More importantly how did their sophisticated investors not know this? This issue has been known in the industry for years.

The whole Theranos fiasco would not matter except for the damage it does to other biotech startups - when sentiment turns it does not matter if what you are doing is real or not, everyone is frozen out.

I highly doubt their sophisticated investors are any more clued in than their board / executive management, which included prominent military figures, industrial complex powerbrokers, politicos, but zero or nearly zero medical expertise.

I need to be a little less subtle with my snark I think. If there ever was a company you could have avoid investing in by looking at their board it is Theranos [1].

1. https://www.theranos.com/leadership

I'm disappointed in myself - I'm usually better at picking it up. So obvious in retrospect. :)

Go figure, right? "Awarded the Nobel Peace Prize" - and also generally considered guilty of war crimes if we're to use the rules of Nuremberg.

Oh, and Bechtel (nuclear, defense), Cargill (hedge funds on the back of deforesting rain forests to grow more soy), antitrust lawyers, Marine Corps General, ex-Armed Services Committee Senators, a Secretary of Defense, a Navy admiral - oh, and an epidemiologist and surgeon. Very unusual leadership.

The surgeon was the ex-leader of the senate. We are just left with a war cabinet and epidemiologist.

If you look through their BoD, there's not a lot of biomed representatives as I recall...

That must be the understatement of the year. The board looks like the board you would put together if you were planning a coup of some central american country.

Hype always beats science and reality, at least in the short term

Maybe the investors are not sophisticated? Similar to the ubeam (ultrasonic power transfer) where the investors don't understand physics.

The study states that they got accurate measurements once they started taking 5 drops of blood which is less than 0.1 ml. A blood sample could vary from 3-10 ml according to the first thing I found on google. So it seems like all they have to do is take a few more drops to be accurate (which will still be an order of magnitude from the volume of traditional blood tests).

first thing on google: https://ethnomed.org/patient-education/blood/how-much-blood-...

To get 100 µl out you need more than a finger prick. Once you go this way you might as well cannulate. There might be some special cases where you can get 100 µl but not 3 mL, but this market is not going to support the weight of a unicorn.

Are you claiming that 5 drops of blood cannot be obtained via finger prick?

If he is, he's generally right. You get 1.5, maybe 3 drops out before it seals back up. Finger lancets are very tiny needles, even smaller than those used for insulin injections.

I worked in diabetes where finger stick tests are the lingua franca. 3 microliter sample sizes were common about 10 years ago for home use systems using relatively fine lancets. Using something just a bit larger would pretty easily get you 5 drops of blood.

Not out of one - well not easily or consistently.

Additionally important is the fact that the minimum required volume varies based on the feature that is being measured. This seems incongruent with Theranos' focus on a few standardized sample containers.

That depends on the sizes. The article says

> Only when the authors tested upwards of five drops combined (60 to 100 microliters) were they able to get accurate results.

That still sounds pretty low volume to me.

I can't read the actual article, so I can't comment in much more detail (also, I'm not a biologist).

I'm sure they do/did, and hope(d) that they could work around it in some way. Unfortunately for them, it sounds like they're going to have to pay the piper before they wanted to.

The best they can do is measure the sample with zero measurement noise - but that's no panacea if the variation is in the sample itself, and not the measurement.

It's not so much the volume that is the problem from what I understand it is the way in which it is drawn. So if that same volume were drawn from a vein then the variability would be substantially less.

> How could Theranos not know about this?

Who says they did not know about this? Maybe they did but it did not agree with their plans, maybe they thought they could overcome it.

>How could Theranos not know about this?

They probably did know but willfully ignored it because the monetary upside was great.