How Theranos' Greatest Invention Was Elizabeth Holmes

Theranos' technology was questionable from the start. But Holmes studied the attributes for which Silicon Valley investors are suckers, then adopted them. 

The cruel irony apparently now at the heart of her legal defense - since she has lost so many appeals aimed at keeping her digital communications secret - is that she is throwing aside all that competent, focused, intelligent, strong woman-who-advocates-for-other-women imagery to claim she was a helpless girl tricked into becoming a fraud by an older man. JL

Elizabeth Lopatto reports in The Verge:

The character seems to be precision-engineered to appeal to Silicon Valley’s vision of itself. The character of Elizabeth Holmes, Girl Genius, was aimed with exquisite accuracy at getting the maximum amount of money out of people to investing in tech. The Holmes persona checked off boxes that Silicon Valley’s startup world loves to fawn over. Dropout from a prestigious school? Check. Obsessed with work, to the point of having no personal life? Check. Under the age of 32? Check. Only hobby is exercise? Check. Steve Jobs worship? Check."I can be tricked by anyone who looks like Mark Zuckerberg."

WhenWhen I say “Elizabeth Holmes,” a character probably comes to mind: wispy bleach-blonde hair, black turtleneck, thin, white, unusually low voice, unblinking gaze. In most of her magazine covers, she’s holding a tiny vial meant to contain the “few drops of blood” needed for her company’s finger-prick blood tests.

“When I finally connected with what Elizabeth fundamentally is, I realized that I could have just as well been looking into the eyes of a Steve Jobs or a Bill Gates,” Theranos advisor Channing Robertson, a Stanford chemical engineering professor, told Fortune in 2014. “She has sometimes been called another Steve Jobs, but I think that’s an inadequate comparison,” former defense secretary and Theranos board member William Perry told The New Yorker the same year. (Perry knew Jobs.) “She has a social consciousness that Steve never had. He was a genius; she’s one with a big heart.”

In the Forbes article, Holmes tells journalist Roger Parloff that she tests a drop of her own blood on a slide after a meal — claiming she can tell the difference between someone who had a healthy dinner and someone who had a cheeseburger. She told Inc that she didn’t date and hadn’t taken a vacation for all of her 20s. “I literally designed my whole life for this,” she said — in what the article describes as “a strikingly baritone voice.” She only stops working to go for seven-mile runs, she told Laura Arrillaga-Andreessen, spouse of Silicon Valley VC Marc Andreesen, in a piece for The New York Times’ T Magazine.

Before John Carreyrou’s exposé was published in The Wall Street Journal, Theranos was valued at $9 billion. Now Holmes is facing 10 counts of wire fraud, along with two counts of conspiracy to commit wire fraud.

The character seems to be precision-engineered to appeal to Silicon Valley’s vision of itself. It’s not clear who created the character of Elizabeth Holmes, Girl Genius — Holmes herself or, as she is expected to allege in court, Ramesh “Sunny” Balwani, former president and COO of Theranos and her former boyfriend. In some sense it doesn’t matter. Whoever created the character, it continues to loom large over Silicon Valley.

In retrospect, Theranos had only a few innovations. First, Theranos exploited a regulatory loophole for its tests — marketing them as “laboratory-developed tests,” which meant Theranos didn’t have to submit data to the US Food and Drug Administration before using the tests on patients. (Theranos is not the only company to do this.) Second, the invention of Elizabeth Holmes, Girl Genius, aimed with exquisite accuracy at getting the maximum amount of money out of people who were accustomed to investing in tech.

THE HOLMES PERSONA CHECKED OFF BOXES THAT SILICON VALLEY’S STARTUP WORLD LOVES TO FAWN OVER

The Holmes persona checked off boxes that Silicon Valley’s startup world loves to fawn over. Dropout from a prestigious school? Check. Obsessed with work, to the point of having no personal life? Check. Under the age of 32? Check. (Paul Graham in 2013, describing what Silicon Valley VCs look for: “The cutoff in investors’ heads is 32.” Also: “I can be tricked by anyone who looks like Mark Zuckerberg.”) Only hobby is exercise? Check. Steve Jobs worship? Check. Unnecessary secrecy around your innovation? In tech, secrecy around new inventions is the norm.

What’s interesting about the Elizabeth Holmes character is how she fit in with this founder myth, since she was, you know, female. But a specific kind of woman: low voice, only wears pants, high-neck shirt, clumsy makeup. Not like those other girls. She began to grace magazine covers during a period shortly after Facebook’s Sheryl Sandberg published Lean In, a misguided book about how the solution to misogyny is simply working harder, and around the time Sophia Amoruso published Girlboss, a 2014 book about founding an online discount clothing store.

The Lean In / girlboss period was a kind of response to tech’s image as a bunch of smelly bros in hoodies. Conditions on the ground for lower-level engineers were often full of sexual harassment. What’s more, women rarely got money: in 2019, 2.8 percent of VC funds went to female founders, an all-time high. These are large, systemic issues! And rather than talk about them, the corporate world elected to bring us inspiration, as though the only thing stopping women from building their own CEO destinies was a lack of role models.

And then there was Holmes. She was, conveniently, a woman succeeding in Silicon Valley, a place some people had suggested was possibly sexist due to things such as Paul Graham’s aforementioned Zuckerberg comment, Ellen Pao’s lawsuit against VC firm Kleiner Perkins, and Travis Kalanick’s “boober” incident.

Theranos had just come out of stealth mode in 2013. Never mind that Holmes’ company was medical — her mythos was pure founder gold and tech money, like that of Larry Ellison of Oracle and Tim Draper of DFJ, was backing her. It’s a lot easier to write about people who have already made themselves into characters, since they’ve selected the signifying details for you in advance. Most readers generally like people and prefer these kooky founders to tedious explanatory paragraphs which may involve jargon. In her New Yorker profile, Holmes’ quotes are primarily big-vision stuff. There are brief references to automation and lab-on-a-chip technology, but when it comes time to explain how her tech works, she drops some real Star Trek-sounding nonsense.

“A chemistry is performed so that a chemical reaction occurs and generates a signal from the chemical interaction with the sample, which is translated into a result, which is then reviewed by certified laboratory personnel.” She added that, thanks to “miniaturization and automation, we are able to handle these tiny samples.”

No self-respecting soap opera about doctors would be this vague. This is the hand-wavey stuff of science fiction, where you need to have something appropriately sciencey-sounding but also move the plot along. Still, Theranos got one FDA approval in 2015: a test for herpes.

Less than a year after this nonsense quote, Carreyrou published his exposé. Theranos wasn’t using its own chemistry to perform chemical reactions to generate signals from the chemical interactions with the sample. It was doing most of its testing on machines made by its fuddy-duddy non-tech competitors. And employees didn’t think the Theranos machine, which was of course named Edison, gave accurate results. Theranos’ response was total denial of the reports, and for a while, many people gave Holmes the benefit of the doubt.

The hits kept coming: Theranos’ labs weren’t up to par, partnerships with Safeway and Walgreens dissolved, the FDA objected to Theranos’ vials, and Theranos tossed two years’ worth of test results. Theranos’ president and COO Balwani left, Holmes was banned from operating labs, and the company finally went bust in 2018.

Holmes’ fall from grace was the first crack in the founder myth. It was followed by Travis Kalanick being booted from Uber over the culture of sexual harassment, bullying, and general lawlessness he’d built. More flamboyantly, Adam Neumann of WeWork was forced out after the company filed frankly deranged paperwork for its IPO, which was then called off. Those three founders had borrowed the notes of tech hype for products that were, well, not tech: Theranos was (at least in theory) medicine, Uber is a car service with a nice app, and WeWork is a real estate company. During this heady period, though, investors tended to overlook tech-hyped things that weren’t actually tech.

Holmes’ mythos helped smooth out any cognitive dissonance that might have occurred on the part of investors who may have otherwise wondered why the board — which contained dignitaries such as former secretaries of state Henry Kissinger and George Shultz and James Mattis, who later became Donald Trump’s secretary of defense — didn’t have anyone on it with experience in diagnostics. Nor were there any experts on the regulatory hoop-jumping required for marketing approval from the FDA. Who needs due diligence when the founder has such a convincing personal story? Besides, a lot of important people vouched for her!

Part of the appeal of the Holmes trial, then, is finding out how closely the Elizabeth Holmes, Girl Genius character resembles the actual person, Elizabeth Holmes, daughter of a former Enron executive. For instance, whether Holmes’ deep voice is real is a subject of actual debate. Every time I tell someone I plan to cover the trial, the person replies “Do you think she’ll use the voice?”

At stake in the trial is whether Holmes and Balwani deceived investors. In The Inventor, the lackluster documentary about Holmes, director Alex Gibney gives a lot of play to the idea that deceiving investors is a normal part of Silicon Valley — fake it til you make it! The documentary’s explanation relies on Daniel Ariely, a psychologist whose expertise is lying and who is now embroiled in a fake-data controversy. In the movie, Ariely suggests that Holmes may have fooled herself, in addition to her investors. (It’s not illegal to be stupidly optimistic, just stupid.) This is the ideal line for Holmes, because the prosecution has to show that Holmes knowingly deceived investors.

HOLMES’ MARKETING AS GIRL GENIUS WAS TOO GOOD, AND NOW OTHER WOMEN ARE COMPARED TO HER BECAUSE THERE AREN’T ENOUGH FAMOUS STARTUP WOMEN

That “knowingly” part is the hardest thing to prove, and that’s where the prosecution will have to work. There are a lot of texts and emails between Balwani and Holmes. Holmes’ team has fought, so far unsuccessfully, to keep them from being presented to the jury as evidence for her state of mind.

But Holmes may be poised to argue she’s not so close to the Elizabeth Holmes character she portrayed after all. Her lawyers may say at trial that the character — and any deception associated with Theranos — was the result of abuse that impaired her judgment; the filings note that Balwani is 20 years older than her and claim that he controlled how she ate, dressed, and slept, as well as overseeing her texts and phone calls. They may even call an expert witness, Mindy Mechanic, to bolster these claims.

If this is true, Holmes’ girlboss persona, which was marketed to women as inspiration, may actually be the creation of an abusive boyfriend. To back this up, Holmes might behave very differently in court.

But it also means that Holmes’ defense is arguing that she was just a prop for Balwani’s scheme — that Holmes actually had no agency. Holmes was just a helpless woman, see, and thus she can’t be held responsible. It’s not the first time Holmes has defended herself by relying on tropes about women, either. In 2015, she implied Carreyrou’s investigation was a witch hunt.

The trial of Holmes — and later, Balwani — may help us settle who created Elizabeth Holmes, Girl Genius, since whoever it is may very well go to jail. Holmes’ defense could also create one more unpleasant surprise for women in the Valley. If her abuse accusation isn’t judged credible, that will likely make it even harder for women in tech experiencing abuse and harassment to be believed. As impossible as it might sound, she can actually still make things worse for other women.

Regardless of who invented the character, the Elizabeth Holmes persona damaged other women. Women in the diagnostics space report having an even higher bar to clear to get funding because of Theranos. Female founders in biotech and medicine can’t escape questions about Holmes. It doesn’t matter that they’re not doing the same thing — Holmes’ marketing as Girl Genius was too good, and now other women are compared to her because there aren’t enough famous startup women. Elizabeth Holmes, Girl Genius, is an awfully memorable character, after all. Isn’t that why she was created in the first place?