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Theranos Has Struggled with Blood Tests (wsj.com)
137 points by OopsCriticality on Oct 15, 2015 | hide | past | favorite | 86 comments



Here's a nice profile from the New Yorker in late 2014:

http://www.newyorker.com/magazine/2014/12/15/blood-simpler

I mean "nice" as in, a good read...it's a flattering profile of Holmes -- she comes off well, as a genuinely passionate person, and even if she had stayed in school, it sounds like she would've still made a great impact.

But the article also raises concerns that seem to be corroborated by the OP:

> Clarke argues that finger-stick blood tests aren’t reliable for clinical diagnostic tests; because the blood isn’t drawn from a vein, the sample can be contaminated by lanced capillaries or damaged tissue. Holmes strongly disagrees: “We have data that show you can get a perfect correlation between a finger stick and a venipuncture for every test that we run.” When I asked for evidence, I was sent a document by Daniel P. Edlin, Theranos’s senior product manager, titled “Select Data.” It purported to show favorable results from numerous comparison tests. I asked Edlin if the tests had been conducted by an independent third party. He replied by e-mail: “The clinical tests were conducted by a combination of Theranos and external labs,” but he wouldn’t say which ones.

Um, OK. I don't know much about this testing process...but...what trade secrets are being protected by hiding the methodology and source of the comparative test results?


I was helping a friend design a microfluidic device for platelet characterisation, and the first thing he told me was that only a vein was suitable for drawing blood for platelets. He had to take a phlebotomy course just for the blood for testing prototypes.


Like many of us, Elizabeth Holmes is smart and had a good idea to change a large industry. Unlike many of us, she has managed to convince several billionaires to make her one too, based almost solely on the strength of her idea. I don't know how much money she has personally taken off the table during her funding rounds, but for her sake I hope it's enough to last her for the rest of her life.

I don't doubt that she is sincere in wanting to build this business and take over the blood testing industry. But Theranos is looking more and more like a cautionary tale about why VC's and angels shouldn't give any Stanford dropout with little more than an idea and a dream a multi-billion dollar fictional valuation and tens or hundreds of millions of dollars in real cash to burn in the streets.


is she smart?


> Mr. Balwani replied the next day, copying in Ms. Holmes. “I am extremely irritated and frustrated by folks with no legal background taking legal positions and interpretations on these matters,” he wrote. “This must stop.”

Wow. What a terrible response to get from company leadership. It should be completely appropriate for an employee to bring a concern to the attention of leadership based on a plain-English reading of a statute or regulation. Obviously, I don't know what kind of email the person sent, but if it was something like, "A plain English interpretation suggests that we are required to ... " then the right response is to thank them for bringing it to attention, and then engage people for an appropriate review. Every time I've dealt with a legal situation in a corporate environment, the plain English reading was ballpark a correct way to understand it, with occasionally some detailed nuances for which it was important to have legal input, but which did not radically change the situation. I've never run into a case where the required action was opposite than it seemed, or anything like that, although I'm sure surprising things come up from time to time.

I understand why they might ask people to stop discussing it, on a big company email list or something like that, but bringing it to the attention of the appropriate company leader, is exactly the right thing to do. Thank them and look into it.


Without seeing the full emails, I'm hesitant to judge. The excerpt sounds reasonable, but for all we know, the subject line could've read, "WHAT WE ARE DOING IS WRONG!"...I thought company lawyers generally frown upon speculation of legal matters via email. Not necessarily to stamp out internal and genuine complaints, but because they end up being a rich source of material to be taken out of context should litigation come up...that said, Mr. Balwani probably should've kept that in mind before writing something that appears quite dickish when excerpted in an investigative news report.

The other parts of Theranos's media strategy, according to the WSJ, doesn't seem particularly friendly:

- Threatening to sue a widow whose Theranos-employed husband expressed doubts to her before killing himself.

- Going around to people who had been interviewed by the WSJ and asking them to sign statements (before the story was even published) that the WSJ had misquoted them.

- Holmes ignoring WSJ for _five months_. Then standing them up last week. The CEO is famous for being an inspirational, thoughtful speaker but can't even make time in _five months_ to give a bland statement of defense or explanation to the Wall Street Journal, on a story that strongly hints at violations of federal health regulations? It's one thing to refuse comment when a news organization ambushes you the night of the deadline -- it's inexcusable to hide for five months..._especially_ if the company isn't actually doing anything wrong.


True. Concern about legal issues is what leads one to consult counsel in the first place typically though. Counsel discourages speculation by people who aren't involved and aren't the right people to be discussing it - like they've read a news article. I haven't heard anyone discourage genuine inquiry into a specific issue they're concerned about, and that it's appropriate for them to raise. It sounds like the employee had specific knowledge about an aspect of the company's operations. The word speculation is used a lot in that context, but every piece of legal advice I've ever received (outside of impersonal training) started with me thinking: it seems like this might be a problem ... I wonder if it's really a problem or not ...

Counsel also gives training about when to ask for legal advice and how to handle privilege and confidential communication, which doesn't sound like were followed here (or maybe never provided). As you say, it could be a liability during litigation. However, the response to that could have been "I've added our legal team for input on the issue you've raised. Please don't discuss legal issues except in privileged communication with our legal team." I guess that's easier to say and do when you have inhouse counsel. -g-

I would also hope that a thread like that would be deemed to be protected by privilege if counsel were immediately added like that as part of a request for legal advice. Perhaps someone more familiar with the boundaries of privilege could comment. From what I understand though, opposing counsel are usually pretty hesitant to attempt to pierce privilege, especially if there's a tinge of legitimacy on it. E.g., random guy raises legal concern to superior, who immediately involves counsel. Opposing counsel has to actually attempt to make the case that it's not privileged communication, which they are reluctant to do in such cases (but doesn't mean it can't happen).


A critical opinion piece on Theranos from the journal Clinical Chemistry and Laboratory Medicine:

http://www.degruyter.com/view/j/cclm.2015.53.issue-7/cclm-20...


Thanks for the article, this quote hit me >> Details of the Theranos technology have not been disclosed to scientific journals and for this reason it is not possible to comment. << So they have handful of tests that are FDA approved and then their protocols or technology never went through scientific scrutiny, but the whole company is valued $9billion? This is disconcerting.


What I find disconcerting is the faith Walgreen's has put in them. To be honest, their revenue plus the partnership with Walgreen's likely justifies the valuation. It is just that Walgreen's shouldn't partner with organizations for testing that aren't on solid scientific footing.


I would hope Walgreens at least did some due diligence.


I am genuinely confused by the overall thrust of the article.

1st Theme says: Theranos doesn't use Edison (thier in house testing device) & instead use regular equipment from companies like Siemens. This is a marketing problem because the company is saying its using one device but is actually using another one.

2nd theme: lab tests from Theranos differ from generally accepted standards. How do they differ if in fact they are using the same tests as everybody else? Is it just the general variability of lab results and similar variability could be find in quest diagnostics as well?

3rd Theme: almost all people say Theranos is dramatically cheaper than competitors. How is that possible when they are using the same equipment as everybody else for most of the tests? Is it a process innovation in operations rather than from Edison/better equipment tech? Or are they just subsidizing these costs and being cheaper and possible have bad unit economics?

The are two plausible storylines that can seem to reconcile these three themes is:

Storyline 1 (Negative)- Theranos seem to be doing a process innovation rather than an underlying equipment innovation. That process innovation perhaps includes diluting blood samples 1) to meet thier marketing promise of taking less blood 2) somehow taking less blood and diluting the samples to meet the standard for traditional equipments AND still lead to cheaper operational costs that lead to lower prices. But - somehow these diluted blood samples show more than normal variability.

Storyline 2 (not so negative) Traditional lab companies are ridiculously inefficient from an operations perspective. Theranos is able to take the same equipment as everybody else but because of thier operational efficiency make the end service dramatically cheaper. The variability in tests results is kind of standard in the lab testing market.

Am I thinking about this the right way or missing any big parts?


It's really pretty simple, and rather clear from the article, that Theranos has been cheating, VW-style. They use regular equipment to get through "proficiency testing", but use the Edison machine for regular patient specimens:

From the article:

> The two types of equipment gave different results when testing for vitamin D, two thyroid hormones and prostate cancer. The gap suggested to some employees that the Edison results were off, according to the internal emails and people familiar with the findings.

> Former employees say Mr. Balwani ordered lab personnel to stop using Edison machines on any of the proficiency-testing samples and report only the results from instruments bought from other companies.

> The former employees say they did what they were told but were concerned that the instructions violated federal rules, which state that a lab must handle “proficiency testing samples…in the same manner as it tests patient specimens” and by “using the laboratory’s routine methods.”


You seem to be missing the part where former employees claim that the company skirted federal regulations by using other machines for the proficiency testing, while using the Edison machines for patient testing. The accuracy of those claims have some relevance to the kind of speculation you hope to make.


exactly, the dilution of samples needs to move to the forefront of the discussion.

Theranos:

(1) takes a much smaller amount of blood, claiming they will use the Edison machine to analyze it

(2)(a) sometimes uses the Edison machine, whose accuracy is disputed

(2)(b) sometimes dilutes the sample to test using a regular machine. The dilution moves normal concentrations outside the range of detection of the machine, so when a 10x dilution has its concentration multiplied by 10, there are huge errors, often causing misdiagnosis

When Theranos receives a proficiency test, they don't receive a small amount of blood. They receive the amount of blood a normal lab receives. These are the only samples that they can run in the manner the standard machines were designed for.

Theranos competes on costing less and taking less blood. The doubts are all around whether you can get accurate results with smaller amounts of blood from a different body part.


This seems to me to be the most premise summary of what likely happened. Startup raises a ton of money for a new model that isn't ready yet.. so they use existing machines to fake it till they figure out how to get the Edison machine to work. Not terribly dissimilar in some way from jet.com just buying goods you ordered off of other sites and paying for the difference, in hopes they can test the market, build a brand and eventually make their model work. Problem is that it isn't obvious that scale helps you reach the ultimate goal here (unless you reason that more money/longer runway = higher likelihood of success). Unfortunately for Theranos, actual lives are at stake here and there is a lot of regulation in the medical space for good reason.


> 2nd theme: lab tests from Theranos differ from generally accepted standards. How do they differ if in fact they are using the same tests as everybody else? Is it just the general variability of lab results and similar variability could be find in quest diagnostics as well?

Because Edison and the dilution procedure produce low quality results. Thus for a large number of the tests Theranos is less accurate than traditional methods.

> 3rd Theme: almost all people say Theranos is dramatically cheaper than competitors. How is that possible when they are using the same equipment as everybody else for most of the tests? Is it a process innovation in operations rather than from Edison/better equipment tech? Or are they just subsidizing these costs and being cheaper and possible have bad unit economics?

The above is possible because they are not currently focused on profit, rather market share. All that money that they have raised has had to go somewhere.


It seems more like an investor story time exercise in order to attract capital in order to acquire the companies already holding the market share.


Well if they're not using their own technology for most of their tests it isn't just a marketing problem, it's an image problem that would lead investors to believe they don't have faith in their own product. Secondly, according to the article, their protocols even when using conventional machines differ from the norm in that they are forced to dilute samples to increase sample volume because they take less blood to begin with. This is generally accepted as being a less accurate practice.


>>Theranos claims that the usual delay of testing in centralized laboratories is approximately 3 days and that they will generate and deliver their data much faster (e.g., within 4 h). The 3-day delay claim is not accurate. The bulk of laboratory testing in centralized laboratories is completed within an hour or two (calculated from time of sample collection to time of results posting for physician review). For example, in our laboratory, more than 90% of creatinine and troponin requests from all wards are completed in <1 h and more than 97% in <2 h. It is thus questionable that Theranos’s technology will be able to deliver faster results than the ones mentioned... Consequently, faster analysis will not have a major impact on patient outcomes.

http://www.degruyter.com/view/j/cclm.2015.53.issue-7/cclm-20...

This is the same kind of bullshit I see in academia, where a new technology is promised to replace an old technology that works fine, but now they have a 9 billion dollar valuation!


> This is the same kind of bullshit I see in academia, where a new technology is promised to replace an old technology that works fine, but now they have a 9 billion dollar valuation!

I am not sure it is bullshit, maybe it's just competition?

Over time, companies within an industry become complacent, cut costs, and decrease quality of service. Somebody (a young idealist perhaps?) comes along and says, hey, we can do better! And because she believes in free markets, it must be that old technology (and indeed newer technology may have marginal benefit) is the culprit, not human greed or laziness or other deadly sin. So she goes, touts, implements and there is some success. However, then the giants will wake up to the threat. They will magically find the way to be more effective, as they always could have been, and they may even grudgingly implement some parts of new technology. And so the margin for the disruptor quickly disappears, and things will return back to the normal state of affairs, where companies can lazily collect fat paychecks for doing the necessary minimum. It's actually win-win for everybody, customers get a small technology/process upgrade, and she is now in the club!

The only minor problem is that this economic model is far from being optimal, but no one really worries about that except academic economists, since no one really knows how to attain the optimal model in the human society anyway.


Theranos' area of interest, diagnostic microfluidics, is nothing exotic or new to the giants in the diagnostic industry.

I spent a number of years with one major company in this field, and back in the 1990s they already had a decade of R&D, and countless millions of dollars, invested in this area. It was a difficult area of research back then and it continues to be.

The idea that one scientist could come up with a concept to outsmart those companies is certainly possible and makes a very compelling investor story. But the reality is probably a little bit different.


>>win-win for everybody

Worst case is that their technology has a few percentage points better outcome, perhaps by selectively sampling candidates during clinical trials or combining it with an existing method, and everybody gets charged a ton more money.


The more I read about this company, Theranos, the more I get this feeling that one day I'll be reading an article in the WSJ or NYT titled "The Greatest Diagnostics Company That Never Was", or something along that line.


I completely agree. Their lack of disclosure about their technology is strange. It's been a "trade secret" for over a decade.


Seems to me like this quote from the paper is not making a fair comparison. As far as I know, the main market that Theranos is targeting is outpatient / home testing. Yes, of course central labs in a hospital setting get simple and/or common tests back within a few hours--inpatient medicine involves a higher level of illness severity and thus a higher priority on lab values. I work with one of the major outpatient laboratory companies on a daily basis and I'll tell you that their basic results are almost always back within 24 hrs and stat labs are back within three hours of the runner picking them up. In fact, probably half of our wait time is from the pick-up schedule (late in the day) and had nothing to do with these "older" technologies taking too long.

That being said, this particular lab company provides horrible customer service and our nurses probably spend more than an hour on the phone with them every week trying to troubleshoot very simple situations. For this reason, I've been hopeful about Theranos' potential to bring some meaningful competition to the market. We'll see.


I would agree from an end user POV (I have to do a set of bloods every 6-8 weeks) the delay is getting test results from lab to specialist.

Though in the UK the fractured nature of the NHS means I can't get my tests done at a hospital near work - I have to take a days leave.

I wonder if There a market for mobile blood testers who come to your work place to take the sample.


When I get blood tests done at my GP's office, they sit around until the next morning when the guy from the lab picks them up. Then they go to the lab, where they might wait in a queue until the next day. Then the tests are run, then they send the results electronically to my GP's office. It takes about three days from the time blood is drawn from me, until the time my GP makes a recommendation based on the test results, and a big part of that is because of the the remote lab testing.


I agree with your turnarounds (I mean, of course, if you don't turn around a trop in under an hour it's pretty much useless) not to mention things like the iStat machines which are used in tonnes of rural Australian hospitals for all range of blood tests, and ABG machines in every emergency department and Icu, all of which require tiny quantities of venous or even capillary blood to work


Aside from whether their technology actually works or not, the central premise that cheaper, easier and more frequent testing will improve outcomes is unproven. There are many potential downsides. It might increase health spending through extra doctor visits, the need for repeat testing and more invasive and expensive investigations. But will it actually make anyone's life better? Bear in mind that even a single, obvious test performed in a high risk population to screen for say breast cancer or ovarian cancer, either barely moves the needle in saving lives or ends up being useless. What effect does Theranos think indiscriminate widespread testing will have?

With all these competing risks, this frequent testing strategy needs to be evaluated in randomised double blind clinical trials. Before that though, Theranos needs to submit their tests for independent validation in many thousands of patients, and publish the results.

I note this single study which compared Theranos' CRP to a conventional method [1]. The Pearson correlation was 0.85, which I don't think is really good enough.

[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091290/


On the other hand you have things like blood glucose testing, which mid-twentieth century happened only in a doctor's office, when today diabetics do it several times daily. Obviously not all tests are going to be like that, and I haven't looked at the list of tests Theranos is performing, so all, some, or none of their tests might be similar.


> Aside from whether their technology actually works or not, the central premise that cheaper, easier and more frequent testing will improve outcomes is unproven. There are many potential downsides.

This is an excellent point. Nevertheless, it's very hard to convince patients, and the public, that more tests do not lead to better outcomes. Think on every time there are revisions to the recommended screening criteria for breast or prostate cancer---it's good evidence-based medicine, but there's an outcry from the public every time.

In addition to your considerations of more testing being invasive and expensive, I'd also add that overtesting can lead to interventions that present a non-minimal risk to the patient and ultimately increase M&M.


It's not necessarily bad business or bad practice to launch a company before the technology is ready, and to use a more conventional, cheaper substitute in the interim. I remember reading about a company that offered automated translation, but started out with human translators to validate the increased market size at the lowered price point. They used the validation to raise enough money to continue growing a user base at a per-unit-loss as well as develop the machine translation software to the point of marketability.


Getting blood from someone's finger will lead to incorrect results in many tests because other things diffuse into the blood. The things can lead to very inaccurate results. This is a BIG problem for Theranos.


It is conceivable that they could use software to correct for this. Is there is something they can measure that indicates the amount of dilution with interstitial fluid,there might be a way to take account of it. Similarly you'd want to correct for hemolysis


I doubt that they'd be able to correct this with software. Take for example Mineral X. A concentration higher than 1mg/ml of X in blood may indicate disease D. Imagine that the tip of the finger has a much higher percentage of X than any other body parts. In testing for D you'd get a reading that may or may not be wrong as you wouldn't know if a high concentration of X is as a result of disease D or as a result of the machine's inherent error. Your screwed both ways. Theranos should understand that it isn't just a traditional software company that can release an MVP for the public. One screw up and their reputation is tarnished for ever. Just ask Volkswagen ;)



"The sources relied on in the article today were never in a position to understand Theranos’ technology and know nothing about the processes currently employed by the company."

This is exactly the problem! Nobody has sufficient information to judge Theranos's technology outside the company, and they're asking the scientific community and public to accept their claims at face value because they've submitted some documents to the FDA.


> The sources relied on in the article today were never in a position to understand Theranos’ technology and know nothing about the processes currently employed by the company.

Note the use of the word "current". Implicitly, they're admitting that the process has changed since the time of the former employees, and they're not disputing the process described by those former employees. Which means, that at some point they indulged in rigging proficiency testing.


> The Journal even declined an opportunity to experience the technology themselves by turning down our offer to send proprietary Theranos devices to their offices so they could have a demonstration of tests conducted themselves, and compare the results to those of other testing providers.

I can't believe the reporter didn't take Theranos up on its free offer to collect his blood and analyze it for personal health information that might be useful to Theranos...er, I mean, to the reporter.


Sounds like the accuracy testing should be blind but isn't. Why not?

It seems like disclosing that a sample is a test is more likely to negatively affect the accuracy of the test than improve it. The need for double blind trials is normally well understood. This is not an experiment, but as a test it seems like it would benefit from at least single blind: lab is unaware - accuracy tests are mixed randomly into the genuine population of testing requests. Kind of like how the TSA is occasionally tested by inspectors who bring all sorts of weapons through.


How are you going to get a vial of blood into their system with precisely known characteristics, but blindly? I mean, you can draw blood just before and hope it's "basically" the same? That's not really satisfying when you're going to pass/fail the lab based on a discrepancy.


Seems only sporting to also include a link to their PR response to the WSJ article: https://www.theranos.com/news/posts/statement-from-theranos

Typical PR drivel. It's also a bit rich to complain about scientific inaccuracy, and boast of opening things up to the FDA, when the Theranos testing platform remains to be thoroughly investigated in the peer-reviewed literature.


> Theranos presented the facts to this reporter to prove the accuracy and reliability of its tests and to directly refute these false allegations, including more than 1,000 pages of statements and documents. Disappointingly, the Journal chose to publish this article without even mentioning the facts Theranos shared that disproved the many falsehoods in the article.

Then why doesn't the statement say what these facts are?

This reads more like an attack on the former employees who spoke up than a scientific rebuttal of the article. Which leads me to think even more that the article is right.


Interesting article. While the article paints a bleak picture of company operations, one item that sticks out in favor of the Company is that "Walgreens says its partnership with Theranos has gone smoothly overall."

Seems like there would a lot more complaints considering the number of tests conducted, and that the relationship would have been soured/severed if the results were not living up to Walgreen's satisfaction.


Too bad if they are undergoing troubles as I'm really hopeful they become more widely available in California. I'm using WellnessFX [0] and InsideTracker [1], but they are expensive and draw too much blood (which could be a good thing, actually).

[0] https://wwws.wellnessfx.com/

[1] https://www.insidetracker.com/


Meh..

You can resell a test so long as you follow the rules of the contract of the manufacturer and applicable CLIA and other FDA regulations. These are subject to audit etc... You should not report clinical results from tests not run in a CLIA or FDA approved way. So if a test is run on Siemens for reporting clinical results then the audit goes on that pathway. Diluting the pinprick blood to run on a test that requires larger volumes probably won't work either unless they've shown it does and that of course depends on the CLIA and/or FDA regulations around the test to prove equivalence. It seems like it won't work since the tests have specific input requirements (e.g. 100mL plasma vs 1mL). You might be able to go the other way.. but you miss the cellular and interstitial components that may add noise (e.g. potassium which cells bioaccumulate etc)..

Which other rules apply probably depends on interpretation of whether these are lab developed tests or FDA regulated and this area may require clarification etc... which will depend test to test etc...

Otherwise it sounds like they may have calibration issues which are normal. Outliers happen all the time. If the technology doesn't have some fundamental limit of detection based on the sample volume then they just need to keep iterating. Or the components of blood from the pin prick differ significantly from blood taken from the vein. The data may just be noisy. What that noise level is matters in terms of the detection limits. It is probably too early to tell. Internally they will be tracking this and trying to figure it out.

So this article seems like click bait, but what do I know.


Is Theranos pulling a Volkswagen?


To bypass the paywall you can search for the title in Google, or click here: http://lmgtfy.com/?q=Hot+Startup+Theranos+Has+Struggled+With...


did not seem to work


I believe parts are a scam and parts are good The pathology diagnostics field is ripe for disruption with easy access and visible pricing and even if they do this well they will probably disrupt the big players. In terms of new technology I very much doubt they have anything substantial.



Sounds like this is a problem with the testing authorities as well. Instead of sending them full blood samples taken from veins by a trained nurse, they should have sent them finger pricks done at Walgreens.


Article is behind a paywall.



In startup-world, this is known as "faking it until you make it." Well done Theranos, keep at it!


Or "doing things that don't scale." Holmes and her hucksterism would have been a great fit for YC!


>Well done Theranos, keep at it!

Really? What if your family member died because of inaccuracy of Theranos' results? Would you still cheer for them?

This whole article is extremely damning. Some stuff just makes your head spin:

>Carmen Washington, a nurse who worked at a clinic owned by Walgreens in Phoenix, says she began to question Theranos’s accuracy after seeing abnormal results in potassium and thyroid tests.

>She says she raised her concerns with the drugstore operator and Theranos’s lab director, asking for data to show that the company’s finger-prick testing procedures produced results as accurate as blood drawn from a vein.

>“They were never able to produce them,” she says. Ms. King says the company did show detailed testing-accuracy data to the nurse.

Anyway, if you ever need any tests done, stay away from Theranos.


I thought the 'well done' was ironic.


Sarcastic, even.


Needless to say, that kind of strategy works for tech and apps, but not when people's lives are potentially at stake.


Depends on what you mean by "make it". Banks quite often convince people to by into funds they know won't perform. They "make it" in terms of fees, but I don't find it very admirable.


>Banks quite often convince people to by into funds they know won't perform

Please provide an example where a bank "convinced" people to buy something it "knew" wouldn't perform. That would be fraud. I'm sure it occurs, but certainly not "quite often".

And, no, Goldman Sachs going short securities it sold as a market-maker isn't an example of such.


Sarcasm is a lost art.


Obligatory click-through-Google URL:

https://www.google.com/search?q=Theranos+Has+Struggled+With+...

edit:

I had known about Theranos mostly for being a highly valued startup by a young college dropout involving something in the medical field...I assumed it was more related to the scientific research side...but in the article it says it's been offering tests to the public since 2013 (and that that appears to be the main potential source of revenue)...has anyone's doctor suggested the tests to them? It looks like they have a couple testing centers in Palo Alto but my general physician has never mentioned the option to me.


I have a friend in Phoenix who has used Theranos's testing system a few times, and he has been delighted by their service.


Is he able to properly evaluate the accuracy of those results?


This is what the results look like:

http://padlet.com/dpetersen/khmmi11wy8hz http://padlet.com/dpetersen/r6dg1vbxmz92

I don't know how an individual could evaluate the accuracy of these results, but the same goes for a non-Theranos blood test as well.


Anecdata: I'm a physician, and get tests done for myself and my family at the Theranos place in Palo Alto, for around $5/test (vs $50 for other labs), and I have no concern about the accuracy of the tests. This abstract discusses some of the possible reasons for variation in test results: http://www.ncbi.nlm.nih.gov/pubmed/10887452 Of course, none of this proves that the tests are reliable (consistent) and accurate, just that there are several explanations for unexpected and unrepeatable values in a given patient.


Do you know if anyone can get their blood tested or do you need an doctor's order? Their prices seem quick cheap and it would be nice to get some periodic readings for my chronic health problems.


New Arizona Law Allows Lab Tests Without Doctor's Order: http://kjzz.org/content/161108/new-arizona-law-allows-lab-te...

As far as I know, Theranos is in two places: Palo Alto and Arizona. It seems like Arizona is passing laws to allow testing without a doctor's order. California, you still need one.


I think you still need a doctor's order in california, and there is effectively only one theranos testing center place open to the public in California (I think the one in the Theranos building is for staff only). One of their staff told me they were focussing on Arizona instead of California because the regulation in California increased the time and cost there.

If you are anywhere near Palo Alto and want to get some tests done, just message me, we'll sort something out :)


Is your friend doing okay?

First link shows Vitamin D is very low and should be affecting your friends energy levels at the very least. Second link shows a 1500%(!) increase in AST in under a year and its way over limit.

One way to evaluate the accuracy is the sniff test, e.g. is the lab result congruent with how the person feels? Information on the internet around understanding your medical tests is pretty crappy unfortunately, but you can usually get to understand whether symptoms match. And if you have a doctor that gives you the time of day and helps you understand it, even more so. Your friend's AST result raises a question of whether there is an accuracy issue and should be investigated.

From WebMD [0] --

> High levels of AST may be caused by:

> * Liver damage from conditions such as hepatitis or cirrhosis.

> * A heart attack or heart failure.

> * Many medicines, such as statins, antibiotics, chemotherapy, aspirin, narcotics, and barbiturates.

> * High doses of vitamin A.

> * Kidney or lung damage.

> * Mononucleosis.

> * Some types of cancer.

> Many different conditions can raise AST blood levels, so other testing is usually needed to interpret an abnormal AST result.

[0] http://www.webmd.com/digestive-disorders/aspartate-aminotran...


Thanks for asking. He is doing fine.

His doctor thinks the high test may have been a result of hard work he was doing with a personal trainer, after a few years of not working out.

He had AST/ALT tested again a few weeks later, also with Theranos, and it was down dramatically (though still above reference range).

It does sounds like he could have been be a victim of their accuracy problems.


Side note: Did anyone else find the writing for this article absolutely horrendous?

     “They were never able to produce them,” she says. 
      Ms. King says the company did show detailed 
      testing-accuracy data to the nurse.
I would have flunked freshman-english if I wrote papers like this. There was zero effort to link thoughts together all-throughout the piece. I thought the point of a pay-wall was to promote and support good content?


I'm missing something. What's hard to follow here? I mean, it's not Hemingway, but the previous paragraphs describe the difficulty of the situation, in which Theranos -- according to the WSJ -- asked its employees to recant their statements to the WSJ (pre-publication).

In the part that you excerpt, the WSJ reports the nurse saying that the company failed to produce data that would prove the accuracy of the test. The company (Ms. King) says that it did produce the data.

...How would you word that and the surrounding paragraphs?


I didn't say the subject was bad, I said the writing sucked.

The excerpt I quoted was isolated like a paragraph, but I don't remember a paragraph being 2 poorly written sentences.

How would I have worded it? For one I would have presented one side of the entire story, and then an opposing view-point (i.e. the view point of Theranos execs), instead of "person a said x. person y said x'".

I guess I'm sorry I'd prefer writing hidden behind a pay wall to be a little more elegant than what an 8 year old could write.


You're quoting out of context. The "she" in the quote is not Ms. King, which is very clear in the article.


It's also pretty clear without context that those two sentences only make any sense if "she" is not Ms. King.


Uh, I understood what they were trying to say, I'm stating that they were shitty at actually saying it.

If someone expects me to shell out a subscription for their articles, the absolute least they should do is make sure the writing is above a 5th grade level.


I found it to be consistent with most similar pieces. Also, the author has won a Pulitzer for investigative journalism.


Ha, I guess if you have to appeal to authority, go big or go home!


It was so snarky. Every paragraph was more damning than the last.


No fan of this bizarre Illuminati-backed startup, but this article reads like a well funded hedge fund hit piece. Maybe some players shorting OTC contracts on their stock? The biotech industry is heavily manipulated so if they're facing this kind of opposition, maybe it really does make sense to have guys like Henry Kissinger on the board ...


They're not publicly traded.


Illuminati??




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