Bad Blood by John Carreyrou

Hi everyone,

Did you get to Bad Blood this month?  Or watch the documentary?  Do you have any experience in lab science?  Psychology?  Medicine?  Law?  Tech start ups?  Have you lost faith in America?

If you answered yes to any of the above questions, please join us Wednesday evening for a discussion of John Carreyrou's investigative report of the Theranos scandal.  (And then, if you've read anything particularly uplifting this summer, will you share that title?!  Because I could use an antidote right now!*)

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Suggested discussion questions are below...but I believe these really only crack the surface.  I know there are several people traveling this week.  Please send in commentary by email if you'd like!  We will miss you!

Drop us a line and let us know if we can hope to see you!

*I have read a few other books since I originally drafted this email, so I feel better about things in general, but I always love hearing about new titles!

Discussion questions:

1. Did you like this book?

2. For expository writing, there is a heavily slanted tone to this book, even from the get-go (Author's Note) when Carreyrou writes that Holmes declined to cooperate with any interview.  He cites examples of her behavior that paint a picture of possible mental health issues and manipulation.  Was there any other side to the story?  What tale would her parents tell?

3. "Imagine detecting breast cancer before the mammogram..." (83).  Um, was I born yesterday?  Is there a known protein marker for breast cancer?!  Why does no one see how flawed this system is!?  And how do we not get an actual doctors' opinion on this until deep into the book -- with Kate's wife opinion that is only described as, "Tracy asked some questions that no one on the Theranos end of the line seemed able to answer.  That evening, she told Kate she was dubious that the company had any truly novel technology" (157).

4.  How did this go on for so long without Holmes being found out?  (Perhaps because people are motivated by greed and the fear of death??  Just a thought.)  Was it really that everyone understood the importance of keeping information confidential?  (Referring to the advertising agency hired in 2012, "In Patrick's experience, all tech startups were chaotic and secretive.  He saw nothing unusual or worrisome in that" (160).)

5. What was the real draw to Holmes' pitch?  Apparently there were already devices on the market (that may not have been able to perform so many tests), like the Piccolo Xpress, that only used a few drops of blood.  What did she say that convinced so many people to invest in her? (97)

6. Similarly, did anyone else think it was odd that new employees only interviewed with Elizabeth and Sunny?  Normally, employees meet several members of the team they will be working on, to see if they will fit into the culture.  But I get the sense that they skipped that and just focused on controlling one-off hot shots who could be seduced by her "deep baritone".

7. And besides their technology, why isn't a doctor making a comment that one blood test is just one tool in the work up of a patient.  In terms of saving lives, I can only think of two tests -- the hematocrit and blood type and screen -- that could be used to make immediate life-changing decisions, such as whether or not to transfuse a patient.  Other tests aren't usually so urgent.  Medicine moves slower than people think.  Or am I missing something?

8. I was really struck by the unhealthy nature of the competition between Walgreens and CVS.  Have you ever been exposed to that kind of rivalry or fear of failing to make a profit?

9. "Even though the startup had never said anything about outsourcing some of the testing, [Safeway CMO Kent Bradley] discovered that it was farming out some tests to a big reference laboratory in Salt Lake City called ARUP" (112).  How did he find this out?  What information leaked and what didn't under Elizabeth's web of security?

10. Anyone else get the sense when reading the "Lighting a Fuisz" chapter that the parties involved were behaving similarly to the cats in that children's tale, Millions of Cats in which the disgruntled characters all kill each other off?

11. How much did your stomach turn to find out that Holmes was paying Boies in stock?  She's a magician! (139)

12. What do you make of how the story unfolds -- the back and forth in time as Carreyrou follows different threads?  In particular, what do you make of the placement of Ian Gibbons' story?  For someone as influential an employee as him (ten years there!  they were his patents!) with such a heartbreaking story (especially when coupled with his wife's story with her own grief over her mother's death), why place this deep into the book? 


13. What was missing from the book?  What else did you want to know about?  (For me, what other research was she building on?  "The ability to perform so many test on just a drop or two of blood was something of a Holy Grail in the field of microfluidics.  Thousands of researchers around the world in universities and industry had been pursuing this goal for more than two decades, ever since the Swiss scientist Andreas Manz had shown that the microfabrication techniques developed by the computer chip industry could be repurposed to make small channels that moved tiny volumes of fluids." 181.  Were LabCorp and Quest working in this area?  Was there any underlying truth to her paranoia that they would develop this technology first or steal hers?)

14. Does Carreyrou imply that Silicon Valley start-ups operate on an unethical premise?  Or is he making excuses for tech start-ups as he distinguishes Theranos as a healthcare company?  ("The term "vaporware" was coined in the early 1980s to describe new computer software or hardware that was announced with great fanfare only to take years to materialize, if it did at all.  It was a reflection of the computer industry's tendency to play it fast and loose when it came to marketing.  Microsoft, Apple, and Oracle were all accused of engaging in the practice at one point or another.  Such overpromising became a defining feature of Silicon Valley.  The harm done to consumers was minor, measured in frustration and deflated expectations." (296))

Follow up:

Hello everyone,

So nice to see you tonight.  For those of you who couldn't make it, we loved hearing your thoughts on Bad Blood via email and would love to hear more in person next time!

I don't know what scandalized us more -- the fact that had she not picked a medical device to develop, Elizabeth Holmes' scheme might have gone on indefinitely...or the fact that so many knowledgeable people failed to see what was going on for so long...or the fact that it seems like it's nearly impossible to gain any protection as a whistle blower when corporations seem to have all of the leverage.  As one of you pointed out, thank goodness for the continued life of hearty investigative reporting.

We are changing gears for next time...back to memoir...  Please join us next time (date TBD) for a discussion of Maybe You Should Talk to Someone by Lori Gottlieb.

Hope to see you there!