The Ultimate Scam
Review by Cicely Shillingford
Secrets and Lies in a Silicon Valley Startup
Book by John Carreyrou
Who can argue against the nobility of a career in medicine? Alleviating human suffering with affordable, fast, and personalized treatment is as virtuous a professional pursuit as any of us can aspire to. This is what Elizabeth Holmes sought when she dropped out of Stanford at age 19 to launch a startup company that boasted a portable blood-testing device, small enough to sit in patients’ living rooms, yet capable of running hundreds of tests from a single finger prick of blood.
Imagine: your personal medical questions answered expeditiously in the comfort of your own home. Vitamin D levels low? Early signs of cancer flowing through your veins? Dangerously high cholesterol? Pregnancy too early to be detected in urine? Mysteries no more, thanks to miniaturized medical innovations pioneered by a luminous and cunning young female entrepreneur leading the sexiest start-up in Silicon Valley.
If this scenario sounds too good to be true, that’s because it is. But if you were momentarily mesmerized by the idea, you are not alone. Elizabeth Holmes founded her fraudulent company Theranos in 2003. A portmanteau of “therapeutics” and “diagnostics,” Theranos swindled millions of Americans, including venture capitalists, politicians, patients, doctors, and even esteemed scientists. A biochemist and soon-to-be Ph.D. chemist myself, even I needed some context about the intricacies of the blood testing apparatus to ascertain that this technology is currently not viable. I was ultimately enlightened by the comprehensive, eviscerating, and disturbing investigative journalism performed by the Pulitzer Prize-winning Wall Street Journal journalist John Carreyrou, in his scathing exposé, Bad Blood.
Bad Blood describes the rise and fall of Elizabeth Holmes. Blonde, blue-eyed, and born into an affluent and politically connected family, Holmes leveraged her charisma, enterprise, and limited knowledge from two semesters of chemical engineering at Stanford to convince numerous family friends and investors—including education secretary Betsy DeVos and her family, the Waltons of Walmart, and media tycoon Rupert Murdoch—that her device would be “the most important thing humanity had ever built.” Teamed up with her boyfriend and number-two executive Sunny Balwani, a portly Pakistani man almost 20 years her senior, Elizabeth built Theranos into a $9 billion business in little more than a decade.
This dynamic and duplicitous duo built an enterprise based on fallacious blood testing technology—a technology that never worked despite their expansive claims that it performed hundreds of blood tests simultaneously from a drop of blood. The company rapidly grew from a Silicon Valley start-up to a nationwide bastion of medical achievement, with major media outlets like Forbes and Fortune lauding Holmes, with a personal worth once valued at $4.5 billion, as the youngest self-made billionaire in history. Holmes seduced the business world and attracted a talented workforce with heart-wrenching tales lives saved by her invention. But, as Carreyrou reveals, there was a dark side to this fairytale.
Elizabeth and Sunny ran Theranos with utmost secrecy. They fired employees for reasons as trivial as sticking a USB into a company computer, duped FDA inspectors, and filed innumerable lawsuits against the disloyal. Biotechnologist Erika Cheung, one of Carreyrou’s main sources and an early whistleblower, was forced to flee her residence when she was served a lawsuit at an address that not even her mother knew. Carreyrou alleges that she was one of several Theranos critics Holmes and Balwani surveilled in an ultimately failed effort to suppress exposure of the company’s fraudulent practices.
Notably, Carreyrou details the almost $1 billion-worth of contracts with Walgreens and grocery chain Safeway that were never realized. Holmes persuaded these companies to develop testing clinics dependent on the performance of non-existent devices. The pressure to deliver on false promises cascaded into Theranos operations marred by a litany of sins: patient blood tests returned with erroneous results, illicit use of commercially available blood analyzers, lies about Theranos devices being deployed in Afghanistan, and wildly falsified profit projections. Holmes’ delusions that she was “building a religion” are unmasked by dozens of testimonies painstakingly pieced together into a searing account that elucidates her scam.
Read this book if you yearn to know more about Elizabeth, whose quirks included speaking fluent Chinese, emulating her idol Steve Jobs’ iconic black turtlenecks, obsessively poaching Apple employees, and blatantly lying to investors; or if your curiosity is piqued about Sunny, whom Carreyrou describes as a “tyrant” and “erratic man-child of limited intellect and even more limited attention span.” The two were masterful sales people who exploited Silicon Valley’s thirst for elevating a young female entrepreneur to nationwide stardom.
John Carreyrou deserves great credit for telling the story of Theranos with detail, objectivity, and wit. His focus on Elizabeth’s early life, personality, family connections, and lust for fame—as well as the company’s inner workings, Sunny’s sadistic management, and the technology’s scientific shortcomings—provide a deep understanding into what lurks at the interface between science, politics, and pride.
Carryrou’s depiction of Theranos’ company dynamics makes for juicy content: Bad Blood often reads more like fictional drama than meticulously researched journalism. In fact, the author refrains from including himself in the account until the very end, simply guiding the reader through a sinuous, unbelievable, and irresistible narrative.
The larger achievement, however, is Carreyrou’s artful creation of an overarching sense of doom caused by a crooked capitalistic culture. He drills a peephole into a world in which the ultra-wealthy throw their money at hot Silicon Valley startups in sheep-like fashion, captivated by personality and dazzling salesmanship rather than being guided by rigorous, evidence-based thinking. Holmes bewitched them with idealism instead of true innovation, charisma instead of concrete data.
Not one person on Theranos’ board knew anything about blood testing, nor did any of her investors. Money cannot wish the scientifically impossible into reality. Theranos peddled fraudulent blood test results—and inflicted devastating emotional and financial stress on innumerableinnocent patients, not to mention the anguish of the employees who were harassed so egregiously by Sunny, Elizabeth, and their lawyers that one even took his own life.
If medical professionals aspire to the nobility of purpose, the antithesis would be imposters who siphon money from powerful, albeit ignorant people and exploit human suffering in order to anoint themselves as almighty scientific saviors. Carryrou’s edifying account, assembled despite Theranos’s relentless attempts to sabotage the project, serves as a humble reminder to all of us that without patient research and persistent inquisitiveness, progress in science is not possible.
Cicely Shillingford is a Canadian scientist and outreach enthusiast with a Bachelor’s of Science in Biochemistry. She is currently pursuing her Ph.D. in Materials Chemistry at NYU. She lives in Harlem.