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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

#91

Post by yourapostasy »

robbiep wrote: post #80
srunni wrote: post #74

Earlier quoted context omitted.

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…

The medical community should reconsider the standard policy of not having that conversation. While it may be medically sound practice, the insurance industry takes these reference values as Gospel Truth. Your life insurance premiums and coverage are predicated on how much deviation you exhibit from the reference ranges.

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

#92

Post by robbiep »

yourapostasy wrote: post #91
robbiep wrote: post #80

Earlier quoted context omitted.

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…

The medical community should reconsider the standard policy of not having that conversation. While it may be medically sound practice, the insurance industry takes these reference values as Gospel Truth. Your life insurance premiums and coverage are predicated on how much deviation you exhibit from the reference ranges.

Only in countries that are allowed to differentiate on the basis of lab tests. Which is not the case where I practice.

If a lab result is outside the normal range and a patient has a reason for it to be outside the normal range, that's fine. If a patient has a deviation that is related to their presenting complaint, that's fine too. If a patient has an unexplained deviation which is not related to the presenting complaint, well, there's a 1 in 20 chance that the variation is statistical only. So you use your clinical judgement. is this a patient who requires outpatient follow-up and repeat, or is this an abberation?

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

#94

Post by martingoodson »

robbiep wrote: post #92
yourapostasy wrote: post #91

Earlier quoted context omitted.

The medical community should reconsider the standard policy of not having that conversation. While it may be medically sound practice, the insurance industry takes these reference values as Gospel Truth. Your life insurance premiums and coverage are predicated on how much deviation you exhibit from the reference ranges.

Only in countries that are allowed to differentiate on the basis of lab tests. Which is not the case where I practice. If a lab result is outside the normal range and a patient has a reason for it to be outside the normal range, that's fine. If a patient has a deviation that is related to their presenting complaint, that's fine too. If a patient has an unexplained deviation which is not related to the presenting comp…

Actually, there is a one in twenty chance that a normal person would generate the results in question. Not the same thing.

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

#95

Post by DanBC »

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…

Here's what England's NICE say about diagnosing hypertension. COmpare the difference between ambulatory measurement, and home measurement.

We know that most people can't even take their medication properly (many organ transplants fail because people don't comply with the medication regime, for example) so easier blood pressure monitoring would probably be useful. Especially if you combine it with something that can lower blood pressure.

http://www.nice.org.uk/guidance/cg127/chapter/Key-priorities...

> Diagnosing hypertension

> If the clinic blood pressure is 140/90 mmHg or higher, offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. [new 2011]

> When using ABPM to confirm a diagnosis of hypertension, ensure that at least two measurements per hour are taken during the person's usual waking hours (for example, between 08:00 and 22:00).

> Use the average value of at least 14 measurements taken during the person's usual waking hours to confirm a diagnosis of hypertension. [new 2011]

> When using home blood pressure monitoring (HBPM) to confirm a diagnosis of hypertension, ensure that:

> for each blood pressure recording, two consecutive measurements are taken, at least 1 minute apart and with the person seated and

> blood pressure is recorded twice daily, ideally in the morning and evening and

> blood pressure recording continues for at least 4 days, ideally for 7 days.

> Discard the measurements taken on the first day and use the average value of all the remaining measurements to confirm a diagnosis of hypertension. [new 2011]

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

#96

Post by DanBC »

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…

It's useful to try to understand what's going on with the blood testing stuff, because it shows how hard it is for people in public health to get accurate messages across.

Some people think more information is always good. We see healthy people without any symptoms will sometimes pay for "whole body MRI scans".

Some people think that if you have an illness it's going to be seen in the blood.

Frequent traditional blood tests are time consuming and not that pleasant.

Theranos claims that they don't need that much blood; that they can do a blood test with just a drop.

This means people don't need to see a phlebotomist nurse to have blood taken, they can just blot a drop of blood on a stick.

So, the claim goes that people can have very many blood tests all the time, and that will give us more data, and that data is always good.

Theranos plays into some deeply entrenched stuff, so while it's alarming they got so much money it shouldn't really be that surprising.

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

#97

Post by madaxe_again »

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.

Also, she doesn't work in health care. Theranos is a pr/investment vehicle. The products are overhyped, she's a figurehead, the entire idea is to get investors to part with their cash for as long as possible - and then when it all goes wrong the pretty face in charge stays out if jail. It ain't her business.

I see her and Shkreli as fundamentally doing the same thing - just she's doing it not like an idiot, like him.

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

#98

Post by madaxe_again »

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.

It's the other way around. They will have approached her, as they smelt an opportunity to use her, as they are still now. Egoistic people are really easy to manipulate, and you only have to stay one step ahead of the wake of your reality distortion field to pull it off.

The house of cards will come tumbling down at some point, but it won't matter, there won't be consequences.

I know this because I've spent enough time in the world of the mega-rich, had enough passes made at me by apparently well meaning robber barons, to know that this is how this works.

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

#99

Post by viggity »

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 startup facilitates at home testing of PT/INR levels (for coumadin/warfarin patients). In general, yes, INR levels stabilize, medicare won't pay for at home testing until the patient has been on warfarin for 90 days. However, it is surprising how many critically high or low results we get in an average week.

Studies [1] show that weekly INR testing results in a 55% reduction in strokes, 35% reduction in major bleeds and 39% reduction in deaths.

[1] Henagen C. et al. Lancet 2006; 367:404-11

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