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US Regulators Find Serious Deficiencies At Theranos Lab (wsj.com)

An anonymous reader writes: 2016 has not started well for blood-testing startup Theranos. Already facing allegations of data manipulation, the Centers for Medicare and Medicaid Services have found problems with Theranos' laboratory in Newark, California, putting the company's relationship with the Medicare program in danger. WSJ reports: "It isn't clear exactly what regulators have faulted Theranos for in their latest inspection, which took several months. Adverse findings would be another regulatory setback for one of Silicon Valley's highest-profile startups, valued at about $9 billion in 2014. Theranos already has stopped collecting tiny samples of blood from patients' fingers for all but one of its tests while it waits for the Food and Drug Administration to review the company's applications for wider use of the proprietary vials called 'nanotainers.' In October, the FDA said it had determined that the nanotainers were an 'uncleared medical device.'"

66 comments

  1. Awesome job, guys! by fuzzyfuzzyfungus · · Score: 4, Insightful

    So, going from a revolutionary plan to do tests with markedly less blood using your super-neat proprietary hardware to not even being able to operate off-the-shelf hardware from competitors well enough to satisfy Medicare?

    I guess we can't all be disrupters...

    1. Re:Awesome job, guys! by 110010001000 · · Score: 3, Funny

      Guys? The CEO is a woman. Don't be sexist.

    2. Re:Awesome job, guys! by Anonymous Coward · · Score: 5, Interesting

      Nothing easy about it

      I led a team that developed a shipping/receiving system for the collection of tissue.
      At the time that we did the work the direction from the FDA led us to believe that it would not be a medical device
      18 months later, when they saw out spiffy new system in the field, they questioned why we did not apply to have it released as a medical device...

      This became a 'Big Deal' as the FDA threatened to recall about three months of product ($50 - $70 million in value) if we could not demonstrate complete traceability through the system with clear reporting of every sample

      Fortunately we designed every piece of the system as if it were a med device and came through the audit with flying colors

      Unfortunately the company that I worked for would not submit the system for formal review as a medical device and we pulled it out of service.

      Understanding the FDA requirements for a medical device, and staying in touch with them throughout your development process to make certain that they have not changed their direction is essential to staying alive in that market space

    3. Re:Awesome job, guys! by Anonymous Coward · · Score: 0

      More evidence that medicine should not be a for-profit industry.

    4. Re:Awesome job, guys! by Anonymous Coward · · Score: 0

      Every time a Theranos story comes up we get misogynists like you making a big fucking deal about her gender.

      Theranos is a fucking sham and it would be a sham no matter who was running it. Any asshole of any gender can try to bilk Medicare money.

      Fuck off and stop being terrified of women you fucking cowardly shit.

    5. Re:Awesome job, guys! by Goldsmith · · Score: 1

      Figuring out where you are in the FDA regulated world can be difficult, but Theranos isn't in that situation. Diagnostic manufacturers and diagnostic labs go through FDA clearance. No ambiguity there (ok, LDTs are ambiguous, but that loophole is closing).

      Theranos knew this, and successfully went through FDA with a herpes diagnostic, as well as being qualified as a diagnostic lab. Given all that regulatory engagement, it boggles the mind that they didn't see this coming. Either they didn't know they were running a lab that was faking test results (which is bad), or they knew and didn't believe the FDA would find out (which is worse).

  2. Regulation; is there no harm it cannot bring? by SuperKendall · · Score: 0, Troll

    Now society has to wait a decade while vastly more blood is drawn than is really needed for tests, because even a single drop of blood being outside the body is too fearsome a prospect to bear for the wilting Nanny State.

    I'd say there's a better than even chance some large testing companies have put the fix in to make sure this technically savvy startup gets shut down.

    --
    "There is more worth loving than we have strength to love." - Brian Jay Stanley
    1. Re:Regulation; is there no harm it cannot bring? by transami · · Score: 0

      That's my feeling too. The whole thing smelled too much like a witch hunt.

      --
      :T:R:A:N:S:
    2. Re:Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 1

      Sure, because nobody every put a medical device on the market that failed due to an unexpected task case, and/or were unable to produce documentation demonstrating that they did or did not have adequate test coverage

    3. Re:Regulation; is there no harm it cannot bring? by Software · · Score: 4, Informative

      Theranos has been making extraordinary claims and providing no proof (to the public, anyway).

    4. Re:Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 1

      To me it seems like they continue to not quite live up to the hype. They have really interesting stuff that doesn't seem to be quite there yet. For medical testing I personally want them to be very rigorous making sure it works as accurately as what we have now. For non medical 'for funz' or 'other' testing I would be less concerned. I definitely want them to succeed as it would be a boon to the world, but it needs to be rock solid, not the 'mostly works' SV startup type stuff.

    5. Re:Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 1

      Yes, I am sure the laws of nature are conspiracy aimed at forcing big government on us and stifling or tech savvy dreams of flying out of the window by flapping our ears.

    6. Re:Regulation; is there no harm it cannot bring? by h4x0t · · Score: 1

      I'd like to think this is true, but are there any patents to back up their tech?

      How do they manage to get by with less material than is generally required, and have they been able to show (through data reproduction) that their techniques get the same results with less?

    7. Re: Regulation; is there no harm it cannot bring? by Entrope · · Score: 3, Informative

      Why do you say they are technically savvy? Their marketing appears to be savvy, but all the impartial stories I've seen (including from Reason, which is usually against regulators and incumbents who benefit from regulations) give the impression of dodgy technology at Theranos.

    8. Re:Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 2, Funny

      Here come the fans of personal responsibility, blaming their failures on others...

    9. Re:Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 1

      Theranos has made unsubstantiated claims from day one, and tried everything they can think of to bypass the process every other medical device manufacturer follows.

    10. Re: Regulation; is there no harm it cannot bring? by Entrope · · Score: 2

      I've read that they have at least one patent. They do not seem to be doing very well on the "reduction to practice" bit that is supposed to be a prerequisite for getting a patent, though.

    11. Re:Regulation; is there no harm it cannot bring? by russotto · · Score: 2

      A capillary blood collection tube is Class I and not subject to pre-market approval (21 CFR 864.6150). But for some reason the Theranos capillary nanotube is class II? Why?

    12. Re:Regulation; is there no harm it cannot bring? by Tsu+Dho+Nimh · · Score: 2

      How do they manage to get by with less material than is generally required, and have they been able to show (through data reproduction) that their techniques get the same results with less?

      So far as I know, they haven't let any independent labs near their technology. To me, an ex-med tech, that is extremely suspicious. If the technology is sound, they should be bragging about it, taking it to trade fairs and letting large hospitals test it out.

    13. Re: Regulation; is there no harm it cannot bring? by NatasRevol · · Score: 1

      Shouldn't they have hundreds to thousands of patents if they're actually doing what they're saying?

      --
      There are two types of people in the world: Those who crave closure
    14. Re:Regulation; is there no harm it cannot bring? by smooth+wombat · · Score: 3, Insightful

      Even worse, a recent article indicated they had effectively stopped using their own process for testing and had gone back to using the previous method.

      If anything screams scam, that should be a flashing red light.

      --
      We will bankrupt ourselves in the vain search for absolute security. -- Dwight D. Eisenhower
    15. Re:Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 3, Insightful

      Theranos device has integrated testing capability and the capillary tube contains the sample while it is delivered to a desperate testing device, which in all likelihood is a medical device

    16. Re:Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 0

      A capillary blood collection tube is Class I and not subject to pre-market approval (21 CFR 864.6150). But for some reason the Theranos capillary nanotube is class II? Why?

      My guess is a hydrophobic surface to decrease the amount of blood required/

    17. Re:Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 2, Informative

      I'd say there's a better than even chance some large testing companies have put the fix in to make sure this technically savvy startup gets shut down.

      Actually, we're not. I'm pretty high up in finance in the California division of the largest testing company. I don't speak for my company so I'm posting as AC.

      It's an interesting situation. We're taking a wait-and-see approach to what Theranos is doing. This is a very highly regulated business, and Theranos' approach was backwards-- they set up their business associations before getting the necessary governmental and regulatory approvals. Start-up style, if you will. And it's coming back to bite them now.

      That's not to say that we won't adopt some of their approaches if it works out. From a business perspective, their plan for consumer-driven testing is an fascinating one. They are targeting the healthcare consumer rather than the physician, which turns the testing world on its head. Unfortunately, that's a lot harder in California than it is in most other states, though.

      The medical testing field is weird that way. The physician, who is the only one who can order most testing, is our customer. So are the insurance companies, and the government, in their role as Medicare/MediCaid administrators. The patient, who supplies the sample and usually pays part of the bill, currently has little or no say about what company actually does the testing. Theranos plans to turn that sideways, which is a very interesting approach. I hope it works out because we'll all benefit. I'd probably be executed for saying so, but if our company has to give up a little so that the patients benefit, I don't have a problem with that.

    18. Re:Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 0

      The Libertarian response MUST include the company being sued out of existence (free market and all), and yet the politicians who promote such libertarian ideas usually are trying to limit the actions of consumers in the courts via mandatory remediation outside the courts

      Funny, it is almost like they are carny hucksters trying to fleece us all

    19. Re: Regulation; is there no harm it cannot bring? by Entrope · · Score: 1

      Thousands seems high. I could see dozens, and maybe hundreds in the US's patent-happy system. I don't know how many they have, beyond one that I saw attributed to their CEO's time in grad school. They might have dozens or hundreds (especially if you include filed but not granted).

    20. Re: Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 0

      I would have no problems being extremely competitive in a whole range of markets if I could also ignore regulations.

    21. Re:Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 0

      Can you fully document that you actually exist. If you can not maybe we should pull your right to post. After all you can not just have dead non corporeal entities posting. We need documentation and evidence. .
      On another note, If we can not prove that everything we do is 100% medically safe we should just not do it. I for instance before I walk outside look at scientifically review peer literature discussing the correlation between going outside and developing a left ventricular aneurysm. If I can not satisfy myself and a team of governmental and industry rule making bodies, I just don't go out. I do this for every facet of my life. I am responsibly in the narrowest most left leaning view of the world imaginable.

      We need more regulations courts and rules to rule every facet of our life. If there isn't a rule against something, they might end up doing it I for instance would pull the arms and legs of the first stray dog I came to. However since I live in a left leaning nanny state, that has a rule against leaving doggy parts on public sidewalks, I have decided not to do this. Liberals and Rules are the only thing keeping society together.

      "Never talk to strangers; they could be a cereal killer or terrorist"
      -Hillary Clinton

    22. Re:Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 0

      Theranos' claim of using smaller amounts of blood has always been a bogus "disruptor". People may fear needles, but they fear medical issues even more. Taking smaller amounts of blood doesn't change whether or not people will get tests, what it needs to be is more accurate, or a new way to understand things. Just about everyone will happily give 2 or 3 vials of blood if it means they gain a greater understanding of their health issues that is actionable towards a treatment.

      Theranos' entire model and value claim is both poor and corrupt. They never gained FDA clearance on Edison, their so-called revolutionary technology; that was always run under the Lab-Developed-Test regulations. Their labs are simply CLIA waived which means they were certified to run approved machines, the machines from Siemens that are also used by Mayo, LabCorp, and Quest. ANd it turns out they weren't actually using those correctly; they were diluting samples which is an improper protocol and reduces the accuracy of the tests, which is why they have been nailed.

      On top of that, diagnostics are useless unless they are actionable. No one will trust Theranos because they refuse to be open about their so-called proprietary technology. Sure, there will be a few techie startup doctors out there that'll trust a Theranos test, but the vast majority of doctors will not treat based on a Theranos test because the accuracy and validity of their technology has always been an open question in the medical community, long before their drama. A doctor risks a malpractice suit and his license by trusting a test that is not validated, so most will not do it; instead they will simply order a valid test from their hospital and charge the patient and the payer. That makes Theranos tests un-actionable and cost the patient more for the same medical care; they might as well just go to the doctor if they're sick and get the same test.

      So in the end, the value proposition has never been there with Theranos, it's always been hype but it's not solving any problems in healthcare. Long before this Wall Street Journal article there were serious questions about them in the medical and diagnostic community; no one who knows how this works ever trusted their company to be legitimate. Claims of witch hunt comments are ridiculous, you might as well be making an "I am rubber, you are glue" comment. Theranos has had weak, defensive, personal attacks to counter their accusers rather than facts, which simply makes them look all the more suspicious.

    23. Re: Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 0

      They have 49 applications that are public, and around 20 or so that were granted, the rest were rejected or expired. Most are around sample collection via the nanotainers. Some of their rejected ones are around Edison, it appears none were granted on Edison. In the end, Edison is just an automatic microfluidic sample handler and analyzer, nothing particularly revolutionary.

      https://patents.google.com/?q=theranos

    24. Re:Regulation; is there no harm it cannot bring? by Anonymous Coward · · Score: 0

      STFU, fucking libertaritard

  3. More corporate welfare... by Anonymous Coward · · Score: 1

    gone wrong.

    1. Re: More corporate welfare... by Anonymous Coward · · Score: 0

      When has corporate welfare ever gone right?

    2. Re: More corporate welfare... by Anonymous Coward · · Score: 1

      US Space Program

  4. Previous articles on Theranos by MobyDisk · · Score: 1
  5. it's not a story about blood by supernova87a · · Score: 5, Insightful

    The real story here is not about some medical device or a failed test.

    The story, and reason we take pleasure in this downfall is because a charismatic, supposed prodigy, Stanford-privileged, everyone-wants-to-believe-in-successful-woman CEO, who was able to convince funders based on flashy visions and compelling talk, has been found out to have nothing behind the emperor's clothes. And that so many people who are purportedly expert at evaluating technology got collectively duped/brainwashed into believing a whole bunch of fluff based on no more than a TED talk-level technology pitch.

    While others who are working on real demonstrable technology, and do not get the benefit of celebrity status, Silicon Valley connections, get passed over for grants / VC money / recognition because they're not connected or privileged in the same way.

    Stop believing so much in the vision and hype. Ask for and act on real results more.

    1. Re:it's not a story about blood by Krishnoid · · Score: 3, Funny

      Between that description and the name 'Theranos', this sounds like the backstory for the next version of an upcoming post-apocalyptic FPS.

    2. Re:it's not a story about blood by N7DR · · Score: 4, Interesting

      And that so many people who are purportedly expert at evaluating technology got collectively duped/brainwashed into believing a whole bunch of fluff based on no more than a TED talk-level technology pitch.

      I am frequently amazed at how willing VCs tend to be to provide money while at the same time being unwilling to express skepticism, even to themselves, about the claims of some of the companies they fund.

      Some time ago, after a particular VC firm had dumped $40m into a "security" (for which read "snake-oil") company, the company suits happened to make a closed-door presentation which, unknown to them, a handful of people with practical security expertise had been invited to attend. A VC representative was also in attendance, although he did not speak. When we recommended, after the talk, that the listeners have nothing further to do with the company product, the VC representative sought one of us out (it happened to be me) and the end result was that I spent a day at the company facility, towards the end of which I had a short meeting with the VC representative and explained at an intelligent layman's level why the product could never work. The money pipe closed that day. But I remain puzzled as to how $40m could have been dumped into a scheme that was so obviously flawed.
       

    3. Re:it's not a story about blood by Anonymous Coward · · Score: 0

      But I remain puzzled as to how $40m could have been dumped into a scheme that was so obviously flawed.

      There's an old saying: "It's not what you know. It's who you blow."

    4. Re:it's not a story about blood by Anonymous Coward · · Score: 0

      I am frequently amazed at how willing VCs tend to be to provide money while at the same time being unwilling to express skepticism, even to themselves, about the claims of some of the companies they fund.

      This extends well beyond the VC sphere, and is a problem extant everywhere the people disbursing the funds are more concerned with how things look than how things are.

      You would be appalled at the amount of taxpayer money funneled to incompetent contractors not because they're the best for the job, not because they've ever completed a similar project before, not because they have the most reasonable bid, but because a minority or a woman (or the jackpot, a minority woman) is on paper as owning the company. You would be even more disgusted to learn how many of these companies have zero minority or female involvement beyond their registered agent. In some cases even the registered agent has absolutely no role beyond signing some papers and accepting a check for the use of their identity. When you bid on US Government contracts, the simple fact is you're far more likely to win if your company is owned by a black woman. Companies are registered in the names of black women for this precise purpose. Everyone controlling the purse strings, from Congress to the OMB to the DOL to the contracting agencies, comes away looking and feeling good because they're "helping minorities," all while the exact opposite is taking place under the hood. And nobody cares when projects triple their budget and time estimates, or fail outright after millions of dollars, because they aren't concerned with getting results. They're concerned with how things look, not how things are.

      In Theranos' case we seem to have funders who were so hell-bent on throwing money at a woman to make her successful and further a particular agenda, that no one bothered to look at what the company actually was (or wasn't) doing. I'm not saying similar things don't happen with men; hell, how many companies did GWB run into the ground and keep getting more money? But in this instance, with Theranos, let there be no doubt that she was funded because she's a woman.

    5. Re:it's not a story about blood by Anonymous Coward · · Score: 0

      $40m is not even a lot. VCs take a wholesale approach to funding. It's just like playing slots: for every successful startup they fund, they make enough to compensate for the failures many times over. Besides that, "snake-oil" makes a lot of money sometimes, and venture capitalists are in it for the short haul. Clueless security managers could very well buy that lame security company's product and by the time the company went bankrupt a couple of years later, the funders (and maybe even the founders) would have dumped their equity already for a good profit.

      Also, VC firms are gambling with other people's money.

    6. Re:it's not a story about blood by Anonymous Coward · · Score: 0

      Posting anonymously for obvious reasons:

      Yes, it's common knowledge that when your business model is built around public money you gain a strategic advantage by appointing a member of a historically disadvantaged class as your CEO/majority owner (or whatever the requirement is for your particular domain). This is why you see many husband/wife teams running small government contractors. The wife is the figurehead and the husband will usually have a role that lets him actually run the company (COO, CFO are common).

      It's unfortunate since the laws themselves have good intentions.

      An example from my past: I once had a business partner who was a minority disabled veteran. Luckily, he also happened to be one of the best in our field so we never bothered to check the boxes. But, it was always on our mind. Of course, it would have been perfectly legal to do so, but we wanted to compete on our abilities since we weren't disadvantaged in any way that affected our performance (about all he couldn't do is jump out of airplanes anymore).

  6. Response is simply common sense by SuperKendall · · Score: 0

    it should up to the free market to decide what punishment to mete out,

    It is, if enough people get second opinion tests and it's shown the testing is flawed, people will not use them...

    Yet a lot of people do continue to use them.

    The nanoliter concept has serious issues - some things you need more than a microliter of possibly contaminated blood to test for.

    Are you so sure? Does it not make some sense that advancements could be made on how much you need to collect?

    Oh but wait, let's just blame Obama. That's easier.

    Who said anything about Obama? This is a vastly larger issue, as the FDA is obviously being paid by existing testing companies to eliminate a potential threat. Let's see if the company can make the process work before bringing in government goons to shut it down beforehand.

    --
    "There is more worth loving than we have strength to love." - Brian Jay Stanley
    1. Re:Response is simply common sense by Anonymous Coward · · Score: 0

      Are you really advocating a system where patients regularly give multiple samples and send them to multiple labs just to check to see if the lab isn't cutting corners at the risk of killing them? We have a regulatory agency to prevent that sort of thing (rather than waiting until after the bodies stack up). In this case it's called the FDA.

    2. Re:Response is simply common sense by rockmuelle · · Score: 4, Informative

      "Are you so sure? Does it not make some sense that advancements could be made on how much you need to collect?"

      On this point, yes, we're pretty sure.

      Here's the problem: when there's something bad (bacteria, virus, mutated DNA) in your system, it usually appears in very small copy numbers (copy number is a technical term that tells you how many copies of something you see in a given sample). The relative abundance (another commonly used term that tells you how common your target is compared to everything else in the sample) of the bad stuff (not a technical term) is usually very small compared to the good stuff. So much so, that often times you need a large sample just to get a single copy of a bad thing. In most biological systems, we're talking needle-in-a-haystack small copy numbers for bad things.

      Think of it this way: Let's say you have a gallon bucket full of coins with only a few quarters. You randomly sample a cup of coins. Can you confidently say there are no quarters in the bucket? Now say the coins are flowing through a series of tubes (no, these are not bitcoins on the internet) and your sample is determined by the coins present when you siphon off your cup's worth. What would the relative abundance need to be before you can confidently say quarters are present in the system using a cup for sampling? How about using a quart for sampling?

      Somewhat like the laws of thermodynamics limit the ability to create perpetual motion machines, relative abundance/copy number place hard limits on the sample sizes needed to detect things in blood with confidence.

      -Chris

    3. Re:Response is simply common sense by Anonymous Coward · · Score: 1

      Are you really advocating a system where patients regularly give multiple samples and send them to multiple labs just to check to see if the lab isn't cutting corners at the risk of killing them? We have a regulatory agency to prevent that sort of thing (rather than waiting until after the bodies stack up). In this case it's called the FDA.

      Except that the FDA is doing much much more than that. If the FDA merely had a certification program that allowed patients to know which labs were more likely to give accurate results - then that would be very useful.

      But the FDA is not allowing people to choose: it is forcing them to only use certified labs. And there are compelling reasons to suspect that the certification process is less about insuring accurate results and more about protecting existing monopolies (e.g. forcing people to pay medical doctors as an unnecessary middleman for the tests rather than getting the tests directly).

      Knowledge is power and I accept that the government has a role in preventing deliberate fraud. But Americans should also believe in freedom: Live free or die, as they say. So we should remain vigilant and suspicious of the motives of government agency that aggressively restricts our freedom.

    4. Re:Response is simply common sense by Anonymous Coward · · Score: 0

      In most biological systems, we're talking needle-in-a-haystack small copy numbers for bad things.

      Given that it's now possible to sequence (most of) an entire genome from a single cell, where now at a point where even a single copy is enough.

      Now, I'm not going to claim that all biomedical tests are easy (there are a lot of tests that we'd like to do that are even impossible with current technology) or that Theranos is entirely honest (I really don't know).

      But there are also strong reasons to suspect that the FDA is motivated less by a desire to protect patients and more by a desire to protect the monopoly profits of certain sectors of the health care industry. For example, there are a lot of medical doctors who would lose a lot of money if patients could cut out the middleman and simply order their own medical tests directly.

    5. Re:Response is simply common sense by rockmuelle · · Score: 3, Interesting

      Single cell sequencing isn't useful as a diagnostic technique for the same reason I outlined above: every cell has a slightly different genome sequence.

      When you're sequencing for diagnostics, you need a consensus genome for the tissue or tumor, not the genome for individual cell in the tissue or tumor. That's because not every cell in the tumor will necessarily have the variation that led to the tumors and it's possible for a single tumor cell to be in the healthy tissue. It's only over populations of cells that the negative effects can be measured properly.

      If you're measure gene expression instead of DNA variants (e.g., looking for gene fusions), the problem is even worse. Not only do you need to sample many cells, but some of those cells need to be actively expressing the damaged gene to be able to sequencing it.

      Disclaimer: I helped develop a single cell sequencing product and currently run a gene sequencing software company. I'm also friends with people at the FDA. I can assure you, they're not protecting profits for anyone and have the best interests of the patients in mind. It might look like bureaucratic overreach at times, but their goal is for only safe products enter the marketplace.

      That goes for interpretation, too, which is why 23andMe got smacked down so hard. The science connecting genotypes to phenotypes is not as strong as the popular press would have you believe (there's currently a reproducibility crisis in the whole genome association study (WGAS) community, where most of the disease/gene associations come from). Sure, you can go to pub med and read all the studies, but understanding the body of knowledge to place those studies in context is difficult even for professionals.

      -Chris

    6. Re:Response is simply common sense by rockmuelle · · Score: 1

      And by WGAS, I meant GWAS (genome-wide association study). Post-workday brain kicking in...

      -Chris

    7. Re:Response is simply common sense by Anonymous Coward · · Score: 0

      ...I'm also friends with people at the FDA. I can assure you, they're not protecting profits for anyone and have the best interests of the patients in mind. It might look like bureaucratic overreach at times, but their goal is for only safe products enter the marketplace.

      That goes for interpretation, too, which is why 23andMe got smacked down so hard.

      Americans are supposed to believe in freedom. There's even a state with the motto "Live free or die." The very first amendment of the bill of rights is supposed to guarantee freedom of speech. But then 23andMe comes along and posts some potentially useful information on a website and the US government comes down on them like a ton of bricks.

      I completely agree with requiring a minimum level of competency in airline pilots and brain surgeons and even with some degree of oversight on food production and preparation. In all those cases, there are no second chances. If someone sells you a toxic burrito and you die from eating it, well, you can't just correct the situation by going out the next day and buying a good healthy burrito.

      But information is different. It is very often much easier to verify that an answer is correct than to suggest the answer in the first place. That's the basic idea behind computer passwords. Let's say that ten people all suggest possible passwords but only one suggestion is correct. It's easy to try all ten and then know which one is correct.

      With 23andMe specifically, no one was going to do a dangerous medical procedure purely on the basis of 23andMe results. For example, let's say you spit in a tube and send it off to 23andMe and it comes back that you've probably have a variant that predisposes you to breast cancer. First thing you're going to do is head to a real doctor and have the result verified. And then you'll discuss your options with the doctor. But it's not like medical doctors were looking on the 23andMe website to see who had the risk variants and then kidnapping such people and surgically removing their breasts without their consent or further tests.

      The science connecting genotypes to phenotypes is not as strong as the popular press would have you believe (there's currently a reproducibility crisis in the whole genome association study (WGAS) community, where most of the disease/gene associations come from).

      The classic GWAS studies looked at common variants - where a significant fraction of the human population was homozygous for the variant with no discernible negative health consequences. There were technical reasons why that was necessary. But the upshot was that the classic GWAS studies focused on variants where there was already compelling experimental evidence that the variant did not have a major health effect. Of course, the original papers made all kinds of hand-wavy arguments about epistasis and cumulative effects of multiple variants all acting together synergistically. But it was like looking for a needle in a haystack where someone else has already gone through and carefully removed all the needles - not at all likely to succeed.

      On the other hand, there are also plenty of well known variants that are dominant embryonic lethal - where even one bad copy of the variant will mess you up so bad that you don't even survive to birth. And there are plenty of variants that are somewhere in between. Of course, for the severe variants you don't need GWAS - just a pedigree analysis of a couple relatively large extended families that carry the variant.

      Rather the crushing innovation in what will be one of the biggest revolutions in the history of medicine (i.e. personal/medical genome sequencing), the US government should be figuring out which variants do actually have medically useful interpretations. But while the US government can spend trillions on things like the war in Iraq, initiatives like ClinVar/ClinGen are languishing with ridiculously low levels of funding.

    8. Re:Response is simply common sense by Anonymous Coward · · Score: 0

      The government didn't come down on 23 and Me like a ton of bricks. 23 and Me was warned that their changes in advertising were pushing the limits, and they changed them again to push the limits further. Then the government said "Okay, back up what you're saying." Which was met with silence. Apparently, 23 and Me wanted to call the FDA's bluff. But it wasn't a bluff. 23 and Me wasn't blindsided, they were warned, and warned again, and just couldn't stop themselves. They ran into that ton of bricks all on their own.

      The FDA has strong guidance about backing up what you say when you start making claims about diagnostic information. Is your test valid for what you claim? Is it reproducible? Was it performed properly? Were the samples tracked rigorously? Can you back up your answers with evidence? They reason that individuals really can't assess the validity of these claims on their own, and in too many cases will act irrationally given some information. This isn't information theory, this is people's lives. It's calling "Fire" in a crowded theater when there isn't one. It's being told that you are likely to develop certain cancers when, in fact, that risk might be 2% vs 1.9% for the normal population. It's being told that by someone who may, or may not be talking out their ass. Certainly, no one was going to perform prophylactic surgery based on a non-CLIA lab test. But it would induce a lot stress for people who would suddenly believe their days were numbered, and a fair fraction of them would make bad decisions. People freak out when they hear things like early onset dementia, cancer or a whole host of genetically linked maladies.

      The FDA's powers and demands have expanded as crises have occurred demonstrating their need. It's after something bad happens that the government asks "Why did this happen?!" that the FDA then is tasked to prevent it from happening again.

      There's plenty of innovation in diagnostics going on out there. But there's also plenty of people who want to shortcut the hard work and spoil the field with scams, boasts and snake oil. Legitimate innovators will get shut out of funding because some charlatan put on a good show and ruined an investors confidence.

    9. Re:Response is simply common sense by Anonymous Coward · · Score: 1

      23 and Me was warned that their changes in advertising were pushing the limits, and they changed them again to push the limits further.

      What specific claims were they making that were so objectionable that you think it was necessary to take away their freedom of speech? Do you imagine that the American public is so stupid that they can't tell the difference between a website and a medical doctor?

      Then the government said "Okay, back up what you're saying." Which was met with silence.

      The variant calls that 23andMe was providing were from a CLIA-certified lab. So the underlying data was as good as what you would get from a test ordered through a medical doctor.

      The question was the interpretation. And the FDA made the assumption that any interpretation made by a random medical doctor, even without any specialized training in genetics, was 100% correct while the FDA also required 23andMe to provide separate studies for each variant - even when such studies already existed in the scientific literature.

      Basically the FDA had a ridiculous double standard where medical doctors were allowed to spout whatever nonsense they wanted while 23andMe were saddled with a burden of proof that was absolute nonsense.

      They reason that individuals really can't assess the validity of these claims on their own, and in too many cases will act irrationally given some information.

      OK, so if we're going to protect people from bad information, how about we start by banning religion?

      It's calling "Fire" in a crowded theater when there isn't one.

      It's perfectly legal to shout "Fire!" in a crowded theater is you genuinely believe that there is a fire. In fact, most people would say that there is an ethical, and perhaps even legal obligation, to do so. The interpretations that 23andMe was providing were state of the art - based on the consensus of the latest scientific research. But the FDA came along and said, "Sorry, unless you spend billions of dollars and many years verifying that there is, in fact, a fire in this theater you are not allowed to express that opinion."

      It wasn't just that the FDA said, "OK, we happen to disagree with your interpretation and have provided out own." The FDA didn't allow 23andMe to provide their interpretations at all.

      There's plenty of innovation in diagnostics going on out there.

      Medical/personal genome sequencing is one of the biggest innovations in the history of medicine. If you're not aware of the massive stifling effect that the FDA has had on innovation in this area then you are just almost incomprehensibly ignorant. Many thousands, perhaps even millions, of people are dying because the FDA is focused on protecting certain monopolies in the healthcare sector - at the expense of patients and freedom.

    10. Re:Response is simply common sense by SuperKendall · · Score: 1

      I'm not advocated for that. I'm saying people will do that anyway, and if results are inconclusive they will let people know.

      People are just like that in case you hadn't yet figured it out.

      --
      "There is more worth loving than we have strength to love." - Brian Jay Stanley
    11. Re:Response is simply common sense by fuzzyfuzzyfungus · · Score: 1

      You'll notice that the 'government goons' are not doing anything to or against Theranos' R&D arm. They haven't actually made their system work for much yet; but they are free to continue poking at it until they can no longer find the money to do so.

      The current inquiries are into Theranos' lab services arm, which is already up and running and (mostly not using their own process to do so) offering various blood tests. For the process that they are researching, efficacy is between them and their investors. For the process that they are already selling, 'wait and see' time is over and we are seeing if they have made the process that they are selling work before selling it.

    12. Re:Response is simply common sense by Anonymous Coward · · Score: 0

      In most biological systems, we're talking needle-in-a-haystack small copy numbers for bad things.

      Given that it's now possible to sequence (most of) an entire genome from a single cell, where now at a point where even a single copy is enough.

      Now, I'm not going to claim that all biomedical tests are easy (there are a lot of tests that we'd like to do that are even impossible with current technology) or that Theranos is entirely honest (I really don't know).

      But there are also strong reasons to suspect that the FDA is motivated less by a desire to protect patients and more by a desire to protect the monopoly profits of certain sectors of the health care industry. For example, there are a lot of medical doctors who would lose a lot of money if patients could cut out the middleman and simply order their own medical tests directly.

      You're wrong with this, because you're not factoring into account the body's natural ability to fight something off, and thus not what's technically possible but what's "medically relevant".

      First to your claim of sequencing a DNA from a single cell. Yes that's true, but finding the cell is the hard part. Let's say you want to know if a patient has cancer and needs treatment. You have to be right, because Chemo is super hard on the patient. When you pull a sample, you may get 1,000,000 cells. Through those 1,000,000 cells, most are normal and let's say one has a mututation that indicates cancer.

      1) How do you find that one? You have a 1 in 1,000,000 chance of getting the right cell if you have only 1 copy of the mutation, so you need a way to sort through the 999,999 and increase your odds of finding. The sequencing is actually pretty easy, it's finding the right target that's the hard part. Typically what's done is PCR to make a lot more copies of everything, sort out what's considered good, and search through the rest for those mutations.

      2) Even if you find one cell with the mutation, is that medically relevant? The body has a natural defense against cancer, so finding one copy of a mutation doesn't imply the patient has cancer and you should start chemo, what it implies is there is a mutation chance but the body simply hasn't had a chance to eliminate this bad copy. What you need to know is are there enough copies rapidly spreading that it overwhelms the body's natural defenses and thus the patient has an aggressive cancer that requires medical intervention.

      Being able to sequence one copy of DNA from a single cell doesn't solve any of those problems, but those are the medically relevant problems that need solving.

    13. Re:Response is simply common sense by Anonymous Coward · · Score: 0

      Then why don't you read about it? There's plenty of articles why they got smacked down.

      http://www.scientificamerican.com/article/23andme-is-terrifying-but-not-for-the-reasons-the-fda-thinks/

      https://liorpachter.wordpress.com/2013/11/30/23andme-genotypes-are-all-wrong/

      http://www.livescience.com/41534-23andme-direct-to-consumer-genetic-test-shortcomings.html

      People often misuderstand what the FDA's mission is. Let me make this absolutely clear: you are able to sell any medical product or service in the US without FDA clearance. You are fully entitled to do so and the FDA will not stop you. What you are not allowed to do is market your medical product or service in any way without FDA clearance. The FDA's primary mission is marketing control of medical products and services.

      The inherent problem is that biological and medical information is extremely hard to understand even for people who are really good at it, and it's combined with the fact that medical fear is probably the biggest fear most people have. That creates an opportunity for people to sell snake oil that can cause real health harm to the community. The FDA's mission is to control this, and thus it's primary goal is to regulate how sellers of medical products and services tell the public what their medical product or service is capable of doing.

      The problem 23andMe had was that their marketing kept getting closer and closer to saying their genetic tests could be used as indicators that you have a genetic medical condition. Despite them saying that, the scientific literature cast serious doubt on whether or not this was true, and 23andMe did not run trials to support this.

      THe big smackdown came though when the FDA made recommendations for them to prove some of their marketing, and they couldn't so they just ignored the FDA warnings and continued to market thier product. That's when it all became public. To their credit though, 23andMe has fixed thier problems

    14. Re:Response is simply common sense by rockmuelle · · Score: 1

      You're posting as an AC, so it's not really worth responding, but...

      Please give me some citations to support your claims that millions are dying due to the FDA holding back innovative treatments.

      While you're at it, give me some citations that show that the average American can properly interpret the result of self-prescribed tests and make sound medical decisions on their own without the advice of experts.

      For the first, cancer is the genomic disease that kills the most people. There are roughly 600k cancer deaths per year in the US (http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044509.pdf) While it's a high number, it's hardly millions (there are about 1.6M new cancer diagnoses per year). And there just aren't any good blanket approaches on the horizon that will make a dent in that number (there are lots of interesting things being tried, but none of them have panned out yet, despite what [pick your favorite popular science magazine] might tell you).

      For the second, I'll "cite" the entire anti-vax community as my counter example. But also see my comment about GWAS and reproducibility (and do the research yourself, it will help you understand how complex and incomplete the data actually is). Most of the science around genomics is not settled yet. And even in the cases where it is, there's still a lot of uncertainty around appropriate responses and treatments.

      I also challenge you to get your genome sequenced and analyze the data yourself. And by that, I mean actually get your genome sequenced, don't do 23andMe's microarray panel. Google "whole genome sequencing service providers" to get a list of places that will do it for you. Go for 30x coverage to get data you can use for variant detection. Do an exome panel if WGS is too expensive for your budget, you'll get most of the useful information with that.

      The ability to sequence individuals is definitely one of the most interesting things going on in biology right now, but it's still in its infancy as far as our ability to understand and apply it. We'll get there, but it's going to take time and effort.

      -Chris

    15. Re:Response is simply common sense by Cinnamon+Beige · · Score: 1

      I don't have the citations where I can get at them anymore, but it's relatively common knowledge in the drug development community that there's a lot of relatively strong candidates that die in development for no other reason than the money required to push them through the FDA tests, meaning that while I agree that the science of genomics is in its infancy, I'm not quite comfortable betting that we might not end up in the very awkward position of simultaneously having genomics being well-accepted in the scientific community with strong, reproducible results being the norm and no FDA-approved tests for the medical community because no company feels it can break even because of the costs and legal issues involved in FDA testing.

      Regulatory burden is something to always keep in mind--and there's some failures involved here on the FDA's side. Regulations that significantly increase the costs involved need to actually deliver what they promise, if nothing else because the costs of those regulations are ultimately paid by the very same public they are supposed to protect.

  7. but by Anonymous Coward · · Score: 0

    the ceo is so pretty, how could she be evil ;^)

  8. She got what she deserves, Man or woman. by Anonymous Coward · · Score: 0

    With all the statements I have seen fall out of this individuals mouth
    "if you have a plan "b" you have allready lost."
    Or something to that effect..
    I think the chip on her shoulder may have caused some blindness.
    Regardles man or woman, any insensitive statements like the arrogant one above should be a negative indicator .
    I beleive the same thing about her feminine colleges Carly and or Meg with reference to the buying of Sacramento California.
    But, moving ahead, I feel bad for the individuals whom have been or are being falsely led by this individual..

    I am sure if this individual was no so publically outspoken about being a successful "female CEO" I bet this (like others) would have not gotten so much attention..

    "living in the lime light, the universal dream"

  9. Medical Uber by Anonymous Coward · · Score: 0

    Stupid fuckfaces from Silicon Valley think that laws and regulations to apply to them. Medical devices are regulated for a reason and that is to stop snake oil salesmen from selling devices etc that simply don't work, put a patient in danger, etc etc.

    They are doing the same model as Uber, fuck the regulations, we're ABOVE THE LAW!

    In short, there ain't no such thing as a free lunch.

  10. Monovision by Anonymous Coward · · Score: 0

    The better way to look at it would be to get the corrupt bureaucracy out of everything we touch. Oh I know.. blah blah but the Government needs to regulate everything.. BULL! Before you jump on your time tricycle remember that Snake Oil selling is ALREADY ILLEGAL. If you die from taking it, person selling goes to jail for murder. If it does nothing, then there is fraud. Problems with industry stagnation are directly related to the corruption which can happen due to massive Government encapsulation of "Medical". The same problems we have with Insurance..

    I'm not a pure anarchist, but I have read some great works. Buy some Stephan Molynoux, he's a good start and very thorough.

  11. This company ticks all the checkboxes. by EmperorOfCanada · · Score: 1

    How many times will investors be fooled by people like this. When I see a company that has a "superstar" on the front page of everything, giving talks, giving interviews, always in the "top 40 under 40" I just know that this is someone who is not minding the store. If you look at companies that were massive successes in their start such as Google, Facebook, Microsoft. These were companies where the top people largely stayed out of the spotlight. Later after the companies had massive and real products the leaders might spend more time on something else. A full time self promotion tour has only one real goal, self promotion. Actually working on a product of this nature takes huge amounts of effort in the lab, and then huge amounts of effort in the regulatory department. There is no time left for strutting and preening. This is what marketing departments are for.

    The other reality is that a product like this can pretty much sell itself. But my first indication of the product being crap was that I was suddenly seeing it mentioned everywhere. Here on /., reddit, local newspapers, international news, everywhere at once. Again this only happens when the product is something for everyone (erection drugs) or has a massive promotion campaign behind it. Except that, again, this product only needs to be promoted to labs, and it pretty much will sell itself if it works.

    Thus all that promotion was aimed at investors. She was aimed at investors. This entire exercise was a combination of promoting her, and getting investor money into her pocket. Full stop. The science would pretty much have gotten in the way. Plus I can see someone like her actually resenting a star scientist who might actually end up with credit. I suspect that the scientists working for her were glorified coffee boys and pencil sharpeners.