Alan had reservations about the dilution part. The Siemens analyzer
already diluted blood samples when it performed its assays. The
protocol Daniel and Sam had come up with meant that the blood
would be diluted twice, once before it went into the machine and a
second time inside it. Any lab director worth his salt knew that the
more you tampered with a blood sample, the more room you
introduced for error.
Moreover, this double dilution lowered the concentration of the
analytes in the blood samples to levels that were below the ADVIA’s
FDA-sanctioned analytic measurement range. In other words, it meant
using the machine in a way that neither the manufacturer nor its
regulator approved of. To get the final patient result, one had to
multiply the diluted result by the same factor the blood had been
diluted by, not knowing whether the diluted result was even reliable.
Daniel and Sam were nonetheless proud of what they’d accomplished.
At heart, both were engineers for whom patient care was an abstract
concept. If their tinkering turned out to have adverse consequences,
they weren’t the ones who would be held personally responsible. It was
Alan’s name, not theirs, that was on the CLIA certificate.
When their work was finished, a Theranos lawyer named Jim Fox
came by Alan’s office and suggested the company patent what they had
done. That seemed to Alan like a ridiculous idea. To his mind, fiddling
with another manufacturer’s device didn’t amount to inventing
something new, especially if it no longer worked as well afterward.
Word that the Siemens machines had been jailbroken made its way
to Ted Pasco, who had succeeded John Fanzio as procurement
manager and in the process inherited his role as the prime recipient of
company gossip. Ted soon got confirmation of what he’d heard
through the rumor mill when he received instructions from Elizabeth
and Sunny to purchase six more ADVIAs. He negotiated a bulk
discount with Siemens, but the order still cost well north of $100,000.
As September 9, 2013, approached, the date Elizabeth had set for
the launch, Alan grew worried that Theranos wasn’t ready. Two of the
assays performed on the hacked Siemens analyzers were giving the lab
particular trouble: sodium and potassium. Alan suspected the cause of