T
he rise and fall of Elizabeth Holmes, former
chief executive officer (CEO) of the high-flying,
privately held, American medical diagnos-
tics company Theranos, has riveted the public
for years. A bestseller, a documentary, and a
seemingly endless stream of news stories have
chronicled the drama, which came to a climax
last week when a jury decided that Holmes commit-
ted fraud. Although a verdict has been rendered, it’s
worth examining how the culture of science innova-
tion contributed to the problem. For too long, fledging
companies promoting technological and scientific ad-
vances have relied too much on style and not enough
on substance.
An exciting and robust technology is generally only
part of the picture in creating a successful life science
business. Investors—especially venture capitalists
in Silicon Valley—are also look-
ing for a compelling CEO who can
dazzle other investors and eventu-
ally Wall Street. It’s often said that
to succeed, a venture-backed com-
pany needs a CEO who is a “force
of nature”—someone who can raise
money for a promised new technol-
ogy even when the supporting data
are not great. This person should
be someone who the investors be-
lieve will “get there or die trying”
and who has the ability to “fake it
till you make it” to keep the com-
pany going through the inevitable
setbacks along the way. None of
these traits have anything to do
with developing a robust technology that saves lives.
Pushed too far, the exaggerations become fraud, and
the Holmes case shows that can be a crime.
As venture-backed companies grow, investors usu-
ally insist on “milestones” that show the steady im-
provement of the technology. The temptation to
misrepresent the progress increases with each step.
If the technology is not actually advancing, then the
executives in the company are committing greater
and greater acts of fraud. There is also a burden on
the investors to carry out due diligence on the claims,
but they only have financial and not criminal liability.
When attention is too focused on charisma and a cer-
tain amount of fakery is considered acceptable, reality
can be overcome by hype.That is what happened with Theranos. Holmes
was more obsessed with her personal impression and
less so about whether the company delivered on its
promise to provide small, automated devices that re-
quired very small amounts of blood to perform nu-
merous diagnostic tests. Her boyfriend and business
associate Ramesh “Sunny” Balwani—who awaits his
own trial—presumably provided instructions on her
personal style and conduct, but nothing about how to
make the technology work. Maybe reading some scien-
tific papers about diagnostic technologies would have
been a good thing. Instead, investors happily followed
the 19-year-old Stanford dropout (with no experience)
down an entrepreneurial path paved with dishonesty,
not reality.
With information technology companies, the stakes
are not so high. If tech CEOs overhype their shiny new
idea, venture capitalists will merely
lose money that they knew full well
was at substantial risk. But fakery
involving new medical tests can
lead to life-threatening harm. In-
terestingly, the jury found Holmes
guilty of defrauding investors, but
not defrauding patients. The latter
verdict may have been influenced
by the fact that physicians who used
the Theranos blood tests followed
up with other lab tests, thereby
limiting the potential damage to
people’s lives. The implications of
this for the commercialization of
science are enormous. Being opti-
mistic that the science might work
is one thing, saying it works when it doesn’t is another.
In Theranos’s case the distinction was clear-cut, but
the efficacy of many other technologies—particularly
in the life sciences—is not as easily deduced. If it works
in cells, will it work in animals? If it works in animals,
will it work in humans? Can you produce it at scale?
“Get there or die trying” sounds snazzy, but the
Theranos case is a reminder that more than money
can be at stake. What happened to Holmes should be
a warning for future start-ups. Instead of forces of na-
ture, how about companies led by highly accomplished
scientists who give dull and boring PowerPoint presen-
tations full of outstanding data?–H. Holden Thorp*When hyping technology is a crime
H. Holden Thorp
Editor-in-Chief,
Science journals.
[email protected];
@hholdenthorp10.1126/science.abo*H.H.T. is a consultant to Ancora, a venture partner at Hatteras Venture Partners,
and member of the board of directors of Artizan Biosciences.
PHOTO: CAMERON DAVIDSON
SCIENCE science.org 14 JANUARY 2022 • VOL 375 ISSUE 6577 121EDITORIAL
“When attention
is too focused
on charisma...
reality can
be overcome
by hype.”