It’s understandable why millions of people would like to see Elizabeth Holmes’s head on a pike.
She has become, conveniently if involuntarily, the poster child for a wide variety of sins: the excesses of Silicon Valley, commonplace corporate lies, a thorough lack of executive accountability. The jury is currently out on the Theranos founder’s trial for multiple counts of wire fraud (that quaintly named crime, suggesting that American statutes have not caught up to the 21st century). Holmes, at one point the world’s youngest self-made female billionaire, could in theory go to prison for 20 years or more, having ostensibly defrauded the investors who put a billion dollars or so into her company.
Whether Holmes is convicted or not, the trial and the Theranos saga have been an object lesson on what is wrong with health care and American capitalism.
It’s impossible to fault Holmes or Theranos for trying to produce a quick, pinprick blood test that would make so much of the world’s health care delivery easier, faster, and putatively cheaper. True, some or perhaps most of Theranos’s champions may have had less-than-pure motivations; John Carreyou’s vital book Bad Blood depicts Walgreens executives, for example, as conspicuously incurious observers of Theranos’s technology, lest there be any obstacle on the path to the cash register. In 2010, the Walgreens CFO visited Theranos’s Palo Alto headquarters and was, according to Carreyou, unfazed by lack of access to the laboratory, happy instead to accept an autographed American flag that Holmes said had flown over an Afghanistan battlefield.
Still, we want entrepreneurs to swing for the fences, don’t we? If venture capital and other investors are going to pump their billions into start-ups, it’s better that they support health care innovation than, say, Juicero, the VC-backed $400 kitchen device for squeezing fruit that quickly went the way of all peels and rinds.
Virtue of purpose is, of course, no excuse for fraud. Theranos, depending on your perspective, committed fraud for many years, almost immediately from its 2003 launch. Holmes’s intensity and gender-pioneer status bamboozled not only investors but a small army of journalists. I was among them: As the editor of Inc. magazine, I put Holmes on our October 2015 cover. (I’ll still defend the story, but regret calling Holmes “the next Steve Jobs” on the cover, not that Jobs was a CEO without flaws.)
More surprising and disturbing than the seduction of journalists is that Theranos’s top-tier investors didn’t smell something unpleasant years ago. This has been an essential discovery during Holmes’ trial; Bloomberg reported: “Theranos forecast revenue of $140 million in 2014, and almost $1 billion for 2015. Holmes’s top financial officer testified that Theranos posted just $150,000 in revenue in 2014. Evidence at trial shows it was even less in 2015.” This kind of shortfall should have triggered nuclear alerts, from major investors and board members; the lack of public flares vividly illustrates the cynical corruption of America’s financial leadership.
But the broader indictment should be of the for-profit health care system that made Theranos attractive in the first place. One of the trial’s most telling threads involved Theranos not disclosing basic information to Walgreens because it was trying to protect trade secrets.
Whether it’s quick blood tests or mRNA Covid vaccines, health care technology is an obvious public good, and the Theranos debacle—regardless if Holmes is convicted or acquitted—shows the predictable perils of entrusting those technologies to a patent-enabled private sector. The public sector is hardly immune to missteps or corruption, but a blood-test technology under the supervision of the government would not have needed to fake revenue results, and would likely not have produced fraud on a Holmesian scale.
That juxtaposition is especially ironic because, as the flag-over-Afghanistan anecdote reminds us, Theranos was in a critical sense a creature of the military-industrial complex. The US military was highly interested in Theranos’s technology, because it believed that this technology could be supremely useful in a battlefield setting. One of Theranos’s board members was former secretary of state George Shultz (in a wonderfully Oedipal twist, his grandson Tyler, briefly a Theranos employee, was a major source for the Wall Street Journal series that destroyed Theranos and ushered in the federal indictment).
I can’t help wondering: If Theranos had been indirectly working on behalf of a taxpayer-funded military, what would have happened if taxpayers had directly funded the blood-prick research? Might we have achieved the science without the fraud? It seems like a useful experiment.