Bad Blood. A review.

My blog, The Weekly Packet, ( ) of April 30, 2016 ran under the title “The Theranos evidence, waiting for a story.”

In the text, I said, “… looking at the facts is like looking at individual organs at an autopsy, after the diener has washed them, weighed them, and put them in clean pans. What we need now is the pathologist to come in, and with knowledge and experience, he or she will tell the story that puts the facts together into a coherent narrative. At some point, the narrative may well make an instructive case study.”

John Carreyrou’s new book, Bad Blood: Secrets and Lies in a Silicon Valley Startup, tells the story with spellbinding skill and detail. Those of us who had some background, however minimal, in laboratory work knew that Theranos had almost certainly over-promised and under-delivered. None of us knew the details.

Carreyrou’s reporting reveals the astonishing extent of the process in a marvelously “coherent narrative.” He details the scope of the deceptions involved, including misleading deals with Walgreen’s, Safeway and even an attempt to involve the army, the vast sums of money lost, and the lives disrupted.

First, no spoilers. Read the book! Then, after the mesmerizing read comes the hard part: what can we learn from this story?

One obvious lesson relates to corporate culture. A corporate culture that encourages tough questioning across disciplines and insists on facts may sometimes seem harsh. In such an environment, though, mutual respect and civility make the system work. What we see in Bad Blood, though, is the destructive effect of siloing and secrecy. And we see that destructive process emanating from the top levels of management.

There’s another lesson, too. A very old one. Making the error of hubris provokes the outcome of nemesis. David Ronfeldt explained in his excellent essay for the Rand Corporation, “Beware the Hubris-Nemesis Complex: A Concept for Leadership Analysis.”

“In Greek literature, hubris often afflicted rulers and conquerors who, though endowed with great leadership abilities, abused their power and authority and challenged the divine balance of nature to gratify their own vanity and ambition. Thus hubris was no common evil: It led people to presume that they were above ordinary laws…”

He continued on,

“Hubris above all is what attracted Nemesis, who then retaliated to humiliate and destroy the pretender, often through terror and devastation. Thus she [Nemesis] was an agent of destruction. The battle won, she did not turn to constructive tasks of renewal and redemption—that was for others to do. Yet her behavior was never a matter of pure angry revenge. There were high, righteous purposes behind her acts, for she intervened in human affairs primarily to restore equilibrium when it was badly disturbed, usually by figures who attained excessive power and prosperity.”

With Bad Blood, John Carreyrou has written not just a stunning piece of non-fiction reporting, but a cautionary tale for our times.

Ink still damp from the press

Back in the 19 century, there must have been times when the weekly packet boats had just started to slip the moorings. Then a young boy came running down to the wharf and tossed the very latest newspaper on board, ink still damp from the press.

That scene describes how I feel watching the evolution of articles in the staid pages of JAMA, the Journal of the American Medical Association, and other AMA publications.

For decades, through the 1970s well into the 2000s, the AMA seemed to have a multiple personality disorder. Politically, the organization represented the views of conservative private-practice oriented white male physicians, while the editorial views of JAMA were blatantly ultra-liberal and anti-pharmaceutical industry. Now, the journal and the other organizational media seem to be making a real effort to deal with issues that occupy the interface of society and organized medicine: opioids, income inequality, and environmental- public health concerns including air pollution and water quality.

My experience as the medical director of a heart transplant program taught me firsthand that public health and prevention are far more effective for the population at large than high-technology approaches to end-stage disease. Now, from the AMA of all places, we seem to be witnessing the same realization taking hold. So, I feel like the youngster tossing the fresh newspaper aboard when I tell you about a really worthwhile read in the April 24, 2018 issue of JAMA titled “Health, Faith, and Science on a Warming Planet.” (JAMA. 2018;319(16):1651-1652.) The authors are Monsignor Marcelo Sánchez Sorondo PhD, of the Vatican’s Pontifical Academy of Sciences, Howard Frumkin MD DrPH, from Environmental and Occupational Health Sciences, University of Washington School of Public Health, and Veerabhadran Ramanathan PhD, Atmospheric and Climate Sciences, Scripps Institution of Oceanography.

This astounding trio opened their article by stating, “Climate change, altered natural cycles, and pollution of air, water, and biota threaten the very conditions on which human civilization has depended for the last 12,000 years. While human health is better now than ever before in human history, climate change is undermining many public health advances of the last century and ultimately may be associated with the unprecedented extinction of species. The increasing gap between the wealthy and poor—already unconscionable, and the cause of profound preventable morbidity and mortality—amplifies the effects of climate change on health and deepens health disparities.”

This message, the news that has me running to the dock, is that this is an establishment voice —JAMA, for heaven’s sake— announcing a new paradigm that aligns public health, environmental issues, and economics in a new view of civic and social engagement. This is big news.

Here are the six main points from the paper:
1. Disciplined, critical thinking, and an unfailing commitment to distinguish what is verifiable from what is not, characterize the best of the health, science, and faith communities.
2. Scientific evidence is a primary basis for distinguishing what is verifiable from what is not.
3. With unchecked climate change and air pollution, the very fabric of life on Earth, including that of humans, is at grave risk.
4. There is a role for reverence and awe.
5. There is a moral obligation to safeguard the earth for future generations
6. There is a moral obligation to care for the most vulnerable.

Take a deep breath, and resolve to become, or to remain, engaged.




Photo is the interior of the Metropolitan Cathedral in Buenos Aires, where Pope Francis, as Archbishop Jorge Bergoglio, used to perform mass. (KZM photo, Mar. 14, 2014. Sony DSC-HX300. 1/25th at f2.8, ISO 800)