{"id":42393,"date":"2018-06-19T10:57:36","date_gmt":"2018-06-19T09:57:36","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=42393"},"modified":"2018-06-26T12:42:17","modified_gmt":"2018-06-26T11:42:17","slug":"benjamin-mazer-theranos-dystopian-vision-lives-on","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/06\/19\/benjamin-mazer-theranos-dystopian-vision-lives-on\/","title":{"rendered":"Benjamin Mazer: Theranos\u2019 dystopian vision lives on"},"content":{"rendered":"

When you go about testing everyone for everything, you don\u2019t create a world of healthy people….you create a nightmare where everyone is sick<\/p>\n

\"\"While reading \u201c<\/span>Bad Blood<\/span><\/a>,\u201d John Carreyrou\u2019s recent expos\u00e9 of the rise and fall of <\/span>laboratory startup Theranos<\/span><\/a>, whose principals were recently indicted by a grand jury on charges of wire fraud, I kept coming back to the old Monty Python sketch about the <\/span>cheese shop<\/span><\/a>. In the sketch, a man walks into a cheese shop, requesting to purchase some gourmet Red Leicester. He\u2019s informed they\u2019re fresh out. So he settles for some Tilsit. No luck either. Soon, he finds out the shop doesn\u2019t actually have any cheese at all. As John Cleese puts it, it\u2019s a beautiful and clean cheese shop primarily because it\u2019s \u201cuncontaminated by cheese.\u201d <\/span><\/p>\n

Time and again, Theranos showed off their clean, high-tech shop to anyone who would pay attention: investors, journalists, the military, drug and grocery stores, even Vice Presidents. Turns out, it\u2019s easy to craft a futuristic vision of convenient, affordable laboratory testing if you don\u2019t actually have to run any tests. In his book, Carreyrou describes all the hopeful, but false promises Elizabeth Holmes and her boyfriend-cum-business partner Sunny Balwani made to solicit investments and business partnerships. Silicon Valley is the land of \u201ctransformative\u201d visions, but no one seems to have expected that showmanship could deteriorate into fabricating financial reports or crafting live demonstrations inspired more by the Wizard of Oz than Steve Jobs.<\/span><\/p>\n

Many will read Bad Blood for the rubber-necking appeal of watching somebody else\u2019s car wreck. But as a pathologist, the source of tension for me was not Theranos\u2019 failure, but the fear over what would have happened had they succeeded. The vision Holmes presented, which garnered her so much attention and funding, was a world in which patients could easily have cheap panels of blood tests performed at home, ultimately facilitating earlier diagnosis of medical conditions. In her <\/span>TED talk<\/span><\/a>, Holmes said, \u201cMy own life\u2019s work in building Theranos is to redefine the paradigm of diagnosis away from one in which people have to present with a symptom.\u201d Bad Blood describes dreams of identifying breast cancer before it shows up on mammograms. Holmes once even <\/span>suggested<\/span><\/a> her testing could detect pancreatic cancer \u201c17 years before a tumor forms.\u201d <\/span><\/p>\n

The reality is the tests Theranos did end up performing were plagued by poor quality control, leading, for example, to erroneous PSA results and panicked patients concerned they had prostate cancer. As someone who spends his days diagnosing cancer, reading these stories didn\u2019t feel like watching someone else\u2019s car wreck\u2014it felt like a reflection of my own. Patients suffer the false fears of prostate cancer every day in medicine, even when the PSA test is done right. <\/span><\/p>\n

For many in the tech community, a world where people receive a constant stream of health data is a medical utopia, one which would allow them to notice disease at its first biochemical perturbation. Manipulating biology, however, is not software engineering, and a deterministic approach to medicine has caused us harm as well as benefit. The idea that diseases smolder within us\u2014silent but treatable\u2014only to emerge later in more advanced, deadly forms is appealing, and, of course, partly correct. But as doctors have expanded our hunt for asymptomatic conditions, we\u2019ve discovered that not all early diseases become advanced ones. Some remain indolent, while others can even regress. We\u2019ve learned that we create a lot of anxiety by performing widespread, false-positive prone testing on healthy people, such as with mammograms and PSA screening. Worse, many of the \u201creal\u201d positives are indolent cancers, and treating everyone doesn\u2019t actually <\/span>prolong most people\u2019s lives<\/span><\/a>. We are currently in the midst of a man-made epidemic of \u201c<\/span>overdiagnosis<\/span><\/a>.\u201d<\/span><\/p>\n

When you go about testing everyone for everything, you don\u2019t create a world of healthy people. Quite the opposite, you create a nightmare where everyone is sick. As we\u2019ve developed more technologically-advanced imaging and lab tests, for example, the number of thyroid cancer diagnoses has gone through the roof. Despite all these new \u201ccancer survivors,\u201d about <\/span>the same number of people<\/span><\/a> still die from thyroid cancer every year. Medicine is frequently disparaged for treating patients only after they present with symptoms\u2014Holmes certainly got mileage out of it\u2014but, in many cases, this happens to be a prudent way to identify those who really need the help. <\/span><\/p>\n

Plenty of real companies are still carrying the \u201cearly detection\u201d baton. Techno-optimism and bio-naivet\u00e9 still mix within Silicon Valley\u2019s veins, even as doctors are taking the problem of overdiagnosis more seriously. Sure, it\u2019s easy for startup wunderkinds to promise us their new tests will be different: more sensitive yet somehow less prone to overdiagnosis and false positives. But until we demand rigorous scientific studies before we start adopting these tests, and until we recognize all diagnosis comes with a risk of overdiagnosis, we\u2019re just telling the world we want another Theranos\u2014another beautiful, clean shop untarnished by the reality of medicine\u2019s tradeoffs.<\/span><\/p>\n

Benjamin Mazer<\/strong> is a resident in the pathology at Yale-New Haven Hospital. His views are his own, and don\u2019t represent those of his employer. Twitter\u00a0@BenMazer<\/a><\/span><\/em><\/p>\n

Competing interests<\/strong>: None declared.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

When you go about testing everyone for everything, you don\u2019t create a world of healthy people….you create a nightmare where everyone is sick […]<\/p>\n

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