Attempt to Transform Venipuncture: A Brilliant Idea Made From Smoke and Mirrors

Get Permission

Venipuncture is the most commonly performed invasive procedure in hospitals daily. The risk of this procedure is nerve damage or an arterial nick. Of course, there are other possible issues, such as hematoma and injection-site infection. Then there’s dealing with caterwauling children and swooning adults with needle-phobic syncope. So, imagine if one could obviate the venipuncture procedure with a simple finger-prick technique and still acquire all the necessary bloodwork panels. It would be, without exaggeration, a revolutionary paradigm shift in medicine.

Such was the dream of a 20-something Stanford wunderkind named Elizabeth Holmes, the founder of the health technology corporation Theranos. Her crash-and-burn story has been in told in documentaries and across international media outlets. However, the best way to comprehend the scope of this Silicon Valley boom and bust is by reading Bad Blood: Secrets and Lies in a Silicon Valley Startup, authored by The Wall Street Journal reporter who broke the story, John Carreyrou.


Title: Bad Blood: Secrets and Lies in a Silicon Valley Startup

Author: John Carreyrou

Publisher: Alfred A. Knopf

Publication date: May 2018

Price: $26.95, hardcover, 352 pages

A Billionaire in the Making

Elizabeth Holmes was well-heeled; her father was Vice President of Enron (not without irony, another disgraced company), and her mother was a congressional committee staffer. Ms. Holmes knew she wanted to be an entrepreneurial powerbroker from a young age. When she was 7, she was determined to build a time-travel machine and filled several notebooks with detailed engineering drawings. When she was 10, one of her relatives asked her the singular question every boy and girl eventually faces: What do you want to be when you grow up? Without skipping a beat, Ms. Holmes said, a billionaire. Somewhat of an outsider, the tall, gangly Ms. Holmes tore into her studies, forgoing much of the whimsy of teenage years for her ambitions.

In 2002, she was accepted to Stanford as a President’s Scholar. She was on her way. An experience as an intern at the Genome Institute of Singapore testing patient samples obtained by low-tech methods convinced Ms. Holmes there a was a better way forward.

Gripping Read

Here, is where Bad Blood begins to gallop along, a gripping read to the final page. As readers turn the pages, it’s important to remember that the woman convincing movers and shakers from the financial sector, the political arena, and Silicon Valley to invest in her startup is only 19 years old. Her device, called Theranos, was a cartridge-and-reader system that blended the fields of microfluids and biochemistry.

The patient would prick his or her finger to draw a small sample of blood and place it in a credit card–thin cartridge that would slip into a reader machine. Pumps pushed the blood through the cartridge and coated it with antibodies, separating all the blood’s elements that would be read and translated into a result. Ms. Holmes envisioned a Theranos unit in homes across the nation, replacing the billion-dollar phlebotomy industry, and more.

Hubris and Then Some

The best example of Ms. Holmes’ hubris and power of persuasion (she dressed and often spoke like her hero Steve Jobs) was in 2015, when then Vice President of the United States Joe Biden visited the Newark, California, laboratory of Elizabeth Holmes’ company. Theranos already had hefty retired politicos on its board, such as George Shultz and Henry Kissinger. Mr. Biden was ushered through rows of state-of-the-art equipment, the machinery of the company’s industry-changing device for testing blood with a finger prick; he couldn’t resist offering over-the-top praise for the “laboratory of the future.” What the Vice President didn’t know was that he was gushing over a fake setup, like a movie set, staged for a VIP’s visit. Once again, Ms. Holmes’ ability to pull a sleight-of-hand trick on some of the most powerful people in the world adds a layer of mysticism to the story, one the author captures with journalistic punch.

“Ms. Holmes’ ability to pull a sleight-of-hand trick on some of the most powerful people in the world adds a layer of mysticism to the story, one the author captures with journalistic punch.”
— Ronald Piana

Tweet this quote

Enter one Ramesh “Sunny” Balwani, a true believer, the President and Chief Executive Officer of Theranos and Ms. Holmes’ boyfriend. At this point, with the addition of a love interest, the story adds yet another layer of intrigue. Mr. Balwani, known by Theranos employees as “The Enforcer,” kept a low public profile. According to the author, “While Holmes served as the figurehead, Balwani stayed behind the scenes, ‘terrorizing everyone.’”

Delusions Trumped Reality

Mr. Carreyrou writes that the heart of the problem at Theranos was that Ms. Holmes overpromised and then drastically cut corners when they couldn’t deliver the goods. Then, not surprisingly, they lied to hide their mounting problems. Mr. Balwani told mega-investors that Theranos had developed about 300 blood tests, ranging from commonly ordered tests to kidney functions and even esoteric cancer detection tests, a claim that had the money people salivating. Of course, it was another lie, only grander.

In the book’s last chapter, aptly named “The Empress Has No Clothes,” Mr. Carreyrou details his part, which was ample, in uncovering the Theranos hoax. Once Ms. Holmes’ castle was discovered to be made of glass, rocks were thrown from all the players: the Centers for Medicare & Medicaid Services, the U.S. Food and Drug Administration, the U.S. Attorney’s Office, and the media. The author notes: “In her all-consuming quest to be the second coming of Steve Jobs amid the gold rush of the ‘unicorn’ boom…her ambition was voracious and it brooked no interference. And there was collateral damage on her way to riches and fame.”

Yes, there was. And if there’s one lesson to be gleaned it is if something seems too good to be true, it often is. This fine book is recommended for readers of The ASCO Post