You Actually CAN'T See Everything
Elizabeth Holmes has been a name I've heard about frequently for the past two years. In fact, before whispers about the documentary coming out even erupted, I was tasked with a semester-long project in my analytical chemistry course at UT Austin during my last year of undergraduate school. For the project, I was supposed to read Bad Blood: Secrets and Lies in a Silicon Valley Startup and write an essay over the science that Theranos was trying to use. So, to say I'm acquainted with the topic is an understatement. To say I immediately bought a ticket to "You Can See Everything" by Nathan Fielder is even more of an understatement.
The entire documentary was three hours of shock, bewilderment, and relatability to Amanda Seyfried (yes, she is actually in the documentary). I love the questions that were being asked, the clarity-inducing bluntness Fielder provides, and the call of Fielder's potential bias into question. The documentary not only tells a story about Elizabeth Holmes --- but it makes a point to remind the audience that perspective is an extremely important part of providing information. What the documentary doesn't do, however, is adequately remind the audience of the severity of the Theranos scandal that sentenced Holmes in the first place.
As I was watching the documentary, I thought about this more than once. Especially when interviews between Fielder and Holmes take place. During these chats, Holmes mentions "the truth" many-a-times, talking about the Theranos scandal as if it was just a simple accident. However, the documentary didn't provide many reminders of just how bad the scandal was, making Holmes appear truly innocent at certain points. There were moments where I even started to feel as if Holmes could have been simply unaware, so I can only imagine how persuasive she was for audiences who don't know the full extent of the scandal. So, I thought I would give some insight.
The story starts at Stanford, where Holmes attended as a chemical engineering major in 2002. According to faculty, Holmes was notorious for coming up with biomedical inventions. She even went so far as to approach Dr. Phyllis Gardner, a professor of medicine at Stanford University, with the concept of a skin patch that was supposed to scan for skin infections, deliver antibiotics, and take blood samples (Holmes seems to always stick to inventions involving diagnostics, blood sampling, and microfluidics). Dr. Gardner proceeded to respond with skepticism, in which she told Holmes that the invention was scientifically impossible, especially regarding the antibiotic dosages conflicting with the microfluidics. Afterwards, Holmes apparently ignored the feedback completely. Instead, she came up with the idea for Theranos, launched it in 2003, and proceeded to drop out of Stanford in the second year of her engineering degree (followed by building credibility as Theranos' CEO and founder by calling herself an engineer).
Now, it is important to note that Theranos is simply the company that Holmes built, not the technology. Instead, the technology was a little box, about the size of a toaster, known as the Edison. According to Theranos' marketing claims, the Edison was supposed to be able to run 200+ different comprehensive and diagnostic tests using only micro-amounts of blood compared to the vials of blood that are usually taken for said tests. Scientists who read that are probably all thinking the same question: "what testing method is the Edison using to examine these samples?" Well, it's something called chemiluminescence immunoassay, or CLIA for short. This technique combines the reaction from antibodies (the Y-shaped things that fight infection) binding to antigens (the things that antibodies are destroying to fight infection) with a chemical reaction that emits light, which is then used to measure and detect certain molecules in liquid samples. CLIA is a great method to use if you're trying to measure things like hormones and certain viruses, for instance. However, if your trying to test for your complete blood count or creatinine levels (tests Theranos claimed the Edison could perform), CLIA doesn't work in determining these. In fact, the majority of the tests that Theranos claimed the Edison could perform could not use CLIA as an accurate form of testing, and that's not even mentioning the issues with the (way too) small amounts of blood the company was trying to use for the exams.
So, we know the Edison didn't work as Theranos claimed, but that doesn't necessarily make the scandal severe. That is, until we learn just how any lives were impacted by the false claim. You see, Theranos was a commercial product that needed investors and customers. So, Holmes tried to form partnerships. One of the first attempted partnerships was with the well-known biopharmaceutical company, Pfizer. In response to Holmes' interest in a partnership, Pfizer wanted to test out the Edison before making any decisions. So, they had Theranos conduct a 15-month scientific study that measured how 27 late-stage cancer patients responded to treatment using the Edison machines. Following the study, Pfizer announced that they had no interest in working with Theranos due to large variations in patient results combined with Holmes' inability to explain why the variations occurred. Still, Holmes decided to use Pfizer's logo on investor documents following the rejection, giving the impression that Pfizer backed Theranos. In fact, not only did Pfizer not have a partnership with Theranos, but there was not a single pharmaceutical company that supported Theranos ---the company's only corporate supporters were commercial corporations (like Walgreens). These commercial partnerships allowed for Theranos to be used by the public without oversight, leading to many adverse impacts of the flawed technology.
Speaking of oversight, it is also important to note that because Theranos was a piece of medical technology that was being made available to the public, FDA approval was crucial to the safety of the public regarding the technology. However, Theranos didn't roll that way. In fact, Holmes was so invested in getting Theranos' failed technology off the ground that she used a loophole to bypass FDA approval --- by operating as a Laboratory Developed Test (LDTs), which is not regulated by the FDA. Instead, LDTs allowed for Theranos to test blood samples (that were meant to be used in the Edison) through commercial laboratory testing devices, provided by a company called Siemens, within the Theranos labs. Despite this initial bypass of the rules, however, Holmes did actually seek FDA approval later on. That is, for one out of the hundreds of tests the Edison technology offered: Theranos Herpes Simplex Virus-1 (HSV-1) IgG Assay. However, when it came to any other FDA approvals, Holmes seemed to neglect the rest of the tests.
Now, there is so much more to this story (hence why John Carreyrou had to write an entire book over it). However, from just these parts, you can piece together that Elizabeth Holmes did not simply make a mistake. This situation wasn't just a matter of correcting "can" with "could". Throughout the years that Theranos existed, Holmes actively played a part in lying about results, pushing for partnerships with no regard for the failed technology, bypassing the FDA with properly working commercial laboratory machines, and even lying on investor documents to make the company sound more secure than it was.
To add a cherry on top, the documentary mentions a desire from Billy Evans, Holmes' long-term partner, to "get the band back together" and start up "Theranos 2.0". Except, the new company that Evans is allegedly talking about is not called Theranos 2.0, but Haemanthus. Even better, the company is another diagnostic technology (shocker) being created by yet another person with zero scientific background (double shocker), as Evans holds a bachelors in economics from MIT. The documentary shows glimpses here and there that center around the creation of this new company, with Evans trying to explain Raman spectroscopy to Fielder cut between scenes of Evans watching science lectures on 2x speed and being impressed by the concept of apoptosis.
Overall, the documentary was worth the watch. Between the inside look into Elizabeth Holmes' life right before prison, Fielder's consistent call-outs of Evans and Holmes, and Amanda Seyfried's refreshing perspectives, whether you know the entire Theranos story or not, you will most likely enjoy the film. However, for the sake of the experience, I would highly recommend looking into the scandal more in-depth before watching. Not only does the insight give you more context, but it also makes dissecting Holmes' commentary that much more interesting.
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