Why was Theranos so believable? Medicine needs to look in the mirror

I watched the recent “60 Minutes” report on the rise and fall of Theranos, the test-everything-with-a-fingerstick company that recently flamed out, costing numerous high-profile investors north of $700 million. The report laid out the standard narrative about Theranos, including healthy doses of deception and greed, an absence of various sorts of oversight, and too much Silicon Valley mythology.

To get some perspective on what happened, I looked back at what was said about the company just a few years ago. I re-read a December 2014 article in the New Yorker on Theranos and its founder, Elizabeth Holmes. What struck me as I compared the “60 Minutes” and New Yorker pieces, which were separated by only a little more than three years, is one simple question that seems to have been missed in the ashes: Why was the Theranos pitch so believable in the first place?

That investors were duped is one thing. But the New Yorker article included generally positive quotes from Dr. Toby Cosgrove, who was then head of the Cleveland Clinic. He told the magazine, “I think it’s potentially a breakthrough company. … It represents a major change in how we deliver health care.”

Dr. Eric Topol, a cardiologist, geneticist, and director of the Scripps Translational Science Institute in La Jolla, Calif., while noting the lack of peer-reviewed data on just how well Theranos performed, said it represented a threat to the status quo. “When Theranos tells the story about what the technology is, that will be a welcome thing in the medical community,” he was quoted as saying. “Until it does that, it can have the big labs saying Theranos is not real, or is not a threat. I tend to believe that Theranos is a threat. But if I saw data in a journal, head to head, I would feel a lot more comfortable.”

As I further contemplated the believability question, I couldn’t help but wonder whether Theranos managed to thrive for as long as it did because it existed in a biomedical innovation ecosystem that is full of hype. In other words, in a world full of stories and claims about the next big transformation in medicine, did the claims made by Theranos stand out as that outrageous, unbelievable, or in need of extra scrutiny?

Not when you measure it by a few examples of standout hype I have collected over the years. Who can forget when James Watson, the legendary yet now disgraced co-discoverer of the DNA double helix, made a prediction in 1998 to the New York Times that so-called VEGF inhibitors would cure cancer in “two years”?

At the announcement of the White House Human Genome Project in June 2000, both President Bill Clinton and biotechnologist Craig Venter predicted that cancer would be vanquished in a generation or two. The ever-eloquent Clinton said, “In fact, it is now conceivable that our children’s children will know the term cancer only as a constellation of stars.”

That was followed in 2005 by the head of the National Cancer Institute, Andrew von Eschenbach, predicting the end of “suffering and death” from cancer by 2015, based on a buzzword bingo combination of genomics, informatics, and targeted therapy.

In 2010, rather than walk back or modify some of his more “optimistic” predictions, Francis Collins, who is still the director of the National Institutes of Health, stuck to his guns and was quoted as saying, “My job it seems to me is not to spend my time apologizing for being optimistic. But rather to try to take that optimism and turn it into reality.”

Verily, the life sciences arm of Google, generated a promotional video that has, shall we say, some interesting parallels to the 2014 TedMed talk given by Elizabeth Holmes. And just a few days ago, a report in the New York Times on the continuing medical records mess in the U.S. suggested that with better data mining of more coherent medical records, new “cures” for cancer would emerge. This optimism ignores that a major (the main?) purpose of electronic health records in the U.S. is billing and coding and that they are not research tools per se.

While I am at it, let’s not forget the innumerable predictions made about stem cells, wearables, liquid biopsies and a host of other “game-changers.” In almost every case, their real-world performance has not lived up to the hype and, as in the case of stem cells, there are various fly-by-night “clinics” that seem more than willing to leverage the hype. Media reports, along with press releases from leading institutions, seem to be participating in this ecosystem of hype.

So, why was the story of Theranos so believable in the first place? In addition to the specific mix of greed, bad corporate governance, and too much “next” Steve Jobs, Theranos thrived in a biomedical innovation world that has become prisoner to a seemingly endless supply of hype. That so many high-profile individuals and institutions fed and continue to feed the hype makes me think it is just a matter of time until we see the arrival of Theranos 2.0.

The investors are out there, and they are being primed on a daily basis.

Michael J. Joyner, M.D. is an anesthesiologist and physiologist at the Mayo Clinic. The views in this article are his own.