A Condition That Was Caught in Time

Pulmonary embolism (Cavallini/Science Source/WSJ)

I had been feeling pretty chipper until the beginning of September. As the month proceeded, my asthma got worse, and I could no longer take 30-45 minute walks in the morning. Last Monday I showed for a scheduled doctor's appointment; the nurse took my vitals and immediately called for oxygen.

The doctor strongly suggested that an ambulance transport me to emergency. Of course, my wife could have driven, but the ambulance had the necessary equipment and personnel if the situation worsened.

Over the next two days I was poked and prodded at Stanford General. There were ultrasounds, chest X-rays, CT scans, echocardiograms, and dozens of blood draws. The good news was that most of the tests were negative. I was short of breath because the asthma had been exacerbated by a blood clot that had formed in the right lung. I will have to take the blood thinner Eliquis indefinitely. I was discharged Wednesday, and my condition wasn't serious enough to warrant being on oxygen at home.

Considering the possible outcomes, I was pretty lucky:

About 900,000 people are diagnosed with blood clots—deep vein thrombosis or pulmonary embolism—in the U.S. each year, according to the American Lung Association. For many, the first symptom is sudden death.

“I call it the people’s disease. It doesn’t spare anyone—rich, poor, male, female,” says Dr. Parth Rali, director of the pulmonary embolism response team at Temple University Health System in Philadelphia... “You could be the healthiest person in the world and unfortunately it can still happen to you.”

Some lifestyle factors increase your risk of blood clots, such as obesity and smoking....Dehydration can thicken the blood. And taking hormonal contraceptives... also raises the risk.

Then there’s movement, or lack thereof. When your legs stay still for too long, the blood may begin to form clots, which can then travel through the heart and into the lungs.

Yes, more things to worry about, but better than the alternative.

Gout's Silver Lining

Probenecid has an unexpected benefit

The first and only gout attack occurred in my 40's when I began drinking a glass of red wine every day for health reasons. After a month of this regimen my left foot hurt so much I couldn't walk. The diagnosis was gout, which my father and brothers all suffer from. I thought I had avoided gout, but alas, I had the gene after all.

Gout is caused by high concentrations of uric acid that crystallize in joints, resulting in painful inflammation. Known triggers include organ meats, shellfish, and alcohol. Drinking plenty of water to dilute and flush the uric acid out of one's system is the way to avoid gout, and probenecid is often prescribed to aid in uric-acid reduction. Your humble blogger has been on probenecid for over 20 years.

Researchers have discovered that probenecid may be an effective treatment for COVID-19:

[Georgia professor of infectious diseases Ralph] Tripp found probenecid blocks the virus from replicating and infecting individual cells, a major discovery.

“Because it works on the whole cell, not the virus, you can’t get resistance to the drug,” Tripp said.

Tested on ten individuals in Florida with COVID-19, researchers found after the individuals were given probenecid symptoms eased in three days instead of weeks.

Funding for large clinical trials must follow, but the outlook is that a drug that has helped with gout for four decades may be what’s needed to stop the suffering from COVID-19.

I've been upping a daily supplement of Vitamin D to help ward off the coronavirus, and now it just may be that I have been regularly taking a drug that affords additional protection. Maybe I did luck out genetically with gout, just not in the way that I thought.

Another silver lining: High uric-acid levels of gout sufferers may afford protection against Alzheimer's disease.

In Giving We Shall Receive

People with blood type O have reduced risk of contracting the coronavirus. Even if they do get infected, the symptoms are less severe: [bold added]

O-positive: the largest plurality

23andMe on Monday published a potentially significant finding that people with the blood type O were on average 14% less likely than other blood types (A, B, AB) to get Covid and 19% less likely to be hospitalized after accounting for age, sex, comorbidities, ethnicity and body mass.

Among exposed individuals, O blood types were 19% less likely to test positive. There appeared to be little difference in susceptibility among other blood types.

Your humble blogger is O+, which means that he can donate to all positive blood types, i.e., over 90% of the population. (O- is the true universal donor.) However, "O's" can only receive blood from other "O's".

In return for this giving-receiving asymmetry, nature has granted "O's" greater resistance to COVID-19. Life does not come with guarantees, but it doesn't hurt to have statistics--and luck--on your side.

Not Super Feats, Just Feet of Clay

We were excited by Theranos' revolutionary blood-analyzing technology in 2013, though we did say at the time "it does seem too good to be true."

In 2015 the Wall Street Journal exposed the technology as fake, and in early 2018 the SEC imposed a $500,000 fine and other sanctions on Theranos' founder, Elizabeth Holmes. On Thursday it got worse for Ms. Holmes when Federal prosecutors filed criminal charges:

Ms. Holmes, 34 years old, and Mr. Balwani, 53, were each charged with two counts of conspiracy to commit wire fraud and nine counts of wire fraud in an indictment handed up Thursday and unsealed Friday. If convicted, they each face a maximum sentence of 20 years in prison and a fine of $250,000, plus restitution to those found to have been defrauded, on each count.

“This indictment alleges a corporate conspiracy to defraud financial investors,” said John F. Bennett, special agent in charge of the Federal Bureau of Investigation in San Francisco. “More egregiously, this conspiracy misled doctors and patients about the reliability of medical tests that endangered health and lives.”

Justice will be meted out to Ms. Holmes, but one huge aspect of the story is the eagerness of people to believe in a young, self-made female entrepreneur who disrupts an industry and even wears black turtlenecks like Steve Jobs.

No, there are no tech superheroes, and our anointing them as such has been bad for their companies and investors alike.

Elon Musk, Tesla; Elizabeth Holmes, Theranos; Travis Kalanick, ex-CEO, Uber (WSJ graphic)

The Final Act Begins

Elizabeth Holmes (Fortune image)

Like many followers of Bay Area tech, we were guardedly excited when we first heard about Elizabeth Holmes and Theranos in 2013:

By extracting a few drops, not vials, of blood, instantly analyzing them, and charging much less for its service than a standard lab, Ms. Holmes' company threatens a vast industry that performs "6.8 billion lab tests annually in the U.S."

1) It does seem too good to be true.

2) Nevertheless, I wish Theranos were a public company; it would be perfect for the small speculative portion of my investment portfolio.

In 2015 the Wall Street Journal ran an exposé on Theranos' blood-testing technology:

the Journal’s article argued that [Theranos'] tests are not reliable, and revealed that it does only a few tests with its own devices, using other firms’ technology for most of them.

In 2016 it became clear that the technology was a will-o'-the-wisp, and Theranos' estimated value (it had not gone public) plunged to zero.

In 2018 began the final act ("the Reckoning"):

It now turns out that Ms Holmes’s claims were deceptive, according to the SEC. She allegedly exaggerated her startup’s capabilities. Theranos only reliably performed a dozen of the 200 tests it offered with its own technology. It also lied about its portfolio of clients. For example, investors were told that its technology had been used by the American military on the battlefield, when it had only been used in studies; and that it was poised to be rolled out by a grocery chain even when the deal had collapsed. The financial figures were apparently concocted, too. Ms Holmes told one investor that Theranos had $108m in revenue in 2014; the real figure was $100,000.

Elizabeth Holmes has been fined $500,000 by the SEC and prohibited from being an officer of any public company for ten years. The story--a self-made female entrepreneur disrupts an industry and becomes a billionaire, she was a college dropout like Steve Jobs and even wore black turtle necks like Steve Jobs---didn't play out as expected. Alas, we were the victims of our own desire.

Unable to Stop the Bleeding

The Wall Street Journal pricked the bubble of Theranos' blood-testing technology last September, and founder Elizabeth Holmes has been unable to stop the bleeding for her company or her own net worth. Now the comeuppance is complete.

We've all had bad investment years, but to go from $4.5 billion to zero? That's one of the biggest fortune wipeouts in history.

Forbes Slashes Theranos Founder Elizabeth Holmes' Net Worth From $4.5 Billion To Zero https://t.co/vBvmI6s0ee

— zerohedge (@zerohedge) June 1, 2016

Timetable Delayed

Two years ago we first heard about Palo Alto-based Theranos and its revolutionary blood testing technology. With only a few drops of blood Theranos claimed that its machines could run hundreds of blood tests.

Theranos tests at Walgreens: a fraction of competitors' prices.

Theranos's processes are faster, cheaper and more accurate than the conventional methods and require only microscopic blood volumes, not vial after vial of the stuff.

At the time we said that "It does seem too good to be true", yet why not? Multi-billion dollar businesses that didn't exist 15 years ago have arisen seemingly from nowhere, disrupting entire industries.

In October serious questioning of Theranos' technology began [bold added].

the Wall Street Journal ran a report that Theranos has overstated its technology’s reach and reliability. Theranos has attracted great acclaim because it claims to be able to perform a wide variety of tests by drawing a few drops of blood instead of using a full-sized needle to take larger samples; and because of its promises to make it cheaper and easier for consumers to get blood tests without having to go through a doctor. However, the Journal’s article argued that its tests are not reliable, and revealed that it does only a few tests with its own devices, using other firms’ technology for most of them.

In response to the WSJ article and questions from scientists and regulators founder and CEO Elizabeth Holmes says

she would release data proving their machines work—the data academics, clinicians, and doctors have been asking to see for over a year, comparing Theranos’ tests to industry standards.

Your humble observer knows nothing about the science of blood analysis or microfluidics. As a student of human behavior, however, let me make a couple of obvious points about why we latched on to this story so willingly:

(SF Business Times photo)

1) 31-year-old Elizabeth Holmes came along at just the right time to be declared the next Steve Jobs. Her oft-worn black turtleneck cinches the comparison, and the dearth of young, female self-made billionaires made her a rockstar.

2) No patient enjoys the inconvenience and discomfort of drawing blood and the days waiting for results. When Theranos promised to be faster, cheaper, and better, everyone (except competitors) wanted it to be true.

We'll defer judgment until after Elizabeth Holmes releases the information and it has been reviewed by experts. One result is certain: unless she has complete vindication the timetable for the IPO will be delayed.

LabCorp: Investor Beware

We've been customers of Laboratory Corporation of America (LabCorp, ticker: LH) for nearly 20 years, ever since LabCorp began offering

hundreds of tests on blood, tissue, urine, and worse [blogger's note: the Barron's columnist's diffidence is charming], generally providing results within 24 hours, using 39 primary labs across the country and 1,750 patient-service centers.

LabCorp's rates are a fraction of those charged by hospital labs. It has been a preferred provider in every medical insurance plan we've participated.

Barron's likes LabCorp's positive fundamentals: increased demand for services, Medicare's greater scrutiny that favors low-cost providers, synergies from a recent merger, and overhead cost-cutting. And LabCorp has a history of outperforming the stock market (chart below).

LH's appreciation is double that of the S&P 500 over the past 10 years.

LabCorp has a great story, but I'm not planning to invest. Technological disruption is looming.

Item: A cheap new test can reveal every virus that invaded you—and help stop infections. The cost is $25.

Item: Palo Alto-based Theranos can run hundreds of tests quickly using only a few drops of blood. Theranos testing is already available at Walgreen's.

LabCorp's business model is vulnerable. Investor, beware.

Not Going With the Flow

The technician tapped my left arm, searching for a vein. She inserted the needle. It was a dry hole. Her second attempt on the right wrist was successful, and the sample vials were filled in short order. The visit was more pleasant than average, however, with three or four tries being the norm.

Lab technicians have explained the multiple pricks and prods (and bandages) as being due to my veins being narrow and difficult to locate. I'm a wuss for admitting it, but the unpleasantness of the experience has caused me recently to forego donating blood (5-10 years ago the technicians seemed more skilled).

It's unfortunate that the blood banks aren't integrated with the labs, because I'd be perfectly willing to donate a pint once they take the relatively small amount needed for testing. After I've made the trip to the laboratory, filled out the paperwork, and incurred the discomfort of getting the flow going, the marginal cost of extracting a pint is minimal. There's probably a bureaucratic reason why blood donation and testing can't be done at the same time, but it escapes me.