Creative Disruption? She's 29 and Set to Reboot Lab Medicine

A Decade of Quiet Building

Dr. Topol: You were a college student in engineering and you had a big idea. You said, "I'm going to start this company." Did you know right away, "I'm going to call it Theranos, and I'm going to be the creator of the destruction of laboratory medicine"?

Ms. Holmes: I knew that this is what I wanted to do with my life. When I designed the first technology layout on how to create a system to do this and figured out that I had built something that would work, that was it.

Dr. Topol: It took a long road too, and you've kept it really quiet throughout that. Nobody knew what you were doing for almost a decade. Was it hard to slog along all of that time and keep all of the activity under wraps?

Ms. Holmes: There is a huge amount of work that we've done to be able to get here. But it has been an incredible privilege to be able to do this work. And being able to talk about it now is amazing, because we haven't done that for 10 years, as you said.

A Sweeping Change in Laboratory Medicine?

Dr. Topol: I kind of liken this in some ways to Elon Musk [founder of Tesla Motors and PayPal] and what he has done with the Tesla electric car. It wasn't just that you developed a new way to do a lab test; it was the entire process. Just like with the Tesla car, the way you buy the car, the way your car is serviced, the way your car is charged -- everything about it is totally different. And you've done a similar thing here with laboratory medicine.

A lot of people don't know yet about Theranos and how you have kind of reengineered this whole thing. I had a Theranos fingerstick before our interview. I won't even call it a fingerstick; it was painless. I didn't even know that that was possible earlier today, and that is only one little piece of what you've reengineered. Can you give us a sense of how comprehensive a sweep this is across what has stuck in laboratory medicine since the 1960s? Nothing had changed for 50-plus years.

Ms. Holmes: It's as you said: We believe that to really be able to help contribute in this quest for actionable information, it's a system that is required. And it's not sufficient to build a great test. You need to be able to create a framework in which that test can become accessible. So we started with the premise that if we could make it possible to do any laboratory test from a tiny sample or a few drops of blood, then that service would be more accessible to people.

We spent many years redeveloping every test that is recognized by Medicare in the form of a CPT (Current Procedural Terminology) code to be able to run it on a tiny sample. We then began to think about how to make that service accessible, and we looked at the habits that exist in terms of people getting tested. Today, the fear of needles is very significant, and rightfully so. It's a phobia.

Dr. Topol: And testing involves a bunch of tubes of blood, not even just a needle.

Ms. Holmes: There are a lot of tubes of blood, and we've had the opportunity to work with pediatric patients and geriatric patients and oncology patients, where it can be incredibly painful for them to go through this. We started thinking about how to make this service accessible to those people. And to us, that meant going to them and creating a framework in which we could ultimately be, in terms of our goal, within 5 miles of every American's home across the country.

Dr. Topol: It's a laudable goal.

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