The corrupted medical psychopath genius - Elizabeth Holmes

"Whom the gods wish to destroy, they first call promising."

Cyril Connolly

This is a beautiful book, and it is all about power, greed, broken promises and money. It is also a story of the statement that when something sounds too good to be true, it probably is not true. This book is about biotechnology and the future of the medical industry. The book takes you through a journey with entrepreneur, businesswoman and CEO of Theranos, Elizabeth Holmes. It shows how she was determined by her fear of needles. She felt she could develop a small mobile device for various biomedical tests that could result in a medical diagnosis with minimal pain, affect millions of lives, and change the world. The book's writer John Carreyrou gives us the impression that Elizabeth Holmes could suffer from a narcissistic personality disorder. Still, her fears and desires were genuine; she wanted to make a real difference and improve things.

Elizabeth, at the time she was working, was driven and slept less than 4 hours every day, working extremely hard. But it seems she was overwhelmed by both the technology and medical side, and she was gambling with people's lives with something she did not fully understand and could not really comprehend. This is something that the real professionals were said to be saying throughout the book, but this was drowned down by her own youthful enthusiasm, naivety and others' desire for her to succeed. Elizabeth came from a family with a long line of medical doctors. The writer gives the impression that she modelled herself as an entrepreneur, business magnate, industrial designer, media proprietor, investor, and Apple CEO, Steve Jobs, both in dress, voice, and presentation. What she wanted most was Steve Jobs's success. But she needed to fully grasp and understand the gravity of what she desired, which seemed lacking. As it was impossible with the technology, they had at that time. If only she had finished her education at Stanford, which would have given her a better perspective on the world she was going introduced to and understand microfluid dynamics, biochemistry and the effect of electrolysis on blood and things in general. Unfortunately, she suffered from what we would now describe as the Dunning-Kruger effect. According to the book, she did not understand the basics, and the book was critical of her fundamental understanding of the scientific method. Only if she could have enough scientific knowledge or had someone she trusted in her team who could explain it to her might she have realised the impossibility of what they were trying to achieve with the technology of that time. It could be achieved in 10 to 20 years, but at the time and her desire to minimise the device was impossible. You can only afford to make a few mistakes in medicine compared to regular software development, where if there were mistakes, they could be corrected in the next version or upgrade. In medicine, you were dealing with people's lives, and such mistakes were very costly and politically impossible. 

There is a whole chapter on Apple, it is captioned "Apple Envy", chapter three. A statement goes that she "worships" Steve and Apple. "She likes to call Theranos blood-testing system, 'the iPod of health care' and predicted that, like Apple's ubiquitous products, it would someday be in every household in the country". Her first idea had to be binned, which was a skin patch that monitored a patient's blood via numerous micro needles and given the appropriate medication for specific diseases or ailments at a specific time. This was due to its practicality as it would need a mini computer and data storing unit; even with nanoprobes, microprocessors and biotechnology, it was not possible with the technology they had at that time. She went a step further by recruiting people who had worked at Apple. The designers at Apple were recapped to design her applications, and the general atmosphere was believed to be similar to Apple's establishment at Stanford.

Elizabeth attracted enthusiastic young individuals with a positive outlook on life. Many believed they were part of something big that was "really going to change the world". They saw themselves as technical disruptors and revolutionist. They moved to Facebook's former large office, which had an air of an upstart technology company. Elizabeth also had a dark side, believing she had to keep everything secret after a single incident. The company was often in "stealth mode", as they put it, restricting information and the free flow of ideas. The engineering department needed to learn what the biochemistry department was doing to work effectively, but with them often in "sheath mode", this proved difficult. This was important as Engineering had to know the reagent viscosity when mixing it with other reagents. At times she could be highly paranoid, and there was a shutdown of information. During this period, almost everything had to go via her, and only she and a few selected others at the top knew the whole picture or gave the impression that they knew. They also had employees signing legally binding contracts. And she had her legal team find dirt on almost every employee to use on them in future. Eventually, because of the cloak-and-dagger stuff, many of the enthusiastic young employees, primarily from Apple, eventually left or felt it wasn't the place for them, as it had become very toxic and unsafe. When Elizabeth sacked any employee, which was becoming increasingly frequent, they just introduced a new term that she or some of the other top managers had  "disappeared them". The sacked former employee was asked not to return to their desk to take their stuff, which would be sent to them or contact their former colleagues with legal threats. As a result, one of the employees, the way he "disappeared" was so humiliating that he was driven to suicide. 

Elizabeth has always wanted to be great in life. As a child, she says she wanted to be a billionaire when she grew up. She was noted as saying when she was only seven years old that she did not want to be President, but with her billion dollars, the President would want to marry her. She has the pedicure for greatness on both sides and clear examples of people in their families who did not live up to their full potential. Her family were accomplishments well known both in the field of entrepreneurship and also medical. Her family were well-connected. With the students in the nearby Silicon Valley, founding Yahoo and later Google attracted attention. Her father had constant work in China and felt that his children should learn Mandarin and arranged that his children should be home-taught. She talked her way into a Summer Program at Stanford for Mandarin with a four-week training program in Beijing, China. Elizabeth was accepted into Stanford in the spring of 2002 as a President's Scholar, a distinction given to the top students with a three thousand dollar grant to be used on any intellectual challenge of their choosing. One of her unique talents as she knew how to "deal" with wealthy old white gentlemen and convince them to part with their millions of dollars and get them to invest in her company. It is expected to inflate claims in the software world and has a culture of faking it until you make it. But when human lives are at stake, one has to be extra careful. Where the first rule is "do no harm."

Some great individuals, like Henry Kissinger, The Clintons, and former US Secretary of State, George Shult, were involved. The only person in Elizabeth's life who had significant work-wise was a shadowy figure called Sunny Balwani, who was of Pakistani origin. They were said to have met during her trip to China in 2002 when she was 18 and Sunny was 37 and married to a Japanese Artist, Keiko Fujimoto. They later became secret lovers after Sonny's divorce, something they failed to mention to investors as he became the Chief Operating Officer. As this could be interpreted as there exists a conflict of interest. Also, there was a significant age difference between them, nearly 20 years. Sunny had set up a software company and sold his shares for $40 million; the company went bust shortly afterwards. Sunny personality was obtuse and aggressive; from his fast luxury cars, all with their personalised licence plates, to his mode of dressing, he displayed a form of vanity. 

They eventually decided on a home-based blood testing system called "The Edison". When presented to sponsors, it was described as a home-based Diagnostic toolkit that could diagnose up to 240 ailments and diseases, ranging from Vitamin D deficiency to Herpes and HIV. This will decrease the cost of medical tests, and treatment will now be cheaper. You could monitor medication, and patients will no longer be required to come for tests but could be managed at home. Also, early detection of various diseases will save millions of lives. In short, it will revolutionise health care. On paper, but in practice, it could only test for 80 parameters; in most cases, these need to be corrected. The blood extracted was so small for all the tests to be carried out that it needed to be diluted, affecting the sensitivity of the results. One seems it was "castle in the sky" thinking, a group of hippies or well-meaning and naive younglings had got together and stated their dreams.

Meanwhile, many people became worried about that, and some were sceptical. Among them was Alan Beam, a pseudonym said to be Adam Rosendroff, who shelved plans for the error-prone Edison to do HIV tests. Another was Timothy Hamil, Vice Chairman of the University of California's Department of Laboratory Medicine, who was reported to have said on record that they could not do those number of tests on a single drop of blood in a "thousand years". 

The last chapter is captioned appropriately, "The Empress has no clothes", which began with an email from Erika Cheung, a bright-eyed and bushy-tailed graduate who joined Theranos. She later became a whistle-blower. She also said that Therano's proprietary devices were unreliable, and the laboratory where she worked had allegations of scientific misconduct to sloppy lab practices. The email was sent to Gary Yamamoto, a CMS field Inspector. The email was captioned "CMS Complaint: Theranos Inc". "It contains words such as "I'm ashamed of myself for not filing this complaint sooner." Also, it indicated that Theranos had misled the CMS inspector in the previous inspection. She had resigned from the company, and she found "potentially devastate someone's life by giving them a false and deceiving result." After that, it was downhill. The CMS inspectors came again and asked correction of forty-five deficiencies in their report. Then the press came after smelling blood, then all the patients brought cases against them for false results. Their law firm withdrew their services, and another smaller firm took over. They were eventually banned by the CMS. Under a settlement with Arizon's Attorney General, Theranos agreed to pay $4.65 million into the state fund that reimbursed up to 76,217 Arizonans who ordered blood tests from the company. They corrected or voided up to 1 million results. 

This book shows how one must be careful when delaying with Human lives. Coming in both fields, Medicine and IT, we could cut corners as it were in IT. We could test on different scenarios and even generate data to test our system in IT. The output sensitivity is considered low, and no one would die if you got the wrong result, which could be corrected with apologies. This rarely occurs due to vigorous testing and running of the systems on real data, but it is unacceptable because of the nature and sensitivity of the medical data.