Theranos as innovation+disaster case study

I just taught the Theranos case in my course on “Innovation and Industry Development,” co-taught with Prof. Elizabeth Lyons. The first half is about positioning a startup: powerful new technology, established incumbents, how should we enter to disrupt the industry and make the world a better place? Any moderate set of numbers makes Theranos’ reputed  $9,000,000,000 valuation look reasonable.

Der Untergang der Titanic

The “case” presently consists of four articles. I put together a set of overhead slides to generate and lead the discussion. The first half ends with some general lessons about disruptive innovation and whether to follow an open or closed IP strategy. The second half starts in December 2015 and discusses the crash. I also compare Theranos with the Google contact lens (another technically impossible pseudo-invention).

“That’s a type of Silicon Valley arrogance,” he said. “That isn’t how science works.” (re Google, not Theranos)

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One Day, a Machine Will Smell Whether You’re Sick – The New York Times

Sniffing disease markers is a fundamentally promising concept. We know that dogs have very good smell, so that is an existence proof that something interesting can be detected in the air. (In my family’s experience, human smell can also become amazingly good, at least for pregnant women!) In fact, if B.F. Skinner were still alive, I wonder if he would be training pigeons to sniff out disease?

But although air is feasible, it does seem like blood is a better choice because it is likely to have stronger signals and lower noise. Air-based sensors would be non-invasive, so perhaps that is why some groups are pursuing air.

…a team of researchers from the ..Monell Chemical Senses Center and the University of Pennsylvania [are working] on a prototype odor sensor that detects ovarian cancer in samples of blood plasma.

The team chose plasma because it is somewhat less likely than breath or urine to be corrupted by confounding factors like diet or environmental chemicals, including cleaning products or pollution. Instead of ligands, their sensors rely on snippets of single-strand DNA to do the work of latching onto odor particles.

“We are trying to make the device work the way we understand mammalian olfaction works,” … “DNA gives unique characteristics for this process.”

Judging by research at UCSD and elsewhere, I envision tests like this eventually be run as add-on modules to smartphones. Buy a module for $100 (single molecule, home use) up to $5000 (multiple molecules, ambulance use), and plug it into your phone. Above $5000, you will probably use a dedicated electronics package. But that package might be based on Android OS.

This is also another example of Big Data science. It could be done before, but it will be a lot easier now. Blood collected for other purposes from “known sick” patients could be used to create a 50,000 person training set. (The biggest problem might be getting informed consent.)

 

Lots of technology policy stories this weekend

There are lots of technology-policy-related stories this weekend.  The first three concern about excess market power in tech markets, and its effects. The remaining three are miscellaneous subjects at the intersection of technology, policy, and politics.

Suggestion: If a newspaper is refusing to let you read an article, you can often get it by searching for it (on Google – irony alert, see one of the stories below), and visiting from the search result.

And a humble brag: Only the last of these stories directly concerns He Who Must Not Be Named. Nor did I mention Juicero, whose idiocy I tweeted about when it first came to market.

Is It Time to Break Up Google?

In just 10 years, the world’s five largest companies by market capitalization have all changed, save for one: Microsoft. Exxon Mobil, General Electric, Citigroup and Shell Oil are out and Apple, Alphabet (the parent company of Google), Amazon and Facebook have taken their place.

They’re all tech companies, and each dominates its corner of the industry: Google has an 88 percent market share in search advertising, Facebook (and its subsidiaries Instagram, WhatsApp and Messenger) owns 77 percent of mobile social traffic and Amazon has a 74 percent share in the e-book market. In classic economic terms, all three are monopolies.

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Point-of-use medical tests go extreme:  sperm tests on a smartphone

Device costs less than $5 and can accurately measure the number and speed of swimmers. Source: With racy sperm pics on a smartphone, men can easily test fertility | Ars Technica If  only Theranos could do as well!

This is just a research project. But it’s still impressive. Smartphones have elaborate sensors, computation, networking, and even databases. Adding a custom sensor modifier will bring lots of inexpensive tests, medical and otherwise.

Medicine Grand Rounds at Stanford

Yesterday I gave a Grand Rounds presentation at Stanford Med School. My title was

Craft, Standardization and Automation: Powerful yet Perilous Paradigms for Control when Lives are at Stake

Most of my talk was about the adoption of procedures (checklists) by US military aviation, during and after WW II. It has close analogies to the situation of health-care today.  Here is my short presentation.  A much longer presentation, with more examples but without discussion of medicine, is here.

Initially, I was concerned that my topic might seem too esoteric for Stanford’s medical faculty. However, their Medical Grand Rounds program covers a lot of ground. My topic was only 1.5 standard deviations away from the mean.

For more of my research on flying paradigms and how technologies evolve from crafts to sciences, please see this page.

 

Each new generation needs to learn the lesson of Theranos: appearance ≠ reality

Every 10 years or so, a conspicuous bubble bursts, and in doing so it resets the expectations of the next generation of young adults.

  • Enron
  • 2008 financial collapse
  • Now Theranos

Reading this article, I’m astonished at how little substance the adulation of Elizabeth Holmes was based on. And how much secrecy her investors allowed her. Given that she was claiming that her system would be ~100x better than established technologies, why didn’t they demand evidence? Why was it left to a reporter to figure out that the emperor had no clothes? And, was she nothing more than a successful con-artist with no genuine scientific expertise?

“In a searing investigation into the once lauded biotech start-up Theranos, Nick Bilton discovers that its precocious founder defied medical experts—even her own chief scientist—about the veracity of its now discredited blood-testing technology.”

Source: Exclusive: How Elizabeth Holmes’s House of Cards Came Tumbling Down | Vanity Fair

Hospital Hand-Washing – how long should it take?

There is a large literature on the importance of frequent hand washing in hospitals, to prevent spreading infectious diseases among patients. It’s a major problem, since hospital-caused infections are growing, and have nasty effects.image5b135d

Brad Stats recently sent me two papers he co-authored on the topic. Both are based on an analysis of  behavior by 4100 caregivers. They led me to ask two sets of questions. First, if everyone did comply with the recommendations on hand-washing frequency and duration, how much time would it take out of their work day? Second, while there have been lots of projects using  electronics for monitoring compliance, has there been any work on straightforward manufacturing-style interventions to make compliance easier?

Here are my questions in more detail, taken from an email to Brad.

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