Theranos


Theranos was a privately held health technology corporation. It was initially touted as a breakthrough technology company, with claims of having devised blood tests that required only very small amounts of blood and could be performed very rapidly using small automated devices the company had developed. However, the claims later proved to be false. Founded in 2003 by then-19-year-old Elizabeth Holmes, Theranos raised more than US$700 million from venture capitalists and private investors, resulting in a $10 billion valuation at its peak in 2013 and 2014. Theranos was hyped to its investors and in the media as a breakthrough in the blood-testing market, where the U.S. diagnostic-lab industry posts annual sales of over $70 billion. Theranos claimed its technology was revolutionary and that its tests required only about 1/100 to 1/1,000 of the amount of blood that would ordinarily be needed and cost far less than existing tests.
A turning point came in 2015, when medical research professors John Ioannidis and Eleftherios Diamandis, and investigative journalist John Carreyrou of The Wall Street Journal, questioned the validity of Theranos' technology. The company faced a string of legal and commercial challenges from medical authorities, investors, the U.S. Securities and Exchange Commission, Centers for Medicare and Medicaid Services, state attorneys general, former business partners, patients, and others. By June 2016, it was estimated that Holmes's personal net worth had dropped from $4.5 billion to virtually nothing. The company was near bankruptcy until it received a $100 million loan from Fortress Investment Group in 2017 secured by its patents. In September 2018, the company ceased operations.
In July 2016, Theranos received sanctions from the CMS, including the revocation of its CLIA certificate and prohibition of Holmes and other company officials from owning or operating a laboratory for two years. Theranos announced it would close its laboratory operations and wellness centers to work on miniature medical testing machines. In April 2017, Theranos said it had reached a settlement agreement with CMS. Following the CMS sanctions, the Walgreens pharmacy chain terminated its contract with Theranos and filed a lawsuit claiming continuous breaches of contract. The suit was settled out of court, with Theranos compensating Walgreens for a much smaller amount than the claimed $140 million, reported at about $30 million. After all efforts to find a buyer went nowhere, what remained of the company dissolved on September 4, 2018.
On March 14, 2018, Theranos, Holmes, and former company president Ramesh "Sunny" Balwani were charged with "massive fraud" by the SEC. One section of the complaint says Holmes falsely claimed in 2014 that the company had annual revenues of $100 million, a thousand times more than the actual figure of $100,000. Theranos and Holmes agreed to resolve the charges against them, with Holmes paying a fine of $500,000, returning the remaining 18.9 million shares that she held, relinquishing her control of the company, and being barred from being an officer or director of any public company for ten years. According to the agreement, if Theranos were acquired or otherwise liquidated, Holmes would not profit from her ownership until more than $750 million was returned to investors and other preferred shareholders. Theranos and Holmes neither admitted nor denied the allegations in the SEC's complaint. Balwani did not settle. On June 15, 2018, the U.S. Attorney for the Northern District of California announced the indictment of Holmes on wire fraud and conspiracy charges. Balwani was also indicted on the same charges. The jury selection for the trial is scheduled to begin on July 28, 2020, with the trial scheduled to commence in August 2020.

History

While at Stanford University, Elizabeth Holmes had an idea to develop a wearable patch that could adjust the dosage of drug delivery and notify doctors of variables in patients' blood. She started developing lab-on-a-chip technology for blood tests, with the idea to start a company that would make blood tests cheaper, more convenient and accessible to consumers. Holmes dropped out of Stanford in 2003 and used the education trust from her parents to found the company that would later be called Theranos, derived from a combination of the words "therapy" and "diagnosis". The company's original name was "Real-Time Cures", which Holmes changed after deciding that too many people were dubious about the word "cure".

Partnerships

In 2012, Safeway invested $350 million into retrofitting 800 locations with clinics that would offer in-store blood tests. However, after many missed deadlines and questionable results from a trial clinic at Safeway's Corporate offices, the deal was called off in 2015. In 2013, Theranos partnered with Walgreens to offer in-store blood tests at more than 40 locations. Although Theranos blood tests were reportedly used on drug trial patients for GlaxoSmithKline and Pfizer, both companies stated that there were no active projects with Theranos in October 2015. In November 2016, Walgreen Co. filed suit against Theranos in a federal court in Delaware, for breach of contract. In June 2017, Theranos reported to investors that the suit, which originally sought $140 million in damages, was settled for less than $30 million.
In March 2015, the Cleveland Clinic announced a partnership with Theranos in order to test its technology and decrease the cost of lab tests. In July 2015, Theranos became the lab-work provider for Pennsylvania insurers AmeriHealth Caritas and Capital BlueCross.
In July 2015, the Food and Drug Administration approved the use of the company's fingerstick blood testing device for the herpes simplex virus outside a clinical laboratory setting. Theranos was awarded the 2015 Bioscience Company of the Year by AzBio.

Exposure and downfall

In February 2015, Stanford Professor John Ioannidis wrote in the Journal of the American Medical Association that no peer-reviewed research from Theranos had been published in the medical research literature. In May 2015, University of Toronto Professor Eleftherios Diamandis analyzed Theranos technology and concluded that "most of the company's claims are exaggerated." In October 2015, John Carreyrou of The Wall Street Journal reported that Theranos was using traditional blood testing machines instead of the company's Edison devices to run its tests, and that the company's Edison machines might provide inaccurate results. Tyler Shultz, a Theranos employee from 2013 to 2014 and the grandson of then Theranos director, former U.S. Secretary of State George P. Shultz, was a key source for the WSJ story. Shultz had attempted to bring company concerns to his management, and when that had failed, he had spoken to Carreyrou and also, under an alias, reported the company to the New York State Department of Health.
Theranos claimed that the allegations were "factually and scientifically erroneous." Walgreens suspended plans to expand blood-testing centers in their stores following the report. At that time, the Cleveland Clinic announced that it would work to verify Theranos technology. Theranos fought back against the Journal's investigation, sending lawyers after sources in the story, including Tyler Shultz, in an effort to stop them from providing information to the press. Former employees of reputation management firm Status Labs said that Theranos had hired the firm to discreetly erase mentions of the WSJs reporting from its Wikipedia article, despite the activity being a violation of the website's terms of use.
Following the WSJ story, the history of FDA interactions with Theranos was scrutinized. The FDA had received a formal inquiry to look at Theranos blood test devices by the U.S. Department of Defense in 2012, before the devices were commercially available and did not require FDA approval. FDA inspection reports from 2014 and 2015 stated that its containers for blood collection were "not validated under actual or simulated use conditions" and "were not reviewed and not approved by designated individual prior to issuance". In 2015, an FDA inspection resulted in multiple observed violations of FDA Title 21 Regulations. After the inspection, Theranos announced that it would voluntarily suspend its tests apart from the FDA-approved herpes simplex virus test.
The Arizona Department of Health Services reported issues with the company's Scottsdale lab meeting regulations in September 2015. The reports were revealed in the Arizona Republic in November 2015.
In January 2016, the Centers for Medicare and Medicaid Services sent a letter to Theranos based on an inspection of its Newark, California lab in 2015, reporting that the facility caused "immediate jeopardy to patient health and safety" due to a test to determine the correct dose of the blood-thinning drug warfarin. In 2016, Walgreens and Capital BlueCross announced a suspension of Theranos blood tests from the Newark lab.
In March 2016, CMS regulators announced plans to enact sanctions that included suspending Holmes and Balwani from owning or operating a lab for two years and that they would revoke the lab's license.
By April 2016, Theranos came under criminal investigation by federal prosecutors and the SEC for allegedly misleading investors and government officials about its technology. The U.S. House of Representatives Committee on Energy and Commerce requested information on what Theranos was doing to correct its testing inaccuracies and adherence to federal guidelines in June 2016. A December 2019 Wall Street Journal report found that Theranos received "digital reputation management services" during the federal investigation from a firm known as Status Labs, which made favorable edits to the company's Wikipedia page.
In May 2016, Theranos announced that it had voided two years of results from its Edison device. The company announced that about one percent of test results had been voided or corrected from its proprietary machines in June 2016.
In July 2016, Theranos announced that the CMS had revoked its CLIA certificate and issued sanctions prohibiting its owners and operators from owning or operating a lab for two years, suspension of approval to receive Medicare and Medicaid payments, and a civil monetary penalty. The company discontinued testing at its Newark location while attempting to resolve the issues. Theranos announced plans to appeal the decision by regulators to revoke its license to operate a lab in California and other sanctions.
In August 2016 the company withdrew its request for emergency clearance of a Zika virus blood test after a lack of essential safeguards during the testing process was found by federal inspectors.
Theranos announced that it would close its laboratory operations and wellness centers and lay off about 40 percent of its work force to work on miniature medical testing machines in October 2016.
In January 2017, Theranos announced that it had laid off 41 percent of its workforce, or approximately 155 people, and closed the last remaining blood-testing facility after the lab failed a second major U.S. regulatory inspection.
Also that month, the company faced lawsuits from several different entities including Walgreens and Arizona Attorney General Mark Brnovich.
In April 2017, lawyers for Partner Investments LP and two other funds, with combined stakes totaling more than $96 million in Theranos preferred shares, charged that Theranos had threatened to seek bankruptcy protection if the investors did not agree to accept additional stock equity in lieu of litigation. Theranos officials said the funds had mischaracterized the exchange offer, which was discussed before the suit was filed. The suit also alleged that Theranos Inc. had misled company directors about its practices concerning laboratory testing and that it had secretly bought lab equipment to run fake demonstrations. On May 1, 2017, Theranos announced that it had reached an undisclosed settlement with Partner Fund Management LP. Theranos' General Counsel David Taylor stated: "Theranos is pleased to have resolved both lawsuits with PFM. Although we are confident that we would have prevailed at trial, resolution of these two cases allows our tender offer to go forward and enables us to return our focus where it belongs, which is on executing our business plans and delivering value for our shareholders."
In April 2017, Theranos reached a settlement with CMS agreeing to stay out of the blood-testing business for at least two years in exchange for reduced penalties, and signed a consent decree with Arizona Attorney General Mark Brnovich over violations of the Arizona Consumer Fraud Act. Alleged violations included false advertisement and inaccurate blood testing. Theranos agreed to refund $4.65 million to the state's residents for Theranos blood testing services, providing a refund to every resident who had received a test, regardless of whether the test results were voided or corrected.
In August 2017, Theranos announced it had reached a settlement with Walgreens.
In December 2017, Fortress Investment Group loaned $100 million to Theranos. Theranos had reportedly been on the verge of bankruptcy, with the loan meant to keep the company solvent into 2018. The loan was secured by Theranos' patents. On April 10, 2018, the company laid off the majority of workers in a renewed bid to avoid bankruptcy. The company's total headcount was down to fewer than 25 employees, after having 800 employees at its peak.
In March 2018 the US Securities and Exchange Commission charged Theranos, its CEO Elizabeth Holmes and former president Ramesh "Sunny" Balwani, claiming they had engaged in an "elaborate, years-long fraud" wherein they "deceived investors into believing that its key product – a portable blood analyzer – could conduct comprehensive blood tests from finger drops of blood". Holmes reached a settlement with the SEC, which requires her to pay $500,000, forfeit 19 million shares of company stock, and be barred from having a leadership position in any public company for ten years. Balwani did not settle with the SEC.
On June 15, 2018, Holmes and Balwani were indicted on multiple counts of wire fraud and conspiracy to commit wire fraud. According to the indictment, investors and doctors and patients were defrauded. It is alleged the defendants were aware of the unreliability and inaccuracy of their products, but concealed that information. If convicted, they each face a maximum fine of $250,000 and 20 years in prison. The case has been assigned to Lucy H. Koh, United States District Judge of the United States District Court for the Northern District of California. The jury selection for the trial was to begin on July 28, 2020, and the trial was to have commenced in August 2020; however, the COVID-19 pandemic has led to a proposed October date. And even this date is uncertain.

Shutdown

On September 4, 2018, Theranos announced in an email to investors that it would cease operations and release its assets and remaining cash to creditors after all efforts to find a buyer came to nothing. Most of the company's remaining employees were laid off on the previous Friday, August 31. However, Theranos' General Counsel and new CEO David Taylor and a few support staffers remained on payroll for a few more days. The Wall Street Journal reported that any equity investments in the company were made worthless by the shutdown.

Technology and products

Theranos claimed to have developed devices to automate and miniaturize blood tests using microscopic blood volumes. Theranos dubbed its blood collection vessel the "nanotainer" and its analysis machine the "Edison". The technology has been criticized for not being peer reviewed. Theranos claimed to have data verifying the accuracy and reliability of its tests that would be published. In February 2016, Theranos announced that it would permit the Cleveland Clinic to complete a validation study of its technology. In March 2016, a study authored by 13 scientists appeared in the Journal of Clinical Investigation, where it was stated that the company's blood test results were flagged "outside their normal range 1.6x more often than other testing services", that 68 percent of lab measurements evaluated "showed significant interservice variability", and that "lipid panel test results between Theranos and other clinical services" were "nonequivalent". In August 2016, the company introduced a new robotic, capillary blood testing unit named "miniLab" at the 2016 annual meeting of the American Association for Clinical Chemistry, but did not present any data supporting the claimed abilities of the device.

Corporate affairs

Location

Theranos was headquartered in Palo Alto, California. It previously had laboratories in Newark, California and Scottsdale, Arizona.

Management

From its incorporation in 2003 until 2018, Holmes was the company's chief executive officer. She recruited Channing Robertson, a chemical-engineering professor at Stanford, to be a technical advisor and the company's first board member during its early years. Holmes' then-boyfriend Sunny Balwani, a software engineer whom Holmes had met during high school, joined the company as its president and chief operating officer in 2009. In July 2011, Holmes was introduced to former U.S. Secretary of State George P. Shultz, who joined the Theranos board of directors that month. Over the next three years, Shultz helped to introduce almost all the outside directors on the "all-star board", which included William Perry, Henry Kissinger, Sam Nunn, Bill Frist, Gary Roughead, James Mattis, Richard Kovacevich and Riley Bechtel. The board was criticized for consisting "mainly of directors with diplomatic or military backgrounds".
In April 2016, Theranos announced its medical advisory board which included past presidents or board members of the American Association for Clinical Chemistry. Members were invited to review the company's proprietary technologies and advise on the integration into clinical practice. The board included past presidents or board members of the American Association for Clinical Chemistry such as Susan A. Evans, William Foege, former director U.S. Centers for Disease Control and Prevention, David Helfet, director of the Orthopedic Trauma Service at the Hospital for Special Surgery and professors, Ann M. Gronowski, Larry J. Kricka, Jack Ladenson, Andy O. Miller and Steven Spitalnik.
Balwani left his position as president and COO in May 2016. At that time, the company announced its new board members, Fabrizio Bonanni, Richard Kovacevich and William Foege, who would help to publicly introduce its technologies.
In May 2016 members of the Theranos board of directors were:
In December 2016, it was announced the Theranos management team would be restructured with the departure of Riley Bechtel. In January 2017 incoming U.S. Secretary of Defense nominee James Mattis resigned from the Theranos board. In January 2017 the Theranos board of directors included: Elizabeth Holmes, William Foege, Fabrizio Bonanni, and Daniel Warmenhoven, former NetApp CEO, who replaced Riley Bechtel.
It was also announced in November 2016 that the celebrity-studded "board of counselors" would be scrapped in January 2017.

Valuation

Theranos raised millions of dollars in its first years. In 2004, Theranos was based in a rented basement near the Stanford campus. By December 2004 the company had raised more than $6 million from investors at a valuation of $30 million. The company had about $45 million total fundraising after Series B and Series C funding in 2006. Theranos raised an additional $45 million in 2010 at a valuation of $1 billion. The company moved to the former headquarters of Facebook in June 2012. The company had significant news coverage starting in September 2013 after profiles in the San Francisco Business Times and The Wall Street Journal. By 2014, Theranos had raised more than $400 million with an estimated value of $9 billion. In 2016, Forbes revised the estimated net worth of the company to $800 million taking into account the $724 million of capital raised.
In May 2017, participating shareholders provided a release of any potential claims against Theranos in exchange for shares of the company's new preferred stock. Holders of more than 99 percent of the shares elected to participate. CEO Elizabeth Holmes contributed shares to the company and gave up equity to offset potential dilution to non-participating shareholders.
In May 2018 John Carreyrou reported that American business and government leaders lost more than $600 million by privately investing in Theranos. Major investments had been made by the Walton family, Rupert Murdoch, Betsy DeVos, and the Cox family . The final liquidation of the company in September 2018 rendered these investments worthless.

Books and documentaries

John Carreyrou, a The Wall Street Journal journalist whose work exposed Theranos, published a book-length treatment in May 2018 titled '. A film version is reportedly scheduled for release in 2020, starring Jennifer Lawrence as Elizabeth Holmes, written by Vanessa Taylor and directed by Adam McKay.
In January 2019, ABC News Nightline released a podcast and documentary about the Holmes/Theranos story called The Dropout.
Also in January 2019, a documentary film entitled ' about Holmes and Theranos was released. Directed by Alex Gibney, it made its debut at the Sundance Film Festival and was released to the general public in March 2019 on HBO platforms.