From the Magazine Exclusive: How Elizabeth Holmes’s House of Cards Came Tumbling Down

Posted on September 8, 2016 by State of the Nation

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In a searing investigation into the once lauded biotech start-up Theranos, Nick Bilton discovers that its precocious founder defied medical experts—even her own chief scientist—about the veracity of its now discredited blood-testing technology. She built a corporation based on secrecy in the hope that she could still pull it off. Then, it all fell apart.

by Nick Bilton
Vanity Fair

The War Room

t was late morning on Friday, October 16, when Elizabeth Holmes realized that she had no other choice. She finally had to address her employees at Theranos, the blood-testing start-up that she had founded as a 19-year-old Stanford dropout, which was now valued at some $9 billion. Two days earlier, a damning report published in The Wall Street Journal had alleged that the company was, in effect, a sham—that its vaunted core technology was actually faulty and that Theranos administered almost all of its blood tests using competitors’ equipment.The article created tremors throughout Silicon Valley, where Holmes, the world’s youngest self-made female billionaire, had become a near universally praised figure. Curiosity about the veracity of the Journal story was also bubbling throughout the company’s mustard-and-green Palo Alto headquarters, which was nearing the end of a $6.7 million renovation. Everyone at Theranos, from its scientists to its marketers, wondered what to make of it all.

For two days, according to insiders, Holmes, who is now 32, had refused to address these concerns. Instead, she remained largely holed up in a conference room, surrounded by her inner circle. Half-empty food containers and cups of stale coffee and green juice were strewn on the table as she strategized with a phalanx of trusted advisers, including Ramesh “Sunny” Balwani, then Theranos’s president and C.O.O.; Heather King, the company’s general counsel; lawyers from Boies, Schiller & Flexner, the intrepid law firm; and crisis-management consultants. Most of the people in the war room had been there for two days and nights straight, according to an insider, leaving mainly to shower or make a feeble attempt at a couple of hours of shut-eye. There was also an uncomfortable chill in the room. At Theranos, Holmes preferred that the temperature be maintained in the mid-60s, which facilitated her preferred daily uniform of a black turtleneck with a puffy black vest—a homogeneity that she had borrowed from her idol, the late Steve Jobs.

Holmes had learned a lot from Jobs. Like Apple, Theranos was secretive, even internally. Just as Jobs had famously insisted at 1 Infinite Loop, 10 minutes away, that departments were generally siloed, Holmes largely forbade her employees from communicating with one another about what they were working on—a culture that resulted in a rare form of executive omniscience. At Theranos, Holmes was founder, C.E.O., and chairwoman. There wasn’t a decision—from the number of American flags framed in the company’s hallway (they are ubiquitous) to the compensation of each new hire—that didn’t cross her desk.

And like Jobs, crucially, Holmes also paid indefatigable attention to her company’s story, its “narrative.” Theranos was not simply endeavoring to make a product that sold off the shelves and lined investors’ pockets; rather, it was attempting something far more poignant. In interviews, Holmes reiterated that Theranos’s proprietary technology could take a pinprick’s worth of blood, extracted from the tip of a finger, instead of intravenously, and test for hundreds of diseases—a remarkable innovation that was going to save millions of lives and, in a phrase she often repeated, “change the world.” In a technology sector populated by innumerable food-delivery apps, her quixotic ambition was applauded. Holmes adorned the covers of Fortune, Forbes, and Inc., among other publications. She was profiled in The New Yorker and featured on a segment of Charlie Rose. In the process, she amassed a net worth of around $4 billion.

Theranos blood-testing machines.

By Jim Wilson/The New York Times/Redux.
One of the only journalists who seemed unimpressed by this narrative was John Carreyrou, a recalcitrant health-care reporter from The Wall Street Journal. Carreyrou came away from The New Yorker story surprised by Theranos’s secrecy—such behavior was to be expected at a tech company but not a medical operation. Moreover, he was also struck by Holmes’s limited ability to explain how it all worked. When The New Yorker reporter asked about Theranos’s technology, she responded, somewhat cryptically, “a chemistry is performed so that a chemical reaction occurs and generates a signal from the chemical interaction with the sample, which is translated into a result, which is then reviewed by certified laboratory personnel.”Shortly after reading the article, Carreyrou started investigating Theranos’s medical practices. As it turned out, there was an underside to Theranos’s story that had not been told—one that involved questionable lab procedures and results, among other things. Soon after Carreyrou began his reporting, David Boies, the superstar lawyer—and Theranos board member—who had taken on Bill Gates in the 1990s and represented Al Gore during the 2000 Florida recount case, visited the Journal newsroom for a five-hour meeting. Boies subsequently returned to the Journal to meet with the paper’s editor in chief, Gerard Baker. Eventually, on October 16, 2015, the Journal published the article: HOT STARTUP THERANOS HAS STRUGGLED WITH ITS BLOOD-TEST TECHNOLOGY.During the two days in the war room, according to numerous insiders, Holmes heard various response strategies. The most cogent suggestion advocated enlisting members of the scientific community to publicly defend Theranos—its name an amalgam of “therapy” and “diagnosis.” But no scientist could credibly vouch for Theranos. Under Holmes’s direction, the secretive company had barred other scientists from writing peer-review papers on its technology.

Absent a plan, Holmes embarked on a familiar course—she doubled down on her narrative. She left the war room for her car—she is often surrounded by her security detail, which sometimes numbers as many as four men, who (for safety reasons) refer to the young C.E.O. as “Eagle 1”—and headed to the airport. (She has been known to fly alone on a $6.5 million Gulfstream G150.) Holmes subsequently took off for Boston to attend a luncheon for a previously scheduled appearance at the Harvard Medical School Board of Fellows, where she would be honored as an inductee. During the trip, Holmes fielded calls from her advisers in the war room. She and her team decided on an interview with Jim Cramer, the host of CNBC’s Mad Money, with whom she had a friendship that dated from a previous interview. It was quickly arranged.

Cramer generously began the interview by asking Holmes what had happened. Holmes, who talks slowly and deliberately, and blinks with alarming irregularity, replied with a variation of a line from Jobs. “This is what happens when you work to change things,” she said, her long blond hair tousled, her smile amplified by red lipstick. “First they think you’re crazy, then they fight you, and then, all of a sudden, you change the world.” When Cramer asked Holmes for a terse true-or-false answer about an accusation in the article, she replied with a meandering 198-word retort.

By the time she returned to Palo Alto, the consensus was that it was time, at last, for Holmes to address her hundreds of employees. A company-wide e-mail instructed technicians in lab coats, programmers in T-shirts and jeans, and a slew of support staff to meet in the cafeteria. There, Holmes, with Balwani at her side, began an eloquent speech in her typical baritone, explaining to her loyal colleagues that they were changing the world. As she continued, Holmes grew more impassioned. The Journal, she said, had gotten the story wrong. Carreyrou, she insisted, with a tinge of fury, was simply picking a fight. She handed the stage to Balwani, who echoed her sentiments.

After he wrapped up, the leaders of Theranos stood before their employees and surveyed the room. Then a chant erupted. “Fuck you . . .,” employees began yelling in unison, “Carreyrou.” It began to grow louder still. “Fuck you, Carreyrou!” Soon men and women in lab coats, and programmers in T-shirts and jeans, joined in. They were chanting with fervor: “Fuck you, Carreyrou!,” they cried out. “Fuck you, Carreyrou! Fuck. You. Carrey-rou!”

The Game

In Silicon Valley, every company has an origin story—a fable, often slightly embellished, that humanizes its mission for the purpose of winning over investors, the press, and, if it ever gets to that point, customers, too. These origin stories can provide a unique, and uniquely powerful, lubricant in the Valley. After all, while Silicon Valley is responsible for some truly astounding companies, its business dealings can also replicate one big confidence game in which entrepreneurs, venture capitalists, and the tech media pretend to vet one another while, in reality, functioning as cogs in a machine that is designed to not question anything—and buoy one another all along the way.It generally works like this: the venture capitalists (who are mostly white men) don’t really know what they’re doing with any certainty—it’s impossible, after all, to truly predict the next big thing—so they bet a little bit on every company that they can with the hope that one of them hits it big. The entrepreneurs (also mostly white men) often work on a lot of meaningless stuff, like using code to deliver frozen yogurt more expeditiously or apps that let you say “Yo!” (and only “Yo!”) to your friends. The entrepreneurs generally glorify their efforts by saying that their innovation could change the world, which tends to appease the venture capitalists, because they can also pretend they’re not there only to make money. And this also helps seduce the tech press (also largely comprised of white men), which is often ready to play a game of access in exchange for a few more page views of their story about the company that is trying to change the world by getting frozen yogurt to customers more expeditiously. The financial rewards speak for themselves. Silicon Valley, which is 50 square miles, has created more wealth than any place in human history. In the end, it isn’t in anyone’s interest to call bullshit.

“I DON’T THINK YOUR IDEA IS GOING TO WORK,” ONE PROFESSOR RECALLS TELLING HOLMES.

When Elizabeth Holmes emerged on the tech scene, around 2003, she had a preternaturally good story. She was a woman. She was building a company that really aimed to change the world. And, as a then dark-haired 19-year-old first-year at Stanford University’s School of Chemical Engineering, she already comported herself in a distinctly Jobsian fashion. She adopted black turtlenecks, would boast of never taking a vacation, and would come to practice veganism. She quoted Jane Austen by heart and referred to a letter that she had written to her father when she was nine years old insisting, “What I really want out of life is to discover something new, something that mankind didn’t know was possible to do.” And it was this instinct, she said, coupled with a childhood fear of needles, that led her to come up with her revolutionary company.

Holmes had indeed mastered the Silicon Valley game. Revered venture capitalists, such as Tim Draper and Steve Jurvetson, invested in her; Marc Andreessen called her the next Steve Jobs. She was plastered on the covers of magazines, featured on TV shows, and offered keynote-speaker slots at tech conferences. (Holmes spoke at Vanity Fair’s 2015 New Establishment Summit less than two weeks before Carreyrou’s first story appeared in the Journal.) In some ways, the near-universal adoration of Holmes reflected her extraordinary comportment. In others, however, it reflected the Valley’s own narcissism. Finally, it seemed, there was a female innovator who was indeed able to personify the Valley’s vision of itself—someone who was endeavoring to make the world a better place.

The original Theranos laboratory, in Palo Alto, 2014.

By Drew Kelly.
Holmes’s real story, however, was a little more complicated. When she first came up with the precursor to the idea of Theranos, which eventually aimed to reap vast amounts of data from a few droplets of blood derived from the tip of a finger, she approached several of her professors at Stanford, according to someone who knew Holmes back then. But most explained to the chemical-engineering major that it was virtually impossible to do so with any real efficacy. “I told her, I don’t think your idea is going to work,” Phyllis Gardner, a professor of medicine at Stanford, said to me, about Holmes’s seminal pitch for Theranos. As Gardner explained, it is impossible to get a precise result from the tip of a finger for most of the tests that Theranos would claim to conduct accurately. When a finger is pricked, the probe breaks up cells, allowing debris, among other things, to escape into the interstitial fluid. While it is feasible to test for pathogens this way, a pinprick is too unreliable for obtaining more nuanced readings. Furthermore, there isn’t that much reliable data that you can reap from such a small amount of blood. But Holmes was nothing if not determined. Rather than drop her idea, she tried to persuade Channing Robertson, her adviser at Stanford, to back her in her quest. He did. (“It would not be unusual for finger-stick testing to be met with skepticism,” says a spokesman for Theranos. “Patents from that period explain Elizabeth’s ideas and were foundational for the company’s current technologies.”)Holmes subsequently raised $6 million in funding, the first of almost $700 million that would follow. Money often comes with strings attached in Silicon Valley, but even by its byzantine terms, Holmes’s were unusual. She took the money on the condition that she would not divulge to investors how her technology actually worked, and that she had final say and control over every aspect of her company. This surreptitiousness scared off some investors. When Google Ventures, which focuses more than 40 percent of its investments on medical technology, tried to perform due diligence on Theranos to weigh an investment, Theranos never responded. Eventually, Google Ventures sent a venture capitalist to a Theranos Walgreens Wellness Center to take the revolutionary pinprick blood test. As the V.C. sat in a chair and had several large vials of blood drawn from his arm, far more than a pinprick, it became apparent that something was amiss with Theranos’s promise.Google Ventures wasn’t the only group with knowledge of blood testing which felt that way. One of Holmes’s first major hires, thanks to an introduction by Channing Robertson, was Ian Gibbons, an accomplished British scientist who had a slew of degrees from Cambridge University and had spent 30 years working on diagnostic and therapeutic products. Gibbons was tall and handsome, with straight reddish-brown hair and blue eyes. He had never owned a pair of jeans and spoke with a British accent that was a combination of colloquial and posh. In 2005, Holmes named him chief scientist.

Gibbons, who was diagnosed with cancer shortly after joining the company, encountered a host of issues with the science at Theranos, but the most glaring was simple: the results were off. This conclusion soon led Gibbons to realize that Holmes’s invention was more of an idea than a reality. Still, bound by the scientific method, Gibbons wanted to try every possible direction and exhaust every option. So, for years, while Holmes put her fund-raising talents to use—hiring hundreds of marketers, salespeople, communications specialists, and even the Oscar-winning filmmaker Errol Morris, who was commissioned to make short industrial documentaries—Gibbons would wake early, walk his dogs along a trail near his home, and then set off for the office before seven A.M. In his downtime, he would read I, Claudius, a novel about a man who plays dumb to unwittingly become the most powerful person on earth.

While Gibbons grew ever more desperate to come up with a solution to the inaccuracies of the blood-testing technology, Holmes presented her company to more investors, and even potential partners, as if it had a working, fully realized product. Holmes adorned her headquarters and Web site with slogans claiming, “One tiny drop changes everything,” and “All the same tests. One tiny sample,” and went into media overdrive. She also proved an effective crisis manager. In 2012, for instance, Holmes began talking to the Department of Defense about using Theranos’s technology on the battlefield in Afghanistan. But specialists at the D.O.D. soon uncovered that the technology wasn’t entirely accurate, and that it had not been vetted by the Food and Drug Administration. When the department notified the F.D.A. that something was amiss, according to The Washington Post, Holmes contacted Marine general James Mattis, who had initiated the pilot program. He immediately e-mailed his colleagues about moving the project forward. Mattis was later added to the company board when he retired from the service. (Mattis says he never tried to interfere with the F.D.A. but rather was “interested in rapidly having the company’s technologies tested legally and ethically.”)

At around the same time, Theranos also decided to sue Richard Fuisz, an old friend and neighbor of Holmes’s family, alleging that he had stolen secrets that belonged to Theranos. As the suit progressed—it was eventually settled—Fuisz’s lawyers issued subpoenas to Theranos executives involved with the “proprietary” aspects of the technology. This included Ian Gibbons. But Gibbons didn’t want to testify. If he told the court that the technology did not work, he would harm the people he worked with; if he wasn’t honest about the technology’s problems, however, consumers could potentially harm their health, maybe even fatally.

The late scientist Ian Gibbons.

Holmes, meanwhile, did not seem willing to tolerate his resistance, according to his wife, Rochelle Gibbons. Even though Gibbons had warned that the technology wasn’t ready for the public, Holmes was preparing to open “Theranos Wellness Centers” in dozens of Walgreens across Arizona. “Ian felt like he would lose his job if he told the truth,” Rochelle told me as she wept one summer morning in Palo Alto. “Ian was a real obstacle for Elizabeth. He started to be very vocal. They kept him around to keep him quiet.” Channing Robertson, who had brought Gibbons to Theranos, recalls a different conversation, noting, “He suggested to me on numerous occasions that what we had accomplished at that time was sufficient to commercialize.”

A few months later, on May 16, 2013, Gibbons was sitting in the family room with Rochelle, the afternoon light draping the couple, when the telephone rang. He answered. It was one of Holmes’s assistants. When Gibbons hung up, he was beside himself. “Elizabeth wants to meet with me tomorrow in her office,” he told his wife in a quivering voice. “Do you think she’s going to fire me?” Rochelle Gibbons, who had spent a lot of time with Holmes, knew that she wanted control. “Yes,” she said to her husband, reluctantly. She told him she thought he was going to be fired. Later that evening, gripped and overwhelmed with worry, Ian Gibbons tried to commit suicide. He was rushed to the hospital. A week later, with his wife by his side, Ian Gibbons died.

When Rochelle called Holmes’s office to explain what had happened, the secretary was devastated and offered her sincere condolences. She told Rochelle Gibbons that she would let Holmes know immediately. But a few hours later, rather than a condolence message from Holmes, Rochelle instead received a phone call from someone at Theranos demanding that she immediately return any and all confidential Theranos property.

The Enforcer

In hundreds of interviews with the media and on panels, Holmes honed her story to near perfection. She talked about how she didn’t play with Barbies as a child, and how her father, Christian Holmes IV, who worked in environmental technology for Enron before going on to work in a number of senior government jobs in Washington, was one of her idols. But her reverence for Steve Jobs was perhaps most glaring. Besides the turtlenecks, Holmes’s proprietary blood-analysis device, which she named “Edison” after Thomas Edison, resembled Jobs’s NeXT computer. She designed her Theranos office with Le Corbusier black leather chairs, a Jobs favorite. She also adhered to a strange diet of only green juices (cucumber, parsley, kale, spinach, romaine lettuce, and celery), to be drunk only at specific times of the day. Like Jobs, too, her company was her life. She rarely ever left the office, only going home to sleep. To celebrate her birthday, Holmes held a party at Theranos headquarters with her employees. (Her brother, Christian, also works at Theranos.)But the most staggering characteristic that she borrowed from the late C.E.O. was his obsession with secrecy. And while Jobs had a fearsome security force who ensured that confidential information rarely, if ever, left Apple’s headquarters, Holmes had a single enforcer: Sunny Balwani, the company’s president and chief operating officer, until he stepped down in May. Balwani, who had previously worked at Lotus and Microsoft, had no experience in medicine. He was hired in 2009 to focus on e-commerce. Nevertheless, he was soon put in charge of the company’s most secret medical technology.According to a number of people with knowledge of the situation, the two had met years before he began at the company, when Holmes took a trip to China after she graduated from high school. The two eventually started dating, numerous people told me, and remained very loyal even after their relationship ended. Among Holmes’s security detail, Balwani was known as “Eagle 2.”

When employees questioned the accuracy of the company’s blood-testing technology, it was Balwani who would chastise them in e-mails (or in person), sternly telling staffers, “This must stop,” as The Wall Street Journal reported. He ensured that scientists and engineers at Theranos did not talk to one another about their work. Applicants who came for job interviews were told that they wouldn’t know what the actual job was unless they were hired. Employees who spoke publicly about the company were met with legal threats. On LinkedIn, one former employee noted next to his job description, “I worked here, but every time I say what I did I get a letter from a lawyer. I probably will get a letter from a lawyer for writing this.” If people visited any of Theranos’s offices and refused to sign the company’s lengthy non-disclosure agreement, they were not allowed inside.

Balwani’s lack of medical experience might have seemed unusual at such a company. But few at Theranos were in a position to point fingers. As Holmes started to assemble her board of directors, she chose a dozen older white men, almost none of whom had a background in anything related to health care. This included former secretary of state Henry Kissinger, former secretary of state George Shultz, former Georgia senator and chairman of the Armed Services Committee Sam Nunn, and William J. Perry, the former defense secretary. (Bill Frist, the former Senate majority leader, and former cardiovascular doctor, was an exception.) “This was a board that was better suited to decide if America should invade Iraq than vet a blood-testing company,” one person said to me. Gibbons told his wife that Holmes commanded their attention masterfully.

Theranos’s board may not have been equipped to ask what exactly the company was building, or how, but others were. While Holmes was bounding around the world on a private plane, speaking on panels with Bill Clinton, and giving passionate TED talks, two government organizations started quietly inspecting the company. On August 25, 2015, months before the Journal story broke, three investigators from the F.D.A. arrived, unannounced, at Theranos’s headquarters, on Page Mill Road, with two more investigators sent to the company’s blood-testing lab in Newark, California, demanding to inspect the facilities.According to someone close to the company, Holmes was sent into a panic, calling advisers to try to resolve the issue. At around the same time, regulators from the Centers for Medicare and Medicaid Services, which regulates laboratories, visited the labs and found major inaccuracies in the testing being done on patients. (The Newark lab was run by an employee who was criticized for insufficient laboratory experience.) C.M.S. also soon discovered that some of the tests Theranos was performing were so inaccurate that they could leave patients at risk of internal bleeding, or of stroke among those prone to blood clots. The agency found that Theranos appeared to ignore erratic results from its own quality-control checks during a six-month period last year and supplied 81 patients with questionable test results.While the government was scouring through Theranos’s inaccurate files and data, Carreyrou was approaching the story not as a fawning tech blogger, but rather as a diligent investigative reporter. Carreyrou, who had worked at the Journal since 1999, had covered topics ranging from terrorism to European politics and financial misdeeds before returning to the New York newsroom and taking over the health-and-sciences bureau. As a reporter of obscure and often faceless subjects, he was not enticed by access, nor was he afraid of lawyers. In fact, he had won two Pulitzer Prizes for taking on nemeses as significant as Vivendi and the U.S. government. After a team of seasoned lawyers arrived at the Journal newsroom, Carreyrou was simply emboldened. “It’s O.K. if you’ve got a smartphone app or a social network, and you go live with it before it’s ready; people aren’t going to die,” he told me. “But with medicine, it’s different.”

Meanwhile, Theranos had its lawyers send a letter to Rochelle Gibbons’s attorney, threatening legal action for talking to a reporter. “It has been the Company’s desire not to pursue legal action against Mrs. Gibbons,” a lawyer for Boies, Schiller & Flexner wrote. “Unless she immediately ceases these actions, she will leave the Company no other option but to pursue litigation to definitively put an end [to] these actions once and for all.” Others who spoke to the Journal were met with similar threats.

By Carlos Chavarría/The New York Times/Redux.

The End

Back in March 2009, Holmes returned to the Stanford campus, where her story had begun, to talk to a group of students at the Stanford Technology Ventures Program. Her hair wasn’t yet bleached blond, but she had started to wear her uniform of a black turtleneck, and she was just beginning to morph into the idol she would soon become in Silicon Valley. For 57 minutes, Holmes paced in front of a chalkboard and answered questions about her vision. “It became clear to me,” she said with conviction, “that if I needed to, I’d re-start this company as much as possible to make this thing happen.”This is exactly what Holmes seems to be doing now. Executives from Theranos, including Holmes and Balwani, declined to sit for interviews. But on a recent July afternoon, I traveled to the company’s headquarters anyway. From the outside, Theranos seems to be in a sad state. The parking lot was devoid of cars, with more than half the spaces empty (or half full, depending on your outlook). The giant American flag that hangs in front of the building was flaccid at half-staff. On the edge of the parking lot, a couple of employees were smoking cigarettes as a single security guard stood nearby, taking a selfie.On the Friday morning that they gathered in the war room, Holmes and her team of advisers had believed that there would be one negative story from the Journal, and that Holmes would be able to squash the controversy. Then it would be back to business as usual, telling her flawlessly curated story to investors, to the media, and now to patients who used her technology.

Holmes and her advisers couldn’t have been more wrong. Carreyrou subsequently wrote more than two dozen articles about the problems at Theranos. Walgreens severed its relationship with Holmes, shuttering all of its Wellness Centers. The F.D.A. banned the company from using its Edison device. In July, the Centers for Medicare and Medicaid Services banned Holmes from owning or running a medical laboratory for two years. (This decision is currently under appeal.) Then came the civil and criminal investigations by the U.S. Securities and Exchange Commission and the U.S. Attorney’s Office for the Northern District of California and two class-action fraud lawsuits. Theranos’s board has subsequently been cleaved in two, with Kissinger, Shultz, and Frist now merely “Counselors.” Holmes, meanwhile, isn’t going anywhere. As the C.E.O. and chairwoman of Theranos, only she can elect to replace herself.

Forbes, clearly embarrassed by its cover story, removed Holmes from its list of “America’s Richest Self-Made Women.” A year earlier, it had estimated her wealth at $4.5 billion. “Today, Forbes is lowering our estimate of her net worth to nothing,” the editors wrote. Fortune had its mea culpa, with the author stating boldly that “Theranos misled me.” Director Adam McKay, fresh off his Oscar for The Big Short, has even signed on to make a movie based on Holmes, tentatively titled Bad Blood. (On the bright side for Holmes, Jennifer Lawrence is attached as the lead.)

Silicon Valley, once so taken by Holmes, has turned its back, too. Countless investors have been quick to point out that they did not invest in the company—that much of its money came from the relatively somnolent worlds of mutual funds, which often accrue the savings of pensioners and retirees; private equity; and smaller venture-capital operations on the East Coast. In the end, one of the only Valley V.C. shops that actually invested in Theranos was Draper Fisher Jurvetson. Many may have liked what Holmes represented about their industry, but they didn’t seem to trust her with their money.

Meanwhile, Holmes has somehow compartmentalized it all. In August, she flew to Philadelphia to speak at the American Association for Clinical Chemistry’s annual conference. Before she stepped out onstage, the conference organizers played the song “Sympathy for the Devil” for the ballroom, packed with more than 2,500 doctors and scientists. Holmes was wearing a blue button-up shirt and black blazer (she has recently abandoned the black turtleneck), and she spoke for an hour while rapidly flicking through her presentation. The audience was hoping that Holmes would answer questions about her Edison technology and explain whether or not she knew it was a sham. But instead Holmes showed off a new blood-testing technology that a lot of people in the room insisted was not new or groundbreaking. Later that day she was featured on Sanjay Gupta’s CNN show and a few weeks later appeared in San Francisco at a splashy dinner celebrating women in technology. “Elizabeth Holmes won’t stop,” Phyllis Gardner, the Stanford professor, told me. “She’s holding on to her story like a barnacle on the side of a ship.”

Holmes may not be prepared to compartmentalize what comes next. When I arrived in Palo Alto in July, I wasn’t the only person setting out to interview anyone associated with Theranos and Holmes. The Federal Bureau of Investigation was, too. When I knocked on a door, I was only a day or two behind F.B.I. agents who were trying to put together a time line of what Holmes knew and when she knew it—adding the most unpredictable twist to a story she could no longer control.

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