So I wanted to get a sense: how many of
you guys have heard of Theranos and the story of it? OK, quite a few of you,
alright. Well I wanted to give a bit of background and kind of take you guys
back in time about the story before we do the Q&A session. So, Theranos.
Theranos was a medical diagnostic company and their mission was to
redefine diagnosis and they were doing this with this new revolutionary
technology where you were able to take one drop of blood, one drop of blood to
run all your blood tests. And so how they did this was with a finger stick. So
instead of putting a big scary needle into your arm, you just need a finger
poke. And that finger poke would place all your blood in these tiny containers
called nanotainers, which then would be inserted into the Theranos devices. And
these devices were about the size of a printer so eventually you would be able
to have a Theranos device in your own home. No longer did you need to go to
the doctor or the hospital to get your lab work done. So the most exciting
portion of Theranos, at least for me, was the fact that it was very cheap. You
knew exactly how much it was gonna cost you when you wanted to get your blood
tests done and for many people, at least in the United States, they wouldn't even
need to have health insurance in order to pay for these tests. And so for me
being a starry-eyed very idealistic recent graduate from UC
Berkeley this mission had really hit close to home for me. So my background: I
grew up in a trailer – or I think you guys call them caravans – and there are many
false assumptions that people make about people who live in trailer
parks. But there is one really strong reality amongst the American working
class and that reality is healthcare costs are too damn high (to
plagiarise a politician that never was) and the consequence of healthcare costs
being so high in the US is that many people will not go to the doctor when
they start seeing symptoms. And I had had my friends, my family, my
neighbours and even myself just choosing not to go to the doctor because we were
scared of how much it was going to cost us. And what would end up happening is a
very minor condition would end up turning into a very major disease and
diagnosis like cirrhosis of the liver or stage four cancer. So this was an
exciting opportunity for me. Working at Theranos was really my opportunity to
fulfil a personal mission of mine which was to alleviate patient suffering.
Finally, I could be of service to my friends, my family in the community that
I cared about and loved so much, and I could do this by alleviating their pains
financially and physically and psychologically. And, in addition to that,
the company was backed by a really charismatic female entrepreneur.
Elizabeth Holmes had graduated – or, she dropped out of Stanford at age 19 to
start this company. She had raised $700m and her valuation
for the company was $9bn to $10bn. She had eccentric qualities, like she would wear the same black turtleneck
every day and she was vegan. She was all the characteristics that we loved in the Silicon
Valley, and the love for Elizabeth Holmes didn't stop there. She also managed to onboard a really prolific team of politicians to be on her board: Henry
Kissinger, George Shultz and James Mattis. And her investors included Betsy DeVos, Rupert Murdoch and Tim Draper. So aside from being a part of the American elite, the one thread that all
these backers had amongst them was none of them had extensive expertise in
biotechnology or healthcare. The media also adored Elizabeth Holmes. She was on
the cover of Forbes and Fortune magazine and she was allotted as being the next
Steve Jobs – but the next Steve Jobs of the most benevolent of industries,
healthcare. And really Elizabeth Holmes was finally a female entrepreneur in a
male-dominated Silicon Valley, who was a part of the most exclusive community: the
unicorn club. So what was the problem here? Well the problem was that the
technology didn't work. The Theranos devices were nothing more than wishful
thinking, and the processes and procedures that we had in place were
full of errors and problems. And the worst part of it was they were still
testing on patients. To give you an example of these errors, there was one
time I was running a patient and I was testing to check what their thyroid
status was. Initially I got a high concentration which is indicative of
hyperthyroidism. I ran it again and it was low, it would be indicative of
hypothyroidism. And I ran the sample one more time and it was normal. So here I
had one patient, three diagnoses, three apparently different sizes of their
thyroid and three radically different treatments. This is just one case
example of the types of errors and problems that we were seeing with
medical tests at Theranos. And when I explained the environment of Theranos
to people I really relayed it as the Wild Wild West of
blood diagnostics. And what they were doing was essentially experimenting on
patients without their knowledge and consent, and making them believe that
they were going to a well-vetted doctor. Being concerned while I worked for
the company, I had approached the COO of the company, Sunny Balwani, and I said:
'Look, we're seeing tons of issues with the patient results, with the medical
devices and our processes. I think we need to pay attention to this
and stop processing patient samples.' His response to me was: 'What makes you
think you're qualified to say that? You need to do the job I'm paying you to do
and process patient samples.' After this conversation,
I quit the very next day and I had only lasted seven months at Theranos. Before
this, I really wanted to give Sunny and Elizabeth the benefit of the doubt. I
really thought that perhaps they didn't know what was going on internally within
the company. But it became clear to me after that conversation that they just
didn't care. It didn't matter how much evidence and how many red flags were
popping up and telling them that they needed to stop, they were gonna continue
to process patient samples regardless. At this point I was heartbroken but I
was lucky that I was approached by a Wall Street Journal reporter, John Carreyrou, and he had heard from other people in the industry and other employees that
there were scandalous activities and potentially fraudulent activities going
on within Theranos. He was conducting an investigative report but,
before it came out, Theranos went on a witch hunt. They decided to lawyer up
with one of the top corporate lawyers in the United States and come after a whole
bunch of prior employees. And the concerning thing about this letter isn't
so much that it was threatening to sue me and that
they were coming after me, and trying to get me to implicate other workers within
the company. The concerning part was the address. I had just moved apartments and
I was staying with a colleague of mine and on this letter that they delivered
to me was my colleague's address. At this point I knew that not only were
they coming after me legally but they were physically following me. So, freaked
out, I called a lawyer and it's actually pretty funny, after I'd gotten off the
phone with a lawyer I had driven to San Francisco immediately to go into the
regulators office – the Centers for Medicaid and Medicare Services – to just
spill everything to them but honestly I was so scared that I was being followed
I kind of just paced the streets of San Francisco crying and was really confused
on what I should do. So instead I bought a burner phone, I called CMS on the phone
and I was able to send them an email. This email had luckily spurred an
investigation, and that investigation finally revealed the truth that Theranos was in fact putting patients' lives at risk. They shut down their
clinical lab, so they were no longer able to process patient samples any more and
they had to reimburse the hundreds of thousands of patients that had received
their blood testing. Now, Sonny and Elizabeth have faced numerous legal
charges against them from class-action lawsuits to CMS to investor lawsuits, and
the biggest one that is outstanding at the moment is criminal charges posted by
the FBI. That has a current pending trial date.
Through this, though I'm here and very well at Inspirefest and happy to be
here, this experience was filled with an immense amount of fear and anxiety and
self-doubt. And I wasn't always sure about what the right thing to do was. But
I think the one anchor that made it a bit easier was the reason why I decided
to join Theranos in the first place. This guiding principle and guiding
mission that had driven me to want to work for the company was also the one
that was able to pull me out of all the chaos and madness, and get the clarity on
what were the right steps to do the right thing.
Fast forward several years later and I had moved to Hong Kong and I was a
programme director for a technology accelerator called Betatron. We
invest in early-stage tech companies, and we give them the training and resources
to be able to scale and grow their companies all throughout Asia. What I
noticed is that we're very good about teaching start-ups and tech workers about
how to build their products, how to scale them, how to iterate on an MVP, but we
never talk about the shadow side of running and operating a start-up. And,
really, we don't have a lot of good resources to know what to do when we
face ethical dilemmas in these environments that are very fast-paced,
very stressful and very challenging, and often about survival. What is out
there to make sure that companies, tech workers and the start-up community can
prepare themselves when they approach these ethical challenges? This was a
leading question that prompted myself, Tyler and my founding team to start
Ethics in Entrepreneurship. It's a non-profit where we are trying to explore
what are the frameworks, resources and people that we can integrate into the
start-up community to make sure that when they face ethical dilemmas they'll have
the resources to know what to do. Hopefully, Ethics in Entrepreneurship
can become as common nomenclature as 'lean start-up' or
'blitzscaling' and all these other words that we
use to develop these companies. And I wanted to leave you all
with a quote that was very powerful for me and was actually given to me from an
engineer who went through Juicero. It says: 'Just because our temple has been
desecrated, it should not allow us to be shaken from our faith.' At the end of the
day for me, doing something that made an impact and that served patients – I was
willing to stand up for that, whatever it took. So now I want to question all
of you: what are you willing to stand up for? And with that, I hope together all of
us in this room can grow and build innovations, projects and companies that
not only empower ourselves and society and, in my case, alleviate the suffering that
we see in the world. Thank you.
