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Secrets and Lies in a Silicon Valley Startup

by John Carreyrou

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Book summary.

The full inside story of the breathtaking rise and shocking collapse of Theranos, the multibillion-dollar biotech startup, by the prize-winning journalist who first broke the story and pursued it to the end, despite pressure from its charismatic CEO and threats by her lawyers.

In 2014, Theranos founder and CEO Elizabeth Holmes was widely seen as the female Steve Jobs: a brilliant Stanford dropout whose startup "unicorn" promised to revolutionize the medical industry with a machine that would make blood testing significantly faster and easier. Backed by investors such as Larry Ellison and Tim Draper, Theranos sold shares in a fundraising round that valued the company at more than $9 billion, putting Holmes's worth at an estimated $4.7 billion. There was just one problem: The technology didn't work. A riveting story of the biggest corporate fraud since Enron, a tale of ambition and hubris set amid the bold promises of Silicon Valley.

November 17, 2006 Tim Kemp had good news for his team. The former IBM executive was in charge of bioinformatics at Theranos, a startup with a cutting-edge blood-testing system. The company had just completed its first big live demonstration for a pharmaceutical company. Elizabeth Holmes, Theranos’s twenty-two-year-old founder, had flown to Switzerland and shown off the system’s capabilities to executives at Novartis, the European drug giant. “Elizabeth called me this morning,” Kemp wrote in an email to his fifteen-person team. “She expressed her thanks and said that, ‘it was perfect!’ She specifically asked me to thank you and let you all know her appreciation. She additionally mentioned that Novartis was so impressed that they have asked for a proposal and have expressed interest in a financial arrangement for a project. We did what we came to do!” This was a pivotal moment for Theranos. The three-year-old startup had progressed ...

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Carreyrou's work has won many accolades; his Wall Street Journal articles on Theranos won the George Polk Award for Financial Reporting, and Bad Blood was awarded the Financial Times and McKinsey Business Book of the Year Award. It also appeared on many "best of" lists for 2018. My vote can be added; I certainly found it to be one of the finest non-fiction accounts I've read, and I highly recommend it to those interested in cautionary tales about the business world or great non-fiction reads in general... continued

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(Reviewed by Kim Kovacs ).

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Bad Blood, book review: The rise and fall of Theranos

Bad Blood: Secrets and Lies in a Silicon Valley Startup • By John Carreyrou • Picador • 339 pages • ISBN: 978-1509868063 • £20

First they think you're crazy, then they fight you...and then they prosecute you for fraud because you were lying when you said you could change the world.

To be young, gifted, and blonde rarely hurt anyone trying to make their way through the world, and Elizabeth Holmes was no exception. By now, the basics of her story are fairly well-known: she dropped out of Stanford at 19 with a plan to revolutionise medical blood testing. The idea behind Theranos was transformative. Instead of drawing blood from people's veins, develop methods for testing on the much smaller volume produced by a finger prick. Less fear, less pain, and less medical knowledge needed. People would be able to do their own blood tests in their homes and have the results uploaded to their doctor for interpretation.

The fatal flaw in this plan was that medical testing isn't like software, where it's routine to handwave over the bits that don't work yet -- and anyway you're not liable because, see, it's right there in the clickwrap licence that whatever happens it's not your fault. Instead, with people's lives at stake, you've got regulators and scientists, who are used to inspecting devices closely and expect peer review. These folks lack a sense of humour about fakery.

But young, gifted, and blonde makes an impression, and the collection of names that Holmes collected as investors and board members is astonishing, though weirdly eclectic. Her board included Henry Kissinger, former Secretary of State George Shultz, and a smattering of former senators and other political bigwigs. The leaders of both the drugstore chain Walgreen's, and Safeway saw in Theranos the opportunity to reinvent their businesses at a time when new directions were needed. Rupert Murdoch invested $125 million of his own money. The famed lawyer David Boies took payment in shares to represent the company in attacking critics. On YouTube you can see former president Bill Clinton's enchantment.

SEE: Launching and building a startup: A founder's guide (free PDF)

The collapse began in late 2015, when Wall Street Journal reporter John Carreyrou told the world that the devices did not work as advertised. Holmes, who had been giddily enjoying the awards and attention, began facing less friendly interviews. In these , she displayed all the evasiveness and aggressive refusal to answer questions of a recent Supreme Court nominee.

In Bad Blood: Secrets and Lies in a Silicon Valley Startup , Carreyrou tells the entire astounding story, based on the extensive research he did for the 30 articles his newspaper published, beginning with Holmes's personal background and ending with her settling fraud charges with the Securities and Exchange Commission. A two-time Pulitzer Prize winner working for the leading US financial newspaper carries weight that is not easily dismissed, and despite lawsuits, threats and terrified witnesses, Carreyrou has long since been proven right. Holmes has had to pay back millions for voided medical tests and lost investments, and watch her personal net worth crash from $4.5 billion to zero. Now, Holmes and her former COO, Sunny Balwani , are facing criminal indictments for fraud. They are pleading not guilty.

One interesting note on the dynamics of being a woman in business. Carreyrou unearthed a suggestion that Holmes's natural voice is much higher than the unusually deep one sported by her public persona. Some internet commenters appear to find this offensively fake. Yet a young woman with a high voice is genuinely disadvantaged in business, and if Holmes had succeeded we'd call her 'smart'. Margaret Thatcher, who famously took voice lessons to deepen her voice and give it that authoritative ability to cut through the braying House of Commons like a buzzsaw, certainly was.

The lesson here, such as it is, should not be "See? You can't trust women entrepreneurs". Instead, it should be: no matter how charismatic the leader of the business is, and no matter how good their story, you must get appropriate experts to check out their claims. Investors were dazzled by the names on Holmes's board. That was fine in the 1980s when nascent businesses were writing hobbyist software. But today software has real consequences for safety in the physical world, and Silicon Valley investors can't go on "asking forgiveness, not permission". Due diligence has to mean more than following the person-to-person chain of trust.

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Bad Blood Review: The Biggest Scam in Silicon Valley

By Kevin Nguyen

Titled after the eleventh best song on 1989 , John Carreyrou’s Bad Blood is a scrupulously reported book about Silicon Valley hubris. You might recall Carreyrou’s reporting last year in The Wall Street Journal , when he exposed the lie behind Theranos (rhymes with “Bailamos” ), the multi-billion-dollar-valued tech startup that sought to simplify blood testing. Theranos—not to be confused with Thanatos, the god of death, or Thanos, the purple Marvel villain—raised money on a too-good-to-be-true promise of a pitch deck: a revolutionary household box that could administer a number of medical tests—all with a single prick. Turns out Theranos would involve a lot more than one prick.

The company’s CEO, Elizabeth Holmes, was a classic narcissist—an intelligent and ambitious entrepreneur who surrounded herself with mediocre yes men. She pitted engineering teams against each other, assuming competition would foster better productivity over collaboration. She was also paranoid and secretive. Holmes’s assistants would Facebook-friend employees just to report on what they were posting. Her entire M.O. could be summed up by a motivational saying inscribed on a paperweight she kept on her desk: “What would you attempt to do if you knew you could not fail?”

The answer to that question: lie. Theranos created devices that simply did not work. So began a convoluted scheme of bait-and-switches (baits-and-switch?) with potential investors and clients to convince suckers that Theranos could deliver on the goods: broken machines and fake results. The technology might be new and shiny, but the scam was as old as time.

Bad Blood argues that Holmes was less an impressive con artist, and something more akin to a cult leader. People—employees and investors alike—were taken by Holmes’s “aura.” It’s no surprise that she deeply, deeply admired Steve Jobs. She dressed like him. Her Audi didn’t have a license plate, a nod to Jobs. After the Apple founder’s death, co-workers at Theranos noticed that Holmes was lifting management tactics from Walter Isaacson’s Jobs biography. (“They were all reading the book too and could pinpoint which chapter she was on based on which period of Jobs’s career she was impersonating.”) If she wasn’t being investigated for “massive fraud,” you’d imagine Holmes’s second startup would invent technology to let her wear Jobs’s skin.

Still, Holmes isn’t the only villain. Theranos's second-in-command was Sunny Balwani, her combative and self-aggrandizing boyfriend. In fact, Balwani’s behavior ranged from petty to straight-up vindictive, even more so than Holmes’s. He harangued people about the number of hours they worked, even summoning security footage to track employees’ comings and goings. At one point, after a flurry of resignations, he and Holmes called an all-hands meeting where Balwani said that “anyone not prepared to show complete devotion and unmitigated loyalty to the company should ‘get the fuck out.’ ” Then he distributed copies of noted trash book The Alchemist to everyone.

Throughout Bad Blood , a number of figures easily uncover pieces of Theranos’s sham. But in nearly every case, the skeptic is overruled by someone who is intoxicated by the company’s potential. That’s how Theranos raised $1.4 billion in capital. (High-profile suckers include: the Walmart heirs, Betsy DeVos, Rupert Murdoch.) They also scored lucrative deals with Safeway and Walgreens. “What if the Theranos technology did turn out to be game-changing?” Carreyrou writes, detailing investors’ approach to the company. “It might spend the next decade regretting passing up on it. The fear of missing out was a powerful deterrent.” That’s right, Theranos was buoyed not by common sense, but by corporate FOMO.

Carreyrou’s reporting in Bad Blood is exhaustive, including interviews with more than 150 people—more than 60 of those being ex-Theranos employees with enough tea to fill an Olympic pool. Still, the book stumbles a bit in its third act, when Carreyrou introduces himself and how he broke the story. Since we’ve spent the last 200 pages in the story, hearing him piece it together after the fact is a bit humdrum. (Carreyrou might have two Pulitzers, but this isn’t exactly Spotlight .)

Still, these are small issues in a book that speaks volumes to tech at large. In the past two years, we’ve watched public opinion flip on Uber and Facebook, and the nerdy opulence of startups has become a frequent punchline, be it through the lampoon of HBO’s Silicon Valley or memes of thicc Mark Zuckerberg . In the same vein, Bad Blood is a satisfying read for anyone who wants a book full of salacious startupenfreude. (Who doesn’t like reading about a good old-fashioned scam?) But more vitally, the resonant moments of the book make not just Theranos out to be a fraud, but the promise of the tech industry itself. Overpromising everything to dazzle investors, abusing employees as the norm for “startup culture,” skirting laws and morality in the name of innovation—these are all features of Silicon Valley, not a bug.

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By John Carreyrou, A thrilling and sensational story of ambition, corporate fraud and deceit

Bad Blood: Secrets and Lies in a Silicon Valley Startup by John Carreyrou tells the story of Theranos, a biotech startup that had a staggering rise to a close to $10 billion valuation and an even more dramatic fall.

The very short version of this review: I was really impressed by this book.

Being in the Bay Area, I’ve heard so much about this, but figured it was mostly hype. When it finally popped up on Bill Gates’s list of Best Books of 2018 a few days ago, I decided to take the plunge.

Theranos Website Screenshot

Book Summary

For the Detailed Chapter-By-Chapter Summary, click here or scroll all the way down .

Bad Blood covers the fall of Theranos, a startup that was founded by Stanford drop-out Elizabeth Holmes when she was nineteen. It claimed to offer faster, cheaper blood tests from just a pinprick of blood ( see their demonstration on YouTube ), as opposed to traditional methods which require needles, lab equipment and technicians.

Over the course of a decade, it ballooned to a valuation of almost $10 billion, but within a few short years was defunct once it became clear their technology was not what they claimed. It’s a saga that ensnared a range of tech, legal, political and other industry leaders such as Henry Kissinger, Rupert Murdoch, and our current Secretary of Defense John Mattis.

While a number of articles have profiled the big issues — they were lying, duh — Bad Blood does a deep dive into the company’s culture and the thousand small decisions that preceded Theranos’ downfall. In also covers the war Theranos waged as the walls slowly started closing in on their fraud. Both Elizabeth and the company’s COO are currently facing serious jail time for wire fraud.

The book’s author, John Carreyrou, is the Wall Street Journal journalist who first started reporting on possible malfeasance at Theranos. He first reported in October 2015 that Theranos was secretly using traditional blood testing machines to test blood instead of their own technology.

I think Bill Gates’s description (which sold me on this book) sums it up nicely: “The story is even crazier than I expected, and I found myself unable to put it down once I started. This book has everything: elaborate scams, corporate intrigue, magazine cover stories, ruined family relationships, and the demise of a company once valued at nearly $10 billion.”

Theranos Walgreens Launch Ad

Book Review

Bad Blood was one of the quickest reads I’ve had in a while. It’s so tantalizingly full of lies and terrible decisions and secrets that it hooks you in for the same reasons you can’t help slowing down just a little when driving past the scene of an accident.

The book paints a compelling image of a girl driven by stories of her family’s past greatness and current state of embarrassment, leveraging both powerful family and personal connections to support her grandiose vision.

Lies and secrecy are used to compensate for the unfulfilled promise of the technology itself. And in the company, those who raise concerns are fired while sycophants are promoted — all of which sets up Theranos for its eventual downfall.

Some of my interest was due having familiarity with many aspects of the book (I previously lived in the city the company was based in, visited the same hangouts, I’m all too familiar with startup pitfalls and founders who think they’re the next Steve Jobs, and I worked for the firm that served as their outside corporate counsel) as a Bay Area tech person. But, I’m pretty sure the drama seeping out from these pages is lurid enough to capture most people’s attention even without all that.

Carryrou has done a commendable job of making the book immensely accessible and readible, helped along by the subject matter itself. It’s a nutty story, even for Silicon Valley standards, mostly because of how out of control things got.

While erratic founders, lack of management skills and startups lying to investors and employees is not remotely notable, Theranos’s scale and subject matter — risking people’s ability to make smart health decisions — took things to another level. Any time you throw billion dollar valuations and cancer patients into the mix, it all gets worse.

And then, by the time the book reaches the point where Carreyrou’s begins his investigation, things have gone totally off the rails, with numerous people risking a lot to help expose the company, private investigators getting called in and armies of lawyers on the march as Theranos was clearly ready to fight to the death.

I was enthralled pretty much throughout the whole book, and I was really impressed by how Carreyrou really took the time to understand the technology, the tech industry, the legal issues and everything else related to the topic. The book wasn’t just interesting, it felt very credible. As someone who routinely whines about the quality of tech and legal reporting, I’m not an easy customer in this department.

Theranos Founder Elizabeth Holmes

Some Small Caveats

That all said, while I clearly enjoyed the book, a quick caveat about Bad Blood I’d point out is that the book is fairly limited in scope — this is one company’s dirty, dirty laundry being aired out. It’s a takedown of two awful people and their massive egos. The schadenfreude in this one runs deep .

I also think the book goes way too easy on the other enablers, decision-makers and people who are supposed to be leaders around them. Theranos attracted top talent (and therefore big dollars) partially due to the deep industry connections and people with deep experience that it was associated with, including a few industry luminaries. The idea that this girl and her boyfriend ran circles around all of these powerless lambs struck me as trying too hard to mold one specific narrative.

Carreyrou routinely dismisses bad behavior from others at Theranos as stemming from “pressure from Elizabeth” or plain ignorance. He also notes often the many, many times people “disapproved” of various unethical practices, but seems to give them a free pass. I get that they’re not really the subject of this book, but ultimately all these people were complicit. Disapproving internally but then doing nothing about it is not good enough.

A Minor Quibble for Music/Science Lovers

Finally, as a very, very minor quibble, it bothered me when he described her natural voice as being “several octaves” above her affected speaking voice (she thinks speaking with a low voice helps her to be taken seriously or something), and that this phrase has been echoed in articles all over because of it. An octave is not some vague indicator of some type of difference in pitch – it is a specific, measurable distance and frequency away from another note. (For you science nerds, the ratio of the frequency of two notes that are one octave apart is 2:1, with the higher note having the higher frequency.)

“Several octaves” is a lot, since most people’s entire vocal range (i.e. the highest and lowest note you can reach) probably spans around two octaves unless you’ve had vocal training — Beyonce likely has a 4-octave vocal range, for example (if judged by her music). Unless Holmes has the voice of a very small chipmunk, I doubt she speaks “several octaves” higher than her affected voice.

Read It or Skip It?

I was entranced by all the drama. Judge me all you want. It’s essentially a thrilling, sensational, schadenfreude-y tale that’s quite frankly fascinating to read. (My apologies to my dog who had to keep begging me to take her to the park instead of reading.)

From the difficulties of designing the blood tests, to the many legal issues involves in various aspects of the story, I was impressed by the level of detail and how accessible Carreyrou made all of that information. It’s excellent in-depth reporting by a highly capable writer. (Plus as a blogger, I loved that Carreyrou acknowledged he was tipped off on the story by a blogger who he’d spoken to in the past.)

It is, of course, drama of the business variety, so you’ll have to decide if that interests you.

Predictably, a movie based on Bad Blood is currently in development with Jennifer Lawrence slated to play the villianous, bleached-blond, steely-eyed disgraced founder.

Is Bad Blood something you think you’d read? Please share your thoughts below if you’ve read it! See Bad Blood on Amazon .

(P.S. I’ve started making notes in Goodreads when I post a review, so feel free to follow along!)

Detailed Book Summary (Spoilers)

1. a purposeful life (elizabeth’s background), 2. the gluebot (the inital prototypes), 3. apple envy (holmes's idolization of apple and jobs), 4. goodbye east paly (therano's move to central palo alto), 5. the childhood neighbor (fuisz's patent), 6. sunny (elizabeth's boyfriend), 7. dr. j (theranos's walgreens partnership), 8. the minilab (development of theranos's new device), 9. the wellness play (theranos's safeway partnership), 10. “who is ltc shoemaker” (theranos's military contract), 11. lighting a fuisz (the fuisz patent case begins), 12. ian gibbons (the fuisz patent case: a missing witness), 13. chiat\day (website and ad launch), 14. going live (walgreens launch lead-up), 15. unicorn (more funding), 16. the grandson (tyler schultz, whistleblower), 17. fame (media attention), 18. the hippocratic oath (theranos skeptics), 19. the tip (carreyrou's involvement), 20. the ambush (tyler vs. theranos's lawyers), 21. trade secrets (theranos on the attack), 22. la mattanza (waiting to publish), 23. damage control (publication and post-publication), 24. the empress has no clothes (theranos shut-down).

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Thoughts on the book “Bad Blood: Secrets and Lies in a Silicon Valley Startup”

I began to read more than usual because of social distancing, going through the list of books I had been planning to read for a while. One of the books that was recommended by a friend was “ Bad Blood – Secrets and Lies of a Silicon Valley Startup ” by John Carreyrou [1], based on the rise and fall of the blood-testing company, Theranos. I was especially interested in it given its relevance to the biotech industry and on recently finishing the book, I realized GSBS students might also find it interesting and thought of sharing a little bit about it. While there are plenty of resources out there that help you understand how to search for a job, determine if it is a good fit and notice red flags, this book paints a picture of life in the biotech industry, both as an entrepreneur and as an employee. I think students interested in careers in industry, entrepreneurship, venture capital, or science policy will gain some perspectives from reading this book. For instance, the book portrays the harsh reality of working in industry when a team of engineers were laid off because the research was headed in a new direction and they were not needed there anymore.

In January 2003, a 19-year-old Elizabeth Holmes founded Theranos with the vision of enabling multiple diagnostics tests to be run from a small volume of blood obtained from a finger-prick rather than the traditional venous blood draw, using the company’s small, portable, automated devices. In October 2015, a reporter from the Wall Street Journal, John Carreyrou, published an article [2] revealing that the company has been misleading investors and consumers, that the blood tests analyzed by Theranos devices were inaccurate and unreliable, and that a lot of the tests were actually performed by third-party commercial analyzers. Expanding the article into a book, Carreyrou walks us through how the company was formed, how it grew to become one worth over $9 billion, and finally, how it dissolved in September 2018 [1]. It is common knowledge that most, if not all, companies in Silicon Valley have skeletons in their closets that make headlines when they are revealed. However, fraud and irresponsibility by a health technology company like Theranos, and at such a massive scale at that, is even more dangerous considering the direct harm to patients’ lives. It is shocking that a company could get so far with technology that never performed as promised, and Carreyrou lays out the various scenarios and circumstances that contributed to it.

This book exemplifies the importance of validated and peer-reviewed data, the need for rigorous testing and quality-control checks, and the need for adhering to regulations – things we already know and are trained to practice. The book also highlights the need for communication within and between different departments in a company, so employees are aware of what stage of development the product is in, identify what exactly is holding up progress and work together to solve the problem. This lack of communication and the unusually high level of secrecy was frustrating to the employees at Theranos [1]. It is therefore important to find a balance between protecting proprietary information and facilitating communication to ensure highest productivity. Besides the need for effective communication between employees, the book also shows how there is a need for open, honest communication and understanding between the employees directly involved in developing the product and higher-level management. Without it, as a leader, you risk facing the dangers of being surrounded by yes-men – a false sense of security that you are doing things right, that the technology is working perfectly, experiments are returning expected and reliable results, and experiments that are not actually feasible can be done – hence wasting both time and money. You do not improve because you do not know where improvements are needed. However, at Theranos, the yes-men were not the only ones contributing to this culture. Holmes was not only a bad listener; she seemed to consider anyone who challenged her as disloyal [1]. She was surrounded by yes-men because she did not foster an environment that welcomed ideas, suggestions, and opinions opposite her own. Employees did not come forward with concerns because they did not want to get fired. This may be especially true of employees with H1-B or other work visas who have much more to lose, considering how their ability to stay in the country is tied to their employment. Abuse of H1-B visa workers is not unheard of; a recent example is Cloudwick Technologies Inc., based in Newark, California, paying their H1-B employees a much lower salary than what was agreed upon, and making illegal deductions from their salaries.

A negative (and savage!) review on the Glassdoor website (a website where employees can leave information about a company they work or worked in, such as CEO approval ratings, company reviews, salary reports) mentioned in the book prompted me to look at what else the ex-employees of the company had to say. Many of the reviews for Theranos are very detailed, with some ex-employees especially taking the time and effort to explain the “Pros” and “Cons” of working there. The most common “pro” mentioned was free food and snacks – something we, as grad students, can easily relate to. The “Cons” part of the negative reviews is where things got interesting. You could get an insight into how the employees felt and how they were treated. Most of them were overworked and underappreciated. It may be typical of employees to put in extra hours or feel like they have no work-life balance at a start-up firm, but at Theranos, they would not only track the number of hours the employees would spend at work, but would also monitor their social media activity [1]. The employees’ dedication was measured by how long they stayed at work and whether they would come in during the weekends. I imagine such a working environment would be suffocating and counterproductive, and it was no surprise that the employee turnover was high. What you can also glean from the reviews is the shattered hopes and dreams of the employees who were inspired by Holmes’s visions and dedicated their time to actualize it. As scientists, we all hope to contribute to making this world a better place. On top of not being able to do that at Theranos, they also feared that their time in the company will work against them in future applications. The book also mentioned how the HR department would post fake positive reviews on Glassdoor, and some of the reviews did spin the “cons” in a way to show Theranos in a positive light. For example, one of the reviews listed the cons as “truths” with statements like, “If you are unable to work in a highly self-directed environment where you are counted upon to create clarity from ambiguity, you will not be successful at Theranos.” This reminded me of reading about people answering the common interview question “What is your biggest weakness?” with “I work too hard.”

All things considered, Theranos did not really ruin the prospects of a biotech-startup in Silicon Valley. As a couple of articles in Wired mentioned, investors may be more skeptical now and that may actually be better. The increased scrutiny will hopefully mean rigorously tested data and more valid claims. Carreyrou points out how tech companies usually exaggerate about how their devices perform, but the same cannot be done with a medical device. No one ever died from a buggy Candy Crush app, but a misdiagnosis can be potentially fatal.

It is also interesting how Elizabeth Holmes and her downfall (from a net worth of $4.5 billion to zero) is discussed by the public. After she and her company were exposed for fraudulent practices, the focus skewed towards her appearance rather than her transgressions. They talked about how her unblinking stare (described as a “hypnotic” gaze in the book) is “ sociopathic ”, how she is not naturally blond, how her makeup is weird, and her deep, baritone voice is fake. Also, concerns about Theranos’ technology and the company’s practice were brought forward to some highly intelligent and experienced investors. Granted, they were not experts in the field of medical technology, but it would not be difficult to get an expert’s opinion and some of them were indeed alerted about Theranos by experts. If they genuinely did not have the power, even as a member of the company’s board of directors, to do anything about Holmes, why continue to be investors and not step down? Were they all simply manipulated and “bewitched” [1] by Holmes’s charm?

People have lots of ideas and opinions on where things went wrong, what Holmes could have and should have done, but the bottom line is, she blew the chance to be an inspirational leader and a role model. The struggle of female entrepreneurs, especially women of color, is no secret. Holmes did have a better chance than most women to become the “first female billionaire tech founder” [1] – she is smart, motivated, hard-working, charismatic and understands how Silicon Valley operates. She comes from a privileged family, had access to opportunities and was well-connected enough to benefit from the support of famous investors at a very early stage of the company. It is unfortunate that what was going to be a huge success story is now in the news for all the wrong reasons.

This book is a cautionary tale for biotech start-up founders and venture capitalists interested in biotech start-ups – providing insight into what makes an effective leader and the responsibilities that come with it, and what employees and venture capitalists should look for when looking to work or invest in a biotech firm. In my opinion, the story of Theranos could be an interesting case study for discussion in an ethics class or at the Tufts Biomedical Business Club. Regardless of whether you are interested in the biotech industry, I think anyone who is a fan of thrillers will enjoy this book. For those interested in something more visual and/or sensationalized, there is an HBO documentary covering this story called “Inventor: Out for Blood in Silicon Valley” and a movie based on Carreyrou’s book is set to release sometime this year.

References: [1] Carreyrou, John. Bad Blood: Secrets and Lies in a Silicon Valley Startup. New York, Knopf Publishing Group, May 21st, 2018.

[2] John Carreyrou, “A Prized Startup’s Struggles,” Wall Street Journal, October 15, 2015.

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• v.87(2); 2020 May

Book Review: Bad Blood: Secrets and Lies in a Silicon Valley Startup

Barbara golder.

The Linacre Quarterly, Bala Cynwyd, PA, USA

Bad Blood: Secrets and Lies in a Silicon Valley Startup. By  John Carreyrou .  New York:  Knopf,  2018.  352pp. .  $15.35. .  ISBN-10: 152473165X,  ISBN-13: 978-1524731656. 

Bad Blood is a gripping account of the rise and fall of Elizabeth Holmes, founder of Theranos, a company that promised to revolutionize laboratory testing through the use of nanotechnology. Holmes faces trial in federal court on fraud charges later this year (August 2020). Underlying the basic tale of an entrepreneur who overpromised and underdelivered is as complicated and instructional a morality tale as modern life has to offer, one of good intentions gone awry, of the temptations of fame and self-deceit and of how those with power can influence can not only seduce others to their viewpoint but use their considerable strength to crush anyone who might have the temerity to challenge their carefully constructed fantasy—noble as that fantasy might be. It is also, in a sense, a story of what it can mean to shoulder the cross of pain and injustice in pursuit of truth, set in the context of modern healthcare systems.

John Carreyrou, an investigative reporter for the Wall Street Journal , has garnered awards from a variety of quarters, including two Pulitzer Prizes and the German Marshall Fund’s Junior and Senior Prizes. His investigation of Medicare, including an in depth investigation of secretive data management and recordkeeping won him the Gerald Loeb Award and set the stage for his investigation of Theranos.

That expose, which eventually gave rise to Bad Blood , was published as a series of articles in 2015—nine years into Theranos’ corporate existence, at a time when it was valued at $9 billion, with over $900 million in investment. How a college dropout with almost no training in laboratory medicine managed to convince and retain such high-flying supporters such as Safeway and Walgreens, The Walton and Cox families, and Rupert Murdoch, and board members like George Schultz, Henry Kissinger, and James Mattis makes for a fascinating analysis of what happens when someone manages to convince influential people that what is too good to be true is still possible.

Holmes wanted to revolutionize laboratory testing with a technology that would use a single drop of blood for multiple, rapid tests. The concept was alluring: eliminating the need for phlebotomy, especially in the young and the debilitated, could indeed be a boon to patient care, as could rapid testing in a small desktop unit. The possibilities for preventative care and for engaging patients in the management of their illnesses were intoxicating.

Unfortunately, it was all based on a lie. No such technology existed or was likely to exist; yet prototypes (which housed traditional technology in a fancy, modern shell) were created, demonstrations arranged, investment plans were created, and investors courted with slick presentations fueled by Holmes’ dynamic personality and engaging good looks. High-profile supporters, including then Vice President Joe Biden, praised Holmes’ vision and audacity in creating a new paradigm for the delivery of medical care. Journalist after journalist produced stories about the revolution in testing that Theranos’ motto One drop changes everything predicted.

Few of them, however, bothered to adopt a healthy skepticism about the bold claims of Holmes and Theranos. In the pathology community, there were rumblings about the impossibility of the Theranos’ model, based on available technology, almost as soon as it was known but little of this made its way into the general wisdom about Theranos. At the peak of Theranos’ rise to prominence, both Holmes and her company were the subjects of endless positive profiles. Holmes was hailed as another Silicon Valley superstar, not unlike Steve Jobs, whose life she both admired and imitated, down to such details as her wardrobe of black turtlenecks and her management practices.

Within the Theranos corporation itself, staff involved with the nitty-gritty of research and development repeatedly tried to warn Holmes that her model would not work; much more development was needed to make it feasible to deliver even a few lab tests, let alone the hundreds she promised investors. Different tests required a range of reagents, conditions, and methods so wide that there was no way to produce multiple results from such a small amount of blood, let alone in a single pass through even the most sophisticated machine. Nanotechnology was a start but not the solution.

They were ignored, fired, and sometimes harassed into silence by threats of legal action. The Theranos corporate model, a “silo” arrangement in which related areas worked with absolutely no knowledge of anyone else’s work and a fanatic emphasis on secrecy and security, made it easier for Holmes to perpetuate the myth that she was always on the verge of a breakthrough, though her explanations about the reasons for delays varied according to time and circumstance.

Holmes’ enthusiasm and compelling personality papered over the problems her fraudulent data and fraudulent demonstrations created; one work-around for the sham instrument she showed investors involved having engineers create a “waiting” icon that allowed her claim malfunction of her instrument was the result of difficulties in wireless connection and Internet connectivity. The smoke-and-mirrors presentations seemed to support Holmes’ potentially lucrative claims; corporate investors lined up.

If the technology really were revolutionary, failing to be in on the ground flood could be a devastating business decision in an especially competitive environment. Walgreens and Safeway invested millions of dollars to produce patient centers in their locations, based on what some commentators have dubbed “FOMO-fear of missing out.” That corporations are both able and willing to invest such vast sums of money in an ultimately worthless business enterprise that compromised the care of patients involved in the pilot programs, sometimes significantly, says something about problems in how corporations develop and deliver healthcare services.

Theranos continued this high-level, dazzling fraud for almost fifteen years. In the wake of its ultimate failure were left millions in lost investment and untold damage to human lives.

Employment conditions at Theranos were abusive: long hours, a culture of fear and reprisal (including monitoring e-mails and hiring private investigators to follow suspect employees), and an overall sense of paranoia. Employees who dared question the company line were harassed, and their lives and business reputations attacked. Cambridge Scientist Ian Gibbons, who was head scientist at Theranos, committed suicide, reportedly because of fears that he was about to be fired. When the pilot projects were actually launched in patient care centers, physicians or patients who left bad reviews were harassed and threatened.

It’s this that makes Carreyrou’s book so compelling and so relevant to anyone, whether in business or heath care of not. He manages to weave together, in a hard-to-put-down narrative, the stories of very real people who were caught up the Theranos’ net, and the deceptions, self and otherwise, and derelictions that led to a disaster that has been compared to Enron in its scale. The rise and fall of Theranos continues to have far reaching effects on corporations and on ordinary people, whose capacity for recovery is far less than a corporation that can write off a bad investment and move on.

Over and over, those in a position to raise doubts and change the course of Theranos failed in their basic responsibilities: the Board failed to question the extravagant claims Holmes made or engage outside experts to review either the technology or revenue projections. They seemed to have accepted, without question, the various and changing explanations for the delays in delivering a working instrument. Perhaps even more surprising, the Board was composed of luminaries with almost no expertise in laboratory medicine and health care. I found myself wondering whether the insurer responsible for errors and omissions insurance caught that and raised a question; it’s one mystery left unsolved.

Those responsible for internal corporate compliance accepted Holmes’ claim that their testing model was outside the usual regulatory processes, thus circumventing a process that might have uncovered the fraud much earlier. Government officials failed to intervene on their own until late in the game. There were no peer-reviewed studies to support the claims that Holmes was making and no one—Board, journalists, no one—seemed to care. Employees cooperated in creating false-front labs and false-front instruments to fool inspectors and investors. When challenged on any of this, Holmes would go on the offensive, within the company and outside, and Bad Blood paints a picture of a woman ruthless when crossed.

One tiny event from an unlikely source ultimately set in motion the events that would result in the demise of Theranos: a pathologist described the technology on his blog, concluding with the sentiment “I’ll believe it when I see it.” As Carreyrou exposed the fraud that was Theranos, Holmes countered with publicity of her own and assumed the mantle of persecuted innovator bravely warring against entrenched powers, who did not want such liberating technology made available to the masses. She even pressured Rupert Murdoch to kill the story; to his credit, Murdoch, a major investor, refused.

As a result of the Wall Street Journal expose, Theranos was sued out of existence, and Holmes faces twenty years in prison with millions in fines at stake. It’s the scale of this disaster and the audacity of the deceit that make this story so compelling. Theranos was a dubious prospect from the beginning, but all along the way, people were more enticed by a well-told story and attractive CEO than by the warning signs of an unsustainable project. Bad Blood is a cautionary tale of how secrecy and hubris make it easy for the powerful to exploit a system, whether it is regulation of medical devices, lab testing, or the settling of differences in court.

This latter particularly impressed me as I read how Theranos used lawsuits to silence legitimate questions and concerns about the feasibly of the product Holmes was marketing. The imbalance of power and resources was staggering; even a very-well-heeled person (and there were some who raised alarms) could not withstand the legal pressure a company with $900 million at its disposal could bring to bear. The level of fraud involved underscores that, in pursuit of a lawsuit, the actual merits of the case are often secondary to the client’s wishes. From the story told by Carreyrou, it appears that Elizabeth Holmes wished to silence naysayers and destroy them if need be. She found ample assistance in our legal system.

It is unlikely that there will be significant changes in much of anything despite the magnitude of this fraud. Start-up companies will remain risky places to work, with entrepreneurs depending on selling an unrealized idea to investors who often know little about the mechanics of the product, but are willing to assume big risks in pursuit of big profits. Boards will remain as useful to corporations for the profile they bring almost as much as for the oversight they provide. Regulatory agencies will always be overworked and subject to interference by those above them, and the regulated will try to skirt the system. Journalists will always pursue a good story that sells papers or magazines, and the bottom line will always be of major importance to all the players, regardless of their roles and relationships.

It is tempting to think of this as a story of villains and of those there are many. But Bad Blood is also a story of heroes, small and large. The uncomfortable questions reading it eventually raised in me, and perhaps the important ones for those in health care, go to the core of what it means to be a moral person working in an environment that is so often hostile to principled actions:

• Am I grounded enough to recognize a problem when it is right in front of me, despite hype and pressure?
• Do I have enough awareness to know how what I am doing is going to affect the lives of people I never met and do I care?
• Do I have the courage to risk my own comfort and security in order to do something about it? In short—will I be like lone blogger who points out that the Empress has no clothes or the engineer who created that deceptive “waiting” icon?
• Would I pursue the story like Carreyrou despite threats of lawsuits and ruination?
• Would I give the go-ahead to a story that might derail a company in which I had millions invested or on whose board I served?

The list goes on. We work in a system of health care too often complicated by greed, dishonesty, and disrespect for others. It is one that too often makes the patient’s interest secondary to profit, convenience, and agenda. Bad Blood paints both a frightening picture of what happens when that goes unchecked, yet it reassures us that the conviction and integrity of even a few of the folks along the way can make all the difference in the world.

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Word of Mouth

Submitting a book for review, write the editor, you are here:, bad blood: a kate shugak novel.

Dana Stabenow is a native of Alaska, and she wraps her stories in the mystery and wonder that her home state inspires. Imagine a place where a national park encompasses 20 million acres; where natives are given 160-acre homesteads teeming with wildlife and rich with trees and vegetation; where people can still live off the land because of the unspoiled habitats of the salmon and moose. During the winter, folks must survive on the provisions they have put away to see them through the months when travel is nearly impossible. It is here, on America's last frontier, where BAD BLOOD is set and played out by a familiar cast of characters, along with some new ones.

"Dana Stabenow has written many previous award-winning mysteries, yet she continues to present a fresh, uncluttered picture of life in the Alaskan Bush to her ever-growing number of fans. Anyone looking for a fast-paced adventure in a fascinating setting would do well to begin this exciting series of books."

As one might guess, the environment and cultural heritage of the Aleuts, Athabascans and a few smaller tribes have produced many interesting individuals. The traditionalists, the adventuresome and the rebellious all have a place in Alaska and in Stabenow's stories. Even those like Bobby Clark --- war hero, paraplegic and now the “voice of Park radio” --- are affected by the sheer awesomeness of this little known area of the United States. And all have developed their own unique characteristics designed to fit them in.

The Kushtakans and Kuskulanans have been at odds for a hundred years, and it seemed like only a matter of time before the bad blood between the tribes would lead to bloodshed. It happens when young Tyler Mack from the Kushtaka tribe is found stuffed into a basket of his uncle's fish wheel. Tyler's death is blamed on the Kuskulanans, regardless of the lack of apparent motive or evidence. Immediately the natural vigilance of the Kushtakans becomes hyper-vigilance. Meanwhile, the Kuskulanans prepare to be blamed for the death and devise ways to fortify their defenses.

Sergeant Jim Chopin is the Park lawman and is fully aware that neither of these tribes will be forthcoming when it comes to helping him discover the truth, as both sides being more interested in pointing fingers and casting blame. Since he is still considered an “outsider” by many of the Park rats (as they refer to themselves), he asks his friend and lover, Kate Shugak, to assist in questioning the families involved. As a former investigator for the District Attorney's office, Kate often has the skill and native savvy to prevail when Chopper Jim needs help.

As subsequent deaths occur, the mystery deepens and suspense builds when obvious leads prove to be dead ends. Added into the mix of Aleutian culture, traditional mores and familiar characters is a modern-day story of Romeo and Juliet. And, in addition to a drug and bootlegging operation gone awry, there are the constant moral and ethical questions that arise despite the story's unique location and situation.

Dana Stabenow has written many award-winning mysteries, yet she continues to present a fresh, uncluttered picture of life in the Alaskan Bush to her ever-growing number of fans. Anyone looking for a fast-paced adventure in a fascinating setting would do well to begin this exciting series of books.

Reviewed by Maggie Harding on March 1, 2013

Bad Blood: A Kate Shugak Novel by Dana Stabenow

• Publication Date: August 27, 2013
• Genres: Fiction , Mystery
• Mass Market Paperback: 304 pages
• Publisher: St. Martin's Paperbacks
• ISBN-10: 1250036968
• ISBN-13: 9781250036964

• ADMIN AREA MY BOOKSHELF MY DASHBOARD MY PROFILE SIGN OUT SIGN IN

by Dana Stabenow ‧ RELEASE DATE: Feb. 26, 2013

To her usual atmospheric detection, Stabenow adds more than a hint of Romeo and Juliet, or the Hatfields and the McCoys.

A clash of family cultures may be behind a series of murders.

The Alaskan villages of Kushtaka and Kuskulana share a salmon-filled river and a deep-rooted mutual hatred. Kushtaka natives, mostly Macks, adhere to the old ways and live in near poverty. Across the river, the Kuskulana residents, mostly Christiansons, reap the benefits of modernity. When state trooper Sgt. Jim Chopin is called in, Roger Christianson takes him to the Mack fish wheel, where the body of Tyler Mack has been found. Although Tyler’s family considered him a lazy schemer, they’re covering up evidence and plotting revenge. Jim’s girlfriend, private eye Kate Shugak, a Native Alaskan with many family connections in the vast area known as the Park, quickly becomes involved. No sooner is Tyler’s death ruled a murder then the body of Mitch Halvorsen is found sealed up in the house he’s building on the Kuskulana side of the river. Mitch’s brother Kenny demands revenge against the Kushtakers. Jim is sure that Mitch and Kenny were smuggling in alcohol and possibly drugs for the nearby mine workers, but his questions produce only silence and lies on both sides of the river. In the meantime, Ryan Christianson and Jennifer Mack, who have fallen in love, are secretly meeting even though their romance is certain to cause more trouble. Kate ( Restless in the Grave , 2012, etc.), along with her half-wolf, Mutt, works her own angle and takes steps that may put her in danger in more ways than she can imagine.

Pub Date: Feb. 26, 2013

ISBN: 978-0-312-55065-3

Page Count: 384

Publisher: Minotaur

Review Posted Online: Dec. 23, 2012

Kirkus Reviews Issue: Jan. 15, 2013

MYSTERY & DETECTIVE | DETECTIVES & PRIVATE INVESTIGATORS

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BOOK REVIEW

by Dana Stabenow

A CONSPIRACY OF BONES

by Kathy Reichs ‧ RELEASE DATE: March 17, 2020

Forget about solving all these crimes; the signal triumph here is (spoiler) the heroine’s survival.

Another sweltering month in Charlotte, another boatload of mysteries past and present for overworked, overstressed forensic anthropologist Temperance Brennan.

A week after the night she chases but fails to catch a mysterious trespasser outside her town house, some unknown party texts Tempe four images of a corpse that looks as if it’s been chewed by wild hogs, because it has been. Showboat Medical Examiner Margot Heavner makes it clear that, breaking with her department’s earlier practice ( The Bone Collection , 2016, etc.), she has no intention of calling in Tempe as a consultant and promptly identifies the faceless body herself as that of a young Asian man. Nettled by several errors in Heavner’s analysis, and even more by her willingness to share the gory details at a press conference, Tempe launches her own investigation, which is not so much off the books as against the books. Heavner isn’t exactly mollified when Tempe, aided by retired police detective Skinny Slidell and a host of experts, puts a name to the dead man. But the hints of other crimes Tempe’s identification uncovers, particularly crimes against children, spur her on to redouble her efforts despite the new M.E.’s splenetic outbursts. Before he died, it seems, Felix Vodyanov was linked to a passenger ferry that sank in 1994, an even earlier U.S. government project to research biological agents that could control human behavior, the hinky spiritual retreat Sparkling Waters, the dark web site DeepUnder, and the disappearances of at least four schoolchildren, two of whom have also turned up dead. And why on earth was Vodyanov carrying Tempe’s own contact information? The mounting evidence of ever more and ever worse skulduggery will pull Tempe deeper and deeper down what even she sees as a rabbit hole before she confronts a ringleader implicated in “Drugs. Fraud. Breaking and entering. Arson. Kidnapping. How does attempted murder sound?”

Pub Date: March 17, 2020

ISBN: 978-1-9821-3888-2

Page Count: 352

Publisher: Scribner

Review Posted Online: Dec. 22, 2019

Kirkus Reviews Issue: Jan. 15, 2020

GENERAL MYSTERY & DETECTIVE | GENERAL THRILLER & SUSPENSE | MYSTERY & DETECTIVE | SUSPENSE | THRILLER | DETECTIVES & PRIVATE INVESTIGATORS | SUSPENSE | GENERAL & DOMESTIC THRILLER

More by Kathy Reichs

by Kathy Reichs

by David Baldacci ‧ RELEASE DATE: Dec. 2, 1997

Irritatingly trite woman-in-periler from lawyer-turned-novelist Baldacci. Moving away from the White House and the white-shoe Washington law firms of his previous bestsellers (Absolute Power, 1996; Total Control, 1997), Baldacci comes up with LuAnn Tyler, a spunky, impossibly beautiful, white-trash truck stop waitress with a no-good husband and a terminally cute infant daughter in tow. Some months after the birth of Lisa, LuAnn gets a phone call summoning her to a make-shift office in an unrented storefront of the local shopping mall. There, she gets a Faustian offer from a Mr. Jackson, a monomaniacal, cross-dressing manipulator who apparently knows the winning numbers in the national lottery before the numbers are drawn. It seems that LuAnn fits the media profile of what a lottery winner should be—poor, undereducated but proud—and if she's willing to buy the right ticket at the right time and transfer most of her winnings to Jackson, she'll be able to retire in luxury. Jackson fails to inform her, however, that if she refuses his offer, he'll have her killed. Before that can happen, as luck would have it, LuAnn barely escapes death when one of husband Duane's drug deals goes bad. She hops on a first-class Amtrak sleeper to Manhattan with a hired executioner in pursuit. But executioner Charlie, one of Jackson's paid handlers, can't help but hear wedding bells when he sees LuAnn cooing with her daughter. Alas, a winning $100- million lottery drawing complicates things. Jackson spirits LuAnn and Lisa away to Sweden, with Charlie in pursuit. Never fear. Not only will LuAnn escape a series of increasingly violent predicaments, but she'll also outwit Jackson, pay an enormous tax bill to the IRS, and have enough left over to honeymoon in Switzerland. Too preposterous to work as feminine wish-fulfillment, too formulaic to be suspenseful. (Book-of-the-Month Club main selection)

Pub Date: Dec. 2, 1997

ISBN: 0-446-52259-7

Page Count: 528

Publisher: N/A

Review Posted Online: May 19, 2010

Kirkus Reviews Issue: Oct. 15, 1997

GENERAL MYSTERY & DETECTIVE | MYSTERY & DETECTIVE

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by David Baldacci

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Children’s Books

In These Books, the Parents Are the Problem

The children in three illustrated satirical tales are up against something far more complex than ogres, witches and big bad wolves.

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By Jon Agee

Jon Agee is the author, most recently, of the picture book “My Dad Is a Tree.”

Children’s books have long featured pint-size heroes overcoming fierce antagonists: ogres, witches and big bad wolves. So it comes as no surprise that a similar drama occurs in these three stories. Only here, children are up against something far more complex: their parents.

These moms and pops — by turns cruel, overprotective, distracted or obtuse — are less than ideal role models. But children (we expect) will prevail. And parents (we hope) will grow up.

In the opening scene of the cartoonist Gary Clement’s K IS IN TROUBLE (Little, Brown Ink, 224 pp., $13.99, ages 8 to 12) , young K, feeling “particularly unwell,” asks his mother if he might stay home from school. Her response — a full-frame, all-caps “NO” — is a blunt foreshadowing of events. Nothing in these pages will come easily for poor K.

After a grim breakfast, K is out the door, walking through a wintry turn-of-the-century city filled with unsmiling grown-ups.

Finally, we see K’s school: a castle-like structure atop a mountain. Since K is late, he is sent to a vast, windowless room, where he awaits some imminent judgment. Much time passes. K even forgets why he’s there. One thing, though, is clear: He’s at the center of a lively graphic novel, inspired by Franz Kafka.

K’s troubles unfold in five chapters. In one, he is harassed by a flock of crows. In another, he is tormented by pompous bureaucrats. And in an especially thrilling scene, he is chased through the streets of the city by an angry mob. You can’t help pulling for K, even if his misfortune is hugely entertaining.

Clement’s artwork — pen and ink, with gouache — treats this nightmarish tale with lightness and wit. In one frame, K is seen as a tiny figure in the center of a vortex of pen lines. In others, he’s the target of pointing fingers or dwarfed by enormous file cabinets.

There is much to admire, from the restrained, sneaky-funny prose, to the shifts between narration and dialogue, to the playful use of lettering in the talk balloons. The result is visual storytelling at the highest level.

There is satire here, and in one section — when K befriends a talking beetle — there are moments of tenderness. Which is why, in the wake of K’s final appeal to his coldhearted father, I half-expected there would be a sign of hope. There wasn’t. After all, that would hardly be Kafkaesque!

For a story that features parents who genuinely care, there is Ziggy Hanaor’s THE EGG INCIDENT (Cicada, 72 pp., $19.99, ages 8 to 12) . The fact is, this mom-and-pop duo cares too much. But then, you would too if your child were a large, fragile egg, about to step out for his first solo stroll in the busy city. Much caution is advised. Most important, Humphrey is forbidden from sitting on walls. There was, after all, the infamous incident with his uncle, Humpty.

So, dutiful son heeds risk-averse parents. He makes his way, baby step by baby step, across a busy intersection, into an idyllic park. Here he meets a spunky young princess, PJ, who tries, and fails, to get him to loosen up.

When the park closes, however, and the front gate is locked, the only way out is — uh-huh! — over a tall brick wall. Humphrey has no choice, and with a boost from PJ he reaches the summit.

Of course, what goes up must come plummeting down.

Don’t fret! No eggs are broken in this book. In fact, Humphrey’s near-splat experience fills him with such zest that even his shellshocked parents can’t resist joining in the fun.

This short graphic novel is a fast-paced read, thanks in large part to Daisy Wynter’s dynamic illustrations. Motion lines, hand-lettered sounds and dramatic page turns are used to great effect. And kids will get a kick out of Humphrey’s expressive reaction shots.

The story comes with a surprising epilogue. If you’ve ever wondered what really happened to Humpty, well, it’ll crack you up.

When children act out, parents have the unenviable task of setting them straight. What parent hasn’t told a fidgety child to “stop squirming!”? Or a howling child to “keep your voice down!”? But what if the squirmer is a worm, and the howler is a wolf?

In YOU BROKE IT! (Rise x Penguin Workshop, 48 pp., $18.99, ages 3 to 5) , Liana Finck takes a slew of familiar parent–child encounters and cleverly places them in a new context.

When a pig berates its muddy piglet for getting dirty, and a tornado scolds its raging progeny for “making a mess,” the joke is squarely on mom and dad.

Finck’s pen-and-ink drawings, like her deftly minimalist New Yorker cartoons, extract unexpected humor from just the right number of lines.

The litany of parental exclamations comes to a sudden end when a defiant young octopus explains to its parent exactly why it can't keep its hands — or, tentacles — to itself.

This serves as the book’s punchline, one that human children will understand all too well.

What follows is a warm 16-tentacled embrace, which gives this high-concept spoof a heart.

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The Biggest New Comic Book Releases of April 2024

Deadpool, nightwing, ghost machine, tmnt #150 and more..

April is here, Spring has sprung and there are a lot of new comics worth checking out over the next several weeks. April is an especially big month for TMNT fans. Not only is the current TMNT volume reaching its conclusion in the epic issue #150 finale, but TMNT co-creator Kevin Eastman is kicking off a new, semi-autobiographical series called Drawing Blood. Comic readers can also look forward to a new volume of Deadpool, a major Superman crossover called House of Brainiac and the debut of the first three monthly titles from Geoff Johns' Ghost Machine.

Read on to learn about these and the other big comics worth reading in April 2024, and be sure to let us know in the comments below what you'll be reading this month.

Deadpool #1

Deadpool (2024) #1 cover art gallery.

Creative Team: Cody Ziglar & Rogê Antônio

Publisher: Marvel

Release Date: April 3

Deadpool is finally blasting his way back to the big screen this summer, so it goes without saying that Marvel has a new Deadpool comic lined up to capitalize on the hype. This series should be an easy way to dive into the franchise. It introduces a new villain named Death Grip, one who seems absolutely determined to kill the unkillable Wade Wilson.

But easily the biggest selling point here is that the new Deadpool is written by Miles Morales: Spider-Man's Cody Ziglar. Ziglar has become an increasingly important voice at Marvel in recent years, and we have faith he can nail that trademark blend of hyper-violent action and self-aware humor that makes for a good Deadpool comic.

Ghost Machine's Geiger, Redcoat & Rook: Exodus

Ghost machine april 2024 launch titles.

Creative Team: Geoff Johns, Jason Fabok, Gary Frank & Bryan Hitch

Publisher: Image

Geoff Johns, Gary Frank, Bryan Hitch and Jason Fabok are some of the biggest names in the comic book industry. It's a big deal that all four have decided to leave DC behind and spearhead a new publishing company together. The result is Ghost Machine , a new publishing line that will comprise no fewer than four shared universes by the end of 2024.

Readers got a taste of what this new line has to offer in the recent Ghost Machine #1 one-shot. Now the creators are launching their first three monthly titles on the same day. Geiger is a known quantity, as it continues Johns and Frank's post-apocalyptic saga from the first volume. Redcoat introduces an immortal rogue who exists in that same universe, while Rook: Exodus is set in a brand-new world where masked wardens can control animals. All three books are looking stunning, and we can't wait to see these new storylines unfold.

Superman: House of Brainiac

Superman: house of brainiac cover art gallery.

Creative Team: Joshua Williamson & Rafa Sandoval

Publisher: DC

Release Date: April 9 & April 16

If you've been reading Joshua Williamson's Superman run (and you really should be), you'll want to make sure you also pick up Action Comics over the next few months. Williamson is pulling double duty as Action Comics undergoes its second evolution of 2024 in issue #1064. That issue kicks off a new crossover called House of Brainiac. As the Superman family clashes with Brainiac yet again, they'll find their enemy has an entire army of Czarnians at their beck and call. Good thing Lobo is ready to throw his lot in with the Man of Steel.

House of Brainiac is shaping up to be one of the most important DC storylines of 2024. It directly sets the stage for Mark Waid and Dan Mora's Absolute Power , introducing Brainiac's latest evolution as the Brainiac Queen.

Rat City #1

Spawn: rat city preview gallery.

Creative Team: Erica Schultz & Zé Carlos

Release Date: April 10

It may not actually have the word "Spawn" in the title, but Rat City is the latest important addition to the rapidly growing Spawn franchise . Fortunately, it also happens to be an accessible series that stands on its own from the rest of the line. It's essentially Spawn's answer to Batman Beyond or Spider-Man 2099. Rat City is set in the futuristic landscape of 2111, as a new Hellspawn takes up the mantle. But the twist this time is that Peter Cairn isn't undead, but a living soldier powered by nano technology.

For more on what to expect from the new series, check out our video interview with writer Erica Schultz:

Nightwing #300

Nightwing #300 cover art gallery.

Creative Team: Tom Taylor, Marv Wolfman, Michael Conrad & Various Artists

Release Date: April 16

Nightwing #113 also happens to be the 300th Nightwing comic, and you'd better believe that DC is celebrating that milestone. This oversized issue features a new story from the regular creative team of Tom Taylor and Bruno Redondo as well as bonus tales from New Teen Titans writer Marv Wolfman and others. Details are scant on this issue, but it looks to be delivering a major new wrinkle to the status quo, even as Taylor and Redondo gear up for the climax of their critically acclaimed run. Enjoy the ride, because it's only going to get more bumpy from here for Dick Grayson.

Teenage Mutant Ninja Turtles #150

Teenage mutant ninja turtles #150 cover art gallery.

Creative Team: Sophie Campbell, Dan Duncan, Vincenzo Federici & Fero Peniche

Publisher: IDW

Release Date: April 17

2024 is a big one of the Teenage Mutant Ninja Turtles comic book line. Not only did IDW recently kick off the long-awaited TMNT: The Last Ronin II , they're ending the current TMNT monthly series at the auspicious issue #150 mark. This issue serves as the capstone to writer Sophie Campbell's long run on the series. Donatello is literally racing against time as he tracks down his future self to learn how to defeat Armaggon. Expect an epic finale and a fitting conclusion to what has easily been one of the best incarnations of the TMNT franchise in any medium. New TMNT writer Jason Aaron will have some tall shoes to fill this summer.

Drawing Blood #1

Drawing blood #1 cover art gallery.

Creative Team: David Avallone, Kevin Eastman, Ben Bishop & Troy Little

Release Date: April 24

TMNT fans should be on the lookout for a very different type of comic the week after TMNT #150 hits shelves. With Drawing Blood, TMNT co-creator Kevin Eastman is drawing inspiration from his own life and career as he helps tell the story of a fictional creator trying to escape the shadow of his world-famous creation.

Shane Bookman and his brother Paul created the Radically Rearranged Ronin Ragdolls as teenagers. But decades later, with fame and fortune having long since evaporated, Shane is struggling to build something new and escape the hired killers gunning for him. The series takes its cues from Eastman's own experiences and the many interesting stories he's encountered in his years in Hollywood, and the result promises to be a comic that's both larger-than-life and deeply personal.

In other comic book news, Marvel's X-Men '97 prequel has its own Sad Wolverine meme , and we've got an exclusive preview of this year's Stranger Things FCBD 2024 story .

Jesse is a mild-mannered staff writer for IGN. Allow him to lend a machete to your intellectual thicket by following @jschedeen on Twitter .

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J. Cole Felt ‘Conflicted’ and Spiritually Unsettled by Kendrick Lamar Diss: ‘The World Wants to See Blood’

By Larisha Paul

Larisha Paul

J. Cole can rest peacefully tonight knowing the regret of having dissed Kendrick Lamar is no longer sitting on his chest. During his headlining performance at his own Dreamville festival this weekend, the rapper led the crowd in a reflective meditation on “7 Minute Drill,” the diss track he released in response to Lamar’s featured verse on Future and Metro Boomin’s “Like That,” admitting: “That’s the lamest shit I ever did in my fucking life.”

During the four-minute speech, Cole detailed the internal turmoil the song caused for him, noting that these past few nights reminded him of how well he’s been sleeping this past decade. “I moved in a way that I spiritually feel bad on,” he explained. “I tried to like, jab my nigga back and I tried to keep it friendly. But at the end of the day, when I listen to it and when it comes out and I see the talk, that shit don’t sit right with my spirit. That shit disrupts my fucking peace.”

J. Cole reveals he regrets dissing Kendrick Lamar on his latest project: “The lamest s**t I ever did in my f**kin life.” pic.twitter.com/b5nJqdGyVG — Pop Crave (@PopCrave) April 8, 2024

In a review of “7 Minute Drill,” Rolling Stone ‘s Andre Gee wrote: “Cole may have thought he was doing the sensible thing by being measured on ‘7 Minute Drill,’ but rap beef is a toxic, nonsensical arena. Rap fans want to hear artists take it all the way there, not be overly conscientious and almost deferential on the battlefield.”

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Drake has yet to respond to the recent drama in any meaningful capacity. The rapper was rumored to make a surprise appearance at Dreamville, but ultimately did not take the stage. Drake and Cole shared a tour together last year in addition to releasing a milestone-achieving collaboration in October. Lamar and Cole have less of a public track record, but the North Carolina rapper’s admiration has always been palpable.

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Healthy Living with Diabetes

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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.