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Trung Phan Profile picture
@TrungTPhan
Sep 6, 2021 • 24 tweets • 10 min read • Read on X
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As you know, Elizabeth Holmes is on trial for defrauding investors and patients.

Her blood-testing startup Theranos raised $700m+ and reached a $10B valuation before imploding.

Why exactly did Theranos technology (nanotainer, Edison, miniLab) fail, though?

Here's a breakdown🧵
1/ Elizabeth Holmes dropped out of Stanford at 19 and founded Theranos in 2003.

One of Theranos' founding myths is that Holmes had a "traumatic fear" of needles and blood.

Her idea: create a system that could run all medical tests on a single drop of blood (via a finger prick).
2/ You're def familiar with the more common blood test method she tried to disrupt.

Known as venipuncture, a phlebotomist draws "whole blood" -- aka blood with none of the components (plasma, platelets) removed -- from a vein.

Then, these samples are sent to a lab for testing.
3/ Not all blood tests are the same.

Some need whole blood:
◻️ Complete blood count: measures parts of your blood (red/white cells, hemoglobin)

Other tests separate serum/plasma from the blood (via centrifuge):
◻️ Biochemical tests (measure proteins, sugar) to diagnose diseases
4/ Different blood tests also require:

◻️ Certain light spectrums (and sensors)
◻️ Right temperature
◻️ Reagents to facilitate a chemical reaction

An industrial analyzer (like the Siemens one below) can run 100s of samples an hour and do different types of tests.
5/ Drawbacks from traditional testing:

◻️ Needle is painful, draws too much blood and requires a pro (less people get tested b/c they are scared or don't have access)
◻️ Samples go to a lab (= time lag for results)

Holmes set out to make it easier, quicker and more accessible.
6/ In technical terms, Theranos offered immunoassays (a biochemical test looking for antibodies/antigens in blood).

There were 200+ options on the test menu (HIV screens, diabetic tests etc).

Theranos' Edison tabletop lab (below) could "run" the tests on a single nanotainer.
7/ In 2013, Theranos partnered w/ Walgreens to offer 200+ tests in Arizona.

Finger pricks have problems, though:

◻️Puncturing skin more easily contaminates a sample (vs. drawing from vein)
◻️Low blood volumes were diluted to run more tests (this is considered "poor practice")
8/ Remember the blood-testing variables (whole blood, centrifuge, light, temp, reagents)?

Holmes said these could all fit into a microwave-size form factor (eventually renamed: miniLab) AND run 200+ tests on a nanotainer.

She was trying to bend the laws of physics and biology.
9/ The idea of a miniature blood-testing machine is not new.

For decades, Abbot has sold a point-of-care blood analyzer (I-Stat) that produces rapid results.

It can run dozens of tests, but each one requires a different reagent, and those are loaded onto separate cartridges.
10/ Further, Theranos lab practices were awful:

◻️Lack of proper equipment (coat, goggles)
◻️ Work benches not cleaned
◻️ Undertrained staff
◻️ Wrong testing procedures
◻️Facilities didn't have filtration/air lock systems

Regulators would revoke multiple Theranos lab licenses.
11/ At its peak, Theranos ran in 40 Walgreens: it sold 7m+ blood tests to 150k+ patients.

The Edison was only able to do 12 of the 200+ tests (it often malfunctioned). Theranos used a modified Siemens machine for the rest.

In the end, Theranos had to correct or void 1m+ tests.
12/ For the 2015 Pepperdine commencement speech, Holmes said "We code-named our product the Edison, b/c we assumed we’d have to fail 10,000x to get it to work the 10,001st time."

This iterative approach is quite fraught when it comes to people's health.
13/ In fact, the very first person Holmes went to with a startup idea -- Stanford medical professor Phyllis Gardner -- was suspicious of her approach.

An 18-year old Holmes pitched Gardner the Therapatch, an antibiotic-releasing patch:
14/ Ultimately, the Theranos "technology" failed to attract top-tier health investors.

And, its board was crammed with big name statesmen from the Cold War (George Shultz, Henry Kissinger), instead of health experts.

At least the miniLab was an improvement over early prototype.
15/ Holmes lied to investors, health partners, regulators and employees (many whistleblowers were legally harassed) about Theranos' testing capabilities.

However, the clearest victims are the patients that received false test results:
16/ Holmes won't even defend her tech in the trial.

She will use the "Svengali defense", arguing her fraudulent actions were guided by ex-BF and former Theranos COO Sunny Balwani.

Opening statements for the trial start on Wednesday. We'll soon find out if her strategy works.
17/ If you enjoyed that, I write threads like this one business and tech 1-2x a week.

Follow @TrungTPhan to see them in your feed.

Here's one on a machine that is *slightly* more effective than the miniLab:
18/ Sources

Google Doc of vids and articles: docs.google.com/document/d/12j…

The #1 go-to is of course @JohnCarreyrou who exposed Theranos with WSJ, then wrote the book "Bad Blood".

His new podcast tracking the Holmes trial is a must-listen:

open.spotify.com/episode/3FITMg…
19/ SIDE NOTE: I discuss interesting topics like this once a week (with a healthy dose of dumb jokes) on the Not Investment Advice (NIA) podcast.

🔗linktr.ee/notinvestmenta…
20/ Here's a salient example of Holme's absurd vision: During the Ebola Crisis (2014-2016), Theranos touted the "all-in-one" miniLab as a rapid-test solution for the outbreak.

It was a total flop:
21/ Theranos cast a huge shadow in blood-testing innovation, but these startups are making progress:
22/ An interesting explainer on Holmes' deep voice
23/ Lord give me the confidence of Elizabeth Holmes that time she went on CNBC and defended herself by quoting Gandhi:

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More from @TrungTPhan

Trung Phan Profile picture
Jan 25
This timelapse of Alex Honnold’s 1 hour 35 minute free solo climb of Taipei 101 is unreal.

He said the main challenge was “not getting complacent up the bamboo boxes, because it’s 64 of the same sequence over and over.”

His music playlist (mostly Tool) helped because each bamboo box took about the length of a song and he could keep pace.

Honnold wants to climb other mega skyscrapers if allowed.

Thinks Taipei 101 was the ideal challenge, though: “This one is so perfect for climbing. There are some buildings that are almost too easy for climbing. Like, ones that have a window washing track on the outside, where you’re just hand over handing on some track the whole way. You can climb it, but it’s not a challenge. The thing about Taipei 101 is it’s perfectly in the sweet spot for me, where it’s possible, and it’s not too insanely hard.”

***

Post-climb intervie with Variety: variety.com/2026/tv/news/a…

Timelapse: reddit.com/r/nextfuckingl…
Honnold says the scariest parts were the dragons:

“The dragons, they’re also probably the scariest thing to actually do. I mean, they’re really fun, they’re really cool. It’s an incredible sequence, cool position. But every time I set up on the dragon, I’d be like, “this is kind of crazy.” You’re like, out over the abyss. It’s cool.”Image
Image
x.com/climbingcoachx… x.com/climbingcoachx…
Read 4 tweets
Trung Phan Profile picture
Jan 16
Matt Damon and Ben Affleck on Rogan taking about how Netflix has changed filmmaking.

A major considerations is dealing with distracted viewers. To keep them tuned in, “you re-iterate the plot 3-4x in the dialogue because people are on their phones.”

Then, in action films, you change the ordering of climatic fights.

In traditional action films, you’d have “three set pieces” in every act (I, II, III) and each would “ramp up” (spend the big money on third set piece).

But streaming has to hook viewers within 5 minute, so the incentive is to put a major battle or action sequence much earlier.

Also, the directors have less incentive to make a film look great because so many people watch on laptops and phones.

They do say that streaming allows for more bets on risky projects since the theatre economics are geared towards IP, sequels and super-heroes.

Example: an independent film with a $25m budget would spend $25m on marketing (1:1 ratio). But since it splits box office with the theatre, the film needs to make $100m (1/2 of which is $50m) just to break even.

They’re realistic about the state of film and call it a supply-demand issue. If the demand is for at-home viewing (eg. Netflix 300m+ subs), then filmmaking approach will change to feed the algo.

When there’s demand for theatre, Damon will go team up with Christopher Nolan to make “The Odyssey”.
A similar dynamic is happening to streaming TV shows. The incentives for story arc, dialogue and character types warped thr medium.

I explain it more here: readtrung.com/p/the-case-aga…
Damon cooks.

Here is full Rogan: youtu.be/AVEZBy1uAk8?si…

Here is Hot Ones: youtu.be/yaXma6K9mzo?si… x.com/trungtphan/sta…
Read 4 tweets
Trung Phan Profile picture
Jan 15
The Economist has a great piece on strategy sportsbetting apps use to throttle smart bettors:

▫️Skilled players are “sharps” and given “stake restrictions” if they play too well (bets are capped).

▫️Rest of players called “Square”.

▫️In 2025, 4.3% of active UK accounts had a “stake factor” below the maximum bet allowance of 100%.

▫️Sportsbook will take bets with a profit margin as low as 4.5%.

▫️If they are able to do good “player-profiling” and keep the “sharps” from playing, the profit margin can reach 10-20%.

▫️As important as keeping out “sharps” is hooking “whales”, the deep-pocketed players that are willing to keep playing (and losing) large sums.

▫️Some “whales” are actually “sharps” in disguise, though. They’ll lose a bunch of bets to lull the sportsbook then put down a massive bet when they have an edge.

▫️While there is a risk of a “whale” being a “sharp”, the value of a real “whale” is so high that sportsbook will take the risk

▫️“In March 2024 PointsBet, raised its share of online sports-gambling revenue in New Jersey from 11% to 24% after wooing a single cash-spouting customer away from DraftKings.” (I can confirm that this wasn’t me).

▫️How sportsbook profile players:

> Playing on Mobile is a good sign (where majority of people play)
> Playing on PCs is a bad sign (it’s easier to compare odds and run models)
> E-wallets are a red flag (sportsbooks prefer debit direct deposit that can attach a player to a single account; e-wallet is more anonymized and players can move cash between sportsbook more quickly to shop for the best odds)
> Women bettors are a red flag (most bettors are men and “sharps” often use women to place bets)

▫️First wagers are a major tells (typical bettors go after top leagues — NFL, NBA, EPL — and do so near the start of the game).

▫️Popular bets for “squares”: who will win, scoring margins and how star player will perform (also, they love multi-leg parlays).

▫️“Sharps” go after less popular leagues and place bets as soon as odds are published, when they are most mispriced. They also go after less popular bets such as “pts in Q3” or stats from a random player (“Sharps” rarely do parlays and don’t withdrawal winnings often).

▫️One gambling consultant tells The Economist that “By the time a customer places his first bet, [sportsbooks] are 80-90% certain they know the lifetime value of the account.”

▫️”Sportsbooks look at a player’s ‘closing-line value’ — a measure that compares the odds at which he bets with those available right before a match begins. If it is consistently ahead of the market over his first ten wagers, he is highly likely to beat the book in the long run.”

▫️Sportsbook mathematically monitor players and creates a new risk score every 6-8 hours (risk score = estimate of probability that customers will wind up unprofitable).

▫️E-wallet users, women and bets over $100 are flagged. These suspicious bettors are given 30% of maximum bet (and proven sharps only allowed 1%).

▫️High-skilled players will often get a “beard” to bet on their behalf. Most sportsbooks ban this practice but it is widespread.

▫️Safest “beards” are close friends and relatives because you can mostly rely on them to pay out any winnings. The “beards” try to look like degens (playing at 3am, bet non-stop and doing ridiculous parlays) before placing a winning bet.

▫️The most effective strategy for “sharps” is “whale-flipping”. Find a losing gambler, then ask to put a (likely) large winning bet amongst their pool of guaranteed losers.

▫️Once “sharps” max out the people they can use as “beards”, they tap professional networks called “movers”. These “movers” employ a bunch of “mules” who can put down bets on the behalf of the network. Low-end movers charge 10-20% while high-end movers charge 50% of winnings.

***

Lots other great details here: economist.com/christmas-spec…Image
On a related note, I wrote on how slot machines make $10B+ a year in Las Vegas (~70% of all casino gaming revenue).

The history, psychology and design of the device…which went from a throwaway game to the industry’s “cash cow” and “gambling’s crack cocaine.”readtrung.com/p/the-ludicrou…
x.com/trungtphan/sta… x.com/trungtphan/sta…
Read 4 tweets
Trung Phan Profile picture
Nov 19, 2025
Satya Nadella on why Microsoft Excel has been so durable after 40 years:

> the power of lists and tables
> the malleability of the software (“a blinking canvas”)
> spreadsheet software is Turing complete (“I can make it do everything”)
> it’s the world’s most approachable programming environment (“you get into it without even thinking your programming”)
fantastic pod ep: Image
throwback!
Read 4 tweets
Trung Phan Profile picture
Jul 28, 2025
The invention of bánh mì is a combination of climate, trade and urban layout of Saigon in late-19th century designed by French colonist.

When the French captured the area in 1859, most economic activity in the region took place along the Saigon river.

The population built makeshift homes tightly bundled by the river banks. Outgrowth from this eventually lead to narrow alleyways between many buildings that is trademark of the city (the Khmer named the region Prey Nokor then French renamed it Saigon and then it was renamed to Ho Chi Minh City in 1976 after end of Vietnam War).

Over decades, the French created European street grids and built wide Paris-type boulevards in the city to funnel commerce to larger markets (also make the city easier to administer).

It was at these markets that French baguettes were introduced and traded.

Bánh mì bread is known for being flaky and crispy on the outside while fluffier on inside (so god damn good).

Two features of Saigon helped create this texture:

▫️Climate: The heat and humidity in Southeast Asia leads dough to ferment faster, which creates air pockets in bread (light and fluffy).

▫️Ingredient: Wide availability of rice meant locals added rice flour to wheat flour imports (which were quite expensive). Rice flour is more resistant to moisture and creates a drier, crispier crust.

Fast forward to the 1930s: the French-designed street layout is largely complete. Now, the city centre has wide boulevards intersected by countless narrow alleyways.

The design was ideal for street vendor carts. These businesses were inspired by shophosue of colonial architecture to sell all types of goods as chaotic traffic rushed by.

Vietnam has some of the most slapping rice and soup dishes, but many people on the move in the mornings wanted something more portable and edible by hand.

Bánh mì was traditionally upper class fare but it met the need for on-the-go food.

Just fill the bread with some Vietnamese ingredients (braised pork, pickled vegetable, Vietnamese coriander, chilies) along with French goodies (pate).

Pair it with cà phê sữa đá (aka coffee with condensed milk aka caffeinated crack) and you’re laughing.Image
Image
Image
Image
Haven’t lived in Saigon for 10+ years but ate a banh mi every other day when I did.

While there, I also sold a comedy script to Fox (pitch: “The Fugitive meets Harold & Kumar set in Southeast Asia”).

It never got made but fun story to retell: readtrung.com/p/im-making-a-…
Classic episode Image
Read 4 tweets
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Jul 26, 2025
the most underrated winner of the AI boom is the 15,000 person Caribbean island of Anguilla (which has a GDP of ~$320m) Image
The research team is happy to announce that we’ve played our part contributing to Anguilla’s windfall.

We also paid $99 to GoDaddy to see if we could secure one more .AI domain. Bearly.AIImage
Polynesian island Tuvalu has an even smaller population (10,000)!!
Read 4 tweets

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