These highlights are from the Kindle version of Bad Blood: Secrets and Lies in a Silicon Valley Startup by John Carreyrou.
Elizabeth had asked him to put together some financial projections she could show investors. The first set of numbers he’d come up with hadn’t been to her liking, so he’d revised them upward. He was a little uncomfortable with the revised numbers, but he figured they were in the realm of the plausible if the company executed perfectly. Besides, the venture capitalists startups courted for funding knew that startup founders overstated these forecasts. It was part of the game. VCs even had a term for it: the hockey-stick forecast. It showed revenue stagnating for a few years and then magically shooting up in a straight line.
Elizabeth incorporated the company as Real-Time Cures, which an unfortunate typo turned into “Real-Time Curses” on early employees’ paychecks. She later changed the name to Theranos, a combination of the words “therapy” and “diagnosis.”
In a twenty-six-page document she used to recruit investors, she described an adhesive patch that would draw blood painlessly through the skin using microneedles. The TheraPatch, as the document called it, would contain a microchip sensing system that would analyze the blood and make “a process control decision” about how much of a drug to deliver.
As the money flowed in, it became apparent to Shaunak that a little patch that could do all the things Elizabeth wanted it to do bordered on science fiction. It might be theoretically possible, just like manned flights to Mars were theoretically possible. But the devil was in the details. In an attempt to make the patch concept more feasible, they pared it down to just the diagnostic part, but even that was incredibly challenging.
The chemistry work was handled by a separate group made up of biochemists. The collaboration between that group and Ed’s group was far from optimal. Both reported up to Elizabeth but weren’t encouraged to communicate with each other. Elizabeth liked to keep information compartmentalized so that only she had the full picture of the system’s development.
Ed was working late one evening when Elizabeth came by his workspace. She was frustrated with the pace of their progress and wanted to run the engineering department twenty-four hours a day, seven days a week, to accelerate development. Ed thought that was a terrible idea. His team was working long hours as it was.
Ed pushed back against Elizabeth’s proposal. Even if he instituted shifts, a round-the-clock schedule would make his engineers burn out, he told her. “I don’t care. We can change people in and out,” she responded. “The company is all that matters.”
One of the assistants kept track of when employees arrived and when they left so that Elizabeth knew exactly how many hours everyone put in. To entice people into working longer days, she had dinner catered every evening. The food often didn’t arrive until eight or eight thirty, which meant that the earliest you got out of the office was ten.
During his last couple of weeks at Theranos, what Matt had seen happen to numerous other employees started happening to him. Elizabeth wouldn’t speak to him anymore or even look at him. She offered one of his IT colleagues, Ed Ruiz, his position if Ed agreed to dig through Matt’s files and emails. But Ed was good friends with Matt and refused.
After some discussion, the four men reached a consensus: they would remove Elizabeth as CEO. She had proven herself too young and inexperienced for the job. Tom Brodeen would step in to lead the company for a temporary period until a more permanent replacement could be found. They called in Elizabeth to confront her with what they had learned and inform her of their decision. But then something extraordinary happened. Over the course of the next two hours, Elizabeth convinced them to change their minds.
Aaron felt someone needed to tell Elizabeth to pump the brakes and to stop pushing to commercialize a product that they were still trying to get to work. But for her to listen, the message had to come from one of the three senior managers—Tim, Gary, or Tony—and none of them were willing to tell her.
When she reported for her new job a few days later, Chelsea learned that she wasn’t the only friend Elizabeth had hired. Just a week earlier, Ramesh “Sunny” Balwani had come on board as a senior Theranos executive. Chelsea had met Sunny once or twice but didn’t know him well. She just knew he was Elizabeth’s boyfriend and that they were living together in an apartment in Palo Alto.
Tax troubles aside, Sunny was proud of his wealth and liked to broadcast it with his cars. He drove a black Lamborghini Gallardo and a black Porsche 911. Both had vanity license plates. The one on the Porsche read “DAZKPTL” in mock reference to Karl Marx’s treatise on capitalism. The Lamborghini’s plate was “VDIVICI,” a play on the phrase “Veni, vidi, vici” (“I came, I saw, I conquered”), which Julius Caesar used to describe his quick and decisive victory at the Battle of Zela in a letter to the Roman Senate.
Sunny’s expertise was software and that was where he was supposed to add value at Theranos. In one of the first company meetings he attended, he bragged that he’d written a million lines of code. Some employees thought that was preposterous. Sunny had worked at Microsoft, where teams of software engineers had written the Windows operating system at the rate of one thousand lines of code per year of development. Even if you assumed Sunny was twenty times faster than the Windows developers, it would still have taken him fifty years to do what he claimed.
When Elizabeth pitched pharmaceutical executives now, she told them that Theranos could forecast how patients would react to the drugs they were taking. Patients’ test results would be input into a proprietary computer program the company had developed. As more results got fed into the program, its ability to predict how markers in the blood were likely to change during treatment would become better and better, she said.
Gary Frenzel and some of the other Theranos scientists had told her that the best way to diagnose H1N1, as the swine flu virus was called, was with a nasal swab and that testing for it in blood was of questionable utility. She’d raised this point with Elizabeth before leaving, but Elizabeth had brushed it off. “Don’t listen to them,” she’d said of the scientists. “They’re always complaining.”
Sunny was also traveling to Thailand to set up another swine flu testing outpost. The epidemic had spread to Asia, and the country was one of the region’s hardest hit with tens of thousands of cases and more than two hundred deaths. But unlike in Mexico, it wasn’t clear that Theranos’s activities in Thailand were sanctioned by local authorities. Rumors were circulating among employees that Sunny’s connections there were shady and that he was paying bribes to obtain blood samples from infected patients. When a colleague of Chelsea’s in the client solutions group named Stefan Hristu quit immediately upon returning from a trip to Thailand with Sunny in January 2010, many took it to mean the rumors were true. Chelsea was back from Mexico by then and the Thailand gossip spooked her. She knew there was an anti-bribery law called the Foreign Corrupt Practices Act. Violating it was a felony that could result in prison time.
Working himself into a fury, Sunny yelled that he was doing everyone a favor by volunteering his time to the company and people should be a little more appreciative. “I’ve made enough money to look after my family for seven generations. I don’t need to be here!” he screamed in Tony’s face. Tony roared back in his Irish brogue, “I don’t have a cent and I don’t need to be here either!”
By February 2010, after six months on the job, Chelsea had lost all her enthusiasm for working at Theranos and was thinking of quitting. She hated Sunny. The Mexico and Thailand projects seemed to be losing steam as the swine flu pandemic subsided. The company was lurching from one ill-conceived initiative to another like a child with attention deficit disorder.
She offered to stay on for a transition period, but Elizabeth and Sunny didn’t want her to. If Chelsea was leaving, better she do so right away, they told her. They asked her not to say anything to the three employees who reported to her on her way out. Chelsea protested. It didn’t feel right to flee like a thief in the middle of the night. But Sunny and Elizabeth were firm: she was not to speak to them.
To rescue the economy, the Federal Reserve had slashed rates to close to zero, making traditional investments like bonds unattractive and sending investors searching for higher returns elsewhere. One of the places they turned to was Silicon Valley. Suddenly, the managers of East Coast hedge funds that normally invested only in publicly traded stocks were making the pilgrimage West in search of promising new opportunities in the private startup world.
Elizabeth wasn’t willing to show them the lab yet, he said. Instead, Sunny showed the Walgreens team his office. There was a sleeping bag on the floor behind his desk, his bathroom had a shower in it, and he kept a change of clothes on hand. He worked such long hours that on many nights he crashed at the office, he proudly told the visitors.
Hunter’s plan had been to have Theranos test his and Dr. J’s blood, then get retested at Stanford Hospital that evening and compare the results. He’d even arranged for a pathologist to be on standby at the hospital to write the order and draw their blood. But Elizabeth claimed she’d been given too little notice even though he’d made the request two weeks ago.
The first commercial spectrophotometer was developed in 1941 by the American chemist Arnold Beckman, founder of the lab equipment maker Beckman Coulter. It works by beaming rays of colored light through a blood sample and measuring how much of the light the sample absorbs. The concentration of a molecule in the blood is then inferred from the level of light absorption. Spectrophotometers are used to measure substances like cholesterol, glucose, and hemoglobin. Cytometry, a way of counting blood cells, was invented in the nineteenth century. It’s used to diagnose anemia and blood cancers, among other disorders.
Greg was in the midst of a breakup with the girl he’d dated in L.A., so he came to the office on Saturdays to get his mind off it. He could see that Elizabeth really appreciated that. She saw it as a sign of loyalty and dedication. She told Greg she wanted to see Kent come in on weekends too; it bothered her that his friend didn’t. Keeping a work-life balance seemed a foreign concept to her. She was at work all the time.
When Greg thought about it, there was a certain logic to her act: Silicon Valley was overwhelmingly a man’s world. The VCs were all male and he couldn’t think of any prominent female startup founder. At some point, she must have decided the deep voice was necessary to get people’s attention and be taken seriously.
The Frat Pack endeared itself to Sunny and Elizabeth by working long days. Sunny was constantly questioning employees’ commitment to the company—the number of hours a person put in at the office, whether he or she was doing productive work or not, was his ultimate gauge of that commitment. At times, he would sit in the big glass conference room and stare out at the rows of cubicles trying to identify who was slacking off.
Would you rather be smart and poor or dumb and rich? The three engineers all chose smart and poor, while the Frat Pack voted unanimously for dumb and rich. Greg was struck by how clearly the line was drawn between the two groups. They were all in their mid-to late twenties with good educations, but they valued different things.
A month or two after Jobs’s death, some of Greg’s colleagues in the engineering department began to notice that Elizabeth was borrowing behaviors and management techniques described in Walter Isaacson’s biography of the late Apple founder. They were all reading the book too and could pinpoint which chapter she was on based on which period of Jobs’s career she was impersonating.
Elizabeth expected her employees to give their all to Theranos, especially ones like Kent whom she entrusted with big responsibilities. Not only had Kent not given his all, he’d devoted part of his time and energy to another engineering project. It explained why he hadn’t been coming in on weekends like she wanted him to. As she saw it, Kent had betrayed her. In the end, a fragile compromise was reached: Kent would go on a leave of absence to give his bicycle-light venture a shot. When he was done indulging his pet project, they’d have a conversation about whether, and under what conditions, he could return.
The occasion was the company’s annual Christmas party. As employees sipped drinks from an open bar inside the winery’s main building before sitting down to dinner, Elizabeth gave a speech. “The miniLab is the most important thing humanity has ever built. If you don’t believe this is the case, you should leave now,” she declared, scanning her audience with a dead serious look on her face. “Everyone needs to work as hard as humanly possible to deliver it.”
Sunny acted put-off whenever Safeway executives asked for status updates, as if his time was too precious to waste and they had no idea what it took to produce an innovation of this magnitude. His arrogance was infuriating. And yet Safeway was still hesitant to walk away from the partnership. What if the Theranos technology did turn out to be game-changing? It might spend the next decade regretting passing up on it. The fear of missing out was a powerful deterrent.
Theranos’s strategy, which envisioned bypassing the FDA altogether, was a nonstarter, he warned Elizabeth, especially if she planned to roll out her devices nationwide by the following spring, as she had asserted to him. There was no way the agency would allow her to do that without going through its review process, he told her. Elizabeth disagreed forcefully, citing advice Theranos had received from its lawyers. She was so defensive and obstinate that Shoemaker quickly realized that prolonging the argument would be a waste of time. She clearly didn’t want to hear anything that contradicted her point of view. As he looked around the table, he noted that she had brought no regulatory affairs expert to the meeting. He suspected the company didn’t even employ one. If he was right about that, it was an incredibly naïve way of operating. Health care was the most highly regulated industry in the country and for good reason: the lives of patients were at stake.
Tony Nugent became upset that nothing was done to honor his late colleague’s memory. He and Ian hadn’t been close. In fact, they had fought like cats and dogs at times during the Edison’s development. But he was bothered by the lack of empathy being shown toward someone who had contributed nearly a decade of his life to the company. It was as if working at Theranos was gradually stripping them all of their humanity.
The upstairs room was the CLIA-certified part of the lab, the one Alan was responsible for. Sunny and Elizabeth viewed its conventional machines as dinosaurs that would soon be rendered extinct by Theranos’s revolutionary technology, so they called it “Jurassic Park.” They called the downstairs room “Normandy” in reference to the D-day landings during World War II. The proprietary Theranos devices it contained would take the lab industry by storm, like the Allied troops who braved hails of machine-gun fire on Normandy’s beaches to liberate Europe from Nazi occupation.
Why not wait until the 4S was ready? Why rush to launch now? she asked. “Because when I promise something to a customer, I deliver,” Elizabeth replied. That response made no sense to Anjali. Walgreens was just a business partner. Theranos’s ultimate customers would be the patients who came to Walgreens stores and ordered its blood tests thinking they could rely on them to make medical decisions. Those were the customers Elizabeth should be worrying about.
Still visibly angry, Elizabeth told the gathered employees that she was building a religion. If there were any among them who didn’t believe, they should leave. Sunny put it more bluntly: anyone not prepared to show complete devotion and unmitigated loyalty to the company should “get the fuck out.”
In an article published on the technology news website TechCrunch on November 2, 2013, a venture capitalist named Aileen Lee wrote about the proliferation of startups valued at $1 billion or more. She called them “unicorns.” Despite their moniker, these tech unicorns were no myth: by Lee’s count, there were thirty-nine of them—a number that would soon soar past one hundred. Instead of rushing to the stock market like their dot-com predecessors had in the late 1990s, the unicorns were able to raise staggering amounts of money privately and thus avoid the close scrutiny that came with going public.
Sunny and Elizabeth’s boldest claim was that the Theranos system was capable of running seventy different blood tests simultaneously on a single finger-stick sample and that it would soon be able to run even more. The ability to perform so many tests on just a drop or two of blood was something of a Holy Grail in the field of microfluidics.
When a blood sample would be tested on an analyzer made by the Italian company DiaSorin, it might show a vitamin D concentration of 20 nanograms per milliliter, which was considered adequate for a healthy patient. But when Erika tested the same sample on the Edison, the result would be 10 or 12 nanograms per milliliter—a value that signified a vitamin D deficiency. The Edison’s vitamin D test was nonetheless cleared for use in the clinical lab on live patient samples, as were two Edison thyroid hormone tests and a test to measure PSA, the prostate cancer marker.
Under the protocol Sunny and Daniel had established, the way Theranos generated a result from the Edisons was unorthodox to say the least. First, the little finger-stick samples were diluted with the Tecan liquid handler and split into three parts. Then the three diluted parts were tested on three different Edisons. Each device had two pipette tips that dropped down into the diluted blood, generating two values. So together, the three devices produced six values. The final result was obtained by taking the median of those six values.
Mattis went out of his way to praise her integrity. “She has probably one of the most mature and well-honed sense of ethics—personal ethics, managerial ethics, business ethics, medical ethics that I’ve ever heard articulated,” the retired general gushed.
WHEN PARLOFF’S COVER STORY was published in the June 12, 2014, issue of Fortune, it vaulted Elizabeth to instant stardom. Her Journal interview had gotten some notice and there had also been a piece in Wired, but there was nothing like a magazine cover to grab people’s attention. Especially when that cover featured an attractive young woman wearing a black turtleneck, dark mascara around her piercing blue eyes, and bright red lipstick next to the catchy headline “THIS CEO IS OUT FOR BLOOD.”
As much as she courted the attention, Elizabeth’s sudden fame wasn’t entirely her doing. Her emergence tapped into the public’s hunger to see a female entrepreneur break through in a technology world dominated by men. Women like Yahoo’s Marissa Mayer and Facebook’s Sheryl Sandberg had achieved a measure of renown in Silicon Valley, but they hadn’t created their own companies from scratch. In Elizabeth Holmes, the Valley had its first female billionaire tech founder.
She was the company’s most powerful marketing tool. Her story was intoxicating. Everyone wanted to believe in it, including the numerous young girls who were sending her letters and emails.
Before he became a full-time employee, Elizabeth had hung inspirational quotes in little frames around the old Facebook building. One of them was from Michael Jordan: “I’ve missed more than 9,000 shots in my career. I’ve lost almost 300 games. 26 times, I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed.”
By using its proprietary devices only within the walls of its own laboratory and not seeking to commercialize them, it was able to continue to avoid close FDA scrutiny. At the same time, it gave the appearance of cooperating with the agency by publicly supporting its drive to regulate laboratory-developed tests and voluntarily submitting some of its own LDTs, like the herpes test, to it for approval.
My source said it was hard for the agency to take any adverse action against a company that portrayed itself as the lab world’s biggest advocate of FDA regulation, especially one as politically connected as Theranos. At first, I thought he was referring to its board of directors, but that was the least of his concerns. He pointed out how chummy Holmes had gotten with the Obama administration. He had seen her at the launch of the president’s precision medicine initiative earlier in the year, one of several White House appearances she’d made in recent months.
Balwani had tasked a Theranos software engineer named Michael Craig to write an application for the miniLab’s software that masked test malfunctions. When something went wrong inside the machine, the app kicked in and prevented an error message from appearing on the digital display. Instead, the screen showed the test’s progress slowing to a crawl.
Negative Glassdoor reviews about the company weren’t unusual. Balwani made sure they were balanced out by a steady flow of fake positive reviews he ordered members of the HR department to write.
Holmes and Balwani wanted to impress the vice president with a vision of a cutting-edge, completely automated laboratory. So instead of showing him the actual lab, they created a fake one.
Why had Holmes always been so secretive about her technology? Why had she never recruited a board member with even basic knowledge of blood science? And why hadn’t a single venture capital firm with expertise in health care put money into the company? For these observers, the story confirmed what they’d quietly suspected.
Like her idol Steve Jobs, she emitted a reality distortion field that forced people to momentarily suspend disbelief.
On March 14, 2018, the Securities and Exchange Commission charged Theranos, Holmes, and Balwani with conducting “an elaborate, years-long fraud.” To resolve the agency’s civil charges, Holmes was forced to relinquish her voting control over the company, give back a big chunk of her stock, and pay a $500,000 penalty. She also agreed to be barred from being an officer or director in a public company for ten years. Unable to reach a settlement with Balwani, the SEC sued him in federal court in California.
Many companies in Silicon Valley make their employees sign nondisclosure agreements, but at Theranos the obsession with secrecy reached a whole different level. Employees were prohibited from putting “Theranos” on their LinkedIn profiles. Instead, they were told to write that they worked for a “private biotechnology company.”
Balwani routinely monitored employees’ emails and internet browser history. He also prohibited the use of Google Chrome on the theory that Google could use the web browser to spy on Theranos’s R&D.
In the part of the clinical lab dubbed “Normandy,” partitions were erected around the Edisons so that Siemens technicians wouldn’t be able to see them when they came to service the German manufacturer’s machines. The partitions turned the room into a maze and blocked egress. The lab’s windows were tinted, which made it nearly impossible to see in from the outside, but the company still taped sheets of opaque plastic to the inside.
As for surveillance cameras, they were everywhere. They were the kind with dark blue dome covers that kept you guessing about which way the lens was directed. All of this was ostensibly to protect trade secrets, but it’s now clear that it was also a way for Holmes to cover up her lies about the state of Theranos’s technology.
Holmes knew exactly what she was doing and she was firmly in control. When one former employee interviewed for a job at Theranos in the summer of 2011, he asked Holmes about the role of the company’s board. She took offense at the question. “The board is just a placeholder,” he recalls her saying. “I make all the decisions here.” Her annoyance was so palpable that he thought he’d blown the interview. Two years later, Holmes made sure that the board would never be more than a placeholder. In December 2013, she forced through a resolution that assigned one hundred votes to every share she owned, giving her 99.7 percent of the voting rights. From that point on, the Theranos board couldn’t even reach a quorum without Holmes. When he was later questioned about board deliberations in a deposition, George Shultz said, “We never took any votes at Theranos. It was pointless. Elizabeth was going to decide whatever she decided.” This helps explain why the board never hired a law firm to conduct an independent investigation of what happened.