Out for blood: the Theranos trial

Hey, Ryan Reynolds here for Mint Mobile. You know, one of the perks about having four kids that you know about is actually getting a direct line to the big man up north. And this year he wants you to know the best gift that you can give someone is the gift of Mint Mobile's unlimited wireless for $15 a month.

Now, you don't even need to wrap it.

Give it a try@mintmobile.com Switch upfront payment.

Of $45 for a three month plan equivalent to $15 per month. Required new customer offer for first three months only. Speed slow after 35 gigabytes. If network's busy, taxes and fees extra. See mintmobile.com hey, Ryan Reynolds here wishing.

You a very happy half off holiday because right now Mint Mobile is offering you the gift of 50% off unlimited. To be clear, that's half price, not half the service. Mint is still premium unlimited wireless for a great price. So that means half day.

Yeah.

Give it a try@mintmobile.com Switch upfront payment.

Of $45 for three month plan equivalent to $15 per month. Required new customer offer for first three months only. Speed slow. 135 gigabytes of network busy taxes and fees extra. Cmintmobile.com.

Hello, and welcome to the Intelligence from the Economist. I'm your host, Jason Palmer. Every weekday we provide a fresh perspective on the events shaping your world. A consistent push toward animal rights in the west has made research on primates increasingly fraught. Yet monkeys hold valuable secrets, and as countries such as China and Japan press ahead, there will be scientific and strategic consequences. And we take a look at a new translation of a lost book by Simone de Beauvoir, a celebrated feminist philosopher. It reveals just how much a childhood friendship shaped both her personal and her professional life. First up, though Elizabeth Holmes once graced the covers of magazines such as Forbes, gave talks at tech savvy conferences like TED, mixed with the political and Silicon Valley elite. Now she's about to stand trial as soon as a sufficiently balanced jury can be found. Theranos, the startup she founded in 2003, claimed to revolutionize the process of blood testing, and in so doing, to alter healthcare itself.

We've created these little tiny tubes which are designed to replace the big traditional tubes and instead allow for all the testing to be done from a tiny drop from a finger.

She raised hundreds of millions of dollars to manufacture those tiny tubes and struck deals to ship them to pharmacies across America. By 2015, the company was valued at $9 billion. And Ms. Holmes was a media darling then Vice President Joe Biden dropped by, calling the company the future of laboratory Science.

The way lab tests have been done have been extremely expensive.

They've been inconvenient to literally get them done.

But then the story came undone, thanks in largest part to Wall Street Journal reporter John Carreyrou.

She commercialized a product, a medical product that she knew did not work. Her machine only did a handful of tests that did not do them well at all.

A year later, the company fell apart and a new narrative took hold in books, miniseries and forthcoming big budget films. That trailblazing brilliant woman of the old story could face up to 20 years in prison.

So Theranos was started by Elizabeth Holmes when she was 19 years old and she had just dropped out of Stanford. And the history of people dropping out of great schools and starting remarkable things is, is formidable in America.

Tom Easton is the Economist's American Business Editor and is based in New York.

You know, you had Bill Gates do the same thing and Mark Zuckerberg and Steve Jobs, and I think people thought about her in the same potential light. And she came up with an incredible idea and the hope was it would solve problems that have really bedeviled the administration of medicine forever.

But that isn't how things turned out. I mean, how did they go south?

So this really is a story where many, many people who work for Theranos doubted its product. They saw that it really didn't work, but they did not speak about it, either because of very, very strict non disclosure agreements or because of the very aggressive legal strategy that Theranos had that was pursued at its apex by a man who went on the board. David Boyce, who's probably the most prominent lawyer in America and a Wall Street Journal reporter, actually was able to put together the story of, and get a lot of people to provide information. I mean, did a remarkable job and by the end of 2015 and 2016 disclosed that what was going on inside of Theranos was really broken.

So now that has resulted in this court date. What exactly is Ms. Holmes accused of in technical terms?

There are two counts of conspiracy and 10 counts of wire fraud. She is accused of lying to investors about the success of her product and equally, perhaps more importantly, lying to doctors and patients about the effectiveness of the Theranos tests.

You said that a complicated non disclosure agreement and kind of an aggressive culture contributed to the lid being kept on this for so long, but some part of it was about Ms. Holmes herself. Right.

So Elizabeth Holmes managed to combine many, many remarkable attributes. She was extremely articulate, she was on the COVID of innumerable magazines. Conferences love to have her. She spoke in very, very clear, idealistic sentences. She could generate tremendous enthusiasm, both among outsiders and among her employees.

We're about to start publishing more data from our laboratory, and we really believe in it because we believe that transparency empowers the individual and that empowering the individual will change the system.

And she also fit the box for what people wanted. After all, knowledge technology companies are run by white guys, and the press and the government, they wanted someone like Elizabeth Holmes to be a flagship for all sorts of reasons, and she played to that as well. One of the things that this story really speaks to is that there's a difference between standard technology companies and a medical product where the consequences of failure are so dangerous and also where the products themselves are very complex. I mean, to have Joe Biden call it the future of laboratory science represents not only Joe Biden's estimate, but probably his staff's. They fundamentally did not understand the science. Neither did anyone on the board of directors. And the case shows that when it comes to things like science, it's very, very hard for outsiders to understand what is really going on.

And we're going into the process of jury selection this week. How is that coming along?

Well, the jury selection is difficult in this case because there has been so much written already. It's hard to get a clean juror who doesn't have some sort of opinion on the subject matter. Apparently, half of the people who have interviewed for the pool have indicated that they have some knowledge of the case already. The judge has apparently ruled that merely exposure to Theranos and to Elizabeth Holmes is not enough to preclude their presence on the case. But do they have a position? This is a really high profile legal exercise, and therefore, to find a juror who has a strictly open mind isn't easy.

Do you have a sense for how she will plead?

Well, she's already pled innocent, and there are a couple likely avenues that she will pursue. The first and most prominent angle is that she believes in the technology, that she thought things were going as well as could be going for some sort of startup. And even if things didn't work, they didn't work within the bounds of what happens in technology companies. And, you know, the prosecution will argue that's ridiculous, that she was endangering patients, that clearly her machines didn't do anything like what she said the machines would do. There's a second defense. On 26 August, the court unsealed a document that had been filed in early January in which Elizabeth Holmes contends that she was under the sway of her number two and her paramour, a guy named Sunny Balwani. Now, he will go on trial next year and he has adamantly objected to these claims. But she says she was abused by Mr. Balwani and that she was manipulated and controlled by Mr. Balwani in all sort of injurious ways. And therefore that seems to be a way to suggest that even if what she did was inappropriate, it wasn't really her fault.

And however this trial goes, there, there is some, some damage to reputations done.

Yeah, there has been tremendous damage. I mean, this has obviously been embarrassing for all the very, very prominent people who were involved. Women in Silicon Valley who are trying to start up companies say that the barriers for them doing things have become harder because of what happened to Elizabeth Holmes. It displays quite visibly and viscerally how much of high tech can be just hype. And it's a blow to all the government people like Biden who actually seem to put their faith in this sort of thing. And it suggests how much do we really know about this sort of ecosystem. On the other hand, I would like to say that it also is supportive of the system. It's important for companies to start up with great ideas and then fail. If there was really a crime here, in some ways it was that it was allowed to reach commercial fruition. If it had never been exposed to individuals, then it would just be one of thousands of companies that started out with a great idea that didn't pan out. In some ways, the most damning part of this is the charismatic founder. Heads of companies shouldn't be based on whether they wear turtlenecks. They should be based on very serious underlying science. And they should be evaluated by people who can understand those sort of things.

Tom, thanks very much for joining us.

Thank you very much.

For more analysis like this from our international network of correspondence, take out a subscription to the Economist. Get a great introductory deal@Equality.com IntelligenceOffer.com the link is in the show notes. Experimenting on monkeys is becoming increasingly unpopular in Western science. The European Union has said it wants to end all animal research at some point in the future and will reconsider its rules on monkey research every five years. Similarly, American lawmakers want to encourage biomedical scientists to move away from a reliance on on animals. But the opposite is happening in East Asia, in particular in China and Japan. That divergence might have serious long run consequences for the West.

In 2014, a German animal rights group called Soko Terschutz planted a caretaker in the laboratory of Nikos Logothetis. He's a neuroscientist working at the Max Planck Institute in Tubingen. There's Tubinger, Max Planck Institut fur Biologische Kubernetik. The infiltrator filmed around 100 hours of neuroscience lab work over six months. And some of that film was broadcast later on German television.

Hal Hodson is a technology correspondent at the Economist.

The footage showed monkeys with metal plugs grafted into their skulls. These are ports which neuroscience researchers use to probe and study the animals brains. One of the monkeys vomited on camera, apparently after having the blood vessels in its brain damaged during the insertion of these sensors. And immediately after the footage was broadcast, about 800 people showed up and started protesting outside Dr. Logothetis lab, demanding an end to his work with monkeys. He was called a monster and a murderer. And after facing charges of breaking animal welfare laws in Germany, which were dismissed in 2020, Dr. Logothetis announced that his laboratory would move to China to a new research facility that he's building in Shanghai. And the thing is, East Asia is increasingly welcoming of monkey research.

And so scientists like Dr. Logothetis are moving to East Asia with their research.

It's not so much that very eminent researchers like Dr. Logothetis are moving, it's more that as the west is relatively stif still, the east is expanding what it does with these kinds of creatures. What's really happening is that neuroscience research on primates, which is almost entirely done on macaque monkeys, is just less and less popular in Europe and the United States. And so if you look at the numbers of lab animals of that kind that are being used for that sort of work in Europe and the U.S. it's pretty much flat or down a bit over the last five years. But in China and Japan, this kind of research is booming. And that's a worrying trend.

A worrying trend because it's just another facet of strategic competition.

Yeah, it is. And it's taken on a new dimension since the beginning of the pandemic, because around February 2020, the Chinese government banned the export of all wild animals, ostensibly in an effort to reduce the problems of viruses spilling over into humans. It was kind of a reaction to the pandemic that had come out of Wuhan. But what that has meant and what it still means is the monkeys that were farmed in China, and that was the vast majority of monkeys used in neuroscience research in the rest of the world, the imports of those have completely collapsed. China is no longer exporting monkeys for neuroscience research purposes. And when you take this with the fact that one of the pillars of Chinese industrial policy at the moment is an understanding of the brain, and using that understanding potentially not just to treat diseases, but also to build intelligent algorithms that do make the economy more efficient and improve performance in the military and across the board, really, it's hard not to see those primates that are now just staying in China and being used in China as kind of a strategic resource.

So what effects will that have then on this kind of research when it's primarily or even exclusively done in China and Japan?

Well, if you eschew a certain kind of research, if you intentionally say, we will not do this kind of research because we think it is wrong, and that kind of research then goes on somewhere else, and then you turn around and say, well, we'll have the fruits of that research, we'll have the knowledge that was generated, or the treatments for Parkinson's that came about because of that research we consider to be ethically immoral, then you've got a bit of a problem.

And the monkeys use is declining in the west because of ethical concerns. But there's clearly serious merit in using them for some kinds of research, right?

It's a very, very thorny question. Monkeys are useful because they have brains that are the most similar to human brains of any creature. That's why you want to study them. There are other possibilities. Some campaigners who want primates to be replaced entirely. They say that through a combination of simulating things on powerful computers, in vitro studies, which means kind of brain cells in a test tube or in a petri dish, and consensual human trials, maybe not ones that are as invasive as the things that are done to monkeys, but the big problem is that there's no point studying the brain unless it's living and working. The brain, more than any other organ, only means anything when it is living and sending electrical signals around, and when you are able to look at those electrical signals.

But that puts the west then on the horns of a dilemma, ethically unpalatable research that it now strategically is minded to do.

One way that Western countries might find a path through this thorny ethical dilemma is that fortunately, the tools of neuroscience, the things that are actually used to probe the brain, the sensors, are becoming smaller and smaller and less invasive. And what this might mean is that while today it is not plausible to consider informed consent from a human being to have those bigger current sensors shoved in their brain in order to study it, if the sensors become less and less invasive. You might have a pathway towards studies that involved informed human consent of their own brains in a way that was safe enough that it was plausible to ask for consent in that way. But unfortunately, in order to minimize those tools in order to get to that point where we might be able to ask human beings for their consent to study their brains, I'm afraid that I don't see a way for science not to rely on monkeys for some time in order to develop those tools in the first place. The unfortunate truth is that we humans don't really understand our brains well enough yet to study them safely.

Thanks very much for joining us. Hal.

Thank you for having me. Jason.

The French philosopher Simone de Beauvoir is best known for her feminist thought in books such as the Second Sex. But she also wrote loosely autobiographical fiction examining France's intellectual elite or her relationship with fellow thinker Jean Paul Sartre. This week, a novel she wrote in 1954, long thought to be lost, is being published in English for the first time. It chronicles the life of someone less famous.

The Inseparables is a very thinly fictionalized account of Simone de Beauvoir's friendship with Elizabeth Lacroix, her childhood best friend.

Rachel Lloyd writes about arts and culture for the Economist.

They met at School in 1917, and de Beauvoir was instantly captivated by her. She described her as a very finished person and everything she had to say was either interesting or amusing. And the novel is the story of their friendship from that first meeting right through to Lacroix untimely early death at the age of 21 from meningitis.

And it's a particularly revealing tale.

The two girls came from very different backgrounds. Laquan was very wealthy. Her family expected that she would marry well or she would join a convent. De Beauvoir, by contrast, was from a bourgeoisie family, but her family had fallen on hard times. Her father had lost their money and she did not have a dowry, so she was expected to go away, get an education, support herself. So she had more options than her friend did. And the book really traces the contrast in their fortunes over their lifetime.

And why is it that it's only just being published now?

So when Simone de Beauvoir wrote the novel in 1954, she showed it to Jean Paul Sartre, her intellectual and romantic partner, and he didn't really rate the novel. She put it in a drawer and didn't touch it again. It was rediscovered by Sylvie le Bon de Beauvoir, Simone de Beauvoir's adopted daughter recently, and she's brought it to publication. It's not the first time Simone de Beauvoir fictionalized or wrote about her friend. She writes about Lacroix in her memoir, Memoirs of a Beautiful Daughter. She wrote a passage about her in the Mandarins, her best known and prize winning novel. And she also based a character in one of her short stories on her.

And so what do we learn about de Beauvoir herself?

So as well as being the story of their friendship, it also offers a window into de Beauvoir's formative years. It talks about her loss of faith, and it talks about other subjects which de Beauvoir would come to explore in her philosophy as an adult. I spoke to the editor of the British edition, Charlotte Knight, and she emphasized how important this novel is to understanding de Beauvoir's oeuvre.

The thing that's really interesting about the friendship in the novel is just how much the two girls talk. You know, they talk and talk and talk. They have really, really long conversations. And it's a meeting of minds. And it's a meeting of minds at a time when I think women, and especially girls, young girls, barely even expected to have minds.

And in the novel, we can see how de Beauvoir's thought developed.

It gives us such a great insight into the formation of one of the most important thinkers of the 20th century that the death of her friend was a driving force in the way that she approached her philosophy and also just her personal philosophy for life.

And how is that? How do you see the development of her philosophy in this novel?

You see lots of themes in the novel that occupy de Beauvoir later on. One of them is faith. She talks about her loss of faith at a young age, but the main one is marriage. She talks in the Second Sex about her frustration at the fact that marriage is one of the only paths available to women and the emphasis placed on marriage and single women, whether they're interested in it or not. Laquan felt frustrated about marriage. She wanted to be educated. She was very intelligent. And she also wanted it to be a marriage of love. She didn't want it to be an arranged marriage, which was popular among the bourgeoisie at the time. Her character in the Inseparable says that selling your body in marriage must be as bad as selling it on the street.

It seems fair to say then that Simone de Beauvoir wouldn't have been the writer, the thinker we know her as, if not for La Groin.

The reason this novel is important is because Lacroix remains an important influence on de Beauvoir long after her death. In fact, Sylvie le Bon de Beauvoir, her adopted daughter, thinks that it was her first great love affair. In Memoirs of a Dutiful Daughter, she says that she's haunted by visions of her friend both day and night. And she thinks that she paid for her own freedom with her friend's death. She thinks that she was able to become a kind of radical feminist and philosopher at the expense of her friend. So it's very moving and it's a short novel, but it's a powerful one.

Thanks very much for joining us, Rachel.

Thanks for having me.

That's all for this episode of the Intelligence. If you like us, leave us a rating and a review and see you back here tomorrow.