Adventures in the Annals of Quackery

In the annals of quack medicine, there is patent medicine, there is quackery, and then there is treating someone with the saliva of a rabid dog:

“Hair of the dog” remedies may do the trick for some hangover sufferers. But health experts say that a Canadian homeopath took the idea too far—way, way too far.

Homeopath and naturopath Anke Zimmermann used diluted saliva from a rabid dog to “treat” a four-year-old boy, according to a blog post she published earlier this year. Zimmermann claims that the potentially infectious and deadly concoction successfully resolved the boy’s aggressive behavior, which she described as a “slightly rabid-dog state.”

The tale fits with the scientifically implausible principles of homeopathy. These roughly state that substances that produce similar symptoms of a particular ailment can cure said ailment (“like cures like”) and that diluting a substance increases its potency (“law of infinitesimals”).

Health experts say Zimmermann’s claims aren’t just farfetched, but, rather, they’re barking mad.

………

Zimmermann quickly sniffed out the source of the problem: when Jonah was younger, a dog bit him. That is, Jonah’s mother said that one time a dog accidentally “broke the skin slightly” on Jonah’s hand while it was reaching to get food Jonah was holding.

Zimmermann pounced on the tidbit, claiming:

A bite from an animal, with or without rabies vaccination, has the potential to imprint an altered state in the person who was bitten, in some ways similar to a rabies infection. This can include over-excitability, difficulties sleeping, aggression, and various fears, especially of dogs or wolves. This child presented a perfect picture of this type of rabies state. Most homeopaths would have easily recognized the remedy required in this case.

The “remedy” to this “state” was clearly the saliva of a rabid dog, Zimmermann concluded. Months later, the mother reported that Jonah’s issues had improved—although they had not resolved entirely.

You can read the whole article for innumerable dog puns, but this is truly horrifying, and Zimmerman needs to be locked up to protect the rest of society.

Ban Agricultural Use of Antibiotics

In a frighteningly short time, an antibiotic resistant gene, MCR-1, has spread around the world.
Investigations have revealed that it originated in the antibiotics inundated world of agriculture:

The mcr-1 gene, which helps bacteria resist colistin – one of the few remaining antibiotic drugs of last resort that still work – has now reached hospitals all across the world.

And thanks to new research, we now have more evidence of where it came from – pig farms in China.

While experts had previously thought the gene developed on Chinese pig farms, due to their extensive use of colistin on the animals, the latest study offers more evidence to back this idea up.

It pinpoints the start of the spread to sometime in 2005.

………

The speed at which mcr-1 spread globally is indeed shocking," says lead researcher Francois Balloux, from University College London (UCL) in the UK.

By sequencing the genomes of 110 bacterial strains and comparing them to existing genomic data, the team identified a large dataset of 457 mcr-1 positive genome sequences, taken from humans and farm animals spread across five continents.

That enabled them to show exactly where mcr-1 had emerged from, and how it spread globally – attaching itself to various bacterial pathogens by "hitchhiking" on different mobile genetic elements.

The supporters of antibiotic use on livestock have always said that no one ever showed that antibiotic resistance has originated from their use on live stock.

Not any more.

This needs to be banned world wide.

Silly Rabbit, Jail Is Not for White Folks

This is one Very white person

And corporate criminals don't come any whiter than Elizabeth Holmes:

Elizabeth Holmes, the founder of blood testing startup Theranos, has been charged with engaging in a "massive fraud" by the Securities and Exchange Commission. The SEC says she and the company's president raised more than $700 million using an "elaborate, years-long fraud in which they exaggerated or made false statements about the company’s technology, business, and financial performance."

No, she won't be going to jail over this. In fact, even though she faces some serious penalties over the charge — she's losing control of the company and won't profit if it is sold — she also doesn't have to admit wrongdoing as part of a settlement with regulators.

To recap, Theranos was once a Silicon Valley favorite because of its promise that its technology could allow for a wide variety of blood tests with just a droplet of blood. That all began to fall apart when the Wall Street Journal raised serious questions about the accuracy of the tests, prompting a government agency to shut down one of its labs.

………

Here's are some of the things Holmes has agreed to do to settle with the SEC.

She'll give up financial and voting control of the company.

• Holmes has to pay a $500,000 fine.
• She cannot be a director or officer of a publicly traded company for 10 years. Theranos is a privately-held company, which means she can continue to be CEO.
• She has to return 18.9 million shares of Theranos stock.
• She will give up her majority voting control of the company by converting her shares to Class A Common shares from Class B Common share

She should be in jail, and she should be banned from managing publicly traded companies for life, but she does not even have to admit liability.

Well, I suppose she's commiserating with David Petraeus about how unfair this all is.

No Blogging Tonight

Between my cold in generally running around, I was so out of it today but I left the restaurant where I had lunch without paying my tab.

I realized this when I left work and looked at my take out. ( Pancakes, I had breakfast for lunch.)

So, I went back to the restaurants, paid my tab, and tipped generously.

In any case, I have concluded that I cannot maintain my usual levels of coherence.  (That sentence positively buggers the mind, doesn't it?)

So, I am taking a not particularly well deserves evening off.

Posted via mobile

I Hate Rhinovirus

Getting over a chest cold.

Cheer the IT Revolution

It turns out that the increasing use of electronic health records saves neither time nor money, but this hasn't stopped a rush by the government and the private healthcare industry from

I thought of working words like “debacle,” “scam,” or “bezzle” into the headline, but today is my day to be kind (and the entire topic really demands that I pull on my yellow waders and write another “Credentialism and Corruption” post, which I might do at a later time). However, the headlines give a sense of what a bombshell this study should be for the EHR industry. On the spectrum from reluctant admissions all the way through to The Bezzle:

1. Electronic health records don’t cut administrative costs Harvard Gazette (February 20, 2018).
2. Electronic Health Records Don’t Reduce Administrative Costs Harvard Business School (February 20, 2018).
3. EHRs fall short in reducing administrative costs Health Data Management (February 21, 2018).
4. Why health IT experts think Apple will succeed where Google failed with medical records Health IT and CIO Review
5. An Introduction to Medicalchain: Blockchain for Electronic Health Records CryptoSlate. (This is from February 8, but I couldn’t resist.)

The complete study (an “Original Investigation”) is here at the Journal of the American Medical Association. Unfortunately, the study is paywalled, and the study material that JAMA exposes muffles the bombshell. From the abtract, the methodology:

IT is going to change the world making unachievable claims based on bad/non-existent evidence, and all we have to do throw money at them.

Brazil Shows Us What We Need for Good Healthcare

It appears that all you need is a community minded hyper-violent drug lord:

Thomaz Vieira Gomes, also known as 2N, is considered one of the most dangerous criminals in Rio de Janeiro, but recently he actually did something decent, albeit still illegal, for once.

He and his gang kidnapped two male nurses and made them vaccinate the poor people of his favela against yellow fever.

For months, Brazil has been dealing with a yellow fever epidemic that has already left dozens dead. Despite the Health Ministry’s plans to vaccinate millions of people in the hopes of containing the outbreak, immunisation centres struggle to keep up with the high number of patients, and, as always, the poorest communities are usually ignored.

………

On January 27th, the young gang leader and a few of his cronies descended on a local state-run clinic in two black cars, took as many syringes and vaccine doses as they could find, and kidnapped two of the male nurses on duty that night.

They then drove to the Amarelinho bar in Salgueiro where the two nurses spent hours administering yellow fever vaccines to members of the local community.

………

After doing their job, the two victims were reportedly taken back to their workplace.

………

Even the country’s former Minister of Environment took to Twitter to comment on this bizarre story, saying that while 2N is still an “a-hole” his actions were a “public service”.

I'm not entirely sure WHAT the lesson to be learned here, but I am sure that there IS a lesson to be learned here.

End Stage of Empire

Deaths of mothers in child birth in the US are skyrocketing:

The rate of Texas women who died from complications related to pregnancy doubled from 2010 to 2014, a new study has found, for an estimated maternal mortality rate that is unmatched in any other state and the rest of the developed world.

The finding comes from a report, appearing in the September issue of the journal Obstetrics and Gynecology, that the maternal mortality rate in the United States increased between 2000 and 2014, even while the rest of the world succeeded in reducing its rate. Excluding California, where maternal mortality declined, and Texas, where it surged, the estimated number of maternal deaths per 100,000 births rose to 23.8 in 2014 from 18.8 in 2000 – or about 27%.

But the report singled out Texas for special concern, saying the doubling of mortality rates in a two-year period was hard to explain “in the absence of war, natural disaster, or severe economic upheaval”.

From 2000 to the end of 2010, Texas’s estimated maternal mortality rate hovered between 17.7 and 18.6 per 100,000 births. But after 2010, that rate had leaped to 33 deaths per 100,000, and in 2014 it was 35.8. Between 2010 and 2014, more than 600 women died for reasons related to their pregnancies.

No other state saw a comparable increase.

In the wake of the report, reproductive health advocates are blaming the increase on Republican-led budget cuts that decimated the ranks of Texas’s reproductive healthcare clinics. In 2011, just as the spike began, the Texas state legislature cut $73.6m from the state’s family planning budget of $111.5m. The two-thirds cut forced more than 80 family planning clinics to shut down across the state. The remaining clinics managed to provide services – such as low-cost or free birth control, cancer screenings and well-woman exams – to only half as many women as before.

Part of the Texas spike seems to be a statistical and data collection artifact, but a 27% increase nationally is nothing short of catastrophic.

It is symptomatic of a some very serious and deep rooted problems that taken root in our society.

What an Evil Little Sh%$!

I am referring, of course, to a Silicon Valley type, who have honed the little sh%$ to a fine edge.

Specifically, I am referring to to Peter Thiel, who is literally vampire who wants to use the blood of the young to extend his lifespan.

The latest bit of evil is his funding "patently unethical" human experimentation, specifically testing a live virus vaccine without any regulatory oversight on the island of St. Kitts:

Heavyweight tech investor and FDA-critic Peter Thiel is among conservative funders and American researchers backing an offshore herpes vaccine trial that blatantly flouts US safety regulations, according to a Monday report by Kaiser Health News.

The vaccine—a live but weakened herpes virus—was first tested in a 17-person trial on the Caribbean Island of St. Kitts without federal oversight or the standard human safety requirement of an institutional review board (IRB) approval. Biomedical researchers and experts have sharply rebuked the lack of safety oversight and slammed the poor quality of the data collected, which has been rejected from scientific publication. However, investors and those running the trial say it is a direct challenge to what they see as innovation-stifling regulations by the Food and Drug Administration.

………

Madden, Thiel, and other investors have invested $7 million into the vaccine’s development, according to Rational Vaccines, the company orchestrating the trial. Though Thiel could not be reached for comment, he has been openly critical of the FDA’s review process. At one point, he claimed that the agency’s processes were so overbearing that “you would not be able to invent the polio vaccine today.”

The lead researcher behind the vaccine, William Halford, formerly of Southern Illinois University, made similar claims. In a positive university press release, Halford was quoted as saying: “Many of the virus vaccines we currently put in our kids—chickenpox, mumps, measles, and rubella—were developed using live-attenuated viruses in the ’50s, ’60s and ’70s when the regulatory landscape was more relaxed… and they have worked remarkably well.”

He went on to suggest that the FDA has made “barriers too high” and that countries with less regulation were better for vaccine and drug development. “There are governments around the world that the WHO [World Health Organization] has approved for vaccine development,” he said. “We’re talking to those types of governments.”

………

Other researchers and experts strongly disagreed with Halford's stance and handling of a live, attenuated virus vaccine, which can cause infections in the uninfected or severe side-effects in those already infected. “What they’re doing is patently unethical,” Jonathan Zenilman, chief of Johns Hopkins Bayview Medical Center’s Infectious Diseases Division, told KHN. “There’s a reason why researchers rely on these protections. People can die.”

Robert Califf, who served as FDA commissioner during the Obama era, agreed. “There’s a tradition of having oversight of human experimentation, and it exists for good reasons,” he said. “It may be legal to be doing it without oversight, but it’s wrong.”

………

A spokesperson for Southern Illinois University, one of the vaccine’s patent holders, said that the university has no legal responsibility to ensure proper safety protocols for the trial. However, after questions about the lack of IRB [Institutional Review Board] approval (a federal requirement), the spokesperson said that the university would “take this opportunity to review our internal processes to ensure we are following best practices.”

(emphasis mine)

In addition to the quality of the study being so poor that it was refused for publication, there are also reports of skin lesions from a study size of only 17 patients.

I would have thought that this would have merited a visit from the FDA, and possibly an FBI investigation for conspiracy, but it appears that the rules do not apply to rich people, which is an even bigger problem.

Deep Thought

I think that my car is getting more miles per gallon of gas than my colon.

Worst Defense Attorney Lawyers Ever

Today in complete moral and intellectual bankruptcy, counsel for the psychologists designed the CIA torture program are attempting to defend themselves against a civil suit by comparing themselves to the manufacturer of Zyklon-B, whose product was used in Nazi death camps:

As the recently departed White House press secretary demonstrated earlier this year, making comparisons to the Nazi regime’s murderous use of poison gas is rarely a good idea. That’s one reason it was so surprising that ahead of a crucial court hearing this week, defense lawyers for the two psychologists behind the CIA’s torture program compared their clients to the contractors who supplied the Nazis with Zyklon B, the poison gas used at Auschwitz and other concentration camps to murder millions of Jews and other prisoners in the Holocaust.

Psychologists James Mitchell and John “Bruce” Jessen were the architects of the CIA’s torture program. Now, in a groundbreaking lawsuit, three survivors and victims of the torture program are seeking to hold Mitchell and Jessen accountable.

This Friday in federal court in Spokane, Washington, Mitchell and Jessen’s lawyers will argue that they can’t be held responsible for their actions. In an extraordinary legal filing, Mitchell and Jessen claim they aren’t legally responsible to the people hurt by their methods because they “simply did business with the CIA pursuant to their contracts.”

A key part of Mitchell and Jessen’s argument hinges on the claim that poison gas manufacturers weren’t held responsible by a British military tribunal for providing the Nazis with the gas because the Nazi government, not contractors, had final say on whether to use it. They argue that they are like a corporate gassing technician who was charged with and acquitted of assisting the Nazis because “even if [Mitchell and Jessen] played an integral part of the supply and use of” torture methods, they had no “influence” over the CIA’s decision to use them and can’t be accountable.

In fact, the Nuremberg tribunals that judged the Nazis and their enablers after World War II established the opposite rule: Private contractors are accountable when they choose to provide unlawful means for and profit from war crimes. In the same case that Mitchell and Jessen cite, the military tribunal found the owner of a chemical company that sold Zyklon B to the Nazis guilty — even though only the Nazis had final say on which prisoners would be gassed.

The military tribunal made clear that “knowingly to supply a commodity to a branch of the State which was using that commodity for the mass extermination of Allied civilian nationals was a war crime, and that the people who did it were war criminals for putting the means to commit the crime into the hands of those who actually carried it out.”

There is a saying among lawyers, "When the facts are on your side, pound the facts. When the law is on your side, pound the law. When neither is on you side, pound the table."

These sadistic psychologists are pounding the table here.

Not a Good Prognosis

Doctors found a glioblastoma when they operated on him for a blood clot in his brain.

This is a very aggressive cancer, and typical survival rate after diagnosis is around a year and a half:

Sen. John McCain (R-Ariz.) has been diagnosed with a brain tumor, his office said Wednesday, throwing into doubt when and if he will return to Washington to resume his duties in the Senate.

The Mayo Clinic said doctors diagnosed a tumor called a glioblastoma after surgery to remove a blood clot above McCain’s left eye last week. The senator and his family are considering treatment options, including a combination of chemotherapy and radiation, according to the hospital.

McCain, 80, has been away from the Senate this week, recovering from the surgery and undergoing tests. His office issued a statement describing him “in good spirits” and noting that his doctors say his underlying health is excellent — but not indicating when he will return to the Senate.

Glioblastoma is an aggressive type of brain cancer, and the prognosis for this kind of cancer is generally poor. Sen. Edward M. Kennedy (D-Mass.) survived less than 15 months after his was found in 2008. McCain’s doctors said the “tissue of concern” was removed during the blood-clot procedure.

In the best case, McCain is unlikely to be back in Washington for a while, which would make things even worse for Mitch McConnell in his attempts to corral votes.

Payback is a Bitch, Corporate Edition

No, I am not referring to Uber, but rather the moral reprobates who comprise Mylan NV board of directors.

You remember Mylan, don't you? They are the ones who jacked up the price of the EpiPen and defrauded Medicaid.

Now their board is facing a shareholder challenge:

An influential advisory firm, the Institutional Shareholder Services (ISS), has urged Mylan’s already mutinous shareholders to vote against the company's incumbent board of directors following the damaging EpiPen scandal and exorbitant executive salaries, Reuters and Bloomberg report.

The ostensible price gouging and greed of the incumbent board led to “significant destruction in shareholder value” and “long-term reputational damage,” ISS wrote in an e-mailed report. In an unusually aggressive move, it urged shareholders to try to oust ten Mylan director nominees, including Chief Executive Heather Bresch, President Rajiv Malik, and Chairman Robert Coury, as well as the compensation committee members.

“All incumbent directors should be considered accountable for material failures of risk oversight over a number of years, when warning signs were available to the company but no actions appear to have been taken,” the firm concluded.

In addition, ISS called executive compensation decisions “egregious,” urging shareholders to reject the company’s compensation packages. Those included paying Coury more than $160 million in compensation and payments last year.

The recommendations from ISS echo that of a campaign from a group of shareholders, who urged their fellow investors to vote against the board, which the group said “reached new lows in corporate stewardship in 2016.” It also follows a government report that Mylan overcharged taxpayers up to $1.27 billion over 10 years by misclassifying EpiPens under the Medicaid Drug Rebate Program. Mylan had previously agreed to settle the matter with the federal government for just $465 million.

Unfortunately, it requires a ⅔ super-majority to remove a member of the board, but the fact that there is a challenge, and that a well respected firm has called them irresponsible in no uncertain terms, means that the writing is on the wall.

If this gets enough ink in their official headquarter nation of the Netherlands, (particularly if the outrageous executive compensation levels) then they might see some regulatory actions on that end.

Remember the Study That Had Rats Killing Themselves with Cocaine?

It turns out that the study placed rats in miserable conditions, and when rats were placed in better environments, not only did they eschew drugged water, but addicted rats placed in better conditions stopped using as well.

The addiction crisis is driven by misery in the lives of ordinary Americans.

The parallels between the current US opioid epidemic and the explosion in drug and alcohol abuse in the Soviet Union just prior to its collapse are striking:

One of the ways this theory was first established is through rat experiments — ones that were injected into the American psyche in the 1980s, in a famous advert by the Partnership for a Drug-Free America. You may remember it. The experiment is simple. Put a rat in a cage, alone, with two water bottles. One is just water. The other is water laced with heroin or cocaine. Almost every time you run this experiment, the rat will become obsessed with the drugged water, and keep coming back for more and more, until it kills itself.

The advert explains: “Only one drug is so addictive, nine out of ten laboratory rats will use it. And use it. And use it. Until dead. It’s called cocaine. And it can do the same thing to you.”

But in the 1970s, a professor of Psychology in Vancouver called Bruce Alexander noticed something odd about this experiment. The rat is put in the cage all alone. It has nothing to do but take the drugs. What would happen, he wondered, if we tried this differently? So Professor Alexander built Rat Park. It is a lush cage where the rats would have colored balls and the best rat-food and tunnels to scamper down and plenty of friends: everything a rat about town could want. What, Alexander wanted to know, will happen then?

In Rat Park, all the rats obviously tried both water bottles, because they didn’t know what was in them. But what happened next was startling.

The rats with good lives didn’t like the drugged water. They mostly shunned it, consuming less than a quarter of the drugs the isolated rats used. None of them died. While all the rats who were alone and unhappy became heavy users, none of the rats who had a happy environment did.

………

Professor Alexander argues this discovery is a profound challenge both to the right-wing view that addiction is a moral failing caused by too much hedonistic partying, and the liberal view that addiction is a disease taking place in a chemically hijacked brain. In fact, he argues, addiction is an adaptation. It’s not you. It’s your cage.

After the first phase of Rat Park, Professor Alexander then took this test further. He reran the early experiments, where the rats were left alone, and became compulsive users of the drug. He let them use for fifty-seven days — if anything can hook you, it’s that. Then he took them out of isolation, and placed them in Rat Park. He wanted to know, if you fall into that state of addiction, is your brain hijacked, so you can’t recover? Do the drugs take you over? What happened is — again — striking. The rats seemed to have a few twitches of withdrawal, but they soon stopped their heavy use, and went back to having a normal life. The good cage saved them. (The full references to all the studies I am discussing are in the book.)

(emphasis mine)

Addiction is not just an artifact of pharmaceutical company malfeasance: It is a canary in a coal mine.

No Posting Tonight

I have been told to stay off screens of all forms for a while as a precaution to allow my brain to rest from the accident.

I might have a mild concussion.

An Old Home Remedy that Worked for Me

They are such cute merciless killing machines

With a feral cat in our house, the infamous RP the Cat, our decidedly non-feral cats, Meatball/Mousetrap and Destructo have suffered from fleas.

This has particularly been hard on Destructo, as he is a long hair.

I have tried the normal treatments, Frontline^® and Advantage^®, but they have been of limited effectiveness, I think that the fleas have developed resistance, and they are rather pricey, and Destructo must have the back of his head shaved (he hates this) for this to work, because otherwise it never makes contact with his skin.

I had heard that brewers yeast ameliorates flea infestations, so twice a week, we take a can of wet cat food, mix in two heaping teaspoons of brewers yeast.

The cats love the wet food, and it works like a dream.

Destructo is now almost completely free of flea sores, and their fur is thicker and more luxurious.

It's easy, cheap, and it involves no cat induced blood loss.

I Hate F%$#ing Plants

Note the syntax here.

The "F%$#" is an adjective that modifies "plants", not an adverb that modifies "hate".

When I come out in the morning, the windshield of my car has a thin layer of dust on it.

When I clean it off with the wipers, it turns out to be a yellow powder.

It's a thin layer of pollen, i.e. plant sperm, and it is making my life a living hell right now.

Thankfully Fexofenadine HCl (generic Allegra^®) takes a bit of the edge off.

Ironic Headline of the Day

Former Obama Aide Who Helped Kill Single-Payer in the ACA Solicits Donations for Sick Friend's GoFundMe Page

The former Barack Obama, and Max Baucus, aide is Jim Messina, who played a pivotal role in close lining even the remotest possibility of single payer or a public option, as well as steering the negotiations towards Baucus, who made a complete hash of the negotiations, and made the bill far worse as a result.

I am not suggesting that you not donate to Will Leaverton, who is having a very rough time dealing with pancreatitis, I am suggesting that you might want to find a way make Messina feel as badly about his role in the current state of affairs as is possible.

Remember When I Said that Big Pharma was Fueling the Opioid Epidemic?

We now have accusations that drug companies bribed doctors to overprescribe Fentanyl:

Fentanyl is an incredibly potent opioid painkiller; it acts quickly and powerfully, but doesn’t last as long as others, meaning its medical application is limited. So if you’re a drug company trying to boost sales of your new fentanyl spray, how do you sell more of a product that very few people have a real need for? You could bribe doctors with paid “speaking engagements,” take them out and show them the “best nights of their life,” all so they write prescriptions for patients who probably shouldn’t be getting your drug.

This is according on an indictment [PDF] filed yesterday by the Justice Department against the former CEO and five other employees of Insys Therapeutics, makers of the Subsys brand fentanyl spray, a fast-acting form of the drug that was primarily intended for cancer patients experiencing high levels of pain that couldn’t be managed through more traditional opioids.

The DOJ alleges that, starting in 2012, former Insys CEO Michael Babich and his fellow defendants bribed and provided illegal kickbacks to at least ten physicians — mostly operators of pain clinics — in ten different states.

Clearly. the problem is that our regulatory solution does not have enough free market.

I'd like to see a sh%$ load of prosecutions.

She Really Needs to Go to Jail

We get some more stories about Theranos, and it sounds more like a Mafia family than it does a medical testing business:

If you think your Thanksgiving dinner conversation will be awkward and stressful this year, just be glad you and your family weren’t involved with Theranos.

As the once highly regarded blood-testing company crumbles under technological scandals and regulatory sanctions, the death toll of relationships among neighbors, friends, families, and long-standing partners is mounting. With lawsuits, investigative reports, and new accounts from a whistleblower, the company’s culture and inner-workings—which Theranos worked hard to obfuscate—are finally becoming clear. And what’s emerged are patterns of dishonesty, callousness, and litigiousness—if not outright belligerence.

Perhaps most startling of the recent revelations is the identity and family drama of one Theranos whistleblower: Tyler Shultz, grandson of George Shultz, the former secretary of state, who also happens to be a Theranos advisor. An exposé by The Wall Street Journal lays out how in the course of eight months, Tyler Shultz went from a bright-eyed Theranos employee to disgruntled whistleblower, personally disparaged by Theranos’ then-president and desperately trying to convince his grandfather to wash his hands of the doomed company.

Fresh out of college, Tyler Shultz started working with Theranos’ assay validation team in 2013, which was in charge of monitoring the precision of its blood test results. He noted wild inaccuracies on some tests before being moved to the company’s production team, where he witnessed the company’s blood testing machines failing quality controls. Both issues were flagged years later in federal inspection reports, validating Shultz’s allegations. But at the time, then-president Sunny Balwani had pressured employees to ignore the problems, Shultz said. (Balwani stepped down from the company earlier this year and was banned by federal regulators from running a clinical lab for two years.) Nevertheless, Tyler Shultz e-mailed his findings and concerns directly to Elizabeth Holmes, the company's founder and CEO.

Days later, Shultz got a message back—from Balwani. “We saw your email to Elizabeth,” Balwani wrote. “Before I get into specifics, let me share with you that had this email come from anyone else in the company, I would have already held them accountable for the arrogant and patronizing tone and reckless comments.” He went on to belittle Shultz’s intelligence and understanding of the company’s technology. “The only reason I have taken so much time away from work to address this personally is because you are Mr. Shultz’s grandson,” Balwani added.

Shultz quit Theranos that day, intending to leave the professional drama behind. However, it was just the start of his family drama. It seems that Holmes called up the elder Shultz directly to inform him of his grandson’s actions and threatened that his grandson would “lose” if he pursued the allegations. While Tyler Shultz was still gathering his things to leave Theranos, his mother called and implored him to stop “whatever you’re about to do!”

After that, Shultz said his relationship with his grandfather became strained—and remains that way. Holmes made a surprising and uncomfortable appearance at his grandfather’s house the following Thanksgiving. She also attended his subsequent 95th birthday. Tyler Shultz did not. Meanwhile, the younger Shultz says Theranos has had him followed by private investigators and pressured by lawyers.

It gets far worse from there.

This is a company that knew that it was peddling snake oil, and used intimidation and a culture of fear to  suppress the truth.

This isn't just a bunch of people who believed their own PR.  This is conscious deliberate fraud, and Holmes and Balwani need to be in the dock.