Why Tech Culture Fails at Healthcare
The first time I heard about Elizabeth Holmes was at a family friend’s party in Mountain View, California. As we enjoyed the late summer days of 2012 in a backyard full of fruit trees, Elizabeth Holmes was portrayed as a genius: a nineteen-year-old, Stanford dropout changing the blood diagnostic industry. Initially, she seemed to be a role model for young, aspiring scientists like me. Once I climbed into my mother’s car, my mother mused about Elizabeth’s qualifications.
“She would have barely completed Chemistry 101--how could she have been able to work at a PhD level?” my mom asked. “Maybe there’s some microfluidics technology I don’t know about; Cepheid is doing something along those lines.”
I initially shrugged off my mother’s skepticism. Growing up in the San Francisco Bay Area, the Silicon Valley entrepreneurial spirit was ingrained in my view of the world. Disrupt the system. Drop out of college and change the world. Fake it till you make it. Move fast and break things.
Studying Computer Science in university only reinforced that ethos. Create the minimum viable product. Hack for 48 straight hours. Sleep is optional. Speed is key.
But as Theranos’s exposure and downfall unfolded starting in 2015, it was John Carreyrou’s article in the Wall Street Journal about the whistleblower that really caught my attention. Tyler Shultz was from my hometown; his father, Alex Shultz, was my high school honors biology teacher. As I became increasingly invested in the story, the more I became disturbed by the real pain Theranos inflicted on people. Due to Theranos’s inaccurate blood tests, Sheri Ackert panicked that her breast cancer had recurred. Kimberley Toy changed her entire lifestyle believing she was on the cusp of becoming diabetic. Mr. Shultz worried about selling his home to help pay for the legal fees.
How could such a promising startup cause so much damage? Reading John Carreyrou’s book, Bad Blood, solidified a few takeaways for me. Theranos dodged investments from life science and biotechnological venture capital firms to avoid experts who could conduct thorough due diligence, filled its board with political and government heavyweights instead of medical and scientific experts, stifled communication between scientific employees, lacked peer-reviewed publications, and impatiently over-marketed promises that had no technological basis in reality.
Elizabeth Holmes, clad in a black turtleneck purposefully intentioned to evoke a Jobs-esque mythology, is indeed a fraud. But the blame lies not only with her and Sunny Balwani; the venture capitalists (VCs) and private investors that continued to fuel Theranos’s rise cannot completely abdicate responsibility either. When VCs make an investment in a company, we make an active choice that we believe in not just the company’s vision, but also the execution of that vision. We have an ethical obligation to both our limited partner investors and society as a whole to make sure our funds have a positive, meaningful impact.
Theranos is only one case in a more disturbing trend of what happens when the Silicon Valley pace and ethos is applied to healthcare. In the Wondery podcast, Bad Batch, Laura Beil explores the companies Liveyon and Genetech who sold unproven stem cell injections that placed at least twelve people in the hospital. After receiving the injections, Dorothy O’Connell had to learn how to walk again. John Herzog could no longer bike or windsurf--climbing a staircase meant pain. Timothy Lunceford thought the injection could improve his back pain, but instead it landed him in the hospital for 58 days.
In Beil’s deep dive, listeners learn how John Kosolcharoen, the Liveyon founder, had a history of involvement in fraud and Ponzi schemes. Genetech ignored the advice of the medical regulatory advisor they had hired, cut corners instead of following safety regulations, and sold treatments without FDA approval. Similar to Theranos, Liveyon’s dodging of federal regulations, lack of relevant medical experts, no peer-reviewed publications, and impatience to get to market resulted in patients becoming septic and staying in the hospital for months. An injection that not only does not work, but actively infects patients with life-threatening bacteria is not a minimum viable product. That impatience, that over-marketing, that need to move fast with no regard for the consequence--that hurts people.
The same tech culture playbook ultimately cost IBM Watson Oncology, which was initially hailed as paving the way for AI to break into the healthcare space and support oncologists’ decision-making. As investigators in STAT News have reported, IBM’s over-marketing, impatience to get to market, lack of peer-reviewed publications validating Watson’s accuracy, and failure to work with physicians’ feedback resulted in MD Anderson Cancer Center’s shutting down of the Watson program and reports of erroneous and dangerous treatment suggestions when used at Memorial Sloan Kettering Cancer Center. Had the physicians not been there to filter through recommendations from IBM Watson, who knows how many cancer patients could have been harmed?
It’s exciting to disrupt old, bureaucratic industries. It’s exciting to hype up your product through slick marketing. It’s exciting to push the minimum viable product. I get it. Goodness knows that when I open up that electronic medical record, I curse the user interface and how absolutely awful it is to navigate. I, too, want more efficiency in healthcare, and new innovations that help the myriad of issues that bog down our system are desperately needed.
Getting FDA approval is slow. Publishing in peer-reviewed journals is slow. Listening to experts is slow. It’s everything contrary to the entrepreneurial spirit that Silicon Valley and startup culture endorses.
There is an abysmal pattern that shows that Silicon Valley startup culture not only does not work when applied to healthcare, but causes harm. If we are to continue to create in the healthcare space, we need to do so in an ethical and productive manner. As VCs and founders, we have the power and responsibility to do no harm. Perhaps this takes the form of having an ethics committee in evaluating new and current funds. Or maybe this takes the form of independent audits. I don’t yet have the solutions, but there is one thing I do know. In healthcare, you can’t just quickly hack something together and hope it sticks. When you move fast and break things, you move fast and break people.
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