VaporWare

I thought the word looked more modern with that sexy millennial middle capital, but the truth is vaporware has been with us since the eighties.

Many software (and hardware) companies used it to push an inexistent product, with various objectives, ranging from supporting or boosting share prices to sidelining competitors.

A big company might, for instance, announce the imminent release of a product a smaller competitor is working on in order to shut them out of the market. Nowadays, in the age of software behemoths, the movie plays out a little differently—big brother simply buys you out—Money talks, very loudly.

In recent years, the best piece of vaporware was produced by a company called Theranos. What they promised was the holy grail, and for a decade or so, they managed to con much of America.

Their demise came at the hands of a reporter from the Wall Street Journal by the name of John Carreyrou, in a process steeped in legal threats, lawsuits, and skulduggery (what an excellent word).

The rise of Theranos possessed a cocktail of ingredients so intoxicating that it fooled the likes of Henry Kissinger, George Shultz, Rupert Murdoch, and James Mattis.

The last name on that list is particularly interesting—General Jim ‘Mad Dog’ Mattis is none other than Trump’s current secretary of defense, a man who earned his call sign CHAOS (Colonel Has Another Outstanding Solution) during his early days in Afghanistan, following nine-eleven. I can’t help thinking how perfectly call sign CHAOS represents the current US administration.

The CEO of Theranos, Stanford dropout Elizabeth Holmes, convinced Mattis that the company’s technology was of great value to the US military, busy in several Mid-East theaters.

The holy grail was a blood-testing machine, which went through various iterations—none of which worked—capable of processing very small samples, obtained through a finger-prick, and accurately producing a battery of test results.

The machine had to be sexy—Holmes was a great admirer of Steve Jobs—so the design criteria for compactness, speed, a glitzy software interface, and a general wow factor were always paramount—accuracy and precision for blood testing played a very soft second fiddle.

Blood testing, like any analytical procedure, is complex. I know this well from marine waters, where practically every known element is present in the matrix—from sodium to yttrium, they’re in the house.

Small samples or very low concentrations make for analytical inaccuracies. Theranos sacrificed sample size because one of Holmes’ key emotional selling points was people’s fear of needles—the company was often pitched as the end of phlebotomy, at least for typical blood work.

Sample dilution was seen as a way to increase finger-prick sample volume. The problems are twofold: first, if the starting volume is variable, the error in the final reading increases. Second, by diluting the sample you lower the overall concentration of the analyte and require a better detection limit on your equipment.

Another issue common to finger-stick approaches is cell lysis—our cells are delicate structures and can easily burst, even by pushing blood out of a fingertip. A couple of years ago, my blood sugar was running higher than it should. Since diabetes is a very dangerous game, and one in which your body loses control of itself, I took the reading seriously—I wanted to get back into the normal range without having to take medication, and the obvious steps are to lose weight and cut carbohydrate intake—I was delighted to find that wine and cheese have hardly any carbs, so getting back to normal was easy.

But I bought a finger-stick glucose analyzer. One morning, the middle finger in my left hand gave a higher reading than usual. I went on a finger-pricking orgy, like a glucose junkie searching for that last main vein. I tried other fingers in my left hand. Then a couple in my right. Then various toes. The test strip vendors would have been overjoyed. Results varied widely—yours will too.

One of the statistics I calculated was Theramed’s undoing—the coefficient of variation measures the spread of values around the average—high values mean that measurements are not precise. In my case, I got values of twenty percent and fourteen percent, and my toes had far less sugar than my hands—every time I’ve asked a doctor for an explanation, they are singularly uninterested.

Results from a 2007 study in Malawi on HIV diagnosis, comparing finger-prick to venopuncture as as sampling procedure for analysis.

This graph shows a comparison from a study on AIDS done in Malawi. The authors have shown this in a rather bizarre format, but the way to read it is to divide the difference (on the vertical axis) by the average (on the horizontal). For instance, a value of -50 at 250 mean CD4 cells tells us that that’s a (50/250) twenty percent difference—not so trivial.

All this reminds me of an old joke featuring three statisticians at an archery range. The first misses the target by ten feet to the left, the second shoots ten feet to the right, and the third happily puts down his bow and shouts “Bullseye!”

Theranos had huge ambitions—it claimed to deal with the four major classes of blood tests: immunoassays, where antibodies are used; general chemistry, where chemical reactions of some type are used; hematology, which involves e.g. cell counts; and gene amplification, a nuclear technique that can help cancer diagnosis.

Vaporware is a hoax, but when it involves people’s health, and potentially people’s lives, it plays in a whole new league. And Elizabeth Holmes, who charmed Safeway, Walgreen, the US military, and the Obama administration, was also in a league of her own.

The investigative work done by John Carreyrou was a classic piece of journalism—an anthem to why the fake news narrative is so pernicious. Theranos was a prime example of the emperor’s new clothes, and the fact that taking the company down required a couple of federal agencies, extended lawsuits, ten years, and hundreds of millions of dollars attests to the power of vested interest, litigation, and deep pockets.

It is also a testament to the fact that for every complex problem there’s an easy solution, and it’s usually wrong.

The India Road, Atmos Fear, Clear Eyes, and Folk Tales For Future Dreamers. QR links for smartphones and tablets.

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