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Theranos Is Subject of Criminal Probe by U.S

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Re: Theranos Is Subject of Criminal Probe by U.S

#51
The Theranos story is unfortunate due to the likelihood of fraud because the healthcare industry is in desperate need of disruption. Even if just from the periphery, which is how I would characterize Theranos' role, I think that could enable a change in how health care is done and delivered in the US.

Re: Theranos Is Subject of Criminal Probe by U.S

#52
post #11

Like I've mentioned before, Theranos needs to shut down. The technology doesn't work (and likely it never will since blood constituents are not evenly distributed at small volumes) and its investors and executives are complicit in fraud. While half-completed/non-working solutions are fine in software world and with consumer electronics, a misreading or missed reading of blood parts can easily cost the health or life…

healthcare is a very hard problem. While we in the tech community may find it morbidly entertaining to watch Theranos burn to the ground. Someone out there needs to attack healthcare. The not dying motivation is fairly important.

Healthcare like almost every major enterprise vertical is a wicked problem[1] and these problems are pretty much rife with far more than just technical problems. Most of the VC founded ventures are honestly quite terrible at attacking the Fortune 100 that dominates these verticals including reasons like collusion as well as regulatory capture. A $10M+ series A seems like big money to a lot of the people in tech, in the enterprise space of the Fortune 100, that's a rounding error resolved by just firing one or two middle managers. I can hardly afford good sales guys covering all the regions for long enough of a sales cycle that I could confidently ever make a single deal on that alone - the enterprise approach to relationship-focused sales and procurement cycles forces the necessity of well-networked, very expensive sales people, unfortunately. That's the kind of slow-moving, massive capital flows that are at play, and there won't be any company that can attack that problem head on because it's not a technical problem whatsoever. Even worse, because these industries are capitalized heavily as public companies, their board of directors appoint super risk averse leaders culturally and will not move forward without finding a business model that will not cannibalize existing sales. Even still, if such a technology and business model existed, it is simply very, very easy to torpedo these efforts politically within these companies because these companies are already so profitable (think Hollywood-style accounting for a second, not tech company or even i-bank style simplistic accounting) they'd rather get rid of emerging competitors than to actually innovate. After all, in the health insurance space, as long as people (and, more importantly, companies) are paying premiums and subsidizing a sufficient number of costly patients that need care, there's little reason to really try to innovate in terms of technology there. That becomes something up to healthcare providers to try to work at, but they're typically courted by a very, very well capitalized and networked cartel of healthcare companies typically founded by doctors first, not technology people. Doctors may be smart oftentimes, but they're just not technology people fundamentally after decades of practicing medicine.

I agree that the problem must be attacked, but I have my doubts that it would come from a VC funded company in the same vein as most SV companies that have done so well. And as Theranos shows, I have my doubts that the highly kleptocratic cronyism driven private government contracting space will do it either. It may very well require a completely new model that incorporates the best ideas of both funding vehicles to avoid the common pitfalls of enterprise b2b companies.

[1] https://en.wikipedia.org/wiki/Wicked_problem

Re: Theranos Is Subject of Criminal Probe by U.S

#54
post #45
post #41

Earlier quoted context omitted.

Actually, yeah. The variance in the amount of quantities present in the blood draws by Theranos is too high to get useful measurements (without very many replicates, defeating its purpose) according to published research: http://ajcp.oxfordjournals.org/content/144/6/885.abstract I was also utterly astonished when I read this. Even if the experimental error of the instrument was zero, you cannot reduce the biological…

Well you also seem to have skipped what that paper is taking about. For cell counts, yes, the stochasticity claim would be true for microliter scale volumes. For molecular constituents of blood, the claim cannot be true until you drop to the femtoliter range. I don't think the company was ever approved for cell counts, but I could be wrong.

The point, though, is that things like proteins ARE bound up in individual cells, so there are a whole host of tests that will vary based on number of constituent cells. Hemoglobin is one of the examples in the paper.

When you say "I don't think the company was ever approved for cell counts" - well, the company wasn't ever really approved for anything besides a herpes test, that's the issue.

Re: Theranos Is Subject of Criminal Probe by U.S

#56

I wonder why WSJ went so aggressively against Theranos. (Not that I'm complaining.) Does anyone know the backstory there?

Basically, it looks like one reporter starting pulling at the thread, and the whole sweater fell apart. I wouldn't really say they went after Theranos aggressively until they realized there was a much bigger story.

Re: Theranos Is Subject of Criminal Probe by U.S

#58
post #49

Earlier quoted context omitted.

You're wrong; a single red blood cell is several femtoliters. To get a good statistical count of much more rare (yet important) features one can sample much, much more than this and still get anomalies from having too small a sample. Here's [1] a cool graphic showing the tip of the iceberg. [1] https://en.wikipedia.org/wiki/File:Reference_ranges_for_bloo...

No, I'm not wrong. You're talking about testing for cell counts, which is not -- as I understand it -- what this company was approved to do. For molecular and protein components of blood on the nanomolar range, you would not encounter this problem until you were sampling in the femtoliter regime. Just use Avogadro's number, and you'll get it.

A lot of those molecules are bound up in cells, they are not freely diffusing in blood. Even those diffusing in blood are not uniformly distributed, blood is highly dishomogeneous.

Re: Theranos Is Subject of Criminal Probe by U.S

#59
post #50
post #45

Earlier quoted context omitted.

Well you also seem to have skipped what that paper is taking about. For cell counts, yes, the stochasticity claim would be true for microliter scale volumes. For molecular constituents of blood, the claim cannot be true until you drop to the femtoliter range. I don't think the company was ever approved for cell counts, but I could be wrong.

Are you trying to model metabolites as perfectly diffusing molecules with D^2 proportional to an idealized Stokes radius?

No. I multiplied 1 nM by Avogadro's number. Do you have any reason to believe that free IgG is not uniformly distributed at steady-state in circulation? ... Because that's what they're testing for.

Re: Theranos Is Subject of Criminal Probe by U.S

#60
post #19

Earlier quoted context omitted.

"tough on Unicorns" :) The plight of Theranos has just become much worse as they will probably be made an example of.

My money is still on the CEO and board of investors bailing out on golden parachutes to whatever their next horrendous executive appointment will be.

Maybe for the board, but not the CEO -- she's not a hired gun, she was the founder.
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