Breaking: Aetna-Humana merger blocked by Federal court

Breaking News from Washington Judge John B. Bates of the Federal District Court for the District of Columbia ruled today (23 Jan), as expected, against the merger of insurance giants Aetna and Humana. Grounds cited were the reduction in competition for Medicare Advantage plans, where both companies compete. “In this case, the government alleged that the merger of Aetna and Humana would be likely to substantially lessen competition in markets for individual Medicare Advantage plans and health insurance sold on the public exchanges.” The decision could be appealed in the US Appeals Court for the DC Circuit, or could be abandoned for different combinations, for example a rumored Cigna-Humana merger, or smaller companies in the Medicare/Medicaid market such as Centene, WellCare, and Molina Healthcare. Certainly there is money about: Humana would gain a $1 bn breakup fee from Aetna, and Cigna $1.85 bn.

No decision to date has been made in the Anthem-Cigna merger, but the general consensus of reports is that it will be denied by Federal Judge Jackson soon. [TTA 19 Jan]

Healthcare DiveBloomberg, Business InsiderBenzinga

Of course, with a new President determined to immediately roll back the more onerous regulatory parts of the ACA, in one of his first Executive Orders directing that Federal agencies ease the “regulatory burdens” of ObamaCare on both patients (the mandatory coverage) and providers, the denial of these two mega-mergers in the 2009-2016 environment may be seen as a capital ‘dodging the bullet’ in a reconfigured–and far less giving to Big Payers–environment. FoxNews

The Theranos Story, ch. 34: It’s a conspiracy! It’s a vendetta!

click to enlargeUpdated Well, that is what one of her major investors says, and he would know! Just when we thought that a week would go by with not a peep about Theranos, we get three. Peeps, that is.

First, the Conspiracy Theory. This is being propounded by early Theranos investor Tim Draper of Silicon Valley VC Draper Fisher Jurvetson. It was all John Carreyrou’s ‘strange vendetta’ against her, to wit: “Elizabeth is the victim of a witch hunt.” The Wall Street Journal reporter set off a cascade of press coverage that compelled, nay, forced Federal regulators (FDA, CMS, SEC, DOJ) and state counterparts to go after Theranos and CEO Elizabeth Holmes. Mr Draper bluntly accused Mr Carreyrou of doing it for money; “the guy is getting $4 million to continue this charade”, referring to the advance on his book proposal “Bad Blood”. The most nauseating part of the Ars Technica interview is this mock-libertarian rejoinder from Mr Draper: “It’s the press creating a series of events that negatively impact technology, progress and our economy.”

So it was all a mistake, an illusion–there was nothing significantly wrong with the Edison Lab, or Theranos’ business practices! (Hat tip to Bill Oravecz of Stone Health Innovations)

Mr Draper perhaps did not consider that Mr Carreyrou’s reporting blew up the $100 million investment of the WSJ‘s owner, Rupert Murdoch (Ch. 27), not just DFJ’s. And SafewayWalgreens, Larry Ellison, Cox Enterprises, Bechtel Group….

Second, the belated reporting of deficiencies at the Scottsdale lab found by CMS (Centers for Medicare and Medicaid Services) on 29 September. According to the Wall Street Journal report (co-authored by Mr Carreyrou), “Theranos responded to the inspection findings in Arizona with a plan to correct its lab deficiencies, but the lab regulator in November rejected the plan and proposed sanctions for the Arizona lab as well.”  This preceded the closing of all labs and the ‘refocusing’ of Theranos on the miniLab. Their general counsel stated, “After months of careful consideration, and prior to CMS’s unannounced inspection in Arizona, Theranos decided to close its laboratories.” Usually, these CMS reports are issued after 90 days. Theranos is appealing the sanctions arising from the California lab inspection with an administrative law judge, which include lab license revocation and a two-year ban on Ms Holmes from blood-testing operations.

Third, Theranos announced an eight-person Technology Advisory Board (TAB) to be led by Dr. Channing Robertson and Howie Rosen. The academics, executives, and entrepreneurs will be charged with “reviewing specific Theranos technology initiatives associated with product development, design and deployment” as well as four other mandates. Analogies concerning horses, roads and the status of barn doors come to mind. Release.

And finally another Theranos Washington connection, besides new SecDef and ‘Warrior Monk’ James Mattis, now an alumnus. It seems that the vetting of Betsy DeVos, nominee for Secretary of the Department of Education, uncovered that she has an investment in Theranos of more than $1 million. However, the Office of Government Ethics also reported her whopping earnings of less than $201. Since others like Rupert Murdoch, Bechtel, Walgreens, Cox, and others ponied up $50 to $100 million, hers is a mere bag of shells by comparison. MedCityNews, who has dubbed it the ‘As Theranos Turns’ soap opera. Hat tip to Bill Oravecz of Stone Health Innovations.

See here for the 33 previous TTA chapters in this Continuing, Consistently Amazing Saga, including Arizona’s lawyering up for a prospective Theranos lawsuit (Ch. 33) the firing of 155 remaining staff (Ch. 32), the resignation of now-DOD Secretary General Mattis from the BOD (Ch. 31), and Theranos’ annus horribilis (Ch. 30).

DC District Court judge to block Anthem-Cigna merger: report

Breaking News  Judge Amy Berman Jackson of the Federal District Court for the District of Columbia is expected to rule against the Anthem-Cigna merger on anti-trust grounds, sources have informed the New York Post. In anticipation of the appeal, Anthem has already filed an extension to the merger deadline from 31 January to 30 April, which Cigna is reportedly opposing in hopes of killing the merger.

The lawsuit was brought by the Department of Justice after Senate anti-trust subcommittee hearings and the displeasure of many state insurance regulators [TTA 21 July]. The hearing starting 21 November had two phases: the first on the merger’s effect on national employers, the second starting 12 Dec on local markets [TTA 21 Nov]. The huge stumbling block, according to the report, is Anthem’s unresolved conflict in a merger due to the ‘Blues Rule’, which requires that they have no more than one-third of its marketed products from other insurers in a state where they also market Blue Cross Blue Shield plans. Anthem is the licensee for Blue plans in 15 states, and according to court testimony by Anthem VP of corporate development Steven Schlegel, may have faced a $3 bn (£2.43 bn) penalty. This likely would have come from the Blue Cross Blue Shield Association, the licensor. Anthem’s hope reportedly was to transfer Cigna customers to its Blue plans to balance this out.

The NYP report also adds fuel to two years of rumors concerning governance and management succession conflicts between the two insurers. One revelation in the DOJ complaint was that in April 2016 “Anthem had established a separate, highly confidential team to work on integration planning without Cigna’s participation”. Earlier reports publicized that Cigna hoped that the DOJ lawsuit would have killed the merger; now Cigna wants no extension and to collect its $1.85 bn breakup fee. Sounds like a Fatal Case of Merger Remorse. Stay tuned. 

The separate Aetna-Humana hearing concluded on 30 December under a different DC District Judge, John D. Bates. Arguments here focused on overlaps in two areas: exchange policies (sold by Aetna in only four states, with overlap in 17 counties) and Medicare Advantage monopolies or near-monopolies. The judge’s ruling is still pending. Bloomberg, Hartford Courant, which lets hometown Aetna have its say.

Weekend viewing: NYeC Digital Health Conference presentations

Now that the bustle of the holidays is over and the frigid days of winter are here, this weekend grab your cup of hot cocoa, an afghan rug or snuggie, and click through a one-page compendium of the NYeC Digital Health Conference in NYC last December. The page links to presentation slides and video; most have both. (Unfortunately, not all presentations nor the lunch breakouts are included.)

This Editor highly recommends the following:

  • The Tuesday keynote on ‘The Digital Doctor’ by Dr Robert Wachter, who is influencing the NHS. (Yes, EHRs and e-prescribing have turned physicians into data entry clerks.)
  • ‘Turning Impossible on Its Head’ on disrupting healthcare with technology: Robert Putrino of Burke Rehabilitation Center on a miracle of 3D printing
  • DSRIP 2017 and readmissions may not sound very interesting, but the presentations by Veyo‘s Josh Komenda on how transportation assistance can also aid compliance, and the discussion on the missing link of population health may be social determinants of health care, are.
  • Wednesday’s ‘Universal Patient Identity’ presentation by Tom Foley of Lenovo Health; a must-see by anyone interested in preventing identity fraud and theft at the provider level
  • “The Patient Room of the Future’ by Joan Saba, partner of NBBJ Architects. Responding to this Editor’s question via Twitter on how design can prevent nosocomial (healthcare-acquired) infections, I was directed to an excellent Becker’s Hospital Review article written by two of their firm’s leaders.
  • The very last presentation, ‘Resuscitating the Child’, was one of the finest and may also break your heart. Peter Antevy, MD, medical director of two EMS in Palm Beach County, Florida, presented the human cost of both EMTs/paramedics in rescue and the frustration of not having the proper tools to calibrate medication and procedures quickly on a patient who cannot be administered full doses, all in emergency situations. His company, Pediatric Emergency Standards, is developing software that can do so quickly and on-scene. Dr Antevy’s passion for his work and for applying technology to this situation is abundantly present.

NYeC Digital Health Conference final presentations pageTTA was a conference/media partner of the 2016 NYeC DHC, and thanks Jesse Giuliani and Andie Egbert for their invitation and coordination assistance.

UKTelehealthcare’s updated event schedule

UKTelehealthcare’s new Managing Director Gerry Allmark was kind enough to advise Editor Donna of upcoming events either organized by UKTelehealthcare, or where they will be represented. His note is reproduced here with minor edits and emphases. Click their advert on the right sidebar or here, which directly links to their special About/Upcoming Event page, for more information.

Our next MarketPlace will be in Carlisle on the 1 March 2017 (registration link); this is an historic occasion for us as this is our first event in the North of England. (Information on the programme is here.)

As part of our national expansion of events and membership we plan to hold MarketPlaces in Luton, Bristol, Nottingham, Dudley and Halifax as well as a high profile London event in 2017/18.  Please see the “Coming up at a glance” section on the first page of our website (see link here) for the latest news on these events.

We will also be exhibiting at Naidex 2017 from the 28 to 30 March and at the Health + Care Show on the 28 and 29 June 2017.  At both these shows we will be offering special show price membership rates to both provider and supplier members as well as our new membership categories for Clinical Commissioning Groups, Consultants and RPI members.

In conjunction with the H + C Show we will also be expanding our successful Telehealthcare Awareness Day which we have run for the last two years to Telehealthcare Awareness Week which will run from 26 – 30 June 2017.  During this week we encourage our members and other TEC providers and suppliers to run local events to raise the profile of health technology in their areas and we will publicise these events though our social  media links and website.  A Telehealthcare Awareness Day pack / toolkit will be available on our website shortly for both members and non-members who would like to take part in this important event.

Babylon as AI diagnostician that is ’10 times more precise than a doctor’

The NHS announced at the top of this month that it would test Babylon Health‘s ‘chatbot’ app for the next six months to 1.2 million people in north London. During the call to the 111 medical hotline number, they will be prompted to try the app, which invites the user to text their symptoms. The app decides through the series of texts, through artificial intelligence, in minutes how urgent the situation is and will recommend action to the patient up to an appointment with their GP, or if acute to go to Accident & Emergency (US=emergency room or department) if the situation warrants. It will launch this month in NHS services covering Barnet, Camden, Enfield, Haringey, and Islington, London. TechCrunch.

The NHS’ reasons for “digitising” services through a pilot like Babylon’s app is to save money by reducing unnecessary doctor appointments and pressure on A&Es. It provides a quick diagnosis that usually directs the patient to self-care until the health situation resolves. If not resolved or obviously acute, it will direct to a GP or A&E. The numbers are fairly convincing: £45 for the visit to a GP, £13 to a nurse and £0 for the app use. According to The Telegraph, the trial is facing opposition by groups like Patient Concern, the British Medical Association’s GP committee, and Action Against Medical Accidents. There is little mention of wrong diagnoses here (see below). The NHS’ app track record, however, has not been good–the NHS Choices misstep on applying urgency classifications to a ‘symptom checker’ app–and there have been incidents on 111 response.

Babylon’s founder Ali Barsa, of course, is bullish on his app and what it can do. (more…)

TechLaw: NDAs are not one size fits all; they are dangerous!

The subject of nondisclosure agreements–NDAs–is often treated as routine, not only in the US but also in the UK and Europe. Editor Donna has reviewed and signed a few, modifying only limited areas of ‘boilerplate’. Our contributor today is an attorney specializing in technology law, Mark Grossman, JD, and he explains to us that an NDA should not be treated quite so cavalierly–and that red flags should fly any time a trade secret is involved. (Editor’s emphases are italicized and bold.)

In the world of tech deals — more than other types of deals — my clients want to sign nondisclosure agreements quickly. I’m sure that many people will disagree with me on this one, but I like to avoid NDAs in the early stages of a deal. My feeling is that you shouldn’t be exchanging secrets with strangers and that doesn’t change no matter what they’ve signed.

Experience tells me that most deals at the “initial feeler” stage never reach fruition. It’s a long way from that first lunch to a closing and a bottle of champagne. I say skip the paperwork and legal entanglements until you’ve at least gone as far as thinking: “This is getting interesting and serious.” In the meantime, keep your secrets to yourself.

Usually, you can get through the early stages of a negotiation with a demonstration of what “it” can do without revealing how it does it. Of course, if what it does is as much a secret as how it does it, then my generalization may not be true for you.

In case you’re not familiar with NDAs, the idea behind them is that you’ll reveal confidential information only if the other side agrees not to improperly disclose or use the information. Right here, it starts getting tricky because you have to decide to whom they can disclose it and for what use.

Watch out for a form with a line for your company name. If you’re tempted to sign it, I have some simple advice: Don’t. Not ever.

Every NDA is customized. Since tech lawyers see NDAs constantly, writing a good one should never be an exercise in reinventing the wheel. Still, they do require some thought. (more…)

UK news updates: UKTelehealthcare changes the guard, Tynetec’s Dementia Dog

UKTelehealthcare, the membership association which supports health and care professionals and suppliers in delivering the widest choice and range of appropriate Technology Enabled Care Services, announced the retirement of John Chambers. Mr Chambers and Doug Miles founded the holding company of UKTelehealthcare, London Telecare Ltd., in 2005. He stepped down as a director at the end of November but will continue to be involved through his shareholding and consulting, especially in PR and marketing. Mr Miles will remain as a director and Chairman. Taking the roles of managing director and company secretary are Gerry Allmark, who joined UKTelehealthcare from Bosch Healthcare three years ago, and Julia Allmark, an IT specialist. Release (top of news page).

TTA also happily supported the Dementia Dog fundraiser in memory of Tynetec’s Billy and Lisa Graham that achieved their £15,000 goal on JustGiving to train a dog to support people with dementia [TTA 5 Dec]. Up on Twitter is a 30-second snippet of a program dog trainer explaining the bonding process. According to the JustGiving listing, Independent For Longer will be following the dog’s progress during training; also see #DogsforGoodUKBoth UK Telehealthcare and Tynetec (Legrand) are long-time supporters of this website.

The King’s Fund Digital Health and Care Congress ’17–update

The latest from The King’s Fund on the upcoming Digital Health and Care Congress, 11-12 July (only six months from now!) is in this video now available on Vimeo. It gives a great overview of how digital health has to be integrated to improve care in the NHS and also in other countries, and the scope of its effects on clinicians, HIT, and patients. This Editor has also received word that the successful projects submitted in the meeting’s call for papers will be announced on Friday 20 January, and that the full programme will be announced at the end of this month.

The King’s Fund’s event page; the Digital Health Congress fact sheet includes information on sponsoring or exhibiting. To make the event more accessible, there are new reduced rates for groups and students, plus bursary spots available for patients and carers.  

Hat tip to KF’s Claire Taylor for the information and the update. TTA will be a media partner of the Digital Health Congress 2017. Updates on Twitter @kfdigital17

US Army researchers use sensors, gels to study, mitigate brain and body blast effects

click to enlargeUS Army research labs have been leading the way for some years in researching how impacts, such as those experienced from explosive devices or other sources of concussion, can affect the brain and body. One tactic Army researchers in the Research, Development and Engineering Command (RDECOM) are taking is to engineer increased protection in ground vehicles (ground vehicle systems in Army-speak). However, testing designs can’t be done with humans. One method used is a sensor-laden crash dummy (Warrior Injury Assessment Manikin or WIAMan, seen above left). Fred Hughes, director of the WIAMan Engineering Office, commented that “The manikin’s sophisticated bio-fidelity and robust sensor design provides an unmatched level of accuracy determining the potential effects of blast on soldiers in new vehicle systems.” Another tool is the Microsoft-designed Hololens which allows researchers to virtually explore explosion simulations. Both are being used to assess survivability and mobility design in vehicles. Armed With Science

At another part of RDECOM located at the Aberdeen (Maryland) Proving Ground, US Army Research Laboratory researchers have simulated brain texture and mass through a specially designed gel. These nanomaterials are designed to fluoresce at graduated intensities under pressure. The goal is that researchers can track blast effects on the brain at the cellular level. ARL research in this area is jointly conducted with counterparts in the Japanese Defense Ministry, where researchers are contributing their knowledge of physiological effects such as cortical depressant, blood circulation and oxygen levels in tissue. ARL News, YouTube video. Both tracks of research are designed to protect soldiers in the field from TBI, and better understand the effects of blast-created trauma to the brain.

The Theranos Story, ch. 33: Arizona gets its lawsuits on

click to enlargeThe state of Arizona is lawyering up to sue Theranos for consumer fraud. TechCrunch found a bid solicitation on Arizona’s state procurement website from the Office of the Arizona Attorney General (AGO). It requests bids for outside counsel to assist the AGO in legal action against Theranos for fraudulent blood testing. From the Outside Counsel RFP:

The purpose of this contract is to retain Outside Counsel to aid the Arizona Attorney General’s Office (the AGO) in commencing legal action against Theranos, Inc. and its closely related subsidiaries for violations of the Arizona Consumer Fraud Act arising out of Theranos Inc.’s long-running scheme of deceptive acts and misrepresentations relating to the capabilities and operation of Theranos blood testing equipment, including but not limited to deceptive acts and misrepresentations made to Arizona consumers in connection with Theranos Wellness Centers in Arizona and California. Upon retention, Outside Counsel will assist the AGO on a contingency fee basis per the terms set forth in this Request for Proposal.

Arizona’s involvement with Theranos went above and beyond ‘deceptive acts and misrepresentations’ made to Arizona consumers. As we noted last September in Chapter 20, in early 2015 lawmakers quickly deregulated blood testing to permit direct consumer order of blood tests, after Elizabeth Holmes and company swept in and turned the governor and legislators quite ga-ga. It turns out the unimpressed Arizona Medical Association was on the mark in their objections. So undoubtedly this first move by a state entity is Powered by Embarrassment.

One wonders which law firm out of their lengthening list Theranos will choose. (See Chapter 29) Bids are due by 27 Jan. Hat tip to Bill Oravecz of Stone Health Innovations.

See here for the 32 previous TTA chapters in this Continuing, Consistently Amazing Saga, including the firing of 155 remaining staff (Ch. 32), the resignation of General Mattis from the BOD (Ch. 31), and Theranos’ annus horribilis (Ch. 30).

VA Digital Health Platform proof-of-concept unveiled; new VA head nominated

Back in April 2016, the Department of Veterans Affairs (VA) in Congressional hearings hinted at an end of year preview of a ‘state-of-the-art’ digital health platform which would integrate veteran health information from multiple sources. That debut was revealed this week in analytics vendor Apervita‘s announcement that they are participating in a proof-of-concept of the VA Digital Health Platform (DHP). According to their release, in the first three weeks, they and the DHP partners demonstrated that they could organize and extract insights from veteran data originating from VA, military, and commercial electronic health records, plus e-prescribing, apps, devices, and wearables. The end outcome is to provide a unified view or dashboard that integrates data, implements a care plan, tracks clinical encounters, optimizes medications, responds to patient needs, and more. The prime contractor in DHP is Georgia Tech, which brought on board Apervita, Salesforce (workflow user engagement), and MuleSoft (API). Next steps are not disclosed. Mobihealthnews, Health Data Management

One of the sparkplugs behind the DHP and also interoperability of DOD’s and VA’s badly outdated VISTA EHR is current VA Undersecretary for Health David Shulkin, MD. Today, at an eventful press conference, President-Elect Donald J. Trump nominated him for the VA secretary position. Dr Shulkin was previously CEO of Beth Israel Medical Center in NYC and president of the Atlantic Health System ACO. He will also be, upon Senate approval, the first non-veteran head of the VA. What is apparent is that P-E Trump has not moved one iota from the promise he made during the campaign to move fast on modernizing, improving quality and speeding up veterans health services–and for that he needs an insider.  Health Data Management

Was 2016 a great or off year for digital health funding, M&A, IPOs? (updated)

It depends on the study you read and how jaundiced your view is. If you believe the StartUp Health Insights 2016 ‘Health Moonshots’ report, 2016 digital health funding has hit a zenith of $8.18 bn (up 38 percent from 2015), with 500 companies enjoying funding from over 900 individual investors. Yet over at fellow funder Rock Health, the forecast is far more circumspect. They tracked only half the funding–$4.2 bn in funding–with 296 deals and 451 investors, down from the $4.6 bn over 276 deals in 2015.

There are significant differences in methodology. Rock Health tracks deals only over $2 million in value, while StartUp Health seems to have no minimum or maximum; the latter includes early stage deals at a lower value (their cross-section of ~$1 million deals has 15). StartUp Health gathers in international deals at all levels (pages 11-12),  whereas Rock Health only includes US-funded ventures. Another observation is that StartUp Health defines ‘digital health’ differently than Rock Health, most notably in ‘patient/consumer experience’, ‘wellness’ and ‘personalized health’. This can be seen by comparing their top 10 categories and total funding: (more…)

A ‘wearable airbag’ belt that prevents hip fractures due to falls (updated)

click to enlargeEditor’s Note: We are reprinting this article (originally from 23 November 2016) due to the comments by the CEO of ActiveProtective, Drew Lakatos, on 10 and 12 January, responding to the reasoned misgivings of one of our Readers. (Click ‘read more’ and scroll to comments at the end of the article.) This unusual step is being taken because this Editor believes that the problem is major–adults at high risk of falling and hip fractures. A technology solution such as this is worthy of examination by our Readers and further debate.

Do you believe older adults at high fall risk would voluntarily wear a belt that would deploy cushioning air bags around the hips in the event of a fall? This Editor was initially skeptical reading the MedCityNews article on ActiveProtective‘s $2.6 million Seed 3 round raise. The belt, looking at their photo and the one on the ActiveProtective website (left above), looks like a hard and uncomfortable ring, which didn’t make much sense as the ring in a fall impact could itself create injury. There was also a brief mention of fall detection but not how they worked together.

But before nominating this as a Thanksgiving Fowl, this Editor wanted to Dig Deeper. In their press, this TEDMED video with founder/presenter Drew Lakatos, while originally from 2014, explained its workings far better. (more…)

Assistive technology tender open for North Yorkshire County Council (UK)

There’s an open assistive technology tender issued by the North Yorkshire County Council closing on 31 March. It doesn’t say ‘telehealth’ but describes needs for a patient-monitoring system, emergency and security equipment, surveillance and security systems, sensors, GPS, health/social work and community health services which are in the aggregate quite close. Award appears to be shortly thereafter but listed as 1 April. Duration is one year out to 31 March 2018. Registration is required on the YORtender website for DN198838 (Historical Ref: CONTRACT-A8SL-W8IAL7) and the contact is Matt Clothier of NYCC. Hat tip to Susanne Woodman, our eye in the sky for tender opportunities.

The Theranos Story, ch. 32: 155 employees out in latest layoffs, 220 left to go

click to enlargeEndlessly, flatly spinning, towards Ground Zero…. As a marketing person made redundant (US=laid off) for various reasons by companies (moving out of area, acquisition, dissolution, etc.), this Editor has zero joy in reporting that 155 Theranos employees will be discharged as it “re-engineers its operations” “towards commercialization of the miniLab testing platform and its related technologies” “aligned to meet product development, regulatory and commercial milestones.” Their Friday press release successfully buried itself on a weekend, aided by a tragic Heaping Helping of Bad News out of Fort Lauderdale. The rationale is that this is justified to better position itself to commercialize the miniLab and “related technologies”. The miniLab reportedly is a compact, microwave-sized lab that automates small volume samples by sending them for analysis to a central server which would do the full analysis, thus driving down cost and time.

Theranos is a company flailing. This Editor notes in its string of releases an endless emphasis on compliance, regulation and operational expertise, the kind of attitude and caution that should have been present years ago. The layoffs follow on last October’s involuntary exits of 340 employees and lab closings (Chapter 21). Run the numbers and there are 220 employees left to go. Will the miniLab, seemingly hastily concocted, be their salvation? Flip back to our Chapter 18 about the October AACC meeting.  Chemical laboratory professionals were distinctly underwhelmed by the miniLab and CEO Elizabeth Holmes’ presentation. Also not boding well was Theranos’ withdrawal of a miniLab Zika test FDA emergency clearance in late August, at the height of the crisis. What may be wafting is the aroma of performing seals on a hot day.

Speaking of leadership, is Ms Holmes among the fired or demoted? Highly unlikely as she controls all $9 of the company’s formerly $9 bn Unicorn Worth. Is she even taking a pay cut? Will you see her out in front of Palo Alto HQ mowing the long grass?

To nearly 500 people now wondering about their livelihood in one of the most expensive areas of the US, how damaged they will be by their association with Theranos? Despite the ‘fail fast’ mantra of Silicon Valley, there’s little tolerance by employers for those at the operational level having a failed company in their past. These people should have our empathy, not ‘guilt by association’, and as appropriate, respect for their skills which were badly used in their last situation.

One also wonders how long it will take before there is another Chapter in The Theranos Story, one that they will file via one of their multitudinous law firms–Chapter 11. Consumerist (Consumer Reports), Yahoo News.

See here for the 31 previous TTA chapters in this Continuing, Consistently Amazing Saga, including the resignation of General Mattis from the BOD (Ch. 31), Theranos’ annus horribilis (Ch. 30) and the law firm feeding frenzy (Ch. 29).