Bad Blood: Secrets and Lies in a Silicon Valley Startup

The Theranos story is so fascinating. Carreyrou paces the book evenly, slowly building his case. I borrowed this from a clinical chemist who plays (per him) a bit role in the story, appearing in a couple sentences within the book. When I returned his copy, the two of us sat in his office just marveling at how things progressed so far. Within my own little clinical chemistry domain, CLIA looms like a Greek god – all-powerful and all-knowing. Should we accidentally make a typo in our data, CLIA will send bolts of lightning to destroy us. The idea that a lab somehow became CLIA-certified with such significant variance in their data even before the straight-out fraud is almost unbelievable.

In addition, this seems like any doctor in their right mind would know what to make of Theranos. My best friend who works with silicon valley startups asked me about it several years ago, when I was still in residency, and I told her that the problem with capillary draws was hemolysis (blood cells splitting) and that you could never get some accurate results do that - and that's baked in to the blood draw, before you even get to the machinery. Any doctor worth their salt knows this.

So this is an almost fantastical story about how someone by force of personality alone paraded out technology that everyone knew was impossible, and somehow, without ever really inventing anything became a billionaire running laboratory testing in clinical labs on patients. It's pretty serious and scary stuff.

While reading it, I couldn't help but be amazed by the number of smart, well-educated people who were at least temporarily a party to this, often bullied by fancy lawyers and nondisclosure agreements. I think there's a lot here about how much the assumptions of civil society are really what keep us in check more so than institutions like CLIA or CAP. Once someone starts operating in bad faith, it's pretty scary how far they can get. On the other hand, Theranos was pretty much brought down by Carreyrou assisted by a pair of early-twenty-somethings who felt they had to speak out. So I think there's also a lot here about the importance of protecting whistle-blowers and the media.