear of allergic reaction). You will hear this from doctors and find this in official manuals, although there is no science to support this (never was), and in fact, there's data indicating that early exposure to nuts reduces allergy.
> Theranos has a very a scientific product with a binary output and so it's claims will stand up to that (i.e. being approved by passing a number of tests)
Output is not binary. Most (often all) data used to evaluate medical products is provided exclusively by manufacturer, who is able to massage data to yield specific desired results, see e.g. VioXX.
> My lesson was for those who wanted to change the world via healthcare, not those who wanted to get rich.
Well then, they shouldn't look to Theranos - those guys obviously care more about getting rich than about changing the world (well, changing the world for the global good, anyway).