Elizabeth Holmes Through the Director’s Lens
Kira Peikoff was the editor-in-chief of Leaps.org from 2017 to 2021. As a journalist, her work has appeared in The New York Times, Newsweek, Nautilus, Popular Mechanics, The New York Academy of Sciences, and other outlets. She is also the author of four suspense novels that explore controversial issues arising from scientific innovation: Living Proof, No Time to Die, Die Again Tomorrow, and Mother Knows Best. Peikoff holds a B.A. in Journalism from New York University and an M.S. in Bioethics from Columbia University. She lives in New Jersey with her husband and two young sons. Follow her on Twitter @KiraPeikoff.
"The Inventor," a chronicle of Theranos's storied downfall, premiered recently on HBO. Leapsmag reached out to director Alex Gibney, whom The New York Times has called "one of America's most successful and prolific documentary filmmakers," for his perspective on Elizabeth Holmes and the world she inhabited.
Do you think Elizabeth Holmes was a charismatic sociopath from the start — or is she someone who had good intentions, over-promised, and began the lies to keep her business afloat, a "fake it till you make it" entrepreneur like Thomas Edison?
I'm not qualified to say if EH was or is a sociopath. I don't think she started Theranos as a scam whose only purpose was to make money. If she had done so, she surely would have taken more money for herself along the way. I do think that she had good intentions and that she, as you say, "began the lies to keep her business afloat." ([Reporter John] Carreyrou's book points out that those lies began early.) I think that the Edison comparison is instructive for a lot of reasons.
First, Edison was the original "fake-it-till-you-make-it" entrepreneur. That puts this kind of behavior in the mainstream of American business. By saying that, I am NOT endorsing the ethic, just the opposite. As one Enron executive mused about the mendacity there, "Was it fraud or was it bad marketing?" That gives you a sense of how baked-in the "fake it" sensibility is.
"Having a thirst for fame and a noble cause enabled her to think it was OK to lie in service of those goals."
I think EH shares one other thing with Edison, which is a huge ego coupled with a talent for storytelling as long as she is the heroic, larger-than-life main character. It's interesting that EH calls her initial device "Edison." Edison was the world's most famous "inventor," both because of the devices that came out of his shop and and for his ability for "self-invention." As Randall Stross notes in "The Wizard of Menlo Park," he was the first celebrity businessman. In addition to her "good intentions," EH was certainly motivated by fame and glory and many of her lies were in service to those goals.
Having a thirst for fame and a noble cause enabled her to think it was OK to lie in service of those goals. That doesn't excuse the lies. But those noble goals may have allowed EH to excuse them for herself or, more perniciously, to make believe that they weren't lies at all. This is where we get into scary psychological territory.
But rather than thinking of it as freakish, I think it's more productive to think of it as an exaggeration of the way we all lie to others and to ourselves. That's the point of including the Dan Ariely experiment with the dice. In that experiment, most of the subjects cheated more when they thought they were doing it for a good cause. Even more disturbing, that "good cause" allowed them to lie much more effectively because they had come to believe they weren't doing anything wrong. As it turns out, economics isn't a rational practice; it's the practice of rationalizing.
Where EH and Edison differ is that Edison had a firm grip on reality. He knew he could find a way to make the incandescent lightbulb work. There is no evidence that EH was close to making her "Edison" work. But rather than face reality (and possibly adjust her goals) she pretended that her dream was real. That kind of "over-promising" or "bold vision" is one thing when you are making a prototype in the lab. It's a far more serious matter when you are using a deeply flawed system on real patients. EH can tell herself that she had to do that (Walgreens was ready to walk away if she hadn't "gone live") or else Theranos would have run out of money.
But look at the calculation she made: she thought it was worth putting lives at risk in order to make her dream come true. Now we're getting into the realm of the sociopath. But my experience leads me to believe that -- as in the case of the Milgram experiment -- most people don't do terrible things right away, they come to crimes gradually as they become more comfortable with bigger and bigger rationalizations. At Theranos, the more valuable the company became, the bigger grew the lies.
The two whistleblowers come across as courageous heroes, going up against the powerful and intimidating company. The contrast between their youth and lack of power and the old elite backers of Theronos is staggering, and yet justice triumphed. Were the whistleblowers hesitant or afraid to appear in the film, or were they eager to share their stories?
By the time I got to them, they were willing and eager to tell their stories, once I convinced them that I would honor their testimony. In the case of Erika and Tyler, they were nudged to participate by John Carreyrou, in whom they had enormous trust.
"It's simply crazy that no one demanded to see an objective demonstration of the magic box."
Why do you think so many elite veterans of politics and venture capitalism succumbed to Holmes' narrative in the first place, without checking into the details of its technology or financials?
The reasons are all in the film. First, Channing Robertson and many of the old men on her board were clearly charmed by her and maybe attracted to her. They may have rationalized their attraction by convincing themselves it was for a good cause! Second, as Dan Ariely tells us, we all respond to stories -- more than graphs and data -- because they stir us emotionally. EH was a great storyteller. Third, the story of her as a female inventor and entrepreneur in male-dominated Silicon Valley is a tale that they wanted to invest in.
There may have been other factors. EH was very clever about the way she put together an ensemble of credibility. How could Channing Robertson, George Shultz, Henry Kissinger and Jim Mattis all be wrong? And when Walgreens put the Wellness Centers in stores, investors like Rupert Murdoch assumed that Walgreens must have done its due diligence. But they hadn't!
It's simply crazy that no one demanded to see an objective demonstration of the magic box. But that blind faith, as it turns out, is more a part of capitalism than we have been taught.
Do you think that Roger Parloff deserves any blame for the glowing Fortune story on Theranos, since he appears in the film to blame himself? Or was he just one more victim of Theranos's fraud?
He put her on the cover of Fortune so he deserves some blame for the fraud. He still blames himself. That willingness to hold himself to account shows how seriously he takes the job of a journalist. Unlike Elizabeth, Roger has the honesty and moral integrity to admit that he made a mistake. He owned up to it and published a mea culpa. That said, Roger was also a victim because Elizabeth lied to him.
Do you think investors in Silicon Valley, with their FOMO attitudes and deep pockets, are vulnerable to making the same mistake again with a shiny new startup, or has this saga been a sober reminder to do their due diligence first?
Many of the mistakes made with Theranos were the same mistakes made with Enron. We must learn to recognize that we are, by nature, trusting souls. Knowing that should lead us to a guiding slogan: "trust but verify."
The irony of Holmes dancing to "I Can't Touch This" is almost too perfect. How did you find that footage?
It was leaked to us.
"Elizabeth Holmes is now famous for her fraud. Who better to host the re-boot of 'The Apprentice.'"
Holmes is facing up to 20 years in prison for federal fraud charges, but Vanity Fair recently reported that she is seeking redemption, taking meetings with filmmakers for a possible documentary to share her "real" story. What do you think will become of Holmes in the long run?
It's usually a mistake to handicap a trial. My guess is that she will be convicted and do some prison time. But maybe she can convince jurors -- the way she convinced journalists, her board, and her investors -- that, on account of her noble intentions, she deserves to be found not guilty. "Somewhere, over the rainbow…"
After the trial, and possibly prison, I'm sure that EH will use her supporters (like Tim Draper) to find a way to use the virtual currency of her celebrity to rebrand herself and launch something new. Fitzgerald famously said that "there are no second acts in American lives." That may be the stupidest thing he ever said.
Donald Trump failed at virtually every business he ever embarked on. But he became a celebrity for being a fake businessman and used that celebrity -- and phony expertise -- to become president of the United States. Elizabeth Holmes is now famous for her fraud. Who better to host the re-boot of "The Apprentice." And then?
"You Can't Touch This!"
Kira Peikoff was the editor-in-chief of Leaps.org from 2017 to 2021. As a journalist, her work has appeared in The New York Times, Newsweek, Nautilus, Popular Mechanics, The New York Academy of Sciences, and other outlets. She is also the author of four suspense novels that explore controversial issues arising from scientific innovation: Living Proof, No Time to Die, Die Again Tomorrow, and Mother Knows Best. Peikoff holds a B.A. in Journalism from New York University and an M.S. in Bioethics from Columbia University. She lives in New Jersey with her husband and two young sons. Follow her on Twitter @KiraPeikoff.
Scientists: Don’t Leave Religious Communities Out in the Cold
[Editor's Note: This essay is in response to our current Big Question series: "How can the religious and scientific communities work together to foster a culture that is equipped to face humanity's biggest challenges?"]
I humbly submit that the question should be rephrased: How can the religious and scientific communities NOT work together to face humanity's biggest challenges? The stakes are higher than ever before, and we simply cannot afford to go it alone.
I believe in evolution -- the evolution of the relationship of science and religion.
The future of the world depends on our collaboration. I believe in evolution -- the evolution of the relationship of science and religion. Science and religion have lived in alternately varying relationships ranging from peaceful coexistence to outright warfare. Today we have evolved and have begun to embrace the biological relationship of mutualism. This is in part due to the advances in medicine and science.
Previous scientific discoveries and paradigm shifts precipitated varying theological responses. With Copernicus, we grappled with the relationship of the earth to the universe. With Darwin, we re-evaluated the relationship of man to the other creatures on earth. However, as theologically complex as these debates were, they had no practical relevance to the common man. Indeed, it was possible for people to live their entire lives happily without pondering these issues.
In the 21st century, the microscope is honing in further, with discoveries relating to the understanding of the very nature and composition of the human being, both body and mind/soul. Thus, as opposed to the past, the implications of the latest scientific advances directly affect the common man. The religious implications are not left to the ivory tower theologians. Regular people are now confronted with practical religious questions previously unimagined.
For example, in the field of infertility, if a married woman undergoes donor insemination, is she considered an adulteress? If a woman of one faith gestates the child of another faith, to whose faith does the child belong? If your heart is failing, can you avail yourself of stem cells derived from human embryos, or would you be considered an accomplice to murder? Would it be preferable to use artificially derived stem cells if they are available?
The implications of our current debates are profound, and profoundly personal. Science is the great equalizer. Every living being can potentially benefit from medical advances. We are all consumers of the scientific advances, irrespective of race or religion. As such, we all deserve a say in their development.
If the development of the science is collaborative, surely the contemplation of its ethical/religious applications should likewise be.
With gene editing, uterus transplants, head transplants, artificial reproductive seed, and animal-human genetic combinations as daily headlines, we have myriad ethical dilemmas to ponder. What limits should we set for the uses of different technologies? How should they be financed? We must even confront the very definition of what it means to be human. A human could receive multiple artificial transplants, 3D printed organs, genetic derivatives, or organs grown in animals. When does a person become another person or lose his identity? Will a being produced entirely from synthetic DNA be human?
In the Middle Ages, it was possible for one person to master all of the known science, and even sometimes religion as well, such as the great Maimonides. In the pre-modern era, discoveries were almost always attributed to one individual: Jenner, Lister, Koch, Pasteur, and so on. Today, it is impossible for any one human being to master medicine, let alone ethics, religion, etc. Advances are made not usually by one person but by collaboration, often involving hundreds, if not thousands of people across the globe. We cite journal articles, not individuals. Furthermore, the magnitude and speed of development is staggering. Add artificial intelligence and it will continue to expand exponentially.
If the development of the science is collaborative, surely the contemplation of its ethical/religious applications should likewise be. The issues are so profound that we need all genes on deck. The religious community should have a prominent seat at the table. There is great wisdom in the religious traditions that can inform contemporary discussions. In addition, the religious communities are significant consumers of, not to mention contributors to, the medical technology.
An ongoing dialogue between the scientific and religious communities should be an institutionalized endeavor, not a sporadic event, reactive to a particular discovery. The National Institutes of Health or other national organizations could provide an online newsletter designed for the clergy with a summary of the latest developments and their potential applications. An annual meeting of scientists and religious leaders could provide a forum for the scientists to appreciate the religious ramifications of their research (which may be none as well) and for the clergy to appreciate the rapidly developing fields of science and the implications for their congregants. Theological seminaries must include basic scientific literacy as part of their curricula.
We need the proper medium of mutual respect and admiration, despite healthy disagreement.
How do we create a "culture"? Microbiological cultures take time and require the proper medium for maximal growth. If one of the variables is altered, the culture can be affected. To foster a culture of continued successful collaboration between scientists and religious communities, we likewise need the proper medium of mutual respect and admiration, despite healthy disagreement.
The only way we can navigate these unchartered waters is through constant, deep and meaningful collaboration every single step of the way. By cultivating a mutualistic relationship we can inform, caution and safeguard each other to maximize the benefits of emerging technologies.
[Ed. Note: Don't miss the other perspectives in this Big Question series, from a science scholar and a Reverend/molecular geneticist.]
Why the Pope Should Officially Embrace Biotechnology
[Editor's Note: This essay is in response to our current Big Question series: "How can the religious and scientific communities work together to foster a culture that is equipped to face humanity's biggest challenges?"]
In May 2015, Pope Francis issued an encyclical with the subtitle "On Care for Our Common Home." The letter addressed various environmental issues, such as pollution and climate change, and it reminded all of us that we are to steward the Earth, not plunder it.
Without question, biotechnology has saved the lives of millions – perhaps billions – of people.
The Pope's missive demonstrates that he is both theologically sound and scientifically literate, a very rare combination. That is why he should now author an encyclical urging the world to embrace the life-giving promise of biotechnology.
Without question, biotechnology has saved the lives of millions – perhaps billions – of people. Arguably, vaccines were the most important invention in the history of mankind. It is thought that, in the 20th century alone, at least 300 million people were killed by smallpox. Today, the number is zero, thanks to vaccination. Other killers, such as measles, diphtheria, meningitis, and diarrhea, are kept at bay because of vaccines.
Biotechnology has also saved the lives of diabetics. At one time, insulin was extracted from pig pancreases, and there were fears that we would run out of it. Then, in the 1970s, crucial advances in biotechnology allowed for the gene that encodes human insulin to be expressed in bacteria. Today, diabetics can get extremely pure insulin thanks to this feat of genetic modification.
Likewise, genetic modification has improved the environment and the lives of farmers all over the world, none more so than those living in developing countries. According to a meta-analysis published in PLoS ONE, GMOs have "reduced chemical pesticide use by 37%, increased crop yields by 22%, and increased farmer profits by 68%."
Even better, GMOs also could help improve the lives of non-farmers. In poor parts of the world, malnutrition is still extremely common. People whose diets consist mostly of rice, for example, often suffer from vitamin A deficiency, which can lead to blindness. Golden Rice, which was genetically modified to contain a vitamin A precursor, was created and given away for free in an act of humanitarianism. Other researchers have created a genetically modified cassava to help combat iron and zinc deficiencies among children in Africa.
Despite these groundbreaking advances, the public is turning against biotechnology.
Biotechnology has also helped women with mitochondrial disease bear healthy children. Children inherit their mitochondria, the powerhouses of our cells, solely from their mothers. Mitochondrial defects can have devastating health consequences. Using what is colloquially called the "three-parent embryo technique," a healthy woman donates an egg. The nucleus of that egg is removed, and that of the mother-to-be is put in its place. Then, the egg is fertilized using conventional in vitro fertilization. In April 2016, the world's first baby was born using this technique.
Yet, despite these groundbreaking advances, the public is turning against biotechnology. Across America and Europe, anti-vaccine activists have helped usher in a resurgence of entirely preventable diseases, such as measles. Anti-GMO activists have blocked the implementation of Golden Rice. And other activists decry reproductive technology as "playing God."
Nonsense. These technologies improve overall welfare and save lives. Those laudable goals are shared by all the world's major religions as part of their efforts to improve the human condition. That is why it is vitally important, if science is to succeed in eradicating illness, that it gets a full-throated endorsement from powerful religious leaders.
In his 2015 encyclical, Pope Francis wrote:
Any technical solution which science claims to offer will be powerless to solve the serious problems of our world if humanity loses its compass, if we lose sight of the great motivations which make it possible for us to live in harmony, to make sacrifices and to treat others well.
He is correct. Indeed, when people are protesting life-saving vaccines, we have lost not only our moral compass but our intellect, too.
Imagine the impact he could have if Pope Francis issued an encyclical titled "On Protecting Our Most Vulnerable." He could explain that some children, stricken with cancer or suffering from an immunological disease, are unable to receive vaccines. Therefore, we all have a moral duty to be vaccinated in order to protect them through herd immunity.
Or imagine the potential impact of an encyclical titled "On Feeding the World," in which the Pope explained that rich countries have an obligation to poorer ones to feed them by all means necessary, including the use of biotechnology. If Muslim, Buddhist, and Hindu scholars throughout Asia and Africa also embraced the message, its impact could be multiplied.
In order to be successful, science needs religion; in order to be practical, religion needs science.
In order to be successful, science needs religion; in order to be practical, religion needs science.
Unfortunately, in discussions of the relationship between science and religion, we too often focus on the few areas in which they conflict. But this misses a great opportunity. By combining technological advances with moral authority, science and religion can work together to save the world.
[Ed. Note: Don't miss the other perspectives in this Big Question series, from a Rabbi/M.D. and a Reverend/molecular geneticist.]