The Fall of Theranos and What it Teaches Us About Skin Care
by Wendy Ouriel
Bitcoin and a Silicon Valley Startup
In 2012 I made a strange phone call. The day prior I was talking to a friend who is eccentric and furtive with his ideas. He said that the world’s commerce will one day be run solely by internet money, which will be so rare that 1 unit of currency will be worth millions. He was referring to Bitcoin.
The idea seemed farfetched but the investment potential was too good to ignore. I decided to dig a little deeper into the small and esoteric cryptocurrency world. One Bitcoin was $9 and I was astounded by how expensive this (seemingly valueless) commodity was. Regardless I decided to buy because I like a gamble, and if one coin had the potential to be worth millions, it would be foolish to not take those odds.
After researching around the internet, it seemed that this currency wasn’t easy to buy. It wasn’t like buying a book off of Amazon, and luckily I wasn’t aware of the (now bankrupt and defunct) Bitcoin exchange, Mt. Gox. But after some digging I found a shady website that was made up of a single black page with yellow plain-text and just the number of a ‘crypto brokers’ office in New York. So I decided to call and see if I could purchase these Bitcoins.
A young man answered what was obviously a cell phone, I told him how much Bitcoin I wanted to buy and we did a wire transfer over the phone. While we were waiting for the transfer we had some small talk, I mentioned my research in biology and he brought up a hot new startup that he heard about while working in Silicon Valley the year prior. This startup was run by a young woman who claimed to have revolutionized blood testing and it was going to be the future of health care.
It was called ‘Theranos.’
Then the wire went through, he gave me a ‘key’ to a digital wallet that looked like a complex password, and we hung up. And, to my surprise, I got my Bitcoins.
What was most interesting at that moment wasn’t the coin exchange, it was the company leading a blood revolution. I remember reading about this startup online right after our call and I thought it was just as strange, if not stranger than the bitcoin transaction I just made.
I couldn’t get a lot of information about Theranos or its founder, other than how "amazing" their tech was, or how great of an "entrepreneur" Holmes was. Everything about the company was written in vague terms, too vague for a company who would be a game-changer in health care. So I forgot about it until I read about Holmes and Theranos again in the New Yorker 2 years later.
The New Yorker article , although far more detailed about Theranos than previous accounts, still left the company shrouded in secrecy. Other articles were published after the New Yorker article and went into great lengths to talk about Theranos leading a blood revolution and how Elizabeth was the Beethoven of health care. But what was missing from all of these articles was a clear explanation of how this technology was done.
Photograph by Jenny Hueston
A lot of things bothered me about this company. First was that a company who was developing complex immunodiagnostic technology that was directly impacting people’s health was run by a college dropout. Who wasn’t even in school for biology, chemistry or medicine.
Dropping out of college has been romanticized in Silicon Valley culture, because it is something a few people needed to do in order to pursue their business, which later became a famed success. Notable examples include Bill Gates and Mark Zuckerberg. But beyond these highly cited examples, there are not many other people for whom dropping out worked so well. Despite thousands of people dropping out of college every year, with little to no notable achievement thereafter, we want to believe in that good story of how someone gave the middle finger to the educational bureaucracy and became a legendary success on their own. No matter how outlandish the details.
One notable difference that most people overlooked between Gates or Zuckerberg and Holmes was their industry. You can become a master at coding by a young age and, with a little luck, become successful in the tech industry. You cannot do the same in the sciences. There is a reason why most people who win Nobel prizes for biology, chemistry or medicine are in their 60s or older. It takes a long time to gain your education, master techniques, carry out experiments and achieve notable results.
Barbara McClintock was 81 when she earned her Nobel Prize
You can work on an experiment for 50+ years and never achieve notable results.
So here we have the leader of a health-care company who has no actual experience in health care, she just had a highly marketable idea, and the means to start a business.
She also had the allure of the Silicon Valley Startup turned Unicorn that so many fell hard for.
We see the same in skin care: someone with no background in the product they are developing, but just the means to make the product and sell it well. And what you get, in the case of Theranos, is a massive fraud at the risk of human health. You can get the same in skin care.
Appeal to Authority
The story of Theranos’ CEO, Elizabeth Holmes isn’t that different from the story of other Skin Care CEO’s: You have someone who does not have a background in the development of their product, but rather are skilled at marketing and very good at selling an idea.
Appeal to authority is a logical fallacy in which we believe something must be true because it is believed by someone who is deemed an ‘authority figure’ on the subject. In the 1950’s Camel cigarettes appealed to the authority bias by claiming in their advertisement that more doctors smoked Camels than any other cigarette. Therefore, Camel’s must be healthier, because a doctor said so.
We fall for appeal to authority fallacies all the time. Its why toothpaste companies always put the ‘#1 dentist recommended brand’ seal on their labels, or why Nike pays millions for athlete endorsements. We believe what the ‘authority figure’ says because ‘they must know whats best.’ A dentist will certainly know what toothpaste to use, and athletes will only use the best brand for their top athletic performance.
People will get paid to say they like something. Regardless of its truth value or their knowledge on the subject.
A dentist couldn’t possibly know whether Crest or Colgate was healthier unless they either conducted their own experiments (which would take years and they likely don’t have the research background to perform properly) or have been following the unbiased non-toothpaste brand sponsored research for years. I have never had a dentist ask me what brand of toothpaste I use, they just want to know that you are in fact using toothpaste. So I doubt that there are dentists out there keeping a complex database of toothpaste brands and their correlation to dental health. Therefore a dentist can only go by their own experience, which is a sample size of 1 and not reliable.
What is reliable is the fact that toothpaste companies will send their products to dentists so that they are used in their offices, making the patient think that the dentist must really like this toothpaste, but in reality they were likely just sold by the company.
And skin care is no different. Skin care companies will pay celebrities hundreds of thousands, if not millions of dollars to endorse their products. But do their products really work? Are celebrities really the proper authority to tell you what is best for your skin and for your health?
I will read on the founders of some skin care companies and their background has as much to do with science as Elizabeth Holmes’ background was to health care. You have people running skin care companies with backgrounds in business, entertainment, or cosmetology. The problem with these backgrounds is that they do not come from the sciences, which makes their product as dubious as The Edison.
A notable aspect of Theranos authority was their illustrious board of directors, which was comprised of high-achieving and famous figures such as former Secretary of State Henry Kissinger, former Secretary of Defense Bill Perry, former Secretary of State George Shultz, former Senators Sam Nunn and Bill Frist, former Navy Admiral Gary Roughead, former Marine Corps General James Mattis, and former CEOs Dick Kovacevich of Wells Fargo and Riley Bechtel of Bechtel.
Other than Bill Frist, who was a former surgeon, none of these people have relevant backgrounds in health care.
Filling your board with high-ranking yet unqualified members is common in skin care too.
There is one brand in skin care that sticks out in particular to me based on my first-hand experience. The brand sells a serum composed of terpenes, essential oils and a plant oil fatty acid profile that is comedogenic and inflammatory. Not to mention it contains no preservatives.
This serum could strip the paint off of a house and prevent anything biological from ever surviving on its surface.
Its no surprise that someone who would make a product so poorly formulated has no background in biology. The person running this company has a background in the food and beverage industry.
The lack of background is most obvious when trying to explain their own product. This CEO (and other CEOs in Skin Care), like Elizabeth Holmes was incapable of explaining how their product worked due to their lack of proper background. I have seen in panels a clumsy attempt to explain the supposed 'science' behind their lines, and their explanation is more of what one would expect from high school freshman not an accomplished and educated scientist. And this is a problem when your company uses 'science' to back up the efficacy of their products.
When Elizabeth Holmes was asked to explain the Edison, she told a reporter for the New Yorker:
"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."
When I was at a Panel with this particular skin care CEO, and someone asked how the product worked, according to the site's own testimony the CEO said:
"It improves the activity of your body's own energy and abilities to harness health in the best possible way."
Those words are tattooed in my brain because I still have no idea what any of it means.
I wondered for a long time why this product is seen on the shelves of high end stores both online and in brick-and-mortar. Its ingredient deck is no different than the door-to-door MLM-brand natural skin care, or the natural skin care you find at the organic grocery store. The bottle isn’t even special or luxurious. Yet here it is being sold in the finest stores in the world for a very high price.
I was invited to a meeting at the headquarters of a famous and exclusive cosmetic boutique about 2 years ago because they wanted to carry OUMERE in their store. I talked to the buying team and this brand was brought up because they carry it in their store and the buying team members all agreed the product “made them break out like crazy.”
I wondered why sell a product in your store that caused everyone severe breakouts, and subject your customers to that. Especially because this store prides itself on meticulous curation of their products, and a lengthy and rigorous approval process by the so-called best in the industry. And then I dug a little deeper and found that the owner, like Elizabeth Holmes had friends in high places who were able to push their influence (and their investment in the company) to get this product sold in stores. I also believe the owner(s) of this store had a stake in the company.
I also found that this company has a very expensive marketing team and online reputation management to make positive reviews on all platforms, delete negative ones, and create the illusion that their product is a revolution in skin care like the Edison was a revolution in blood diagnostics. Which is very similar to the militant and litigious methods used by Theranos to keep bad information out of the press.
A lot of OUMERE customer’s came to us because the aforementioned product ‘destroyed their skin.’ I also declined my products being carried in the aforementioned boutique.
Another thing that Theranos was known for was falsifying their data. One notable example was when former Vice President, Joe Biden went to tour the Theranos Facility. He was told that he would have his blood analyzed within the hour. So they did the pin-prick on the finger, extracted the blood into a cartridge, and put the cartridge in the Edison for analysis. Then he went to tour the rest of the facility while the analysis was performed. Well, what happened next was a lab scientist came into the room where the Edison was, took out the cartridge, and performed the immunoassays on a Siemens machine.
In skin care, the same happens constantly. Its common for skin care companies to use misleading testimonials or data on their website.
It is also a common occurrence where a skin care or cosmetic company will ‘fund’ research on a particular topic. One notable example are vitamin C serums. If you look at the data ‘supporting’ vitamin C serums benefits, you will almost always see that it is funded by a company that sells vitamin C serums, which is suspicious and can be considered a conflict of interest.
Futhermore, I have often tried to replicate many famous skin care studies in my own lab, and I find that these studies are often not replicatable, and I do not achieve the same results as published in the studies. Such as not seeing any increase in collagen when the study says collagen increased.
Its a nice idea, but…
The Theranos story began because a sophomoric college student took a couple of classes, got excited about this new world that opened up to her and conjured up fantastical ideas that were less medical-science and more science fiction. Which is easy to do when you’re first starting out in the sciences because you are ignorant of the limitations of physics, chemistry and biology. You start to experience these limitations once you further yourself in school and conduct your own experiments. Elizabeth Holmes may have realized this if she had not dropped out after 2 years.
Skin care is the same story. And you don’t want to buy your products from those who are not educated enough to delineate between skin care science and skin care science fiction.
I believe the reason why we see so many skin issues nowadays is because skin care is more about marketing and less about science. And there are more Theranos’ of skin care than we may think.
But I'm not so sure about Bitcoin going to a million dollars.
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