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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

#81

Post by adevine »

bane wrote: post #48

Theory: They had some early tech that looked promising in some specific clinical circumstances that through dumb luck were the ones that were tested early on. Holmes, as an almost engineer with no particular experience in anything, thinks medicine is just like engineering. It didn't work in the general case or was less accurate than acceptable for medicine, and so now Theranos is basically just doing normal lab tests…

It's interesting that the only test cleared is one for herpes. Conceptually, a finger prick sample would very clearly work for binary, "you've got it or you don't" tests, like STD tests (e.g. you've been able to buy home HIV tests for years that just require a few drops of blood from a finger).

Most blood tests, though, are about detecting whether levels of a substance are in a particular range - milligrams of cholesterol per deciliter of blood, mg glucose per deciliter, etc. Taking a much smaller sample is pretty much guaranteed to make the plus/minus error range larger, and capillary blood from a finger prick will have a greater percentage of contamination from intracellular fluid.

Even glucose meters you can use at home are much less accurate than glucose readings taken with a venous draw in a lab. In that case, the benefit to a diabetic of being able to do frequent home testing outweighs the loss of accuracy. If you're going to get work done by a lab, though, you are going to want it to be as accurate as possible, and in that scenario I don't see how a finger prick will be able to compare to a venous draw.

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

#82

Post by laarc »

RockyMcNuts wrote: post #79
laarc wrote: post #75

Earlier quoted context omitted.

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....

You know, I didn't expect this to be on his Wikipedia page. My apologies for not doing the most basic of searches. (The topic was uncomfortable enough to want to avoid it, but I still should've checked.)

Thanks!

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

#83

Post by srunni »

steven2012 wrote: post #67
n0us wrote: post #7

The idea of rapid disruption in the healthcare industry makes me uncomfortable for some reason. I admire Holmes's ambition and in interviews I've watched she seems competent and well guided but something just doesn't seem to add up. How was a college dropout able to get a break in the healthcare sector? Becoming a doctor requires years of education and training and along comes this young woman who just decides "I'm g…

This is an ignorant viewpoint. It's not just phobia. If a fingerprick blood test were actually possible it would make a huge win for children. One of my kids needs to get his blood tested for lead ( standard blood test for his age). Good luck trying to get him to hold still while he's screaming and fighting and drawing enough blood for a test. It would also be a huge win for premature babies, some of which only have…

> It would also be a huge win for premature babies, some of which only have 2oz of blood in their entire system.

Take a look at Baebies, which is doing exactly this (neonatal screening): http://www.newsobserver.com/news/business/article28910089.ht...

The cofounders previously founded Advanced Liquid Logic, a diagnostics company using microfluidics technology developed in a Duke research lab that was subsequently sold to Illumina for $96M in 2013. Baebies is now licensing that technology from Illumina.

Unlike Theranos, their work has been published in peer-reviewed journals. For example, here's a publication from 2004: http://pubs.rsc.org/en/content/articlelanding/2004/lc/b40334...

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

#84

Post by laarc »

robbiep wrote: post #78
laarc wrote: post #73

Earlier quoted context omitted.

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…

It seemed promising to do some experiments with sewing a BP sleeve into a shirt, then setting up an Arduino to trigger it to inflate/deflate. It should be possible to record the result digitally. It'd be slightly uncomfortable, but even if it's only once per hour, it's still better than zero per hour. The noise would be annoying, but I have some ideas for how to make it quiet. But would anyone actually want such a thing?

Thanks for batting around the idea with me, and for the valuable references. I didn't know there was any other way to measure BP than the old-fashioned way.

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

#85

Post by CamperBob2 »

specialp wrote: post #66
CamperBob2 wrote: post #35

Earlier quoted context omitted.

Perhaps I just don't understand the phobia that some people have around blood tests but it is my understanding that you get a blood test as a way to gauge your health, not because it makes you feel nice. The hold up doesn't seem to be that tons of people are afraid of needles otherwise they would be getting tested all the time. The hold up to people getting blood tests all the time is that doctors don't order them, p…

Basic panel of blood tests is reimbursed $8 from medicare. That is pretty darn cheap. I know here we always think that industries are ripe for disruption, but the lab industry is mature, highly competitive, and has a high barrier to entry that is not possible to circumvent (FDA/CLIA approval) for tests.

That does not make them "free." Somebody's paying, even if you aren't.

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

#86

Post by bane »

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…

I have several people in my family who demonstrate various levels of hypochondriasis. Imagine the nonsense over gluten-free and every other fad diet of the last 30 years, non-specific symptoms, alternative "medicine" and that's two or three people in my immediate family. Now let them start ordering their own blood tests and it'll make the anti-vaxing movement look like a cultural blip.

Most people simply aren't smart or informed enough to understand things like "false positives".

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

#87

Post by robbiep »

laarc wrote: post #84
robbiep wrote: post #78

Earlier quoted context omitted.

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…

It seemed promising to do some experiments with sewing a BP sleeve into a shirt, then setting up an Arduino to trigger it to inflate/deflate. It should be possible to record the result digitally. It'd be slightly uncomfortable, but even if it's only once per hour, it's still better than zero per hour. The noise would be annoying, but I have some ideas for how to make it quiet. But would anyone actually want such a th…

You're describing creating an ambulatory blood pressure cuff. I've had one attached to me and you get used to it fairly quickly, although it failed to measure blood pressure when I was active (I was cycling for a few of the readings, which you think would keep your arm fairly still and not cause a problem) Cool to make it yourself though! Have a look at these further links. The australian prescriber article you may find particuarly useful

http://www.racgp.org.au/download/documents/AFP/2011/November...

http://www.australianprescriber.com/magazine/20/1/18/20

https://en.wikipedia.org/wiki/Ambulatory_blood_pressure

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

#88

Post by bane »

Asparagirl wrote: post #70

Have you guys seen Elizabeth Holmes' Twitter favorites? 99% of them are faves for someone saying how inspiring she is. How she breaks glass ceilings. How she's doing something significant. How the press just wants to build people up to then tear people down. How she should run for president. How her speeches were transformative. How she has vision. Her bio. Her story. Videos of her. Press puff pieces about her. Her f…

That's pretty weird. I didn't believe you until I checked it out myself.

I wonder how much of Theranos is a long-play effort to create a "brand" around Holmes?

Perhaps years later, long after Theranos is dust, she'll point to it as a huge success that made her into the billionaire she became.

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

#89

Post by aj7 »

ZanyProgrammer wrote: post #11
n0us wrote: post #7

The idea of rapid disruption in the healthcare industry makes me uncomfortable for some reason. I admire Holmes's ambition and in interviews I've watched she seems competent and well guided but something just doesn't seem to add up. How was a college dropout able to get a break in the healthcare sector? Becoming a doctor requires years of education and training and along comes this young woman who just decides "I'm g…

She comes from a very, very privileged family with the kind of connections most of us can only dream about. Alas that still counts for a lot, even amongst the VCs (especially amongst?) in PAMPA.

Yes, and she is apparently unmatched at creating reality distortion fields. And her minions just played the oldest game in technology. When people come over, and you don't want to show them anything, show them the machine shop. The Times was mystified by a dial indicator and chips (garbage) from a milling machine.

This whole episode is the best justification for the thesis that that VCs are successful, not from adding value, but simply being presented with the best deals. Perhaps that bull at the Dallas Morning News could do as well.

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

#90

Post by aj7 »

n0us wrote: post #14
ZanyProgrammer wrote: post #11

Earlier quoted context omitted.

She comes from a very, very privileged family with the kind of connections most of us can only dream about. Alas that still counts for a lot, even amongst the VCs (especially amongst?) in PAMPA.

This is a true point. When you have a lot of money available to invest and you already have a diverse portfolio of high risk-reward investments I suppose it isn't such a big deal to spend 1m on an intelligent family friend. Still... they didn't get to be that wealthy by being careless with their money so I suppose we/I just don't know the full story.

I see a lot of old men, who once wielded a lot of power, being assiduously ego stroked by a young master, whose upbringing served to hone that skill to perfection.
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