Demystifying Medicine One Month at a Time

Tag: WSJ

Theranos: In Need of a Little Sunlight

If you haven’t heard of Theranos (a made-up word coming from “therapy” + “diagnosis”), a startup company promising to disrupt the clinical laboratory industry, you might have seen news about it this week — the company has hit a wave of negative press inspired by a Wall St. Journal expose on its early failures.

elizabeth-holmes_416x416Theranos has a compelling backstory: Founder and CEO Elizabeth Holmes dropped out of Stanford at age 19, spent 10 years in obscurity developing a new technology for blood tests, then launched the company with a wave of publicity that would make Donald Trump and Steve Jobs envious: Business magazine cover stories, a New Yorker profile, a TEDMED talk. Along the way, she creates an advisory board with names like Kissinger, Frist, Shultz, Nunn, Perry, etc. — high-ranking former government officials. The company garners a valuation of $9 BILLION, making Holmes, at 31, on paper the youngest self-made female billionaire in the world (Mark Zuckerberg of Facebook is three months younger than Holmes).

The premise is this: Holmes hated giving blood for routine medical tests. Her phobia was so great she thought there had to be a better way to do it: Microfluidics. Using a finger stick to collect of drop of blood instead of the more traditional practice of puncturing a vein near your elbow, Theranos promises the ability to run dozens of medical tests from that single drop — instead of the numerous traditional blood vials. Moreover, Theranos promises to perform the tests at a fraction of the cost of industry leaders LabCorp and Quest.

Disruptive technology indeed.

The problem is that Theranos is highly secretive about its methods, choosing to go the press to announce its new technologies and partnerships, never proving its mettle in a peer-reviewed scientific publication. Medical and scientific skepticism therefore abounds.

In appearances, like one moderated by an acquaintance, Holmes seems more like the charismatic mouthpiece for some sinister group than a true wunderkind.

Last week the WSJ reported extensively on the fact that Theranos is outsourcing its blood tests to third parties, not running the tests themselves. Moreover, the microfluidic (finger stick) assays work on only five of the company’s menu of dozens of tests — the rest of the time their test centers obtain blood via traditional veinipuncture.

What’s going on here?

Rather than come out and discuss the company’s problems and plans to address them, the company has simply issued denials and obfuscations, hiding behind attorneys rather than letting its CEO speak.

Schadenfreude is the word for it — now it seems every business publication is piling on after the WSJ story. Nobody likes an upstart that promises to trample the established way of doing business, then fails to measure up — especially when dis-inviting scrutiny at every turn.

This is shaping up to be a story of colossal underperformance for such high promise — if not outright fraud in the hype and publicity departments.

Retrospethics [Updated.]

Update: You can click here and hear an interview with Michael Phillips of the WSJ.

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A few weeks ago I wrote about dubious medical research from the 1950s involving prostate biopsies on skid row alcoholics. The research had been brought back to life by an expose in the New York Times.lobotomy5

In what is arguably becoming a trend, the Wall Street Journal has added to the genre. The Journal’s project is well worth a look, not only because of the first-rate reporting by Michael M. Phillips, but also because the digital presentation of text, photos, and video is arrestingly beautiful (if haunting). In all, some twenty-two people were involved in creating this project, as the credits at the end reveal.

The series opens with a short video of an archivist (reporter? researcher?) wheeling a box of old records to a library table and unearthing Department of Veterans Affairs memos about the practice of lobotomizing mentally ill soldiers.

The accompanying investigative reports by Phillips center on one still-living lobotomized veteran, Roman Tritz, who underwent ‘pre-frontal lobotomy’ in 1953 at the VA hospital in Tomah, Wisconsin. Tritz, now 90 years old, still receives his medical care at the same facility.

Here’s an excerpt from Part I that well captures the state-of-the-art in psychiatry for ‘shell shocked’ vets at the time. I include it because it mentions several other therapies that seem absurd and unethical to us today (notable exception: electroshock–still performed):

During eight years as a patient in the VA hospital in Tomah, Wis., Mr. Tritz underwent 28 rounds of electroshock therapy, a common treatment that sometimes caused convulsions so jarring they broke patients’ bones. Medical records show that Mr. Tritz received another routine VA treatment: insulin-induced temporary comas, which were thought to relieve symptoms.

To stimulate patients’ nerves, hospital staff also commonly sprayed veterans with powerful jets of alternating hot and cold water, the archives show. Mr. Tritz received 66 treatments of high-pressure water sprays called the Scotch Douche and Needle Shower, his medical records say.

When all else failed, there was lobotomy.

“You couldn’t help but have the feeling that the medical community was impotent at that point,” says Elliot Valenstein, 89, a World War II veteran and psychiatrist who worked at the Topeka, Kan., VA hospital in the early 1950s. He recalls wards full of soldiers haunted by nightmares and flashbacks. The doctors, he says, “were prone to try anything.”

Lobotomy perhaps had it’s most famous treatment in the book and Oscar-winning film “One Flew Over the Cuckoo’s Nest.” The Journal’s project will add greatly to the historical record of the abandoned practice.

The comments by readers are worth a look, too, and highlight the inherent tensions in such a project: It’s work that’s stunning, haunting, and probably prize-winning. The project raises the level of multi-media digital reporting to a higher level. Many commenters are laudatory, finding great value in the information and artful presentation. But many vociferously criticize the project, accusing Phillips and the Journal of applying modern ethical standards to practices that were medically acceptable at the time. Moreover, the critics question the motivations of the Journal and suggest that Mr. Tritz, who still suffers with paranoia and delusions, has been exploited to sell, er, newspapers.

I believe it’s incumbent upon us to support this type of work. Rediscovering lost history helps us fill in the composite about where we’ve come from and what we value as a society. Collective memory on behalf of those that have suffered also provides catharsis and ties us to our past and our very humanity.

I also think the Journal (and other online publications) have raised the bar in terms of answering the question of how what we used to think of as ‘newspapers’ can more fully realize their digital potential.

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