Pressure, Prodigy and Profit - A look at Theranos and Elizabeth Holmes (Patreon)

What would you attempt to do if you knew you could not fail?

Today I want to tell you a little story about a tech startup in Silicon Valley and a founder with a dream who set out to try and change the world. You might have heard this one before, and you’ve almost definitely heard at least another one like it.

In this story, a visionary young person who dropped out of university fought against naysayers and doubters to show the world that their idea could work. This founder’s unorthodox approach to leading a company divided observers between calling them a sadistic egomaniac driven by an utter detachment from reality and delusions of grandeur and seeing them as having what it takes do what everybody else said could never be done.

Eventually, securing the funding to create their revolutionary product, the founder was met with celebrity, magazine covers, interviews and near-legendary status, with a growing base of other young dreamers looking up to them, inspired by the burning path they cut through the impossible to change the world and their industry forever. There were human costs of course, there always are, but everyone who supported the company knew that when the rubber finally hit the road even its harshest critics would convert.

There was just one tiny hitch - the product they were selling didn’t exist

Pressure, Prodigy, and Profit

A look at Elizabeth Holmes and Theranos

By Sophie from Mars

Theranos, originally incorporated as Real-Time Cures in 2003, was a biomedical tech startup founded by Stanford dropout Elizabeth Holmes with the goal of producing miniaturised blood testing devices. At first the idea was to create a wearable patch that would be able to monitor a patient and transmit data over the internet to their physician as well as a machine to carry out a whole battery of tests on a single drop of blood from a finger-prick, then after the patch proved unworkable just the machine with the machine going through various different iterations, generally getting bulkier and more low-tech along the way as the ability to do what they had claimed it would be able to do continually failed to actually materialise.

The story of Theranos is inextricable from the story of its founder, Elizabeth Holmes, because at core this is the story of someone claiming that she had a wondrous idea that was going to change the world and convincing other people to give her their money to make it happen. An important fact to learn up front about Holmes is that she idolised Steve Jobs, the founder of Apple - absolutely worshipped the ground he walked on. This will be relevant throughout. If the central conceit of Theranos seems like it’s just existing blood testing technologies but smaller, that would be because miniaturisation was frequently credited as one of Steve Jobs’ ingenious master strokes, so naturally Elizabeth Holmes’ multi-billion dollar idea to shake up the biomedical industry had to involve miniaturisation as well. She was trying to turn a phlebotomy clinic into an iPod.

It’s also worth thinking about the figure of “the dropout” in capitalist enterprise culture, and how it both delivers us Elizabeth Holmes and also can be reflexively used to understand her story better. This will also be relevant throughout - in fact, Holmes is so readily identified with the CEO-dropout archetype that the ABC News podcast and then eventual Hulu TV adaptation of her story was titled The Dropout. Actually it’s hitting me right now that they probably thought there was clever wordplay there because of drop, as in blood drop, right? Heck

The stories of entrepreneurs like Bill Gates and Steve Jobs who both dropped out of college drove a capitalist mythmaking strain that suggested college dropouts who founded companies had seen through the drudgery and monotony of academia and were simply smarter than all their peers by choosing the rational self-interest of making lots of money instead of the conformist path of contributing to the knowledge base of society. They are, simply put: too cool for school.

Of course before we really get going with Elizabeth’s story I think it’s really worth acknowledging not only that she was setting impossible standards for herself by comparing herself to some of the most successful founders in history, but also that Bill Gates’ and Steve Jobs’ products were actually a lot easier to make. Supposing that the R&D team has the funding, a personal home computer with a graphical user interface, or a small portable music player, or a touch screen phone with lots of ancillary features and applications - these are all obviously things that people will want to buy and so the pressure to bring a viable product to market first is a real pressure, but in the end user case nobody’s life is on the line. No one is going to be misdiagnosed with a serious medical condition or worse not diagnosed with a serious condition they do have if you mess up.

So how did this go down? In the initial stages, Theranos would seem to be a pretty normal company developing a new product. The original idea proved impossible, so they worked towards something more pragmatic and viable, developed a process for the blood to be taken into the machine and transported through various stages of testing internally. This machine was known as the Theranos 1.0 and after 2 years of working on developing the prototype, the Theranos 1.0 finally started to successfully transmit blood test results just in time for Holmes and crew to meet with Swiss pharmaceutical giant Novartis. Here, 2 years into the 12 year story of this company, was where the whole thing took a sharp left turn directly off a cliff.

The night before the meeting and proposed demo to Novartis, the prototype stopped working. Having worked on prototype electronics myself I can say there are any number of things that can go wrong in between controlled lab testing of a device and trying to run it in a hotel room half way around the planet, but the headline was that the Theranos 1.0 was no longer generating or transmitting results. Rather than delay the meeting Elizabeth had her employees work all night trying to fix it to no avail. In John Carreyrou’s book about Theranos Bad Blood, Carreyrou writes that one employee offered so much of his literal actual blood to testing the machine that by the morning his finger could no longer be pricked for more tests - there was no blood in it.

Faced with this intractable solution, Elizabeth Holmes, the most normal and mentally well startup founder in history, came up with an ingenious solution: lie. She demoed the Theranos 1.0 in front of the Novartis team and had the lab in california transmit results to the machine synchronously with the demo to make it look like it had authentically tested the blood sample in real time in front of them.

It would be reasonable to attribute Elizabeth’s motives here to a common adage in the startup community, especially among CEOs: “fake it til you make it”. This expression is used in tech startup and venture capital circles with alarming frequency to mean everything from “dress for the job you want” to “pretend you have a working prototype when you know you don’t and just pray to whatever you believe in that you’ll have one by the time it matters”. Companies will frequently list their founding date on public sites as more recent than it was to make the achievements they can show look like they happened in less time and willfully look the other way and “forget” to take employees off their site after the employees leave the company to make the company look like it has the capital to keep more people on payroll than it actually has. These are relatively harmless but incredibly commonplace examples of “faking it til you make it” because “fake it til you make it” is upsettingly sound advice when the basic catch-22 every aspiring founder is in is that they need venture capital funding to get started and to attract venture capital funding they need to look like they’re achieving more than they could possibly do with what they already have. The obvious problem when “fake it til you make it” moves from common sense advice to all-encompassing way of life is that some of the times that some of people are faking it, they won’t make it, and some of those times, not making it would be fine if it weren’t for the fact they had been faking. Some of those times, faking it and then not making it will seriously hurt a lot of people.

To revisit the issue of feasibility and miniaturisation for a second, let’s just examine why exactly the full promises of Theranos were never going to work. What Holmes saw as the sexy revolutionary innovation of companies like Apple, miniaturisation, relies on the shrinking in size of a very specific technology: the transistor. To explain in more detail, microchips rely on binary logic and in physical space that binary logic is represented by transistors that are used to create circuits that can store data. I did study electronic engineering, I am simplifying for my youtube audience, please leave your reddit bro shit out of my comments. As the smallest possible size that a transistor can be shrinks, the number of transistors that can fit onto an integrated circuit increases, a devastatingly resilient observation known as Moore’s Law, which is basically why we keep getting smaller and more powerful computers whether we want them or not. No matter how small the technology used, however, blood can’t be scaled down in the same way, and certainly not for the hundreds of tests that Theranos were claiming to be able to do on a single drop. Blood isn’t totally homogenous, and a single drop could contain far more of something that you’re trying to measure than the total circulatory system, or it could crucially not contain cells and markers that indicate exactly the thing you’re testing for. Some blood tests require blood to be spun in a centrifuge, some blood tests require the sample to be kept at precise temperatures. Even some tests, like HIV, that can be done on a single drop if that’s the only thing you’re testing for can’t be done accurately alongside hundreds of other tests on a single drop that’s been diluted and shot all around an iMac-looking nonsense machine. Tests like HIV can be done on a single drop but not in this way not by this technology and not reliably. That’s foreshadowing.

Over the next few years, Theranos continued to gain notoriety as the biomedtech company of the future that was going to change everything, while the engineers struggled to make anything even remotely viable as a product. Holmes’ role over the next few years became increasingly detached from anything going on at the company except to protect the company and herself from legal repercussions. This is where the phrase “proprietary information” entered frequent use both as a way to avoid ever having to explain how the machine supposedly worked and a legal warning to employees to uphold their Non-Disclosure Agreements on pain of a bankrupting lawsuit. Holmes deployed her IT guys, Bissel and Lortz, as the de facto secret police of the company, surveilling employees’ emails and even watching what they used their computers for. Employees were forbidden from talking between departments and eventually security teams were moved into the company offices to make sure employees never strayed too far from their designated work areas under the justification of, you guessed it: protecting proprietary information.

In 2010, Ian Gibbons who was originally hired in 2005 as Theranos’ chief scientist, one of the few people with a clear overview of the whole project who wasn’t a craven profit-thirsty parasite, confided in a friend that the claims being made externally by the company were not at all in line with the actual efficacy of the product. The friend told Elizabeth who promptly fired Gibbons but after many other employees protested, Gibbons was re-hired as a technical consultant and kept away from his own team within the company by security.

The unpopularity of this move was down to several factors: reports describe Gibbons as generally reasonable and well-liked; Gibbons was an early and vital part of the team having authored 23 of Theranos’ patents; and Gibbons had battled with cancer and needed the employment based health-insurance that his job provided. If Holmes had cared what her employees thought of her, the possibility of her being a benevolent dictator was rapidly vanishing over the horizon.

So now we need to talk about Richard Fuisz, and I really think it’s worth spending a minute to appreciate a lot about the Fuisz situation. Richard Fuisz is a bit of a character - I can’t really get into all of it but the titles in his wikipedia article read like this

And I encourage you to go read it yourself if you’re interested. Maybe the onus is on me to clarify he is the one making the allegations of arms sales to Iraq not the one having the allegations made against him.

Richard Fuisz was a family friend of the Holmeses when Elizabeth was growing up, and besides being notable for his long entanglement in various CIA operations he generally just comes across as quite a peculiar dude. His success came through multiple decades of working in the pharmaceutical and biomedical technology industries and Fuisz is relevant to the Theranos story for several reasons. Firstly because when Carreyrou started writing his expose and then book about the situation, Fuisz seems to have been somewhat instrumental in introducing him to people, and secondly because Fuisz, Theranos and Holmes became embroiled in an absolutely bizarre legal slapfight in 2011.

So it seems that Fuisz patented a piece of technology to do with transmitting medical data over the internet once he heard that Holmes had founded a company in his field of interest without involving or consulting him. I’m not speculating on his motives there, I am stating the order of events. He found out what Theranos was claiming to do and then he filed a patent for something they hadn’t thought of patenting and then Elizabeth and Theranos sued him and his sons - apparently - with Holmes’ legal representation claiming that the Fuiszes had thought they could take advantage of her because she was “young and female”. So you have one side of this case who are family friends with the other side of the case patenting a part of a fake technology that doesn’t exist and can’t work anyway to force the other side to pay them some kind of dues, and the other side’s main argument in response is “you just hate to see a girlboss winning”. The space I am giving to discussing this is primarily because the fact that this man in some way represents the community Elizabeth Holmes comes from says something to me about the American upper middle class that I can’t repeat because it would be in violation of YouTube’s terms of service.

However there is another big reason to talk about Fuisz and the lawsuit. In 2013, Ian Gibbons was notified that he was being subpoenaed and would have to testify in the case. Knowing that the technology Theranos was working on didn’t do anything like what they were claiming it did, Gibbons found himself between a rock and a hard place. He felt strongly that if he told the truth he would lose his job, possibly be sued by Theranos for sharing “proprietary information” and he feared that he wouldn’t be able to find work anywhere else. Speaking on Ian’s state of mind around the time, his wife said "It was hell for him to work there. It was complete hell. I think that he was very confused about why he was being treated so badly."

On May 16th Gibbons overdosed on wine and acetaminophen, and his wife found him unconscious and had him rushed to hospital where he died of liver failure a week later. When she called the offices to let them know what had happened, Elizabeth didn’t call her back, but she did receive an email from Theranos’ legal representation asking her to give them anything that might have been in Ian’s possession which could contain proprietary information.

So many strange and noteworthy things happened at Theranos that it’s often better to tell the story not chronologically but grouped by theme, and along those lines Carreyrou’s book has a chapter titled “Apple Envy” so let’s talk about some stuff that Elizabeth Holmes did in her ongoing quest to Detroit: Become Steve Jobs.

One of Holmes’ early meetings was with Larry Ellison, who was on Apple’s board of directors and later invested in Theranos. She also recruited Avie Tevanian, Apple’s former vice president of software engineering to the board in 2006, and hired Ana Arriola, a designer at Apple, to oversee product design at Theranos around the same time. Ana left behind 15,000 Apple shares to join the company because she wanted to work on something which was going to help people, and she quickly became one of the employees who stood up to Elizabeth to her face more than anyone, as her job should really require a complete overview of the project and Holmes did as much as possible to keep Arriola on a need-to-know basis.

Over time the project moved away from the Theranos 1.0 model of transporting the blood through tubes and to a new prototype based on a robotic arm used for automated glue placements. This new machine earned the nickname “gluebot” among Theranos employees, but Holmes, eager to switch to a canonised name, declared “we’ve tried everything, so let’s call it the Edison” - a reference to a Thomas Edison quote “I haven’t failed, I’ve just found 10,000 ways that don’t work”. This is funny not only because of the very on-the-nose acknowledgement of Theranos’ ongoing fraud but also because Holmes isn’t even a modern Thomas Edison, a hack who stole other people’s working inventions and took credit for them. If she were a modern Edison she wouldn’t have a product called the Edison, she would probably do something like buy the controlling shares of a company called Tesla and then be bizarrely spiteful, petty and mean towards the actual founder and inventor.

Anyway, regarding the aesthetic design of the Edison, Carreyrou writes in Bad Blood:

“Elizabeth wanted a software touchscreen similar to the iPhone’s and a sleek outer case for the machine. The case, she decreed, should have two colors separated by a diagonal cut, like the original iMac. But unlike that first iMac, it couldn’t be translucent. It had to hide the robotic arm and the rest of the Edison’s innards.”

She also contracted Yves Béhar, a prolific product designer in the silicone valley space who has done work for, among other companies, Apple, to design the look of the Edison, which Ana was then in charge of making work on a technical level.

Carreyrou also writes that:

“Ana felt that Elizabeth could use a makeover herself. The way she dressed was decidedly unfashionable. She wore wide grey pantsuits and christmas sweaters that made her look like a frumpy accountant. People in her entourage like Channing Robertson and Don Lucas were beginning to compare her to Steve Jobs. If so, she should dress the part, she told her. Elizabeth took the suggestion to heart. From that point on, she came to work in a black turtleneck and black slacks most days.”

Carreyrou chooses violence by repeatedly reading people’s fashion choices for filth throughout the book, which I have to admit I enjoy. My guy did not have to leng her down like that by calling her a frumpy accountant.

Elizabeth’s apple envy didn’t mean that she treated the crumbs she managed to catch falling off Apple’s plate particularly well. She still had to protect the company’s “proprietary information” after all, and both from above as part of the board of directors Avie could see it was quite troubling that the company strategy, the executive staff and basic product had all changed in a very short amount of time, and from below Ana could see that there were far too many problems with the technology for Theranos to already be conducting a large scale study on actual patients, as it was trying to do by this point in 2007. For asking questions about the state of the company, Avie began to be pushed out, and even threatened with a lawsuit for “publicly disparaging the company”.

Carreyrou writes:

“Avie was astonished. Not only had done no such things, in all his years at silicone valley he had never come close to being threatened with a lawsuit. All over the valley, he was known as a nice guy. A teddy bear. He didn’t have any enemies. What was going on here?”

What indeed? Ana resigned in the summer of 2007 and Avie left the board a little while after, effectively peeling the Apple skin off the company, though it would still be some time until the worm was discovered.

Alongside the Edison and later the MiniLab, Theranos also patented a device for drawing a very small amount of blood and feeding it into the testing machine which they called the Nanotainer, and I just want to briefly appreciate the meaningless miniaturisation-obsessed corporate brand speak of making a portmanteau out of “nano” and “container”. Nanotainer. It’s sickening. Nanotainer.

If we’ve done a section setting up Theranos’ fraud and the last one was apple envy, I suppose this final part of telling the story of the company would be called, off the top of my head, something like multi-billion dollar corporate fraud. No I can do better than that, hang on. Blood bank robbery. Hmm, no. Bleeding Out. There we go.

In 2012 Theranos landed a partnership with supermarket chain Safeway, with the supermarket investing $350 million into putting Theranos blood testing machines into 800 of its 900 locations. In 2013, Walgreens partnered with Theranos to put machines in 45 of their locations, and it should be pointed out that Walgreens belongs to Walgreens Boots Alliance which also owns Boots pharmacy and Alliance healthcare. If you’re watching this in Germany, France or the UK and thinking “gee what a silly situation those yanks got themselves into, glad it didn’t happen over here” well it’s at least conceivable that if that partnership had continued to develop, Theranos could have been operating in stores internationally.

In July 2015, the FDA approved the use of Theranos machines outside of clinical lab settings specifically for herpes. This was still a far cry from the use in new medical research that had generated the vast majority of buzz and speculative value around the company, but it would mean they could start rolling out their faulty devices to actual patients in a commercial setting. FDA approval may be something that has occurred to my more canny viewers already as a major roadblock for Theranos, but since it had pivoted at least temporarily to a model where it didn’t sell its machines to other labs, it didn’t actually need FDA approval to start selling tests to patients directly.

The Walgreens partnership did actually result in real locations in operation. 42 of them were in the vicinity of Phoenix Arizona, with two in California and one in Pennsylvania. The reason so many locations were opened in Arizona can reasonably be attributed to the fact that Holmes successfully lobbied Arizona state government to pass a law allowing patients to get blood tests without doctors’ orders.

In late 2015, our boy John Carreyrou wrote an article in the Wall Street Journal exposing that an internal understanding of just how useless the Edisons were had led Theranos to start doing tests in its “wellness centre” locations using traditional blood testing machines instead. The more they did this, the more it became apparent that tests being run on the Edison were completely unreliable, and the more they reduced the proportion of tests being run on the Edison and relied on other technology instead. You might assume that this meant they were correcting toward straightforwardly reliable tests, but remember: they promised to run all these tests from just a drop of blood, and traditional blood testing machines use a full vial drawn from a patient’s arm with a needle.

In order to run their tests on non-Theranos machines, they started diluting the blood samples they collected which gave results for levels of well, everything that are well below the safe ranges. Given that Theranos was frequently producing results far higher when compared to hospital tests, it might be a reasonable conclusion that Theranos was multiplying the numbers to account for the dilution and in doing so multiplying the traditional machines’ margin of error.

Crucially the exposure of the fact that their tests were being run on technology they hadn’t developed shot a massive, gaping hole in their “proprietary information” defence. They couldn’t argue that disclosing details about their technology would harm their business once it was out that their business was relying less and less on their own technology, and more and more on them misusing someone else’s.

Naturally, after this article came out, things started to unravel at Theranos at incredible speed, but Holmes had been aware of Carreyrou’s investigation already for several months. During that time she had met with Rupert Murdoch - the owner of NewsCorp which owns the Wall Street Journal - who had recently become Theranos’ biggest investor multiple times to try to get the story killed. At the same time, executives at Theranos and their legal representation tried to silence Carreyrou’s sources, including sending Ian Gibbons’ widow a letter threatening to sue her if she kept talking negatively about the company that had killed her husband. They at least temporarily managed to stop some sources talking to Carreyrou, and pressured one source who was a doctor into using their tests in her lab so that her accusations against them would look less credible.

Nonetheless over the course of 2015 and 2016 the Walgreens and Safeway partnerships fell apart and CMS and the FDA banned Holmes from operating blood testing facilities. Over the next few years official investigations were opened into Theranos and the legal case United States v Elizabeth A Holmes et al made its slow steady work towards conviction. Along the way, hours of deposition and testimony from everyone involved were collected, including absolutely fascinating testimony from Holmes herself.

At this point Holmes’ own impulse to lie about everything and dependence on the fact that claiming proprietary information protected her from ever needing to evidence any claims led her to live in a near-total science fiction fantasy world. She claimed the Edison was being used by American troops in combat zones. She said there were Edisons on military helicopters.

Carreyrou closes out Bad Blood with the following paragraph about Holmes:

“A sociopath is often described as someone with little or no conscience. I’ll leave it to the psychologists to decide whether Holmes fits the clinical profile, but there’s no question that her moral compass was badly askew. I’m fairly certain she didn’t initially set out to defraud investors and put patients in harm’s way when she dropped out of Stanford 15 years ago. By all accounts, she had a vision that she genuinely believed in and threw herself into realising. But in her all consuming quest to be the second coming of Steve Jobs amid the gold rush of the “unicorn boom”, there came a point where she stopped listening to sound advice and began to cut corners. Her ambition was voracious and it brooked no interference. If there was collateral damage on her way to riches and fame, so be it.”

And I have quite a few thoughts about that. As inseparable as Holmes is from Theranos, leaving the story there with conjecture about her internal motivations and mental state misses something quite important in my opinion. The forest for the trees, if you will.

It is noteworthy that Henry Kissinger, one of the most evil people in human history, became an investor in Theranos. If you’ve never heard of Kissinger before I won’t go in depth here and instead just let you know that Anthony Bourdain once said “Once you've been to Cambodia, you'll never stop wanting to beat Henry Kissinger to death with your bare hands.” There’s probably some kind of joke to make here about the most likely candidate in the real world for an actual honest-to-god vampire being drawn to invest in a blood company, but the final version of that joke is proprietary information so you’ll just have to imagine how it works.

The DeVos family, Ex-Secretary of State George Schultz, US General Jim Mattis and the above mentioned Rupert Murdoch were also among the coterie of investors in Theranos by the time the deception was exposed. Elizabeth also did fundraising events for Hillary Clinton’s presidential campaign, appearing on stage with Bill and Hillary, and she even gave Vice President Joe Biden a tour of the lab, where Biden reportedly said “Talk about being inspired. This is inspiration. It is amazing to me, Elizabeth, what you’ve been able to do.” The lab that Biden was shown around was a fake lab set up specifically for the tour and was automated so that the vice president wouldn’t have any chance of accidentally talking to a real employee about how the company was doing.

At time of writing, Elizabeth Holmes has been sentenced to 11 years in prison on charges of wire fraud and conspiracy to commit wire fraud, and is expected to surrender herself next month. She was briefly accused of attempting to flee to Mexico although her legal team denied this allegation, saying that she and her partner bought tickets before the sentencing hoping that it would go differently.

So let’s take a bit of a detour to talk about what informs my perspective on all this. I worked in startups for basically my whole work life before YouTube - that is to say, programming was my “career” a word which here means an illusion young people are subjected to by capitalism that suggests they .

I started working as a programmer when I was 16, and all told it was a pretty nice time. They really just wanted to give me work experience but still pay me for my time, I was learning to develop apps for iphone while working on a very useless iphone app for them which I don’t think really helped their business at all, but they just kinda let me hang out at the office with them and they paid me for it when it was done. Low bar, I know. We’re working up to some shit.

After that I went to work for a dude, a guy, a fella. He had a proper team of developers set up with clients and deadlines and like, a whole business. A very small business though. I was still learning to work as a developer and I won’t pretend I wasn’t the weakest asset on that team, but I worked through what I was assigned by the time I was supposed to do it, and it was ehhh fine. It was fine. The work itself was fine, but then the guy I was working for went bankrupt and the summer holiday I’d spent working for him he just didn’t have any money to pay me, so he didn’t pay me, and then he just disappeared. It was a shitty time, especially for a teenager, especially after I’d already done the work during my summer holiday.

Okay, the next one is actually pretty funny. I’m not gonna name the company but I can tell you they were trying to make a social media app that was trying to use the location and maps feature of smartphones as prominently as snapchat uses the camera. It was a pretty bad idea to begin with, but they’d got the funding because of a family friend of the founder. One time I took the train out of London to their office to meet with the full team in person for the first time, and when I got there the office was not actually an office but a two bedroom apartment they had rented to use as an office and it was very obvious that the two korean employees who had flown out from Korea to work on this were both living there. I was just trying to earn enough to pay my rent but the founder kept on talking to me about California and really wanted to offer me shares in the company instead of more money. I remember the marketing guy basically grilling the CEO looking for absolutely anything they could use to market the company with like “why maps though” and the CEO sitting on the floor of the officepartment and saying “I just really like maps”. I quit when I got home from the trip.

Okay, the next few jobs I had were all nightmarish. I went to work at a digital marketing agency - they made websites for brands and increasingly they had fancy bullshit that clients wanted in store like touch screen menus and shopfloor displays where clients naturally wanted all the latest toys - VR, remote control doohickeys and so on - and in many ways the job had the potential to be quite fun. It became immediately clear though that the company had a horrible work environment and a rampant blame culture where everyone was hyper stressed all the time and all the clients wanted all their projects finished yesterday so all the responsibility was just flowing downstream onto the lowest paid workers. The CEO - he’d been brought in to manage the company, he wasn’t the founder - was also really weird. One time he told he’d looked up my address because he saw me at a train station during his commute and “felt curious”. I think about that dude a bit. Weird guy. In the time I was there because of the stress and blame over a quarter of the staff quit and were replaced, and I was only there 6 months. One time a girl came in to work for her first day, and by lunch time she saw what the company working environment was like and she just peaced out. I mean, baller shit, she just got up, took her coat and bag and left without saying anything and never came back. I have never admired another human being more and possibly never will.

After a few months the weird CEO and my department head who had been a loner programmer before I joined - I was the first member of his new department - called me in for a performance review and they basically said that because I wasn’t staying past closing for unpaid overtime like a lot of other people were being forced to and because the department wasn’t working well together, clearly this all my fault. I was 19. They gave me a month to meet their standards so I put a lot of effort into making sure I was playing their game. I actually worked a lot slower that month but just spent a lot more time sending emails and making sure there was a paper trail for everything I had done, and then after they gave me another review and said that I’d successfully improved I handed in my notice because the whole place was a fucking nightmare. I had recently diagnosed BPD and this weird thing was going on with me where I thought I was a man?!?!?!?!!? So I really needed a supportive chill work environment and this place was very very much not that. I was constantly learning on the job in order to program in new languages I didn’t know because they’d seen that I was a fairly fast learner and extrapolated that I could probably handle an entire client-deliverable project in a new language I hadn’t used before and then blamed me when there were problems. It was neat.

After that I went to work for a Fashion-tech startup. The work environment itself was a lot more chill, or so it seemed. There was a really nice guy there who was working remotely from Oklahoma and I think about him often too, but in a complete opposite way, he was really cool. So what happened with this fashion place was that I had a panic attack, which was fairly frequent in my life with all the mental health stuff I just mentioned and repeatedly getting myself hired as some kind of competent experienced programmer which I was not, and when I told my boss that I needed to take tomorrow, which was a saturday, off, she fired me. Well she didn’t actually fire me. She just deleted my work email - which was a nightmare down the line because she’d sent all my payslips to my work email - and locked me out of all company resources, blocked me on whatsapp and refused to pay me for the last month of work I had done or the two weeks notice that I was contractually owed. I’m not naming names here but if you ever get the chance to work for a member of a double-barrelled west european aristo family, for the love of G-d don’t do it, my sample size may be small but based on my experience 100% of them will steal £3000 from you. Out of anyone I’ve actually met, the woman I worked for there gave me the most intense Elizabeth Holmes vibes.

Okay, last job before Youtube - I went to work for a friend who I had been acting as a consultant for in my spare time while I was at the last place. She was working on a mental health diary app thing and she saw what had happened with the wage theft at my last job and how it had made me seriously scared for my housing situation and she offered me a job, which was really nice to begin with and then when she didn’t get the next round of funding she expected, she accused me of stealing intellectual property from the company because I went to a meeting with some designers she had asked to consult and they hadn’t emailed her their designs yet, then she threatened to also not pay me unless I did a bunch of extra unpaid labour. A very compassionate and caring supportive mental health environment. Much mindfulness wow.

I think my story can certainly sound, and certainly felt at the time, like a very strong-willed young person making a lot of decisions she wasn’t ready for and biting off more than she could chew, but with a bit of time to reflect, to get older and wiser, I can clearly see there were people around me at basically every step who were incredibly happy to accept the idea that I was some kind of wunderkind who was going to shoulder a lot of their burden for less pay at the same level of responsibility as people who had been working in their fields for like 20 years.

I don’t want to make a very obvious error here and compare my experience too closely to hers when I was a worker and she was assigned bourgeois at birth, but I’ve seen firsthand how in the desperate alchemists’ den that is startup culture where bullshit artists are constantly trying to spin nothing into a million dollars, young people who promise they can take on a little responsibility for reasonable pay can quickly get given a lot of responsibility and told they only have themselves to blame if it all goes wrong.

The internal galvanising myth of the unicorn gold-rush broadly and Theranos and Elizabeth Holmes specifically was that the founder, in this case Holmes, was a special person, a unicorn, a genius, a disruptor, someone who was going to change the world. Her success was guaranteed because she had every advantage and she had decided at an early age that she was going to be a billionaire.

Elizabeth had a paperweight on her desk with an inspirational quote that read “what would you attempt to do if you knew that you could not fail?” Success, everyone was assured, was simply her destiny.

In turn this meant that Elizabeth could weaponise the dedication of her employees against any perceived threats or enemies. Former employees frequently came under suspicion or even became public enemy number one, since their departure from Theranos implied that they may have figured out what the company was up to, whether they were willing to break their NDAs and say so or not. Loyalty within the company was rewarded over competency, willingness to protect the vision over ability or even intention to help people. Despite the obvious incompleteness of their work, all employees were required to not only tolerate the lack of communication between teams as a measure to protect proprietary information but revere it as a demonstration of faith that the greater whole would make up for their individual failings.

Furthermore this cult-like climate in the company meshed seamlessly with Holmes’ personal mythmaking. Anything that she valorised about herself and Theranos was obviously the same thing for which her enemies were trying to destroy her. Theranos was trying to help people, so Theranos’ enemies just wanted to make money. Holmes and much of her team were quite young, so critics must be old establishment cogs afraid of change. Holmes positioned herself as some kind of feminist icon, so her enemies must be angry misogynists who hate to see a girlboss winning.

So I’d like to examine some of this mentality for a bit because I am, despite my best efforts to end business, capitalism and money as a concept, at least for the time being technically a girlboss and I do have experience of and thoughts about women working in male-dominated fields and industries. While I do enjoy looking good and dressing well, for example, my appearance is under close scrutiny in a way that my male peers and colleagues do not experience. The first thing that many people reach for when they disagree with me is to call me ugly in one way or another and people make all sorts of bizarre and invasive comments about my appearance constantly even when they seem to be otherwise enjoying my content. I get DM requests, messages from patrons, replies on twitter, and of course my beloved, darling YouTube comments where I think I’m about to be engaged with on the terms of what my work is actually about, I think that I’m going to have a conversation with an invested party about my work and they turn out to be about my gender, or my thoughts on gender, or about how I dress, and I know that men - especially cis men - doing the same job as me don’t have that or don’t have that nearly as much. Gender isn’t actually a big feature of my work, and I don’t spend a lot of time thinking about it outside of defending my right to be treated as much like a human being as everyone else, but it is a huge part of the response to my work. I’m not trying to drive away compliments (please tell me I’m pretty) but sometimes I feel like I look around at the people driving the conversations in our space and I see intelligent, charismatic, well-read and insightful women doing actually the majority of the heavy-lifting and the critical responses even when they’re good are frequently entirely superficial. And then there’s the bad responses - men in our discursive community get the refreshing, delightful opportunity to argue about the things they’re actually talking about, and women - especially women of colour - get treated like they’re emotionally driven gibberish-spouting lunatics when they’re frequently making twice as smart twice as eloquent arguments as their male counterparts for half the recognition.

I have to think about how everything I say could be quickly dismissed if I’m not extremely careful to protect the feelings of the people I’m talking to because women are expected to do labour to protect men’s feelings, so in a straightforward disagreement with any man in our space, I need to go in knowing that everything he says will be taken with as much benefit of the doubt as possible, and everything I say needs to be utterly crystal clear or else. We all know smart women who are good at their jobs who’ve had to leave a space permanently because the mounting cascading bullshit of utter gibberish that starts stacking up as soon as you first perceived as a woman in the public eye and never goes away but can come crashing back down on you over and over and ever more any time people think they’ve found a rational, justified reason to call you a bitch.

And I don’t just have to think about that, I have to think about how knowing that that is how I will be treated effects how I conduct myself, I have to think about the paranoia I experience because of the trauma of how women are treated, and then even in saying this right now I have to think about the people who will take what I said at the start of this sentence and use it to dismiss any time I am validly pointing out that I am experiencing misogyny.

It’s crazy-making, is my point, and if you’re a cis man and you think you already know all this and don’t need to hear it, fuckin… patreon.com/sophiefrommars - highest tier, as penance. And then shut up and listen to women.

We also need to briefly talk about sexual harassment, assault and rape. Literally all the women you know have been sexually harassed, and most of the women you know have been or at some point will be sexually assaulted. As a survivor myself, I want to draw attention to how much this can affect your feelings about your own life and achievements, how it can create a need to assert yourself so that you don’t feel like the experience drained you of your ability to live your own life, and I think it’s worth pointing out that Elizabeth Holmes dropped out of Stanford after she was drugged and raped by another student.

I would err on the side of not bringing this up, but Holmes talked about it at her trial, saying

"I was questioning what — how I was going to be able to process that experience and what I wanted to do with my life, and I decided that I was going to build a life by building this company."

And then she very really did make the company her life and defended it like it was her life even though in doing that she was doing horrible things to other people.

None of this exonerates her, I’m talking about systems.

The TV adaptation The Dropout is highly fictionalised, so I don’t know how exactly Elizabeth’s meeting with angel investor Larry Ellison went, but the show depicts Ellison taking her with his male assistant out on his boat into the middle of fucking nowhere and asking her if she’s willing to do “anything” to succeed, before indoctrinating her into the bizarre magic thinking of the CEO mindset and getting her to repeatedly chant “get the fucking money!” I don’t know how their meeting actually went, and in the scene nothing explicitly untoward happens, but I don’t think the construction of this scene was an accident. The TV adaptation, perhaps a lot more deftly than I’ve managed here, shows us the two sides of her story, and in seeing both of those sides we can understand that putting all the responsibility on her is missing a bigger picture. Or maybe you all just hate to see a girlboss winning.

I’m not talking about all of this to justify any of Holmes’ actions but rather to explain what would internally create a plausible narrative that her critics were misogynists. We can see how this would look believable if you found yourself on her side because say, for instance, she was paying your salary. We can see how narratives like this could be used to create the cult-like environment at the company that led to such scenes as Elizabeth and Sunny gathering all the employees together in the cafeteria to respond to John Carreyrou starting to expose the company and making them all chant together “fuck you Carreyrou! Fuck you Carreyrou!”

On a darker note, it’s exactly these narratives and this gaslighting that would lead Ian Gibbons to die by suicide. He believed quite correctly that telling the truth in the deposition would get him fired from Theranos, but he also believed that he wouldn’t be able to find work anywhere else, a belief based on the assumption that nobody else would see that what he had done was the right thing to do. If he hadn’t been kept in the dark like all of the other employees he would have seen the full scope of how wrong what Theranos was doing was, and if he hadn’t been deliberately manipulated to doubt the credibility of claims made against Theranos then he wouldn’t have been afraid to speak out.

Ultimately one thing goes beyond any manipulation or implicit biases, however, in creating the culty environment at Theranos: money. The employees all needed money to eat, to have water and power, to have somewhere to sleep, to live life at all, because we live under an economic system where you either work or you die and on the way to dying you’ll probably break several laws by trying to stay alive. It’s not illegal not to work, it’s just de facto illegal to expect to stay alive unless you do.

I’m reaching the part of the essay where I’m supposed to talk about what went wrong and what could be done differently, and it’s probably not going to be a huge surprise that my answer is: communism. The issue here is capitalism and the model that our society uses to innovate and invent, and to fix it, we would need to untether innovation and invention from the shackles of investment capital and profit.

David Graeber very astutely points out in Debt: The First 5000 Years how capitalism requires what he calls “little everyday communisms” in order to function at all. People constantly work for the common good and to take care of each other rather than for profit, and in the places where things get made that actually help people that’s even more the case. Most invention and innovation still happens in publicly funded academic research spaces.

The point here is not to defend Elizabeth Holmes, who has done absolutely atrocious things in the pursuit of profit, but to look at her story in a way that puts the system around her as the main focus instead of the individual person. I think that The Dropout does that pretty well - it’s hard to look at someone’s whole life and see them represented as a vulnerable child learning and growing and making mistakes and if not feel sympathy for them, then at least see the other people in the story as more responsible for the outcomes than you otherwise would. At the very least it shows the other people around her as influencing her mistakes, which they certainly did.

The Dropout, I think, was made by people who do understand the problems here. Some parts are obviously fictionalised, but they’ve put a real emphasis on the sacrifice of work-life balance and eventually life altogether that this culture encourages.

Holmes is facing an 11 year prison sentence for several counts of wire fraud and conspiracy to commit wire fraud. In her trial the jury found her not guilty on the charges of defrauding patients. In other words, all the punishment that she’s facing is for taking rich people’s money, which I’d say is the least harmful thing she did. I don’t care very much if Henry Kissinger got all his apes stolen, this woman put a vulnerable employee in a position where he felt his best option was suicide, and she made the decision repeatedly over the course of years to push to have her completely useless technology made available to patients, knowing it would put them in danger. It’s not like I’m advocating that she should receive more prison time - as a prison abolitionist I believe that all incarcerated people should be freed and people like Holmes should be kept in a little zoo where they enact ironic performances of the horrible things that they did to get their money. Jeff Bezos having to piss in bottles, Elon Musk mining lithium, Bill Gates jumping over a desk chair and so on.

I just think that it betrays such a flagrant disregard for public safety, for workers’ rights, and for anything except the right of the wealthy to hold onto their wealth that people should be broadly angry about the verdict she received and what it says about the priorities of the criminal justice system.

In popular gothic fantasy roleplay setting Vampire: The Masquerade, there is a society of parasitic undead living parallel to and feeding off of mortals. It has been pointed out many times how this works to describe the politics of the ruling class, with the longest living vampires having hundreds or even thousands of years to feed off humans becoming more powerful, completely losing touch with their humanity along the way. Among this parasitic culture the greatest known crime is diablerie - for one vampire to devour another. When this happens, the murderer is able to absorb some of the power of the victim, and the punishment when the crime is discovered is called Lex Talionis, or “the law of the hunt”. When the hunt is called, the diablerist, the murderous vampire, becomes fair game and every vampire is given free licence to hunt and devour them themselves - to diablerise them in return.

All of this with Theranos - the complete disregard for her defrauded patients, for the employees she surveilled and stalked and brainwashed and even caused to die by suicide - is diablerie. She fed on the most powerful parasites instead of just exploiting the working class and that is what she is being punished for.

Everything that is said about how awful Holmes is can be true. Carreyrou’s claim that she is a sociopath could be true, but the way he uses it seems in line with how people talk about serial killers and psychopaths - attributing some sort of manipulative super powers to her - when actually she is the beneficiary of enormous societal privilege. She even went to a private elementary school. A lot of journalists now are incredibly blind to the kinds of privilege afforded to the establishment and ruling class because they benefit from it themselves and so they have to talk about someone like this as if they’re uniquely talented in some way, even if it’s a bad way.

Carreyrou obviously highlights the privilege that she has benefitted from in her life, but I think that this final claim of the book, that she might be a sociopath, is deployed to explain why an otherwise functional system could produce someone who does such awful things. The fact is, it’s not a functional system.

One ironic tragedy of the whole situation is that with so much money behind them and so many smart people working together, on a long enough timeline they would have invented something. Not necessarily the thing they set out to invent, which by all accounts is probably impossible, but they could have invented something that would have been useful to someone, something that could have improved people’s lives, and with all of the resources at their disposal they could have rigorously tested and refined it if there weren’t a pressure to get the machine out and into Walgreens by yesterday.

A similar example we could think about away from Theranos is how technology is discussed in relation to the environment. A lot of people deluding themselves that climate change can be stopped without the dismantling of capitalism talk about Carbon Capture and Storage (CCS) as the solution that will keep us from total climate apocalypse. The argument basically goes that at some point someone will invent something that will make it possible for us to suck the carbon back out of the air and reverse climate change, and these same proponents of CCS will point to very limited examples that exist now that barely store more pollution than they generate in operation.

I think Theranos is a really good example of how the perverse incentives of profit corrupt everything downstream and frequently create climates of fear and silence that take people who would otherwise be able to actually innovate and demand that they produce the exact thing that has been promised to investors, and do it right now. If that’s the system that we’re banking on inventing something to stop climate change, then quite frankly, we’re fucked.

A communist world would put every available resource into inventing anything that could stop the annihilation of the ecosystem. A capitalist world will put investment capital towards pressuring otherwise smart and capable people into, not even inventing the thing that was promised, just ensuring there’s a return on investment, and failing that, punishing the people who fail to produce.

Imagine if we lived in a world where attempting to help people were completely free from the mechanisms of profit and wage labour, where failing to achieve what you set out to do didn’t mean complete abject failure, poverty, losing your health insurance, being unable to provide for your family. Imagine living in a world where your freedom to test and grow your abilities was supported by the society you lived in and, along with your comrades, your achievements can both be your own and benefit everyone.

What would you attempt to do if you knew you could not fail?