If Evil Be Said of Thee

Three encounters with Elizabeth Holmes as Theranos imploded

I knew her by her voice.

That morning in 2018, I had driven down to Silicon Valley to pitch the venture capitalist Tim Draper. My biotech startup Nivien Therapeutics was developing an experimental medicine for pancreatic cancer and it was time to raise our next round of funding.

A big part of the reason I’d leapt into biotech in the first place — majoring in molecular biology, leaving Harvard to launch a startup — was the inspiration of the brilliant dropout founder Elizabeth Holmes.

Draper had been the first VC to back her. He was eccentric: his building was part incubator, part man-child playground. Life-size superhero decals flanked the path to his glass-walled mezzanine conference room. He wore a Bitcoin pin on his lapel. Five minutes into my pitch, he interrupted to share the text-to-speech app one of his startups had prototyped, which he was piloting by transcribing our meeting. It didn’t look good for Nivien’s funding prospects.

On my way out, I started to text my co-founder to tell her that the pitch hadn’t gone well. Then I heard a voice behind me greet Draper in the faux-baritone that would soon become notorious. I spun around.

“You’re Elizabeth Holmes!” I exclaimed.

Her stare lived up to the hype. She was preternaturally wide-eyed, as if gazing into the future (or acting astonished by an accusation). She wore her trademark black turtleneck, black slacks and black shoes, like she’d just stepped off the cover of Forbes.

“Yes I am,” she intoned.

Two weeks earlier, the SEC had charged Holmes with “massive fraud” as CEO of Theranos, her blood testing company. With a looming debt obligation to the investment firm Fortress, which was threatening to seize her IP as collateral, Holmes was tapping her early, loyal investors to stave off bankruptcy — investors like Draper, whom she’d made extremely rich (on paper).

“Nathaniel was just telling me about his biotech startup,” Draper remarked, “You should hear it!”

Before either of us could object, Draper swept us back into the conference room and I pitched again. Holmes leapt in with incisive questions. Afterwards, she handed me her card and offered to share advice. After all, she quipped, she’d become “a walking book of what not to do.”

I spent the following week agonizing at the intersection of caution and curiosity.

Holmes had once been an inspiration to me, as she had been for an entire generation of healthcare entrepreneurs. She was the inventor of what had appeared to be a life-saving technology to catch diseases early enough to help. Unlike my other early inspirations — the physician-scientist Siddhartha Mukherjee, the CRISPR pioneer Jennifer Doudna, the Vertex founder Joshua Boger — Holmes was a young entrepreneur who broke into an industry no one our age had broken into before. She had given us hope that with the right idea, hard work, and a little luck, maybe we could do the same. I’d followed her story since middle school. By the time it became clear she was a fraud, I was 21 and the youngest founder-CEO of a VC-backed therapeutics company, learning on the job the many reasons why the median biotech CEO is in their 50s.

I decided I had to learn more about one of the people who had guided me here. I called her.

We had a wide-ranging conversation. She advised me how to refine my pitch and maximize my odds with Draper. We spent a long time on the phone, until I had to go to my next meeting. I realized that she wasn’t ready to hang up: that in the sudden isolation of her downfall, she had time on her hands, perhaps for the first time since dropping out of Stanford fifteen years earlier. Her advice seemed valuable and I was intrigued. We planned to talk over coffee a few weeks later.

By the time we met again, the WSJ reporter John Carreyrou had published Bad Blood, his masterful takedown of the Theranos scam.

I met Holmes at the San Francisco café Wrecking Ball. She arrived on foot, without her fabled security detail or black Suburban. The turtleneck was gone as well: she was disguised in jeans and a light blazer. When I ordered my coffee, she flashed her card to the cashier. I said I’d pay — the words “blood money” flashing through my mind — but she looked me in the eyes and said she’d get it. I felt she knew exactly what I was thinking.

We walked down to the bay, talking about biotech, entrepreneurship and VC. She was self-deprecating and admitted mistakes, but also rejected the charges that she’d perpetrated fraud or risked people’s health. We sat on the edge of the harbor looking out at the bridge with our legs dangling over the water.

Eventually, I admitted that I’d just read Bad Blood.

“How was it?” she inquired, claiming: “I haven’t read it.”

“It’s pretty damning,” I replied.

I didn’t believe she hadn’t read it. She asked about its depiction of her, and remarked she’d never met Carreyrou. This struck me as unlikely as well. Then again, the investigative reporter Bob Woodward never met Richard Nixon.

We spoke about the people who stood by her, like Draper. She boasted that remarkably few from her inner circle jumped ship — and that she was happy to be rid of the ones who had. Then she recommended the Discourses by the stoic philosopher Epictetus.

I asked her about the future of Theranos, which still had substantial resources, despite its ruined reputation, discredited technology and imperiled assets. She said she planned to rehabilitate the company; its reputation, and hers. Shockingly, she claimed she wouldn’t rebrand.

“Theranos has extraordinary name recognition,” she said. “Name recognition is everything.”

This sounded absurd — but at the time Trump was President. On our walk back up Fillmore Street, as if the universe sought to prove her point, a woman recognized Holmes and stopped us in the crosswalk. I thought for a moment the woman might spit at her. Instead, she proudly stated that she’d written in Holmes’ name on a recent electoral ballot, “because we need people like you who will change the system.” Holmes thanked her and we parted where we’d begun outside Wrecking Ball.

Today, as Elizabeth Holmes stands trial, prosecutors must get inside her head to prove that she not only lied, but intended fraud. Many observers ask: was Holmes malevolent, or merely delusional? I believe a third phenomenon. She was a liar, certainly — but also a prodigy, at least in some ways. A would-be visionary who leapt into the stratosphere with materials to build a rocketship, but couldn’t do it fast enough. So she lied to fill the gap, trying not to crash back down to earth. I believe those lies were calculated and that she is guilty.

The week after we had met for coffee, there was a volley of new indictments against Holmes. She resigned as CEO of Theranos. If there were going to be any reputational rehabilitation, she wasn’t going to be part of it.

Having just finished reading the Discourses she had recommended, I texted her what felt like a timely quote by Epictetus.

She did not reply. We never spoke again.

—NBH

Principal at RA Capital, on the boards of 7 biotech companies. Founder/CEO of Nivien Therapeutics. Australian-American. 50 countries and counting.