When Ethics in Healthcare Impact Real People

In a recent Twitter argument someone posed the question: how does Elizabeth Holmes, founder of Theranos, a company that claimed to change the world of blood tests, differ from any other startup founder?

Startup founders are asked to… bend the truth. Shareholders want to know that the biggest, brightest, most exciting new idea is coming, and startups get their funding by guessing and convincing others that their guesses are right. But while it’s fine to guess how many people will use a rideshare service or want to post public messages of less than 140 characters, it’s not okay in healthcare. Ethically, we can’t guess about a product that impacts people’s health.

This reminds me of when I first heard Sara Holoubek speak on ethics in technology. Holoubek said that technology moves fast, but healthcare moves slow. She said that maybe technology moves too fast for healthcare.

Nothing convinced me of the accuracy of that statement more than reading the book Bad Blood, about the Theranos debacle. And so I asked myself: when did Elizabeth Holmes move from typical startup founder to criminal?

Ethics in a Startup

Startups are an exciting type of company. Whether they get funding through VCs or from Kickstarter, they have an opportunity to do far more than their larger, slower, more established counterparts. Sometimes that means skirting rules and regulations. Sometimes it means not having to worry about good benefits or work/life balance, in favor of passion. The mentality of a startup isn’t meant to be sustainable. It’s all about capitalizing on the moment.

If someone helping to fund a startup asks “does the product work?” the answer is always “almost.” It’s part of the magic. The secrets and the problems stay internal, just up until it really does work. And for most startup founders, they aren’t even lying. They truly believe that with a few more hours of work, a few more days of testing, the product will work perfectly.

Ethics in Healthcare

There’s a reason healthcare is heavily regulated. Though body snatching seems outlandish, unethical behavior to “further medical discovery” still exists. Consider situations such as the Tuskegee experiment, or the all-too-recent story of Henrietta Lacks. Regulations are intended to protect ethics in healthcare. In that way, they protect patients and ensure no doctor is “almost ready” with a new surgical procedure.

Even with regulations in place we see disasters such as the current opioid crisis destroy families and communities. Consider – opioids were overprescribed in part due to a system that rewards doctors for writing prescriptions. That’s certainly not ethical. So no, the FDA and the CMS aren’t perfect. But they are necessary. Their structure and regulations and procedure help ensure we give medicine and not poison.

From Startup Founder to Monster

So where did Elizabeth Holmes go wrong? Three years into the creation of Theranos the product wasn’t working. The Theranos team lied in a few demos, and made it looks as though it was – to buy time and improve the product. Although Holmes hasn’t given in-depth interviews with any reporters, she certainly came across as passionate about the space. I would guess that she actually believed Theranos’ blood tests would work with just a few more days or weeks of fiddling.

But three years in people called her bluff. And instead of pivoting the product, or taking a step back, she doubled down. Over the next 12 years Theranos went farther than fudging the truth. They lied to providers and to patients. They sold blood tests they knew did not work. They gave patients inaccurate results that they knew could not possibly be accurate.

At that point, three years in, Holmes stopped thinking like a Startup founder. She started thinking like a con artist. Perhaps if she had been working on a startup to revolutionize travel or home cleaning it wouldn’t matter so much. Yes, money would be lost, and yes she would be a criminal. But only in a field like healthcare can one person’s desire to “move fast and break things” literally kill people.

We Can Be Better

At the end of Bad Blood, author John Carreyrou suggests that perhaps Elizabeth Holmes is a sociopath, incapable of empathy. To me that is too easy of an answer. Because within each of us there is the drive to create, the drive to move fast. It’s why we’re so excited when startups do come to market.

It’s not enough to say “we couldn’t be like her, because she’s a sociopath.” Instead we must look at Theranos as a lesson. This is what happens when people value money over human lives. This is what happens when ethics are ignored and healthcare becomes a game. These are peoples’ lives, and they deserve our respect, our care, and our protection.