Clout-busting

"When the status incentives change, I change my mind. What do you do, sir?"

Henry Kissinger was such an era-spanning historical figure that, even in his 90s, he was involved at the cutting edge of headline-making institutional wrongdoing. For most of his professional life, the former (and now late) US Secretary Of State was a businessman. From 1982, he ran his own consulting business: Kissinger Associates. In the mid-2010s, amongst other directorships, he was on the board of Theranos, the biotech company that wasn’t. So, when Kissinger died last week, one of his odder legacies was that his lawyer, Daniel Mosley, had schmoozed into place a third-to-a-half of the billion or so of pure investment money raised by that scam before it all came crashing down.

Theranos was founded by now-convicted fraudster Elizabeth Holmes. In the absence of enthusiasm for her product claims from people who actually understood biotech, it took the willingly loaned non-expert credibility of the likes of Kissinger and, for example, Bill and Hillary Clinton to persuade investors to fund the foundations of her folly.

Even (especially?) his enemies wouldn’t deny that Henry Kissinger was a clever man. In the eyes of willing marks, whatever domain-specific knowledge Kissinger lacked in the areas of microfluidics or medical diagnostics, he made up for in conspicuous erudition, seriousness, and fame.

The Dropout (on Disney+) dramatises the life of Elizabeth Holmes over the years leading up to and during the scandal. As someone with an academic and professional interest in this affair at the time, I followed its twists obsessively as they unfolded in the real world, so I watched the first episode of The Dropout with interest, because I wanted to learn more about what happened before Theranos and Holmes became news that I could read in the UK.

I find criminals dull and biotech interesting; but, because so much of the rise and fall of Theranos flowed from the personality of its founder and from the response of the outside world to that personality, there’s too much to learn from knowing about Holmes as a person to dismiss her. Accordingly, the first episode of The Dropout plays out like a Marvel supervillain origin story.

Two linked scenes in that episode, portraying a meeting between Holmes, then a Stanford undergraduate, and Phyllis Gardner—a real-life doctor, professor, and kosher tech entrepreneur—say a lot, both within the history of Holmes herself and about the internal and external mindsets that made the rise and fall of Theranos inevitable. For example:

1. It’s not a stretch to see the demise of Theranos as a textbook dramatic tragedy: Circumstances (rather than the stars) shaped the protagonist; the protagonist could only act according to her nature; her actions could only lead to disaster.

2. The Theranos affair could not have continued to happen as long as it did without the judgement of those not directly involved in the scandal being clouded by the poison of identity politics.

Anyone “in the business” with a more-than-basic understanding of the relevant science and technology could see that there was only one way Theranos’s dream of diverse, reliable medical diagnoses based on single drops of blood was going to go. Gardner, one of Holmes’s earliest critics certainly could.

In these scenes, Gardner stomps on an earlier, related, technological dream of Holmes’s for her own (Holmes’s) good. It’s the kind of mercy killing often performed by an Oxbridge don on an over-imaginative student: based on first principles and flowing from the decades of research that preceded it; but also brutal and concise, because the don murdering your idea doesn’t want to waste their time and doesn’t want you to waste yours. When bright young dreamers first experience such a stomping-of-their-dreams, the pain can be excruciating. If they subsequently go into research, they might learn that this pain is so much less terrible than that of having such dreams crushed by their own hard-won data, that early stompings, self-inflicted or otherwise, hurt far, far less less than late ones.

Unfortunately, the YouTube clip I’ve embedded above ends before the follow-up scene, outside Dr¹ Gardner’s office. In that one, the professor tries to bring home to student Elizabeth Holmes that what might seem to be harshness on Gardner’s part is borne of her own experience of having to back up every scientific claim in her career with solid research work—more work than her peers—and her hope that Holmes grinds as hard to ensure that Holmes’s own science is taken as seriously. Gardner strongly implies that she (Gardner) has had to produce so much supporting data for other scientists to take her seriously because she is a woman in a man’s world.

The irony in Gardner’s warning is obvious to anyone familiar with Holmes’s ascent. While earlier anti-female sexism made Gardner’s past path to legitimate academic and business success rockier, Holmes’s future path to multibillion-dollar crime would correspondingly be smoothed by the fact of Holmes’s sex—to such an extent that the absence of scientific evidence to back up her claims would be widely disregarded and that criticisms of her would be branded “misogynist”, a disastrous endpoint of one kind of “Believing All Women”. It would be difficult to deny that another kind of sexism helped her: many straight men and not-straight women must have been, at the very least, distracted by Holmes’s youth, good looks, and deep voice.

When you are selling empty dreams, appearances matter. Theranos’s products were mirages. It wasn’t merely that they were technology that hadn’t been refined yet; they were, like Holmes’s wheeze in the dramatized clip, imaginary. Even with the vast sums of money at the company’s disposal, “faking it until they made it” was impossible, because there were first-principle reasons why such tech was impossible without inconceivable leaps in available technology. Without concrete evidence of such breakthroughs, Theranos could only establish itself with the donated heft of high-status/low-knowledge supporters (like Kissinger and his friends).

Biomedical science and Internet old-timers have seen this kind of thing before.

More than a decade before the Theranos scandal, the anti-MMR vaccine scandal started. At its inception, the theory that MMR vaccination caused autism via some kind of disruption of the human gut was a high-status one. It started with a research doctor publishing in a peer-reviewed journal famous even outside medicine (if one not held in high esteem by practising biomedical research scientists). Once it had percolated down from the ivory tower to the lay public, the parents most likely to withdraw their children from vaccination programmes were among the most educated and affluent.

Those actually working in science (like me) who scoffed at the flimsy case for this “new immune syndrome” were accused of being unqualified, envious, closed-minded, in the pay of Big Pharma, or worse. Even Private Eye, the comedy court circular of the skeptical elite, the satirical outsider organ of media insiders fell for the snakeoil.

But, years later, after grim resurgences in the infectious diseases the MMR vaccine protects against, this kind of anti-vax hysteria had become low-status, and its original fomenter had been struck off the UK medical register.

The SARS-CoV-2 pandemic launched a new flotilla of charlatans. This time, the politics motivating the quackery was much simpler and more obvious. But there were multiple medical debates—even though a debater’s position on those issues could usually be inferred from their politics. There were fights over:

• the efficacy and safety of COVID vaccines,

• the efficacy and costs/benefits of non-pharmaceutical interventions (NPIs), and

• whether or not there was something especially novel and terrible about this particular coronavirus, over and above its higher fatality rate,

• and, of course, the origins of the virus.

In these cases and others, cranks abounded on the extremes, sometimes the extremists even linked metaphorical arms while performing their respective voodoo dances.

On these questions, most people “in the business” familiar with the longstanding evidence base in the control of respiratory infections and with no pre-existing political axe to grind took up what became known by more polite online commentators as “COVID Centrist” positions. Such moderate positions were not so popular with start-up culture “tech bros”.

There were different kinds of COVID Centrist, with different views along each debating spectrum, but they all had some things in common with Our Phyllis above (and one I am guessing she shared):

1. They considered good experimental and epidemiological evidence to be paramount. They elevated it above status, credentials, emotions, vibes, and politics.

2. They took first-principle scientific arguments more seriously than worst-case, science-fiction-movie speculation, and they took tried-and-true treatments more seriously than novel ones.

3. They recognised that all interventions carry trade-offs.

4. They knew that pandemics are marathons, not sprints.

It’s in the spirit of the last of these that I tell you that there are going to be more posts from me about this—and warn you that I am just getting warmed up.

1. Dr Gardner is a physician as well as a PhD.