5 ms·

It is interesting to look at their test menu at: https://www.theranos.com/test-menu?ref=our_solution https://www.theranos.com/test-menu?ref=our_solution You ca

by Gatsky 12y ago

It is interesting to look at their test menu at: https://www.theranos.com/test-menu?ref=our_solution https://www.theranos.com/test-menu?ref=our_solution You can see here that they have replicated most of the routine blood tests out there. Interestingly, they have also replicated some of the archaic and pretty useless blood tests like Rheumatoid Factor. They also offer Erythrocyte Sedimentation Rate (ESR). This is pertinent because ESR is actually a physical property of blood, it is performed by measuring the rate at which red blood cells fall to the bottom of a tube. Perhaps they have developed a microfluidic method to measure this, but it wouldn't be a 'chemical process'. But at the end of the day, they are offering the same tests that are currently available. If someone said to me we can now do the same old blood tests faster and cheaper, I would say that this is going to have very little impact on people's health. None of these tests are truly useful in prevention or screening unselected patients. It does really seem that Theranos is a case of packaging the existing blood diagnostics and trying to capture a large part of the market. Exciting for investors I guess, but for patients or healthcare workers probably not so much. I wish they were doing something like cheap, easy and reliable comprehensive circulating DNA analysis, or proteomics, or something with immune cell function profiling... I hope with all this cash they have a program for giving this technology to places that can't afford the usual lab infrastructure, that would be a very good thing.

tel 12y ago
> If someone said to me we can now do the same old blood tests faster and cheaper, I would say that this is going to have very little impact on people's health. None of these tests are truly useful in prevention or screening unselected patients. Are you kidding? I'm not completely familiar here, but I'd love to see a comparison of the current SOC for time between measurements of each of these endpoints and then a clinical judgement that genuinely nothing interesting happens in these levels at timeframes shorter than SOC. A person I'm familiar with has a severe endocrine disorder which has eliminated nearly all of his natural hormone production. Instead, he must self-administer all hormones in proper dosages. In order to survive this way he has become vastly more familiar with his own blood panel than most human beings ever would dare. On insurance dime he takes far more regular blood tests than you usually can get access to and understands, even very roughly, how events in his life, diet, exercise, stress, weather, etc begin to affect his blood chemistry and, subsequently, his life. In his, of course anecdotal, experience these are things that he cannot converse with doctors about because they're not able to speak confidently so far outside of SOC. It's not necessarily surprising stuff, but there's comparatively little real-world evidence to give it a bite. Theranos could make similar analyses achievable for far more people. It opens an entirely new branch of clinical research---blood chemistry fluctuation at the level of perhaps up to multiple times per day over months at a reasonable cost in both testing and human time (given adequate distribution---Walgreens or, even, eventually, a home edition). You can't pretend that Phizer and GSK, known partners, aren't all about that. > Exciting for investors I guess, but for patients or healthcare workers probably not so much. Only if you assume SOC doesn't change under the influence of massively more available quantitative data.
- streptomycin 12y ago
  > A person I'm familiar with has a severe endocrine disorder He said "unselected patients". The point is, some random guy with no preexisting condition might not actually benefit from being able to measure shit in his blood more easily. It could mostly lead to false positives, stress, and unnecessary costs. The only way to know for sure would be to do a study on it... but Theranos doesn't seem to like doing studies. Making blood tests faster and cheaper would definitely be a good thing, but it's possibly not a completely transformative thing.
  - tel 12y ago
    I am not claiming that any individual will receive personal benefit from their own use of Theranos, but instead that large scale clinical researchers will.
- Gatsky 12y ago
  I am assuming that SOC won't change under the influence of massively more available quantitative data, or at least any gains would be both slight and only applicable to a very small number of people. I think it is probably a misconception that humans are simple enough that measuring something (on Theranos' current testing panel) which is produced in ten different ways in five different organs from millions of cells and then diluted in 7 litres of blood is going to tell you anything revolutionary. Certainly happy to be proven wrong, but there is a risk of harming people (financially, psychologically and perhaps medically) if you convince them that relentless tracking of their serum sodium tells them something useful.
  - tel 12y ago
    I think the difference here comes in use. I agree that misinforming people about the meaningfulness of their blood chemistry is dangerous and low value. My target users are not Quantified Selfers (although my anecdote example might have thrown that off) but instead large scale clinical research sponsors.
pcrh 12y ago
I'm skeptical that there is anything massively different between the technology Theranos uses and that used by existing clinical diagnostic labs. Their greatest claim, as least in the popular press, appears that they can do these tests on "a few drops of blood" (it appears to be about 0.5 ml from the image) as opposed to 10 ml or so. This claim is nothing special, as in fact almost all tests are eventually done on an aliquot no larger than a few microlitres that is withdrawn from the larger sample. As to speed of results, this would likely be linked to organizational efficiency rather than a technical innovation. Further, there is no way all the tests shown on their website can be done with one 0.5 ml sample, as samples need to be collected into different anti-coagulants for different tests as some anticoagulants interfere with some tests but not other (this is why the doctor usually takes two or three samples into different tubes -- not because s/he needs 30 ml of blood). They may however have improved automation, or a better run or cheaper service, in which case, good for them.
- lotsofmangos 12y ago
  This gives a bit of perspective on their current system, it is far off something like a hand held scanner. It is from a blog article by a bio-chem due diligence company. Whether it was due to the quantity of tests (7 tests) or the particular tests I ordered, I was quickly informed that I would be receiving a standard blood draw for my first visit. To my surprise, only 75-80% of patients receive the finger stick method, while the remaining 20-25% require a standard blood draw. The company’s goal to expand nationally relies upon the ability to integrate within the infrastructure of existing Walgreens’ drugstores, a feat made difficult by the need for a trained phlebotomist to serve a specific group of test orders. While the company currently offers more than 200 blood diagnostic tests, the internal assay development team is working to expand this menu to include over 1,000 of the most commonly ordered tests at their CLIA laboratory located in Palo Alto, CA. In addition to my own blood draw, I stayed to observe the highly publicized finger stick, a staple of the start-up’s competitive appeal over established companies like LabCorp or Quest. It was here that the charm of Theranos became more obvious. Rather than a phlebotomist, a Walgreens pharmacy technician is easily able to perform the “nanotainer” blood collection steps, a testament to the simple and integrated workflow system developed by Theranos. Blood collection kits are provided to the technician, which include alcohol swabs, a warm compress, a finger stick, and a “nanotainer” (kept separately in a fridge). After scanning and labeling the sample tubes, the pharmacy tech begins the simple process as follows: apply warm compress to finger, clean the finger with alcohol swabs, massage blood towards the tip of the finger, stick the finger using one of 3 prick sizes (purple = small, pink = mid-size, blue = large), collect blood. The “nanotainer” which collects only a few drops of blood via capillary action, has continuously been an attractive marketing tool for Theranos, inflating the nano-sized tube with a larger than life persona. These samples are then stored in the fridge until a courier system can transport them to the CLIA certified lab in Palo Alto, where proprietary platforms allow the company to run traditional tests on 1/100th to 1/1000th of the ordinary volume. My results were emailed to my physician the following day. http://decibio.com/blog/theranos-small-sample-big-opportunity/ http://decibio.com/blog/theranos-small-sample-big-opportunit...
Eridrus 12y ago
> If someone said to me we can now do the same old blood tests faster and cheaper, I would say that this is going to have very little impact on people's health. I think you vastly under-estimate the impact of cheaper prices. We're not all sitting around with computers in our pockets because they're drastically different, we're sitting around with them because they're cheap. Obviously there is skepticism on the applications, this is why she is giving all these talks about what this would enable. I don't have any particular insight about what this kind of price drop will produce (though cheaper STD testing can't be a bad thing), but I think massive reductions in price do fundamentally change how things get done.

by Gatsky 12y ago

tel 12y ago

> If someone said to me we can now do the same old blood tests faster and cheaper, I would say that this is going to have very little impact on people's health. None of these tests are truly useful in prevention or screening unselected patients. Are you kidding? I'm not completely familiar here, but I'd love to see a comparison of the current SOC for time between measurements of each of these endpoints and then a clinical judgement that genuinely nothing interesting happens in these levels at timeframes shorter than SOC. A person I'm familiar with has a severe endocrine disorder which has eliminated nearly all of his natural hormone production. Instead, he must self-administer all hormones in proper dosages. In order to survive this way he has become vastly more familiar with his own blood panel than most human beings ever would dare. On insurance dime he takes far more regular blood tests than you usually can get access to and understands, even very roughly, how events in his life, diet, exercise, stress, weather, etc begin to affect his blood chemistry and, subsequently, his life. In his, of course anecdotal, experience these are things that he cannot converse with doctors about because they're not able to speak confidently so far outside of SOC. It's not necessarily surprising stuff, but there's comparatively little real-world evidence to give it a bite. Theranos could make similar analyses achievable for far more people. It opens an entirely new branch of clinical research---blood chemistry fluctuation at the level of perhaps up to multiple times per day over months at a reasonable cost in both testing and human time (given adequate distribution---Walgreens or, even, eventually, a home edition). You can't pretend that Phizer and GSK, known partners, aren't all about that. > Exciting for investors I guess, but for patients or healthcare workers probably not so much. Only if you assume SOC doesn't change under the influence of massively more available quantitative data.

streptomycin 12y ago
> A person I'm familiar with has a severe endocrine disorder He said "unselected patients". The point is, some random guy with no preexisting condition might not actually benefit from being able to measure shit in his blood more easily. It could mostly lead to false positives, stress, and unnecessary costs. The only way to know for sure would be to do a study on it... but Theranos doesn't seem to like doing studies. Making blood tests faster and cheaper would definitely be a good thing, but it's possibly not a completely transformative thing.
- tel 12y ago
  I am not claiming that any individual will receive personal benefit from their own use of Theranos, but instead that large scale clinical researchers will.
Gatsky 12y ago
I am assuming that SOC won't change under the influence of massively more available quantitative data, or at least any gains would be both slight and only applicable to a very small number of people. I think it is probably a misconception that humans are simple enough that measuring something (on Theranos' current testing panel) which is produced in ten different ways in five different organs from millions of cells and then diluted in 7 litres of blood is going to tell you anything revolutionary. Certainly happy to be proven wrong, but there is a risk of harming people (financially, psychologically and perhaps medically) if you convince them that relentless tracking of their serum sodium tells them something useful.
- tel 12y ago
  I think the difference here comes in use. I agree that misinforming people about the meaningfulness of their blood chemistry is dangerous and low value. My target users are not Quantified Selfers (although my anecdote example might have thrown that off) but instead large scale clinical research sponsors.

pcrh 12y ago

I'm skeptical that there is anything massively different between the technology Theranos uses and that used by existing clinical diagnostic labs. Their greatest claim, as least in the popular press, appears that they can do these tests on "a few drops of blood" (it appears to be about 0.5 ml from the image) as opposed to 10 ml or so. This claim is nothing special, as in fact almost all tests are eventually done on an aliquot no larger than a few microlitres that is withdrawn from the larger sample. As to speed of results, this would likely be linked to organizational efficiency rather than a technical innovation. Further, there is no way all the tests shown on their website can be done with one 0.5 ml sample, as samples need to be collected into different anti-coagulants for different tests as some anticoagulants interfere with some tests but not other (this is why the doctor usually takes two or three samples into different tubes -- not because s/he needs 30 ml of blood). They may however have improved automation, or a better run or cheaper service, in which case, good for them.

lotsofmangos 12y ago
This gives a bit of perspective on their current system, it is far off something like a hand held scanner. It is from a blog article by a bio-chem due diligence company. Whether it was due to the quantity of tests (7 tests) or the particular tests I ordered, I was quickly informed that I would be receiving a standard blood draw for my first visit. To my surprise, only 75-80% of patients receive the finger stick method, while the remaining 20-25% require a standard blood draw. The company’s goal to expand nationally relies upon the ability to integrate within the infrastructure of existing Walgreens’ drugstores, a feat made difficult by the need for a trained phlebotomist to serve a specific group of test orders. While the company currently offers more than 200 blood diagnostic tests, the internal assay development team is working to expand this menu to include over 1,000 of the most commonly ordered tests at their CLIA laboratory located in Palo Alto, CA. In addition to my own blood draw, I stayed to observe the highly publicized finger stick, a staple of the start-up’s competitive appeal over established companies like LabCorp or Quest. It was here that the charm of Theranos became more obvious. Rather than a phlebotomist, a Walgreens pharmacy technician is easily able to perform the “nanotainer” blood collection steps, a testament to the simple and integrated workflow system developed by Theranos. Blood collection kits are provided to the technician, which include alcohol swabs, a warm compress, a finger stick, and a “nanotainer” (kept separately in a fridge). After scanning and labeling the sample tubes, the pharmacy tech begins the simple process as follows: apply warm compress to finger, clean the finger with alcohol swabs, massage blood towards the tip of the finger, stick the finger using one of 3 prick sizes (purple = small, pink = mid-size, blue = large), collect blood. The “nanotainer” which collects only a few drops of blood via capillary action, has continuously been an attractive marketing tool for Theranos, inflating the nano-sized tube with a larger than life persona. These samples are then stored in the fridge until a courier system can transport them to the CLIA certified lab in Palo Alto, where proprietary platforms allow the company to run traditional tests on 1/100th to 1/1000th of the ordinary volume. My results were emailed to my physician the following day. http://decibio.com/blog/theranos-small-sample-big-opportunity/ http://decibio.com/blog/theranos-small-sample-big-opportunit...

Eridrus 12y ago

> If someone said to me we can now do the same old blood tests faster and cheaper, I would say that this is going to have very little impact on people's health. I think you vastly under-estimate the impact of cheaper prices. We're not all sitting around with computers in our pockets because they're drastically different, we're sitting around with them because they're cheap. Obviously there is skepticism on the applications, this is why she is giving all these talks about what this would enable. I don't have any particular insight about what this kind of price drop will produce (though cheaper STD testing can't be a bad thing), but I think massive reductions in price do fundamentally change how things get done.