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systems designed to ensure that clinical lab results are accurate. Normally, labs must be certified under the Clinical Laboratory Improvement Amendments (CLIA)—a process overseen by the federal Centers for Medicare and Medicaid Services (CMS)—and the machines they use must be approved by the Food and Drug Administration. But Theranos argued that its technology fell into an obscure category called “laboratory-developed tests” that neither agency closely regulated. The company did obtain CLIA certification for its Palo Alto lab, but it didn’t show inspectors its proprietary equipment, only the room full of commercial analyzers. Until Tyler Shultz blew the whistle, no one outside the company knew that its entire far-flung testing business was being operated under the cover of that single certificate.
That’s just one of the shockers Carreyrou unearthed. A full accounting of the governance failures and regulatory loopholes that cleared the way for the Theranos hoax will take years, but Bad Blood makes an excellent start.
Inevitably, readers won’t share Carreyrou’s circumspection. Why did she do it? My own sense is that Holmes is a kind of female Tom Ripley: a fantasist so accomplished that she convinced even herself that all the corner-cutting was for a righteous cause. But just as critically, she accumulated power in a way that allowed her to keep outsiders from seeing the whole picture and to swat away anyone who challenged her. When Avie Tevanian, an early board member who’d been Steve Jobs’s right-hand man at Apple, went to Lucas with his qualms about Holmes’s management in 2007, he was told to resign.
Over time, most skeptics or critics were forced out of Theranos. There’s a precept in high-reliability “Lean Six Sigma” manufacturing that even the lowliest assembly line worker, if they spot a defect, is empowered to pull the “Stop” cord and shut down the whole line. Theranos took the opposite approach. Asking questions was the quickest way to get fired.
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ALEX GIBNEY’S FILM, THE INVENTOR, FLESHES OUT THE STORY, BUT DOES NOT ADVANCE IT MUCH. As the title advertises, it’s focused more on Holmes herself than on the system she exploited. This isn’t surprising: film is a visual, personal, and emotional medium, and a good documentary needs strong characters, even if they’re anti-heroes like Holmes. But the film sinks at times into voyeurism, as if demonstrating Holmes’s strange magnetism were the same as explaining why so many people fell victim to it for so long.
Much of the key footage in Gibney’s film was actually shot by rival documentarian Errol Morris. Theranos’s ad agency, Chiat\Day, hired Morris—famous for films like The Thin Blue Line and The Fog of War and for his ad campaigns for Apple and other big companies—to make commercials and promotional videos for the startup. So, while Gibney’s narration unfolds, we see a white-coated Holmes striding authoritatively around Theranos’s glass-walled headquarters and speaking earnestly (and, we know now, untruthfully) to the camera about the life-saving potential of the company’s faster, cheaper diagnostics.
Morris was working to build up the Theranos myth and now Gibney is using the same footage to dismantle it. But once you grasp that irony—and get over the weirdness of the fact that one of our greatest living documentarians unwittingly became the main contributor to Gibney’s film—you realize that it’s still just surfaces, images, reflections. It’s odd that a nonfiction film about a crafty illusionist should be this obsessed with appearances. No matter how long we gaze into Holmes’s eyes, we aren’t going to find the source of the darkness in her soul.
There is some clever visual storytelling in the film, such as the CGI tour of the insides of a Theranos machine, as well as lots of aerial drone footage of idyllic Palo Alto. We get to meet many of the people who helped Carreyrou crack the story open, including Tyler Shultz. Gibney recruits smart and entertaining expert witnesses, including behavioral economist Dan Ariely, who explains why stories are more powerful than data and why it’s easier to cheat when you’re convinced it’s for a good cause. And there’s a revealing sequence where Holmes is on stage at Theranos, mic in hand, boasting to a roomful of employees about meeting the president of Brazil. The camera swings to the seated workers, who were probably meant to look worshipful; instead they’re glancing around like nervous hostages planning their escape.
We come away from the movie even more convinced that Holmes is some kind of sociopath. But we don’t learn anything new about why the system around her was so ripe for manipulation or how the scheme might have been foiled sooner. Reading Carreyrou’s book leaves you feeling righteously angry; Gibney’s film creeps you out.
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IF YOU ARE A GLUTTON FOR DISASTER YOU CAN ALSO IMMERSE YOURSELF in a four-hour audio treatment of the Theranos saga. The Dropout from ABC News and Nightline reintroduces all the same folks we met in the Carreyrou book and the Gibney film, and they repeat the same basic story. But host and co-producer Rebecca Jarvis, the chief business and technology correspondent at ABC News, has extra time to share source material not found elsewhere, such as tape from court depositions. The podcast format allows her to break the story into six digestible segments, each ending with the requisite cliffhanger.
One perceptive moment in the podcast comes in the fourth episode, when Jarvis speaks with John Ioannidis, a Greek-American professor of medicine at Stanford University. After commenting wryly that the name Theranos sounds like a combination of the Greek words tyrranos (“tyrant”) and thanatos (“death”), Ioannidis points out that any technology as ostensibly disruptive as the Theranos finger-stick test ought to have been vetted in thousands of peer-reviewed scientific papers. Instead he “practically found nothing” after a 2015 literature search, which prompted him to write a JAMA opinion piece critical of Theranos-style stealth research. “How can the validity of the claims made be assessed, if the evidence is not within reach of other scientists to evaluate and scrutinize?” Ioannidis asked.
It’s a seemingly unassailable point, and it was the first time anyone had dared question Theranos in public. But the disturbing fact is that many early-stage life sciences and biotechnology startups sidestep the scrutiny and disclosure that comes with peer review, lest they divulge their intellectual property and risk being outflanked by competitors. Holmes didn’t invent this culture of secrecy; she exploited it.
For the most part, the Gibney film and the ABC podcast foreground the deception and the deceivers and leave these important process questions in the back seat. At bottom, what’s happening is that Americans aren’t committing enough true crimes to satisfy the market demand for true-crime documentaries, true-crime cable series, and true-crime podcasts. Theranos is fundamentally a business story about Silicon Valley ethics and investing practices gone awry—about venture capitalists and board members who let themselves be duped by a protégé and who failed to ask the most basic questions about the company they were duty-bound to govern. But because the story features a young female founder, and because it’s also got all that scary, scarlet blood, it’s been sucked into a transmedia content-generating machine that, like Theranos’s own devices, dilutes its meaning more and more at each stage.