Blood Will Have Blood

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One Woman’s Drive to Revolutionize Medical Testing. Elizabeth Holmes says that her test can help detect ailments from just a few drops of blood. Credit. Photograph by Jenny Hueston. One afternoon in early September, Elizabeth Holmes took the stage at TEDMED, at the Palace of Fine Arts, in San Francisco, to talk about blood. TEDMED, a part of the Technology, Entertainment, and Design enterprise, is an annual conference devoted to health care; its speakers span a range of inquiry from Craig Venter, the genomic scientist, discussing synthetic life, to Ozzy Osbourne discussing his decision to get his entire genome sequenced. The phrases “disruptive technology” and “the future of medicine” come up a lot.

Holmes, who is thirty, is the C. E. O. Blood analysis is integral to medicine. When your physician wants to check some aspect of your health, such as your cholesterol or glucose levels, or look for indications of kidney or liver problems, a blood test is often required. This typically involves a long needle and several blood- filled vials, which are sent to a lab for analysis. Altogether, diagnostic lab testing, including testing done by the two dominant lab companies, Quest and Laboratory Corporation of America, generates seventy- five billion dollars a year in revenue. Holmes told the audience that blood testing can be done more quickly, conveniently, and inexpensively, and that lives can be saved as a consequence.

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She was wearing her daily uniform—a black suit and a black cotton turtleneck, reminiscent of Steve Jobs—and had pinned her hair into an unruly bun. As she spoke, she paced slowly, her eyes rarely blinking, her hands clasped at her waist. Holmes started Theranos in 2. Stanford the following year. Since then, she told the audience, the company has developed blood tests that can help detect dozens of medical conditions, from high cholesterol to cancer, based on a drop or two of blood drawn with a pinprick from your finger. Theranos is working to make its testing available to several hospital systems and is in advanced discussions with the Cleveland Clinic. It has also opened centers in forty- one Walgreens pharmacies, with plans to open thousands more.

If you show the pharmacist your I. D., your insurance card, and a doctor’s note, you can have your blood drawn right there. A typical lab test for cholesterol can cost fifty dollars or more; the Theranos test at Walgreens costs two dollars and ninety- nine cents. In conversation, Holmes speaks in a near- whisper; onstage, her voice drops an octave and takes on a formal instructional cadence.

The TEDMED crowd listened intently as she spelled out what she sees as the shortcomings of the existing blood- testing business. The tests are too costly, are available at inconvenient times or places, and involve unpleasant syringes. Holmes has an aversion to needles, and her mother and her grandmother fainted at the sight of them and at the sight of blood. Recently, she told me, “I really believe that if we were from a foreign planet and we were sitting here and said, . She told the crowd that between forty and sixty per cent of people who are ordered by their doctor to get a blood test do not. Diabetes, sexually transmitted diseases, and other common medical conditions could be diagnosed and treated earlier if the tests were less onerous and more accessible, she said.

In recent months, Holmes has been giving similar versions of her TEDMED presentation in talks and interviews around the country. Investors have valued the company at more than nine billion dollars, comparable to the two major diagnostic labs. Holmes owns more than fifty per cent of the company; she was profiled last spring in Fortune and subsequently featured in Forbes as “the youngest self- made female billionaire in the world.” The board of her company is stocked with prominent former government officials, including George P. Shultz, Henry Kissinger, Sam Nunn, and William H. By Our Love more. Foege, the former director of the Centers for Disease Control and Prevention. The plummeting costs of DNA- sequencing technology have made it possible for companies such as 2.

Smartphone apps let users track their heart rates, their sleep cycles, and the number of steps they’ve taken, and share the data with a doctor or with friends. In her talk, Holmes said, “My own life’s work in building Theranos is to redefine the paradigm of diagnosis away from one in which people have to present with a symptom in order to get access to information about their bodies to one in which every person, no matter how much money they have or where they live, has access to actionable health information at the time it matters.” Cosgrove predicts that blood tests for many common health issues, including high cholesterol and diabetes, will be initiated by patients as well as by doctors.

Food and Drug Administration barred 2. Some observers are troubled by Theranos’s secrecy; its blood tests may well turn out to be groundbreaking, but the company has published little data in peer- reviewed journals describing how its devices work or attesting to the quality of the results.

It needs to be clinically valid and provide useful information.”Holmes counters that Theranos is only trying to protect itself from competitors while it tries to do something unique. We’re in a market for people who don’t like having a needle stuck in their arm.”The day after her TEDMED talk, I met with Holmes in a conference room at the Theranos headquarters, a single- story building two blocks from the Stanford campus. Although she can quote Jane Austen by heart, she no longer devotes time to novels or friends, doesn’t date, doesn’t own a television, and hasn’t taken a vacation in ten years. Her refrigerator is all but empty, as she eats most of her meals at the office. She is a vegan, and several times a day she drinks a pulverized concoction of cucumber, parsley, kale, spinach, romaine lettuce, and celery.

Growing up, Holmes was in constant motion. Her father, Chris, worked for government agencies, including, for much of his career, the U. S. Agency for International Development and the State Department, often travelling abroad, overseeing relief and disease- eradication efforts in developing nations; today, he is the global water co. Her mother, Noel, worked for nearly a decade as a foreign- policy and defense aide on Capitol Hill, until Elizabeth and her brother Christian, two years younger, were born.

The family moved several times, which meant there was little opportunity to develop lasting friendships. Holmes describes herself as a happy loner, collecting insects and fishing with her father.“I was probably, definitely, not normal,” she said. I read a ton of books.

I still have a notebook with a complete design for a time machine that I designed when I must have been, like, seven. The wonderful thing about the way I was raised is that no one ever told me that I couldn’t do those things.”Chris Holmes’s great- grandfather Christian Holmes emigrated from Denmark, studied engineering, settled in Cincinnati, and became a physician. When Elizabeth was eight, she was given a tour of the local hospital where he worked and which was named in his honor. He had married the daughter of a patient, Charles Fleischmann, who pioneered packaged yeast and built a baking empire around it. She knew that her father felt guilty for uprooting the family, so she wrote a letter to console him: “What I really want out of life is to discover something new, something that mankind didn’t know was possible to do.” She reassured him that Texas suited her, because “it’s big on science.”For several years in the nineteen- eighties, Chris Holmes spent two weeks a month in China, helping American companies invest in large- scale development projects. Soon after the family moved to Houston, Elizabeth started studying Mandarin; by the summer following her sophomore year of high school, she was intent on taking summer classes in Mandarin at Stanford. She repeatedly called the admissions office for information, only to be told, each time, that the program did not enroll high- school students.

One day, her father recalls, the head of the program became so annoyed that he grabbed the phone from the employee who was talking to Holmes. I’m going to give you the test right now!” He asked questions in Mandarin; she answered fluently, and he accepted her on the spot. She completed three years of college Mandarin while still in high school.“O. K., one last big rhubarb score. But then I’m out of the pie game for good.”In 2. Holmes applied to Stanford, was accepted, and then was named a President’s Scholar, which came with a small stipend to select her own research project.

Her parents sent her off with a copy of Marcus Aurelius’ “Meditations,” her father said, “to convey to her: Live a purposeful life.” Holmes elected to study chemical engineering. She was drawn to the work of Channing Robertson, the chemical engineer and, at the time, a dean at the engineering school. Robertson is seventy- one and fit, with thinning hair and a relaxed smile; I visited him in his home on campus. Holmes’s first class with him was a seminar on devices designed to control the release of drugs into the human body.

One day, in her freshman year, Robertson said, she came to his office to ask if she could work in his lab with the Ph. D. He hesitated, but she persisted and he gave in. At the end of the spring term, she told him that she planned to spend the summer working at the Genome Institute, in Singapore. He warned her that prospective students had to speak Mandarin.“I’m fluent in Mandarin,” she said.“I’m thinking, What’s next? She’s already coming into the research group meetings at the end of her freshman year with my Ph. D. I find myself listening to her more than to them about the next experiments to be done and the progress that’s been made.