bloody unbelievable

I was in the middle of my first break from work when Elizabeth Holmes and her black turtleneck burst onto the scene with the brilliance  of a thousand suns. Valued at 9 billion dollars, her company Theranos promised to revolutionise a key diagnostic aspect of healthcare- laboratory testing. Her ascent to business stardom was inspiring and felt personally relevant. She had taken a ton of risks- dropped out of college young, turned a passion project into a life goal, persevered in a field that isn’t known to be particularly kind to women. It also felt like a timely cultural intervention against years of male- led innovation in the startup space. Her poise and her power showed up shows like The Big Bang Theory for their mean- spirited portrayals of women in science. Comically inept at doing life, these women exhibit a strong self- sabotaging streak evidenced by their relationships with narcissistic men. Their low self esteem makes them undeserving of the little kindnesses that make up healthy romantic relationships. While their immaturity and habitual boasting get the men our love and our laffs, the women are punished for far less egregious errors by being written off as a scold, a bumbling idiot, or a shrew (Bernadette, Amy and Leslie respectively). 

Holmes was different. She brought a self assured grace to the table, and her premise was elegant and disruptive. Pinprick- based bloodwork felt like real scientific progress as opposed to her peers’ formidable but fundamentally inessential sells. This wasn’t an app that hyper- connected people or a phone that commanded luxury prices. Her idea didn’t need spin- it really could make the world a better place. She was a force for good. 

That is, until investigative reporter and two- time Pulitzer winning team member John Carreyrou began asking questions. Carreyrou had a habit of reading the New Yorker on his daily subway commute and remembers being unmoved by their gushing coverage of Holmes’ exploits.

‘…there were some things I’d read in that article that I’d found suspect.’, he writes, ‘The lack of any peer-reviewed data to back up the company’s scientific claims was one of them. I’d reported about health-care issues for the better part of a decade and couldn’t think of any serious advances in medicine that hadn’t been subject to peer review. I’d also been struck by a brief description Holmes had given of the way her secret blood-testing devices worked: “A chemistry is performed so that a chemical reaction occurs and generates a signal from the chemical interaction with the sample, which is translated into a result, which is then reviewed by certified laboratory personnel.” Those sounded like the words of a high school chemistry student, not a sophisticated laboratory scientist…(I ) found it hard to believe that a college dropout with just two semesters of chemical engineering courses under her belt had pioneered cutting-edge new science. Sure, Mark Zuckerberg had learned to code on his father’s computer when he was ten, but medicine was different: it wasn’t something you could teach yourself in the basement of your house. You needed years of formal training and decades of research to add value. There was a reason many Nobel laureates in medicine were in their sixties when their achievements were recognized.’ A few weeks later he got a tip from an obscure pathology blogger who shared his scepticism of Holmes’ technology despite advances in the field of microfluidics. Carreyrou officially initiated the investigation after former key Theranos employees joined his quest for the truth.  Bad Blood- Secrets And Lies In A Silicon Valley Startup is the sum of his excellent investigative work and a fly on the wall look at how Theranos contained and deferred an epic implosion by way of Holmes’ gumption and bald faced lying.

To me Carreyrou is a journalistic outlier because he refused to buy into the prodigy narrative, nor was he swayed by the names on Holmes’ formidable board, which included Henry Kissinger and former US Secretary of State George Shultz. In one interview he explains why he was unimpressed with her lineup of directors. He talks about two types of investors; ‘Dumb Money’ are typically privileged old white men who cultivate proteges in the hallowed Washington tradition of post- retirement philanthropizing. They invite pitches in their stately old drawing rooms and invest with the understanding that they are patrons and advisors, not investors. Their admiration is fawning and mostly uncritical. ‘Smart Money’ is VC firms that have entire teams dedicated to diligence and research. They demand periodic updates from their investees and closely monitor their company’s progress. While investigating Carreyrou understood why Theranos didn’t have a single doctor, healthcare or medicine tech investor on her board- she just couldn’t afford to.

Carreyrou was dogged, meticulous and painstakingly ethical in his search for the truth. His findings force us to take a hard look at our universal awe of Unicorns- rare Silicon Valley startups valued at 1 billion or more, their founders celebrated in the media and held up in homes and classrooms as career role models. At the time of his investigation there were only 39. These companies had another distinguishing feature. ‘Instead of rushing to the stock market like their dot com predecessors had in the 1990’s,’ writes Carreyrou, ‘the Unicorns were able to raise staggering amounts of money privately and thus avoid the close scrutiny that came with going public.’ This means that Unicorns can potentially get away with toxic work policies and grey- area practices, neither of which overly concern their RoI- minded investors. 

It is important to understand why Holmes got away with deception and fraud for over a decade without anyone- regulators, investors, retail partners, the media- noticing. The only people who did notice were ordinary folk who’d had Theranos do their bloodwork via physician referrals. The physicians especially were mistrustful of the company after patient reports threw up repeated inaccuracies. Sometimes a Theranos device would throw up improbable potassium values for a patient, a value possible only if they were dead. The frequency of these errors was frightening but meant nothing when voiced by ordinary people. This is because we romanticise the entrepreneur. They remain the objects of an enduring cultural fascination and feature prominently in our resignation fantasies.  Before I go into why, let’s first draw a distinction between the old and the new entrepreneur, even though both are mainstays of the same capitalist ecosystem. One, the idea of genius is strongly embedded in the stories of the new entrepreneur or new guard. This is an important myth to perpetuate because it precludes uncomfortable discussions around race, class, privilege or accountability. Prodigious talent confers a godlike status on its wielder, and you don’t knock your gods down easily. As a result the idea of genius has become inseparable from and central to the origin story; in many cases they’re one and the same thing. Two, they’re good at performative anti- establishmentarianism. Whether its Zuckerberg’s hacker ethos or Google’s anti- formal offices, there’s an egalitarianism and benign irreverence to their vision. You want to root for the guy that won’t spend his money on an expensive suit just to impress an investor.  But just because they aren’t staid or predictable doesn’t mean they aren’t problematic in a typically capitalist way- Amazon’s been panned consistently for making their employees work unforgivable hours and Facebook’s business model is built on the exploitation of privileged- access data on consumers. They are beneficiaries of the same system they claim to reject. Three, with origin stories that almost always feature a rejection of the formal education system, rough- around- the- edges personalities and unmistakable youth, these guys have great relatabilility. These stories almost always feature a garage/ dorm/ basement, a broken- down car, dubious finances, suspiciously uncritical parents and a friend or two willing to participate in a shared delusion. We’ve all been broke and saddled with an uninspiring thesis/ job at some point in our lives and harboured dreams of working for ourselves. Dropping out of school was once considered delinquent behavior, but the Valley entrepreneur introduced us to the idea of the Good Delinquent. The Good Delinquent plays on our own dissatisfaction with the formal education system- its expensiveness, its pointlessness in a competitive job economy and its ultimate futility. There’s also the matter of appearances- in the contrast of their wealth with their enduring frumpiness (Gates) and normal, low- key domesticity (Zuckerberg) we see our own lives and possibilities reflected. Seductive conclusions (I’m not so different from these guys, I too can have this if I try hard enough) are thus easy to draw. Four- these guys are now the most valued employers in the world- by recruiters, potential employees and media alike. It’s difficult to challenge that level of validation. Five, a lot of these guys are Meta Curators; their algorithms control the visibility (or lack thereof) of images, news, issues, opinion, conversations- everything. It’s not easy to step back and say I think this needs a closer look. Five- the Valley entrepreneur understands the power of iconography. In Steve Jobs’ black Issey Miyake turtlenecks, Zuck’s normcore grey sweats and Elon Musk’s douchebro swagger we see evidence of a carefully cultivated image that’s as valued by consumers and market watchers as the company itself. All of these combine to concentrate unprecedented amounts of power, influence and public goodwill in the hands of these men. We see in them an essential goodness, even when they’re locking horns with regulatory bodies and lawmakers over indefensible policies and market manipulations.

Carreyrou’s book challenges the notion that these titans are beyond reproach. He mentions a number of red flags that should’ve alerted anyone watching Theranos closely. My personal favorite is his assessment of Holmes’ derivative personal style. She modelled herself after Steve Jobs and took to black turtlenecks with enthusiasm. She also spoke  at a false pitch, a baritone several octaves below her natural one. When I watch her in interviews I see another glaring affectation. She mimics presidential speech patterns quite competently, particularly Barack Obama’s; she gets his vocal fry down pat. Several observers have also commented on her intense blue gaze. The fact that she could go longer- than- average without blinking meant that her stare had an earnest, hypnotic quality. ‘A woman must continually watch herself,’ says John Berger in Ways Of Seeing. ‘She is almost continually accompanied by her own image of herself. Whilst she is walking across a room or whilst she is weeping at the death of her father, she can scarcely avoid envisaging herself walking or weeping. From earliest childhood she has been taught and persuaded to survey herself continually.’ He writes that ‘Men look at women. Women watch themselves being looked at. This determines not only most relations between men and women but also the relation of women to themselves. The surveyor of woman in herself is male: the surveyed female. Thus she turns herself into an object – and most particularly an object of vision : a sight.’ In a world run by older men with questionable fashion choices, Elizabeth Holmes- with her beauty and her audacious vision- was a sight. She presented as the male- approved version of herself she liked best, a version that allowed her to pass as harmless and well intentioned even as she pulled an elaborate con.

Carreyrou’s book is an important, unputdownable read. It demonstrates what a free press can accomplish when left to do their work unhindered. It endorses unconventional/ alternative media platforms- like blogs- as no less essential to democracy for their lack of eminence or institutional backing. It confirms our worst suspicions about corporate culture; despite their professed egalitarianism, these remain some of the most oppressive, opaque workplaces in the world, discouraging dissent and scepticism in much the same way as the old guard did- strong-arming newcomers and junior employees into submission on threat of termination. It illustrates the flip side of can- do work culture, a culture that sees questioning as incendiary and dangerous, minimizes employee concerns, and goes to great lengths to protect the reputations of its heroes. It is also a testament to the human spirit- what a bunch of honest, confident employees can do for the greater good. It reignites conversations around extending protection to whistleblowers in the workplace and making offices more transparent. It makes a case for nurturing our rusty bullshit detectors, too afraid or lazy to ask questions even when we’re suspicious or clamping down on our discomfort or repelled by the authority figures who matter. And finally, it’s a firm squeeze on the shoulder to anyone who’s been made to feel small, worthless and insignificant at their place of work- you didn’t deserve it. No one does. Not ever. Your voice matters even if you’re the newest or lowest- paid member of company. Let no one tell you otherwise. 

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