Even though this scandal happened very recently, and on a very large scale, I have to say that I ready had no awareness of it in real time. To be fair, I was in grad school on the other side of the country, so it does make sense that my general knowledge of Silicon Valley start-ups, no matter how scandalous, was minimal. And then I saw all the great reviews this books got when it was published – lots of reviewers that I trust were talking about how interesting and unbelievable the story was, but I, personally, just wasn’t super interested in picking it up. So, I didn’t. It wasn’t until I recently read Jia Tolentino’s collection Trick Mirror that I really got a full, if overview-level, introduction to this story. One of her essays (in fact, one of my favorites of the whole collection) was about how the millennial generation is partially defined by the idea of great cons as success stories, and she went on to list a few that stood out to her and why, including the infamous Fyre Festival and this one, the story of Theranos. And that peaked my interest enough that, as I was browsing for a new audiobook, this one caught my eye and I decided to go for it.
“Hyping your product to get funding while concealing your true progress and hoping that reality will eventually catch up to the hype continues to be tolerated in the tech industry. But it’s crucial to bear in mind that Theranos wasn’t a tech company in the traditional sense. It was first and foremost a health-care company.”
Just in case you know about as much as I used about this story, let me give a quick overview. Theranos was a Silicon Valley tech/health start-up founded by Stanford drop-out Elizabeth Holmes when she was 19. Holmes had a vision of a new way to test blood, using minimal amounts of blood (and therefore avoiding a full needle-draw) and using ground-breaking technology that would be able to test for hundreds of things simultaneously in a device small enough and easy enough to use that it could be placed directly in patient’s homes. It’s a phenomenal vision, and would have been truly revolutionary, except the technology didn’t exist and Holmes spent years using secrecy, sleight-of-hand and eventually straight lies to deceive investors, partners and the public, not just in raising funds and finding financial support, but eventually using faulty equipment to test blood on actual patients (causing untold numbers of unnecessary medical complications and mental/emotional strain). Concerns from employees and doctors using the equipment were silenced with impunity, until eventually things reached a critical mass, culminating in a Wall Street Journal expose article on the overall falsity of the company. That first article was the start of an investigative journalistic series that eventually became the basis for this book.
First and foremost, this is a nonfiction piece written by a journalist. So, of course, bear that in mind with the writing. For me, that meant a couple things. First, I was very glad I chose to consume this as an audiobook. The writing was smooth and intelligent and exactly what it needed to be, but, at least for me, that’s just not my favorite style to read. So having the audio helped move things forward. Similarly, I was interested in the overall story, and less so in the individual names and exact sciences behind everything. I think, had I been reading a physical copy, the sheer amount of details would have gotten me bogged down. So again, for flow reasons, audio was a great choice. (All these “issues” are very personal, as I felt similarly about Moore’s The Radium Girls, a similar investigative-journalism-style nonfiction novel). Other than that, this entire situation was fascinating to read about. Carryrou’s investigating/reporting is incredibly thorough and he did a fantastic job getting it all down in a linear way, considering how many different aspects were in play at any given time. Despite the amount of detail and names and specifics, I definitely never felt like I got lost in the story. And the unfolding drama and step-by-step intensification of secrecy and misleading from Holmes had me hanging on tight waiting for the next reveal. I feel like this is about as “thriller” as one could make a nonfiction account/investigative report.
As far as my personal reactions to the story itself, I was emotionally all over the place. Which, at least for me, marks a great author and “plot.” Let me just go ahead and “stream of conscious” list out some reactions. Hopefully this doesn’t get too long or confusing. First, my honest to goodness first reactions to the ridiculously toxic work environment situation (and how it was possible that no word got out about it for so long) made me so angry. Like, come on employees, speak up at least to each other and to potential new hires about how bad it is! But then I took a step back and calmed down and realized that I was mad on their behalf because I’ve been there – in a very toxic workplace environment that didn’t even have all the legal NDA stuff to scare me out of talking – and for many reasons I haven’t said anything more internally or publicly about it. If someone asked me, I would be very clear that I think they should apply to work elsewhere, but that’s kind of it. And there’s no way my workplace has the same resources to come after me as Theranos did. So actually, I get it, I really get it and I think more than anything else, I was just mad for all of us that there aren’t more options for what to do. Also, things seemed to intensify/happen in the “frog in boiling water” way – so we can ignore little signs over time and by the time we realize something is deeply wrong, maybe it’s too late.
I respect, to start, Holmes’ level of passion and persistence. All the biggest inventions and discoveries are pushed forwards by visionaries who, often, are deemed “crazy” at the time because they continue on through myriad failures, etc. – it’s a popular truism. And it’s clear to me that she started that way, because her charisma and passion are what allowed her to get so many major names/backers (I mean seriously, Henry Kissinger, General Mattis, the Obama administration, Walgreens, Rupert Murdoch, to name just a few…) and keep going for so long. However, it’s also clear that, at some point, the fame and recognition started to mean more than the product/service itself…and the actual benefit she could give to real people/patients was ignored in favor of her own reputation. At that point, her charisma and product-hyping took a turn into manipulation and lies. We’ll never know exactly what happened (and maybe neither does Holmes)… Perhaps she truly had some sociopathic tendencies? Perhaps she got in over her head and wasn’t quite sure how to get out? Perhaps, though this does seem unlikely to me, she was strong-armed into certain things by her business partner/boyfriend? Regardless, the lies were told, the laws were broken, the harm was done to people, patients, investors, companies and that cannot be undone. On a tangential note, I would like to have as much money as many of the Venture Capitalist groups and individuals that invested so much financially into Theranos and were held off so long from actually seeing the product(s) in action – I mean, if it were my money, I would want some damn better proof than they ever got before handing it over. How Holmes managed to fend off so many requests for so long, in such creative ways, is astounding and, in a terrible way, impressive in its own right. (Maybe the fact that that’s considered impressive at all, not just awful, is, in fact, the issue Tolentino was referring to in her millennials-as-a-con-based-generation essay).
Final thought: zealotry is dangerous. Holmes had it in spades (to a point where she was able to self-delude to an incredible degree) and was able to pass it on to so, so many others. The way this start-up snowballed over the years is fascinating and scary and honestly, made for a great read. I feel like the moral I’m taking from this entire situation is “when you’re in a hole, stop digging.” Also, I feel like this demonstrates the separation between those working on a macro-level versus a micro-level to a frightening degree, and that the long-term/big-picture goals/successes justify some smaller/individual-based “sacrifices” along the way. That speaks in direct contrast to my public-health-heart (I do work from both levels every day and I see the dangers being stuck in one mindset completely can pose) and it was hard to read.
This genre or topic will definitely never be my favorite, but I have really enjoyed the few that I’ve read over the past few years and plan to continue to sprinkle them into my reading. These types of stories are such visceral examples of how sometimes real life is crazier than fiction. And Carryrou did a great job breaking everything down and walking the reader through it in an understandable and interesting (even though it leaned long and very detailed) way. So just know what you’re getting into when you pick it up. But if that’s what you’re looking for, get ready for a wild ride!