In the biotech world, you can’t see everything

Earlier this week, I attended a screening of You Can See Everything, the buzzy new documentary about the disgraced former biotech CEO Elizabeth Holmes.

I went in not really knowing what to expect. I’d avoided spoilers (and won’t be giving anything away here, either!). I was wondering what new information this film could reveal, given how familiar many of us are with the Theranos story thanks to years of media coverage, the best-selling book Bad Blood, and the Hulu series The Dropout, starring Amanda Seyfried.

Like many others who have seen the film, I came away feeling unsettled. But not just about Holmes’s fraud and the somewhat disturbing interactions between the subjects. The film reignited a concern I’ve had about covering science for most of my career: Despite our best efforts, we never can actually see everything.

In case you’re rusty on the details, Elizabeth Holmes dropped out of Stanford University in 2003 to run Theranos, a diagnostics company she founded, when she was just 19. She went on to claim that her company had invented a way to run over 100 diagnostic tests on just a few drops of blood.

Holmes raised hundreds of millions of dollars for Theranos, which was valued at $9 billion in 2014. Forbes named her the youngest self-made female billionaire—she was worth $4.5 billion when she was just 30 years old.

Things started to unravel in 2015, when an investigation by the Wall Street Journal raised concerns by former Theranos employees that the tests didn’t work. Some also said that the company’s device had not been tested properly, and that blood samples had been analyzed on machines from other companies instead. MIT Technology Review named it one of the biggest technology failures of 2015.

Forbes had revised Holmes’s worth to $0 by 2016. That year, a damning government report said that the company’s lab was struggling with basic procedures and gave patients results even when they knew they could be wrong.

In 2018, Theranos, Holmes, and former company president Ramesh Balwani were charged with “massive fraud.” In 2022, she was sentenced to a little over 11 years in prison for defrauding investors. She began serving her sentence in May 2023.

It was around a month before this that filmmakers Nathan Fielder, Lance Oppenheim, and their colleagues began documenting Holmes and her partner, Billy Evans, at home with their two young children. I’m not giving anything away when I say it’s an extremely intimate portrayal—at least of how the two adults interact with Fielder, who is also a central character in the film.

As you might know if you’ve seen the trailer, there are plenty of super close-ups. I felt as if I spent most of the film staring straight into the faces of those people. And almost the whole way through, they all seemed to be trying to figure each other out. Holmes is known for her dishonesty, but she invited cameras into her home in an apparent bid to reframe the narrative and position herself as an honest person with an unusual mind. Will anyone believe her?

I couldn’t help feeling some empathy for Holmes, a mother we see preparing to leave her two kids for a lengthy prison sentence. And even though I have long known the facts, Holmes is clearly an effective manipulator. You can see her plant the seeds of doubt in Fielder’s mind. At times, I felt she was convincing me, sitting in my cinema seat. Maybe she really didn’t mean to lie?

But then I remembered how other journalists felt after being taken in by her claims. “I blew it,” Fortune’s Roger Parloff reflected in 2015, a year after profiling Holmes and her company. “I’m pretty sure she lied to me,” STAT’s Matthew Herper wrote recently, having interviewed Holmes in 2015. Even the former employee turned whistleblower Tyler Shultz, who knew the product didn’t work, said that he could “have a five-minute conversation with her and walk away feeling like my work was changing the world,” he said in 2022.

I didn’t cover Theranos in the 2010s. If I’d interviewed Holmes, would I have fallen for it all?

One of the early red flags in the Theranos case was the lack of published, peer-reviewed data. Much of the company’s work was classified as a “trade secret.” Scientists tend to publish their work in journals—a slow process that involves having the work evaluated by often anonymous experts in the field, who provide feedback, highlight questionable conclusions, and often ask for clarification. Peer review is meant to add rigor to the publication process. You should be able to trust published scientific papers.

Except that sometimes you can’t.

Scientists aren’t perfect. Some will exaggerate their results or inflate their importance. Some manipulate data to serve a hypothesis. Sometimes these infractions are caught during peer review, but not always. There are plenty of examples of scientific findings that could never be replicated by other labs and ended up collapsing under the weight of real evidence. Many papers ultimately end up with corrections. Some are withdrawn—10,000 research papers were retracted in 2023.

At any rate, there’s been a shift to sharing research in other ways. Today, many scientists opt to publish their work at preprint servers like arXiv, medRxiv, and bioRxiv before they submit them to established journals. Those outlets bypass peer review. So do company press releases, social media posts, and many conference presentations. And I get a lot of my stories from conversations and interviews.

I’ll admit I’ve looked at a scientific finding and thought: A scientist has just said they’ve done that. How can I be sure they really have?

I like to think that I hold myself to high journalistic standards here, as does everyone at MIT Technology Review. I would never publish a story about some new scientific development without doing my own form of peer review, and asking scientists—ideally people I know and trust—what they think of a new claim.

But the film is a stark reminder of how easy it can be to fall for an appealing narrative. While most scientists are, I hope, pretty honest, and Holmes is certainly an outlier, we should all continue to interrogate the claims being fed to us. If you’ve seen the film, let me know what you think!

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.