COMMENT BOOKS & ARTS

Elisabeth’s, because “in the family, the BIOTECHNOLOGY child is without a doubt a hardly bearable burden”. These provide proof that he effectively signed their death warrants. Nearly 800 children were killed in Am Blood, sweat, Spiegelgrund. Asperger went on to enjoy a long academic career, dying in 1980. Both Asperger’s Children and Czech’s paper converge on the same conclusion. tears and biotech Personally, I no longer feel comfortable with naming the diagnosis after Hans Asperger. In any case, this is a category Eric Topol extols a gripping account of the rise and fall rendered moot in the most recent of US medical-testing company . edition of the DSM (used in the United States). European nations will follow this diagnostic lead in 2019, with the 11th ew scandals have so gripped both the to study chemical edition of the International Classification health-care and technology indus- engineering at Stan- of Diseases. tries as the seismic rise and fall of ford University The future use of the term, of course, Fblood-testing company Theranos. In Bad in California as a is a discussion that must incorporate the Blood, acclaimed investigative journalist President’s Scholar, views of autistic people. Many take pride John Carreyrou, who broke the story in a prestigious pro- in the term Asperger’s syndrome as part 2015, presents comprehensive evidence of gramme that comes of their identity, feeling it refers to their the fraud perpetrated by Theranos chief with a grant. She personality and cognitive style, which executive . Specifically, dropped out in her obviously do not change simply because Holmes and the company’s former presi- Bad Blood: second year to start of historical revelations. They might not, dent Ramesh ‘Sunny’ Balwani raised more Secrets and Lies Real-Time Cures, the therefore, want a change. Others have than US$700 million through “elaborate, in a Silicon Valley Palo Alto-based com- already written about switching to using years-long fraud in which they exaggerated Startup pany that became ‘autism’ (or autism spectrum disorder, or or made false statements about the com- JOHN CARREYROU Theranos and oper- Knopf (2018) autism spectrum condition) to describe pany’s technology, business, and financial ated for 15 years. their diagnosis. performance”, as the US Securities and Carreyrou explores For brevity and neutrality, I favour the Exchange Commission put it in March Holmes’s talents and liabilities. Driven, and single term autism. However, because of this year. with an exceptional gift for selling ideas, the considerable By the time Carreyrou’s Wall Street she built up a board of high-level politi- heterogeneity “The future Journal story and a long chain of follow- cal figures, such as former secretaries of among autistic use of the term ups had led to regulators closing down state and , people, I think Asperger’s Theranos’s labs in 2016, nearly 1 million former secretary of defence , it could be help- syndrome is lab tests had been run in California and Marine Corps general (now secretary of ful for them a discussion Arizona. A significant proportion of these defence) James ‘Mad Dog’ Mattis, and for- and their fami- that must were erroneous; all had to be voided. An mer senator . Investors included lies — together incorporate the untold number of people were harmed by media magnate ; partners with autism views of autistic the erroneous results: some underwent numbered supermarket giant Safeway and researchers, people.” unnecessary procedures, received misdiag- pharmacy chain . Channing clinicians and noses of serious conditions and experienced Robertson, a professor of Holmes’s at relevant professionals — to discuss emotional turmoil. Stanford, was a board member and adviser whether subtypes should be introduced. Carreyrou presents the scientific, human, to the company. In 2015, Holmes was rec- When Wing coined the term Asperger’s legal and social sides of the story in full. ognized by then-president Barack Obama syndrome, none of us was aware of Hans Although some of it was previously reported as a US ambassador for global entrepre- Asperger’s active support of the Nazi in his extensive coverage, he unveils many neurship. The same year, vice-president programme. As a result of the historical dark secrets of Theranos that have not previ- Joe Biden sang her praises at a launch of research by Sheffer and Czech, we now ously been laid bare. the miniLab (which Carreyrou uncovers as need to revise our views, and probably also The company’s alluring goal, which completely fake; the lab was not operational our language. Asperger’s Children should changed as it evolved, was to quickly analyse at the time). be read by any student of psychology, a drop of blood for hundreds of differ- All the while, as Carreyrou reports, psychiatry or medicine, so that we ent assays, at a fraction of prevailing costs. Holmes was lying about the nanotainer, learn from history and do not repeat its Collected in ‘nanotainers’ and allegedly contracts with the pharmaceutical industry terrifying mistakes. The revelations in tested in a diagnostic ‘miniLab’ the size of a and assay validation. She made false this book are a chilling reminder that the microwave oven, the method was publicized statements to the US Federal Drug Admin- highest priority in both clinical research as revolutionizing an industry that hadn’t istration (FDA) and to the US government and practice must be compassion. ■ changed for decades. Holmes, who idolized agency that regulates blood-testing labs, the Apple entrepreneur Steve Jobs, called it “the Centers for Medicare and Medicaid Services. Simon Baron-Cohen is director of the iPod of health care”. And she claimed that Theranos was being Autism Research Centre at the University As a child in the 1990s in the United used on the battlefield in Afghanistan, saving of Cambridge, UK, and president of States, Holmes declared that she wanted soldiers’ lives. the International Society for Autism to be a billionaire when she grew up. By Holmes described the miniLab as “the Research. age 30, she had achieved her goal. Highly most important thing humanity has e-mail: [email protected] intelligent, she had been accepted in 2002 ever built”. But at best, the lab could do

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Elizabeth Holmes, chief executive of Theranos, in a company facility in Newark, California.

immunoassays using microfluidics. The tiny — allegedly showing, for instance, normal Carreyrou’s tipster, a pathologist and blog- blood sample had to be diluted extensively glucose and lipid levels in accordance with ger, along with so many employees who (for which there are no reference standards previous testing. Little did I know that they were rightfully afraid of hurting patients or precedents), leading to artefacts and spu- were run on a standard Siemens machine with fraudulent lab results. The combina- rious results. Later inspections by the FDA (I was not allowed to see the lab area) in tion of these brave whistle-blowers, and demonstrated poor quality control of mul- the back room of a tenacious journalist who interviewed tiple lab tests using Theranos equipment, Theranos, and had “An untold 150 people (including 60 former employees) and several examples of failed proficiency nothing to do with number of makes for a veritable page-turner. testing. The rest of the hundreds of routine the miniLab. Like people were My only criticism is the book’s lack of CARLOS CHAVARRIA/NYT/REDUX/EYEVINE CARLOS assays the lab was supposed to deliver would so many others, I harmed by reflection about lessons learnt from this require cytometry, general chemistry and had confirmation the erroneous debacle. How did a company rise to a DNA amplification. These were done using bias, wanting this valuation of $9 billion in a network of so routine commercially available lab equip- young, ambitious results.” many influential people, even as people ment, or were hived off to other facilities. woman with a were endangered? In my view, letting this That was the well-kept secret inside the great idea to succeed. The following year, technology loose (despite grand claims) toxic work environment that Bad Blood in an interview with The New Yorker, I without a single publication by independ- exposes. expressed my deep concern about the lack ent scientists, never mind replication, was Carreyrou describes firings and legal of any Theranos transparency or peer- a recipe for jeopardy. Had the medical threats to and serious intimidation of reviewed research. community and regulators held the com- employees, as well as industrial espionage Near the end of Bad Blood, Carreyrou pany accountable, this could have been involving spying on employees’ social- describes how, in 2015, litigator David pre-empted. There have been other exam- media accounts. The book even goes Boies — then Theranos’s legal counsel — ples of Silicon Valley companies that rose into the suicide of a former leader of the attempted to prevent meteorically, but none has put patients’ company’s chemistry group. from publishing Carreyrou’s reportage. For health at risk. Hopefully, the evidence in I met Holmes twice and conducted a instance, Boies accused the paper of pub- Bad Blood will stop it happening again. ■ video interview with her in 2013, for the lishing Theranos trade secrets and making medical-information website Medscape. false and defamatory statements. Despite Eric Topol is executive vice-president of At the time, I gave a fingerstick nano- the $125 million invested in Theranos the Scripps Research Institute in La Jolla, tainer blood sample and within 30 minutes by Murdoch, the newspaper’s owner, the California. received my results for many routine tests pieces were published. We also learn about e-mail: [email protected]

©2018 Mac millan Publishers Li mited, part of Spri nger Nature. All ri ghts reserved. ©2018 Mac millan Publishers Li mited, part of Spri nger Nature. All ri ghts re17ser vMAYed. 2018 | VOL 557 | NATURE | 307