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SAN FRANCISCO — In Alex Gibney’s career as a documentarian, he’s spent a lot of time peering into ingenious fraudsters, liars, and questionable charismatic figures. Among them: the Enron executives, the cyclist Lance Armstrong, and Scientology leader David Miscavige.

Which is why it comes as no surprise that his latest subject is Elizabeth Holmes.

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Gibney’s Theranos documentary, “The Inventor,” will be in theaters for one week starting on Friday in San Francisco, Los Angeles, and New York City. It will premiere on HBO on Monday night. STAT sat down with Gibney to talk about his new film at a premiere on Monday night here in the lion’s den.

In your view, how does Elizabeth Holmes compare to some of these other figures you’ve made films about? In what ways does she stand out — and where do you see commonalities?

I think she’s similar in the sense that you see somebody who believes that the end justifies the means. And that sounds like good news — but actually it’s bad news. And it’s bad news in the sense that I don’t believe that Elizabeth was ever a scammer, like a Bernie Madoff. I think she truly believed in her mission. And I think she also truly believed in wanting to find a mission for herself that fit her high ambitions.

But what happens with some people who have that dynamic sense of mission is when the dream and the reality begin to depart: Instead of investing in the reality, they invest in the dream and pretend that that is the reality. And then they begin to feel entitled to cut corners. So I think that’s what happened at Enron. In a way that’s what happened with Lance Armstrong.

And also I think there are lessons to be learned, too, from the Scientology film “Going Clear.” The subtitle of that film was “The prison of belief.” I think Elizabeth was caught in her own prison of belief — and that it blinded her to the mistakes that were being made and the danger into which she was putting people.

So, I want to back up and talk about how you got involved in this project. HBO approached you about directing a film about Elizabeth Holmes. Why did you say yes?

I said yes because I was interested in the psychology of fraud. Enron was actually a much bigger cataclysm in terms of a fraud coming crashing down. But what was interesting about this one was you had a character who was so dynamic, so seemingly idealistic, and also embodied the hopes and dreams of many people, particularly women, who were hungry for a young female entrepreneur rising up out of male-dominated Silicon Valley to try to do something fundamental about changing health care. That all sounded great.

But to understand how that could turn into something so bad, that’s what was interesting to me. And I was interested in the idea of deception — but also the extent to which there was self-deception that allowed the deceiving to be more convincing. And I was also interested too in how the journalists and the investors were deceived, and why.

I want to ask you about your preparation as you got ready to direct this film. Tell me about your learning and research process.

It’s usually an all-hands-on-deck kind of thing, to begin to research and explore different facets of the story that are not necessarily so obvious — not just what happened, but to riff on things. That’s a musical term. It’s like you play the melody, and the melody is what happened, but then you riff on the melody by way of exploring things that come up, like Edison. That was the name of her machine. So we explored Edison. Who was he, and what relation did he have in unexpected ways to this story.

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Talking about psychology, we began to explore behavioral economics through an interview with [behavioral economist] Dan Ariely, who’s written some wonderful books both about dishonesty and also about how predictably irrational we all are. In fact, that’s the name of one of his books.

And I think we also began to explore the idea of storytelling. And that came out of Edison, too. Because I think one of the things that makes Elizabeth interesting is that she was a storyteller: She was the writer, director, and producer of her own story. And she did it in a pretty compelling way. And she would hire people like Patrick O’Neill from [ad agency] Chiat\Day, who had worked for Apple, as a very compelling production designer who was designing the look of Theranos in order to be able to tell a better story.

So all those things I think were part of what we were interested in. And by the way, those were interesting and important paths for us to go down because early on, none of the employees from Theranos would talk to us, because they were all terrified of [Theranos lawyer] David Boies.

When I watched the film, I was really struck by the story you told about Thomas Edison — who lied to journalists, faked results, and was really the first practitioner of Silicon Valley’s fake-it-until-you-make-it culture. In that lens, tell me about the title of the film, “The Inventor.” What made you decide this had to be the title?

I think Elizabeth really wanted to be perceived as an inventor. It wasn’t enough for her to be a CEO, it wasn’t enough for her to be somebody who oversaw the work of others. She wanted to be perceived as somebody who really invented the technology. And so she put her name on a lot of patents. So of course that was an element of it.

Alex Gibney
Alex Gibney Andrew Brucker/Courtesy of HBO

But there’s two obvious meanings to the word inventor. The other one is to make stuff up. And that’s the flip side. And sometimes even in inventing when you’re presenting your invention, you’re making stuff up because you haven’t gotten to where you want to be yet. That’s what Edison did.

The other thing that’s interesting about inventing, in terms of Elizabeth and Thomas Edison, is they both invented personas for themselves to inhabit. And they sold their companies in a way by creating larger-than-life celebrity figures that they wrote, produced, and directed. And Thomas Edison was the wizard of Menlo Park. And Elizabeth was this larger-than-life figure, who had her own look, who had her own very deep voice. So that idea of self-invention, which is a very American idea, was very important to this film, too.

You said in a previous interview that you tried to interview Holmes for the film, and talked with her off the record for five hours, but in the end she decided not to participate. What was your impression from talking to her?

So it wasn’t I who met with Elizabeth. It was Jessie Deeter, one of my producers. And she sat down with her for five hours. Jessie would say that most of what happened was Elizabeth asking questions of Jessie, as if she was auditioning us to see whether we were worthy to do something about her.

But I think broadly speaking, it was clear that at that moment in time — and this would have been 2017 — Elizabeth perceived herself to be a victim. Not somebody who was contrite but somebody who was brought low by forces who were out to get her because she was a woman.

I want to ask you about some of the most striking moments of the film, which came in the form of in-house footage that was provided to you by someone inside Theranos. There’s footage of Elizabeth answering questions in front of a white screen. Then there’s the footage of Elizabeth and her No. 2 Sunny Balwani jumping in a bounce house and getting down to MC Hammer’s “U Can’t Touch This.” What did you think when you saw that footage for the first time?

I was slack-jawed. I mean, I couldn’t believe it. Because this is what you hope to get, if you’re in a situation where you’re able to follow a company from start to finish in cinéma vérité fashion. This is the kind of footage you get: Everybody dancing to “U Can’t Touch This” at a time when they scored a really minor victory [a clearance from the Food and Drug Administration for a test]. But they were celebrating like it was 1999.

And then these company meetings, led often by Elizabeth and/or Sunny Balwani, which were kind of like religious revival meetings.

It was jaw-dropping to see the delusional behavior inside the company. And also in the hands of a director they hired — a fellow documentarian, Errol Morris — a series of interviews in which Elizabeth got to present herself the way she wanted to be presented. And that was precious to us, because, if you’re talking about the psychology of deception, now we had an opportunity to show from the inside out how that deception was manufactured.

There’s one great question where she’s asked: Can you tell us a secret?

It’s the one time where she doesn’t have an answer right on the tip of her tongue. And she starts to stumble, and pause, and says, “I don’t have many secrets.”

Well, it turns out she did.

This interview has been lightly edited for concision and clarity. Listen to an audio version of the interview on an upcoming episode of STAT’s biotech podcast “The Readout LOUD.”

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  • It is telling that Errol Morris has seemingly lost stature as a reveal the truth documentarian despite his contributing–unknowingly, but gullibly–in the selling of this fraud. all he had to do was take an Edison blood test and a genuine blood test to see it was a scam.

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