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    • Yes and it's an INCREDIBLE book!! I have also listened to a few interviews with the author. Oh my God, how he managed to track this info down is an amazing story. I'd love to tell some juicy tidbits here but spoilers. I don't ever remember seeing a book get reviews like this on Amazon.

      One thing I wonder about is what causes entrepreneurs to go over the top like this? Elizabeth is young and she could get prison for life. I think she must have been under incredible pressure and just couldn't bear to believe they couldn't make it work.

      I personally worked in two companies—Pixar and NeXT—which were obviously failing with no way out and Steve Jobs would say anything to keep them alive. The pressure on him was unreal and he just couldn't bring himself to face reality that they were doomed.

    • She did, but I was wary of them. They weren't technical in Elizabeth's field of blood testing, most were not technical at all. The vision was incredibly compelling but pulling all those tests off with so little blood... I think that would have been a yellow flag for someone who knew that stuff.

      I was once an earth scientist and damn some of the tests on oil, contaminated water, etc., were hard.

    • I enjoyed reading this book a great deal, but was saddened to see what finally devleoped.

      I did wonder why no one seemed to be willing to state to Elizabeth that blood delivered from a finger stick is not venous blood, but blood with extra-cellular fluid and intra-cellular fluid all mixed together in a variable mix, such that there is no way that they will reliably correlate with venous blood - at least for quanitative Na, K, Cl levels or even hematocrit levels. Also that no one on the board ever really asked if finger stick blood is a reliable substitute for venous blood. That was just glibly assumed, something no clinical pathologist would have agreed to.

      I liked the pathologist - Timothy Hamill MD - who said he would more likely believe someone had returned to the present time from the 27th century, than finger stick blood results would match venous blood results.

      As a retired physician - in a previous life - one of the things all doctors learn about lab results, is to never believe them if they seem unbelieveable. If the blood results tell you the patient sitting calmly in front of you answering questions, without distress, should be dead or at least very very ill - the lab results are unbelieveable - not in error, they are not believable in the truest sense, since you are talking the patient. They need to be repeated, preferably by another lab or a different test technique. Positive and negative lab errors carry grave risks for doctors and patients, alike.
      Labs do make errors from time to time and all physicians know this in their bones - but if a lab is frequently in error, physicians will simply not use it at all. Untrustworthy numbers are far more dangerous than no numbers at all.

      Which is what the author finally found out when he began to talk to some of the physcians in Arizona late in the book - they had already quit using Theranos because the reslts were not believable.

      The legal profession really did itself proud in this story too, didn't it?

    • Thanks for the medical insight. I just finished a fiction adventure novel, so, now I am jumping into this book. It sounds like it has the same mystery and intrigue as a Robin Cook fiction but real life.

    • Jim -- I was interested in your observation about how physicians interpret lab results and have an anecdote to share that supports what you said. In one of my prior lives, I was in charge of clinical computing at a major academic medical center. In the course of upgrading our lab results reporting system we realized that for at least a decade, we were displaying the wrong unit of measurement for blood glucose. Taken literally, the result was off by three orders of magnitude, which as you said, meant that the patient should have been dead. Now the interesting thing is that despite the hundreds of thousands of times this error appeared, it was never once reported. The physicians were mentally converting what they saw to the correct order of magnitude without even being aware of it.

      I worked with Tim for a while, so I guess that means I'm going to have to read this book.

    • Makes me think that the word was passed from the lab's human clinical director that the lab results were labled incorrectly with the wrong units - but that the actual numerical results were verified to be correct - even physicians know that computers can make collossal mistakes if programmed in error, and that getting errors in programming corrected can be costly and quite time consuming.

      Whenever test results seem unusual, the first thing a good clinician does is to discuss the unusual test result with the lab's human director, just like an unusual X-Ray gets a face to face consult with the human radiologist who read the film.

      This may have been the case for a long time in the hospital you mentioned, but was fully discussed, known, and understood by the medical staff, who were reassured that the human lab director was aware of the "issue". I would bet that the lab director discussed this with the hospital staff at a medical staff meeting.

      But I'll bet back in the beginning, somewhere a physician chatted with or called the lab's clinical director and asked what the heck was going on, and were assured that the clinical director had real faith in the accuracy of the reported numbers, even if the computer was reporting them with the incorrect units.

      I can't tell you how many times I have been reassured by IT folks that they system will work quickly, accurately, without errors, because computers are so much more accurate than people.

      I even believe this ( I am writing this on a computer after all ) - but folks writing and selling medical software are not computers, and vastly overstate the capability of their systems they are hawking - DAMHIK but I have been involved in the purchase of at least half a dozen different "better" medical records systems and they are still not near perfect.

      While I, and every other physican I know undertands the theoretical advantages of an electronic medical record, most of them fall short of the promise, and make physicians spend their day looking at a computer monitor, rather than at a patient - and the answers to most diagnostic questions are in the patient, not the record.

      I remember when I was an intern, many years ago, and responsible for screening dental patients who were scheduled for general anasthesia the following morning for major dental work. When I walked into the room it was obvious, just by looking at the patient, that they suffered from severe hyperthyroidism - an important reason to defer elective general anesthesia - the labs were said to be "normal" - but her pulse was 140+ resting in bed, she had been losing weight for 6 weeks ( her dentist thought due to bad teeth ) and her skin was very dry, fragile, and her hair was thin and dry, and her tendon reflexes were very exaggerated. I cancelled her procedure until an internist saw her, despite the "normal" labs.

      The book is about how an individual was unable, or unwilling to seperate fantasy from fact, and promoted a fantasy despite the FACT that the equipment she was selling did not, and would not work. She was able to convince hundreds of very smart, able, people that her fantasy was true. She had the reality distortion field that Jobs had, apparently. But almost all of the people she convinced of her fantasy, were not practicising clinical physicians.

      On a different note, I just finished reading https://www.cake.co/conversations/pc0WBTh/book-recommendations-yuval-noah-harari - I suspect you might enjoy it as well, Richard.

    • Thanks, Jim. I've listened to him speak a few times now, and he's on my reading list. But I've started Bad Blood and want to finish it first.

      You may be right about it being common knowledge or even part of the new physician orientation that the units were off (it was either the incorrect presence or absence of an 'm' (milli) prefix, I don't recall which), but since the actual digits were accurate (and the abnormal flags were not affected), I think it's possible that it simply wasn't noticed. We worked closely with the lab director and it was literally a ten second fix once we noticed--oddly it was a programmer who spotted it, not one of the docs. We did discuss it with one of our physician advisors though. He used it as an example of the role of information redundancy in medical decision making, and was more amused than concerned.

    • Well, I am on page 139 and....omg.....This is like Breaking Bad but in real life. The volume of firings are amazing....But, similar to Breaking Bad....one lie turns into a deeper lie which turns into a deeper lie....The amount of talent that was disposed of like stale bread.....hard to put this book down.

    • Just finished reading it. Chris asked earlier:

      One thing I wonder about is what causes entrepreneurs to go over the top
      like this? Elizabeth is young and she could get prison for life. I
      think she must have been under incredible pressure and just couldn't
      bear to believe they couldn't make it work.

      I think you're being too compassionate. Although the word didn't appear till the last page of the book, I kept thinking sociopath the whole time. I see nothing in this account that suggests that she started out idealistic only to succumb to pressure later. Other than not liking needles, her behavior showed a total disregard for the well-being of her employees, investors and customers. She should go to jail. The only uplifting part of this tale is the number of people who were unwilling to go along.

    • Just finished. Great. If they made it into a movie the two primary villians regain their Unicorn status. Even though no one died from the faulty testing, I hope that pending litigation can somehow invoke a parallel to attempted murder. Tyler Shultz was my hero. Totally maintained his personal integrity despite the angst he felt knowing his aging grandfather could have had his entire professional career sullied by his blind crush on Holmes.

    • They are making a movie and Jennifer Lawrence is playing Elizabeth Holmes!

      Tim Draper, the venture capitalist, still maintains that it was legit and Holmes simply got stalked a bullied by a reporter.

    • Dunno, but it seems like the science was fundamentally flawed from the outset. She may not have understood that, but should have been asking people who knew.

    • I am certain somebody somewhere must have told her along the way - but it wasn't what she wanted/needed to hear. She really tried to compell employees to create/devise a system that would work, but when they could not, she tried to fake it, just the same.

      Trying to achieve reliable, accurate lab tests with small amounts of blood that don't require needles is comendable. I applaud that attempt as most people would.

      Lying about the ability and accuracy of lab tests is immoral, felonious, and deplorable. Lying to investors about how you are actually doing lab tests, versus how you are pretending to do lab tests, is criminal. Actively reporting lab test results known not to be reliable, is also criminal.

      As I said earlier, good clinicians would rather have no lab tests, than inaccurate unreliable lab tests. False positives or false negatives can cause real grievous harm - people can die. At least with no lab results, the clinician is aware of the limitations of information he or she must deal with, and look for another lab.

    You've been invited!