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Theranos Founder Faces a Test of Technology, and Reputation

nytimes.com

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Re: Theranos Founder Faces a Test of Technology, and Reputation

#71

Post by Asparagirl »

colmvp wrote: post #63
daveguy wrote: post #29

Earlier quoted context omitted.

"It makes me wonder if she had spent at least a couple more years beefing up not just her engineering experience, but life experience, that some of the poor CEO decisions she's made would have been mitigated." I think that is a very astute observation. When you are in the top 0.01% of CEOs you don't have a lot of scrutiny. Bill Gates says that he got lucky with his success and that graduating is a much more sure path…

> but the fact that she didn't spend the extra year or two finishing her degree will make it more difficult if she does fail. If she weren't so well connected or known I'd agree with you. But she isn't some unknown dropout who failed fast and hard trying to get into YC or bootstrapping in some random location in SF. Unless Theranos gets revealed as a giant fraud, I doubt she'll find it tough to find another position…

That "unless" is looking more and more likely by the day.

Re: Theranos Founder Faces a Test of Technology, and Reputation

#73

Post by laarc »

robbiep wrote: post #62

There is so much ... hype around this technology. But some of their use cases aren't all that useful, and their technology (while supposing to be cheaper) is often done on handheld units at the moment in isolated regions. Let me explain: Use cases outlined in this article that have minimal real medical benefit, but sound great: - Home blood testing (why? there are only 2 types of people who may find this useful: pati…

I was hoping the product would pivot to passive blood pressure monitoring. I want my blood pressure to be recorded every few seconds, logged and cross-referenced against what I did, ate, and drank. For correlation purposes, knowing those things can be as simple as snapping a photo.

Smart people apparently claim that blood pressure is one of the most reliable indicators of how long you'll live. If so, then it's always seemed strange it's (almost) never measured.

Re: Theranos Founder Faces a Test of Technology, and Reputation

#74

Post by srunni »

robbiep wrote: post #62

There is so much ... hype around this technology. But some of their use cases aren't all that useful, and their technology (while supposing to be cheaper) is often done on handheld units at the moment in isolated regions. Let me explain: Use cases outlined in this article that have minimal real medical benefit, but sound great: - Home blood testing (why? there are only 2 types of people who may find this useful: pati…

My biggest concern with Theranos, which I haven't really seen acknowledged in any of these articles, is that multiparametric panels on asymptomatic individuals will lead to a proliferation of false positives. Running hundreds of tests whenever a patient decides to do so doesn't make sense unless that ultimately enables better clinical outcomes for patients. And this is true regardless of whether the underlying measurement technology that Theranos has developed actually works or not.

It's discussed in a journal article from earlier this year by a pathologist:

> panel profiling, which was introduced in the 1970s as a way of identifying early biochemical changes of disease in asymptomatic individuals, had been abandoned in the 1980s, not so much for the cost. It has long been realized that with multiparametric testing, approximately 5% of results will be false positives, i.e., test results outside the reference intervals, in otherwise normal subjects. This is due to the definition of reference intervals, as being values between the 2.5 and 97.5 percentile of a reference (normal) population. The high cost of investigating seemingly abnormal results in normal people, and the added anxiety of patients, has led to the complete replacement of such biochemical profiling with what is now known as “discrete testing”. In the latter, tests are performed by the testing laboratory, only if requested specifically by the physician.

http://www.degruyter.com/view/j/cclm.2015.53.issue-7/cclm-20...

Re: Theranos Founder Faces a Test of Technology, and Reputation

#75

Post by laarc »

mikesickler wrote: post #40
jerryhuang100 wrote: post #13

> Dr. Bill Frist, the former Senate majority leader from Tennessee who joined Theranos as a director last year, supports Ms. Holmes and asserts that “the data I have seen speaks.” But he also points out that the Theranos story has taken on the cast of a vicious political campaign and there’s nothing more appealing than watching a front-runner fall from grace. This is ridiculous. A lifetime politician accuses other cl…

As a med student, Bill Frist adopted cats from animal shelters under false pretenses so he could experiment on them, sometimes fatally. Definitely a good fit!

An accusation this serious should be accompanied by evidence, or dismissed.

Re: Theranos Founder Faces a Test of Technology, and Reputation

#76

Post by OopsCriticality »

robbiep wrote: post #62

There is so much ... hype around this technology. But some of their use cases aren't all that useful, and their technology (while supposing to be cheaper) is often done on handheld units at the moment in isolated regions. Let me explain: Use cases outlined in this article that have minimal real medical benefit, but sound great: - Home blood testing (why? there are only 2 types of people who may find this useful: pati…

> I wonder how popular this viewpoint will be here on HN - the home of lifehacking and microanalysis of bodyfunction (often without the corresponding knowledge to go with it, but prefaced with a view that 'more data will always be better').

This would be what I see as the fundamental flaw behind Theranos, even if their technology worked (works?) as promised: the idea that more data will always be better is sophomoric (and I select that word judiciously, considering the founder). Evidence-based medicine clearly shows that more data does not, in itself, lead to a better outcome.

Re: Theranos Founder Faces a Test of Technology, and Reputation

#77

Post by malandrew »

laarc wrote: post #73
robbiep wrote: post #62

There is so much ... hype around this technology. But some of their use cases aren't all that useful, and their technology (while supposing to be cheaper) is often done on handheld units at the moment in isolated regions. Let me explain: Use cases outlined in this article that have minimal real medical benefit, but sound great: - Home blood testing (why? there are only 2 types of people who may find this useful: pati…

I was hoping the product would pivot to passive blood pressure monitoring. I want my blood pressure to be recorded every few seconds, logged and cross-referenced against what I did, ate, and drank. For correlation purposes, knowing those things can be as simple as snapping a photo. Smart people apparently claim that blood pressure is one of the most reliable indicators of how long you'll live. If so, then it's always…

My mom is terminally ill and recently started experiencing orthostatic hypotension, so I just picked up an Omrom armband blood pressure monitor that is trivially easy to use and stores the last 100 measurements for two people.

http://amzn.com/B00KPQB2SS

It's still not what you want, but it looks like things are moving in the direction you suggest. That said, I'm wondering if it is even possible to do what you suggest without being inconvenient to the user. Having an armband inflate and tighten around my arm every few seconds with become infuriatingly annoying. Are there alternatively ways to measure blood pressure that are imperceptible?

What I'm looking forward to seeing is conductive textiles making their way into compression clothing so we can measure heart rate all the time. i.e. a wearable EKG shirt. The use case would be older people at risk for a heart attack and heart fail so we can detect problematic heart abnormalities that are predictive of failure.

Re: Theranos Founder Faces a Test of Technology, and Reputation

#78

Post by robbiep »

laarc wrote: post #73
robbiep wrote: post #62

There is so much ... hype around this technology. But some of their use cases aren't all that useful, and their technology (while supposing to be cheaper) is often done on handheld units at the moment in isolated regions. Let me explain: Use cases outlined in this article that have minimal real medical benefit, but sound great: - Home blood testing (why? there are only 2 types of people who may find this useful: pati…

I was hoping the product would pivot to passive blood pressure monitoring. I want my blood pressure to be recorded every few seconds, logged and cross-referenced against what I did, ate, and drank. For correlation purposes, knowing those things can be as simple as snapping a photo. Smart people apparently claim that blood pressure is one of the most reliable indicators of how long you'll live. If so, then it's always…

Now that would be a cool product. Lots of datapoints. I'm skeptical about the claim - yes, it's important, but there are so many variables that feed into it, and I need to be convinced that constant, 24 hr monitoring of BP would enable better management than spot tests, home BP management and the occasional 24 hr ambulatory monitoring.

It's a very consumer-targeted technology, although it would certainly find a place in emergency departments and ICUs. I am at a loss to think of ways as to how we would actually capture the data, although better minds than mine I hope come up with ways.

The problem is that to get a good read on arterial pressure you either need to do it the old fashioned way (occlude the artery and record that pressure, then slowly drop it until it's constantly flowing again - see [0]) - or you need to stick a cannula into an artery, as we do in ICUs, and measure pressure using a transducer.

Even technologies that stress their 'passivity' (see [1]) and try to capture this market use the old fashioned way. I don't see that changing anytime soon - you could try and somehow monitor the stretch of a small artery maybe using some variation of current o2 saturation sensors, coupled with advanced computer models of flow rate and variation in small arterioles, but that is a world away and would seem to me to be highly subject to variation/sensitivity.

My prediction is that this won't be possible until we are commonly implanting biometrics in people, but I guess we will wait and see!

[0] https://en.wikipedia.org/wiki/Korotkoff_sounds [1] http://www.visimobile.com/

Re: Theranos Founder Faces a Test of Technology, and Reputation

#79

Post by RockyMcNuts »

laarc wrote: post #75
mikesickler wrote: post #40

Earlier quoted context omitted.

As a med student, Bill Frist adopted cats from animal shelters under false pretenses so he could experiment on them, sometimes fatally. Definitely a good fit!

An accusation this serious should be accompanied by evidence, or dismissed.

He wrote about it in his book -

https://en.wikipedia.org/wiki/Bill_Frist#Medical_school_expe...

http://web.archive.org/web/20021101052043/http://www.boston....

Re: Theranos Founder Faces a Test of Technology, and Reputation

#80

Post by robbiep »

srunni wrote: post #74
robbiep wrote: post #62

There is so much ... hype around this technology. But some of their use cases aren't all that useful, and their technology (while supposing to be cheaper) is often done on handheld units at the moment in isolated regions. Let me explain: Use cases outlined in this article that have minimal real medical benefit, but sound great: - Home blood testing (why? there are only 2 types of people who may find this useful: pati…

My biggest concern with Theranos, which I haven't really seen acknowledged in any of these articles, is that multiparametric panels on asymptomatic individuals will lead to a proliferation of false positives. Running hundreds of tests whenever a patient decides to do so doesn't make sense unless that ultimately enables better clinical outcomes for patients. And this is true regardless of whether the underlying measur…

This is a really valid criticism. I often send patients home from the emergency department with values outside of the normal, usually without discussing that finding with them (ie, it is not useful for a patient with some level of kidney failure to know that their sodium is 130, and has been on every presentation they have had for years). Trying to have a conversation with every second patient about why this value is slightly outside of reference and how the reference ranges are actually calculated is not productive and will likely only lead to confusion and obsfucation of the actual reason they presented
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