Why is the Uber of Healthcare such a trainwreck?
Her company, Theranos, is a delivery-model-improvement draped in sweeping language about human empowerment. A seismic disruptor. And its technology has some troubling implications. And it is less-than-forthcoming about its own mistakes. And it’s prickly when anyone deigns to ask questions.
Everyone wants the Uber of healthcare so badly, and I wish we’d stop pining over the concept, because it makes those of us who want to change healthcare the right way look like assholes.
There are a lot of relative outsiders trying to bring new ideas and perspectives to American healthcare these days.We are. We work with people and talk with people everyday who are. It’s rewarding, and those of us that can do it professionally are luckier than Charlie Bucket, because every day we get to work with brilliant minds and have a chance to make the world incrementally better. Few of us are worth $4.5 billion, but that’s okay.
Elizabeth Holmes is worth $4.5 billion. Her company is worth $9 billion. She started Theranos at 19 when she dropped out of Stanford 12 years ago. The Wall Street Journal did an exposè on the company last week, and boy does it look bad. Former employees claimed that Theranos, which offers 240 different blood tests and claims to require only a tiny vial of blood (a Nanotainer!), doesn’t even use its own technology to do most of the tests. It doesn’t use it, because employees don’t think it’s reliable. This week, the wound kept gushing. Fortune published two terribly damning accounts of patients who got back numbers from Theranos tests that were totally out of whack when compared to tests done at prestigious hospitals.
Holmes has been defiant, and promises to release data on the efficacy of her technology. “Data is a powerful thing because it speaks for itself,” she said this week in a talk at the Cleveland Clinic. As Charlie Brown once told Schroeder, “Tell your statistics to shut up.” I don’t trust a lick of the data that we’ll eventually see now, because Theranos has been evasive at best—negligent at worst—and has steadfastly refused to participate in peer review. Trade secrets, you see.
Peer Review isn’t some sacred cow that Holmes ran over in an uberBLACK. There’s a damn good reason why the scientific community has relied on the peer review system since, depending on who you ask, 1731.
Carl Sagan said in The Demon-Haunted World: Science as a Candle in the Dark,
“Why do we put up with it? Do we like to be criticized? No, no scientist enjoys it. Every scientist feels a proprietary affection for his or her ideas and findings. Even so, you don’t reply to critics, Wait a minute; this is a really good idea; I’m very fond of it; it’s done you no harm; please leave it alone. Instead, the hard but just rule is that if the ideas don’t work, you must throw them away.”
But the employees at Theranos were too busy, and the ideas too precious to follow accepted practice. That’s disruption, right? TED talks all around!
That’s what Uber did. It ignored regulation. It trampled over an established industry with disregard and open disdain. Its founder said that he only started the company so that, “Me, my cofounder, and our hundred friends could roll around San Francisco like ballers.”
Its comrade-in-arms, Airbnb, just last week put its nose in the air and responded to the indignity of having to pay taxes in San Francisco with a series of snarky billboards suggesting how the money could be used. This after its platform has been hijacked by, as the Huffington Post recently put it, “real estate operatives (who) evade local laws and taxation, evict long-time tenants and convert entire buildings into tourist hotels.”
The billboards were truly hideous.“Dear Public Library System,” one read, “We hope you use some of the $12 million in hotel taxes to keep the library open later. Love, Airbnb.”
In response, Charlie O’Donnell, a venture capitalist who manages Brooklyn Bridge Ventures found the crux on Twitter, saying, “The Airbnb flub is a result of a Valley startup culture that tells itself that the world is lucky that it even exists.”
Uber and Airbnb are born of this fetishized startup culture. It’s where the money from Theranos comes from, too. Spend any time in the Valley and you’ll quickly realize it always comes back to where the money comes from. As designers—relative outsiders—battling every day to make healthcare better, we must not indulge the attitude of this culture.
We cannot roll over people who have devoted their lives to medicine and sneer at them from the artificial heights of app-class success. The industry is under siege from all sides, and it’s not going out of its way to look for additional voices to join the Greek chorus. We designers, reformers, analysts, etc. are already seen as untrained interlopers by some, and we have to earn the right to an opinion through both the quality of our ideas and the depth of our empathy.
I don’t know Elizabeth Holmes. She seems sharp, and Theranos has the kernel of a good idea. But I do know the kind of people that gave her business a $9 billion valuation and in turn license—and a mandate—to trample the established order. Charitably, we can strive for their drive and savvy, but we do not want their entitlement in healthcare. We do not want their money, and we do not want the influence they wield, because they do not give a damn about the collateral costs of progress when progress means a billion-dollar valuation. In medicine, those costs could be lives lost.