Elizabeth Anne Holmes (born 1984)


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Elizabeth Holmes

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Elizabeth Holmes


Holmes at TechCrunch Disrupt, San Francisco, 2014


Born

Elizabeth Anne Holmes

February 3, 1984 (age 37)

Washington, D.C., U.S.

Nationality

American

Education

Stanford University (degree incomplete)

Occupation

Health-technology startup founder

Years active

2003–2018

Title

Founder and former CEO, Theranos

Spouse(s)

Billy Evans ​(m. 2019)​

Partner(s)

Ramesh Balwani (2003–2016)

Children

1

Elizabeth Anne Holmes (born February 3, 1984) is an American former businesswoman who was the founder and chief executive of Theranos, a now-defunct health technology company. Theranos soared in valuation after the company claimed to have revolutionized blood testing by developing testing methods that could use surprisingly small volumes of blood, such as from a fingerprick.[1][2] By 2015, Forbes had named Holmes the youngest and wealthiest self-made female billionaire in America on the basis of a $9-billion valuation of her company.[3] The next year, following revelations of potential fraud about Theranos's claims, Forbes had revised its published estimate of Holmes's net worth to zero,[4] and Fortune had named her one of the "World's Most Disappointing Leaders".[5]

The decline of Theranos began in 2015, when a series of journalistic and regulatory investigations revealed doubts about the company's technology claims and whether Holmes had misled investors and the government. In 2018, the U.S. Securities and Exchange Commission charged Theranos and Holmes with deceiving investors by "massive fraud" through false or exaggerated claims about the accuracy of the company's blood-testing technology; Holmes settled the charges by paying a $500,000 fine, returning 18.9 million shares to the company, relinquishing her voting control of Theranos, and being barred from serving as an officer or director of a public company for ten years.[6]

In June 2018, a federal grand jury indicted Holmes and former Theranos Chief Operating Officer (COO) Ramesh Balwani on nine counts of wire fraud and two counts of conspiracy to commit wire fraud for distributing blood tests with falsified results to consumers.[7][8] The case, U.S. v. Holmes, et al. began on August 31, 2021,[9] and is expected to last 13 weeks or longer. If convicted, Holmes faces up to 20 years in federal prison, plus potentially millions in restitution and fines.

The credibility of Theranos was attributed in part to Holmes's personal connections and ability to recruit the support of influential people, including Henry Kissinger, George Shultz, Jim Mattis, and Betsy DeVos, all of whom had served as cabinet officers. Holmes was in a clandestine romantic relationship with Balwani, who Holmes claims "dominated" her to such an extent she was unable to make her own decisions, an accusation Balwani denies. Following the collapse of Theranos, she married hotel heir Billy Evans.

Holmes's career, the rise and dissolution of her company, and the subsequent fallout are the subject of a book, Bad Blood: Secrets and Lies in a Silicon Valley Startup, by The Wall Street Journal reporter John Carreyrou, and an HBO documentary feature film, The Inventor: Out for Blood in Silicon Valley.

Contents

Early life[edit]

Elizabeth Holmes was born February 3, 1984, in Washington, D.C.[10] Her father, Christian Rasmus Holmes IV, was a vice president at Enron, an energy company that later went bankrupt after an accounting fraud scandal. Later he held executive positions in government agencies such as USAID, the EPA, and USTDA.[11][12] Her mother, Noel Anne (née Daoust), worked as a Congressional committee staffer.[13][10]

Holmes attended St. John's School in Houston.[14] During high school, she was interested in computer programming and says she started her first business selling C++ compilers to Chinese universities.[15] Her parents had arranged Mandarin Chinese home tutoring, and partway through high school, Holmes began attending Stanford University's summer Mandarin program.[16][10] In 2002, Holmes attended Stanford, where she studied chemical engineering and worked as a student researcher and laboratory assistant in the School of Engineering.[13]

After the end of her freshman year, Holmes worked in a laboratory at the Genome Institute of Singapore and tested for severe acute respiratory syndrome coronavirus (SARS-CoV-1) through the collection of blood samples with syringes.[15][17] She filed her first patent application on a wearable drug-delivery patch in 2003.[18][19] In March 2004, she dropped out of Stanford's School of Engineering and used her tuition money as seed funding for a consumer healthcare technology company.[13][20]

Theranos[edit]

Founding[edit]

In 2003 Holmes founded the company Real-Time Cures in Palo Alto, California, to "democratize healthcare".[15][21][22][23] Holmes described her fear of needles as a motivation and sought to perform blood tests using only small amounts of blood.[12][21] When Holmes initially pitched the idea to reap "vast amounts of data from a few droplets of blood derived from the tip of a finger" to her medicine professor Phyllis Gardner at Stanford, Gardner responded, "I don't think your idea is going to work", explaining it was impossible to do what Holmes was claiming could be done. Several other expert medical professors told Holmes the same thing.[12] However, Holmes did not relent, and she succeeded in getting her advisor and dean at the School of Engineering, Channing Robertson, to back her idea.[12]

In 2003, Holmes renamed the company Theranos (a portmanteau of "therapy" and "diagnosis").[24][25] Robertson became the company's first board member and introduced Holmes to venture capitalists.[13]

Holmes was an admirer of Apple founder Steve Jobs, and deliberately copied his style, frequently dressing in a black turtleneck sweater, as Jobs did.[26] Holmes says her mother dressed her in black turtlenecks when she was young,[27] but an employee says she suggested copying Jobs's famous Issey Miyake turtleneck look in 2007.[28]

During most of her public appearances, she spoke in a deep baritone voice, although a former Theranos colleague later claimed he heard her use the voice of a typical woman in her twenties to welcome him when he was new.[16]: 97 [29] Her family, however, has maintained that her baritone voice is authentic.[30][31]

Funding and expansion[edit]

By December 2004, Holmes had raised $6 million to fund the firm.[13] By the end of 2010, Theranos had more than $92 million in venture capital.[18] In July 2011, Holmes was introduced to former secretary of state George Shultz. After a two-hour meeting, he joined the Theranos board of directors.[32] Holmes was recognized for forming "the most illustrious board in U.S. corporate history" over the next three years.[33]

Holmes operated Theranos in "stealth mode" without press releases or a company website until September 2013, when the company announced a partnership with Walgreens to launch in-store blood sample collection centers.[34][35] She was interviewed for Medscape by its editor-in-chief, Eric Topol, who praised her for "this phenomenal rebooting of laboratory medicine".[36] Media attention increased in 2014, when Holmes appeared on the covers of Fortune, Forbes, T: The New York Times Style Magazine, and Inc.[37] Forbes recognized Holmes as the world's youngest self-made female billionaire and ranked her #110 on the Forbes 400 in 2014.[38] Theranos was valued at $9 billion and had raised more than $400 million in venture capital.[13][39] By the end of 2014, her name appeared on 18 U.S. patents and 66 foreign patents.[19] During 2015, Holmes established agreements with Cleveland Clinic, Capital BlueCross, and AmeriHealth Caritas to use Theranos technology.[18]

Downfall[edit]

John Carreyrou of The Wall Street Journal initiated a secret, months-long investigation of Theranos after he received a tip from a medical expert who thought the Edison blood testing device seemed suspicious.[16] Carreyrou spoke to ex-employee whistleblowers and obtained company documents. When Holmes learned of the investigation, she initiated a campaign through her lawyer David Boies to stop Carreyrou from publishing, which included legal and financial threats against both the Journal and the whistleblowers.[16][40]

In October 2015, despite Boies's legal threats and strong-arm tactics, Carreyrou published a "bombshell article"[41] detailing how the Edison device gave inaccurate results, and revealing that the company had been using commercially available machines made by other manufacturers for most of its testing.[42] Carreyrou continued to expose problems with the company and Holmes's conduct in a series of articles and, in 2018, published a book titled Bad Blood: Secrets and Lies in a Silicon Valley Startup, detailing his investigation of Theranos.[43][44]

Holmes denied all the claims, calling the Journal a "tabloid" and promising the company would publish data on the accuracy of its tests.[45][46] She appeared on CNBC's Mad Money the same evening the article was published. Cramer said, "The article was pretty brutal", to which Holmes responded, "This is what happens when you work to change things, first they think you're crazy, then they fight you, and then all of a sudden you change the world."[47]

In January 2016, the Centers for Medicare and Medicaid Services (CMS) sent a warning letter to Theranos after an inspection of its Newark, California laboratory uncovered irregularities with staff proficiency, procedures, and equipment.[48] CMS regulators proposed a two-year ban on Holmes from owning or operating a certified clinical laboratory after the company had not fixed problems in its California lab in March 2016.[49] On The Today Show, Holmes said she was "devastated we did not catch and fix these issues faster" and said the lab would be rebuilt with help from a new scientific and medical advisory board.[50][51]

In July 2016, CMS officially banned Holmes from owning, operating, or directing a blood-testing service for a period of two years. Theranos appealed that decision to a U.S. Department of Health and Human Services appeals board.[12][52] Shortly thereafter, Walgreens ended its relationship with Theranos and closed its in-store blood collection centers.[53] The U.S. Food and Drug Administration also ordered the company to cease use of its Capillary Tube Nanotainer device, one of its core inventions.[54]

In 2017, the State of Arizona filed suit against Theranos, alleging that the company had sold 1.5 million blood tests to Arizonans while concealing or misrepresenting important facts about those tests. In April 2017, the company settled the lawsuit by agreeing to refund the cost of the tests to consumers, and to pay $225,000 in civil fines and attorney fees, for a total of $4.65 million.[55][56] Other reported ongoing actions include an unspecified investigation by the U.S. Federal Bureau of Investigation and two class action fraud lawsuits. Holmes denied any wrongdoing.[12]

On May 16, 2017, approximately 99 percent of Theranos shareholders reached an agreement with the company to dismiss all current and potential litigation in exchange for shares of preferred stock. Holmes released a portion of her equity to offset any dilution of stock value to non-participating shareholders.[57][58]

In March 2018 the U.S. Securities and Exchange Commission (SEC) charged Holmes and Theranos's former president, Ramesh Balwani, with fraud by taking more than $700 million from investors while advertising a false product. On March 14, 2018, Holmes settled an SEC lawsuit.[59] The charges of fraud included the company's false claim that its technology was being used by the U.S. Department of Defense in combat situations.[60] The company also lied when it claimed to have a $100 million revenue stream in 2014. That year, the company only made $100,000.[61] The terms of Holmes's settlement included surrendering voting control of Theranos, a ban on holding an officer position in a public company for 10 years, and a $500,000 fine.[62][63][64]

At its height in 2015, Theranos had more than 800 employees.[65] It dismissed 340 people in October 2016 and an additional 155 in January 2017.[66] In April 2018, Theranos filed a WARN Act notice with the State of California, announcing its plans to permanently lay off 105 employees, leaving it with fewer than two dozen employees.[65][67] Most of the remaining employees were laid off in August 2018. On September 5, 2018, the company announced that it had begun the process of formally dissolving, with its remaining cash and assets to be distributed to its creditors.[68]

Criminal charges[edit]

On June 15, 2018, following an investigation by the U.S. Attorney's Office for the Northern District of California in San Francisco that lasted more than two years, a federal grand jury indicted Holmes and former Theranos chief operating officer and president, Ramesh "Sunny" Balwani, on nine counts of wire fraud and two counts of conspiracy to commit wire fraud. Both pleaded not guilty. Prosecutors allege that Holmes and Balwani engaged in two criminal schemes, one to defraud investors, the other to defraud doctors and patients.[7][69] After the indictment was issued, Holmes stepped down as CEO of Theranos but remained chair of the board.[8]

In June 2019, Bloomberg News reported Holmes and Balwani were looking into a possible defense strategy of blaming the media for the downfall of Theranos and whether journalist John Carreyrou's reporting caused undue influence upon government regulatory agencies in order to write a sensational story for The Wall Street Journal.[70] Later unsealed documents indicated Holmes's plans to blame Balwani, who "dominated" her to such an extent she was unable to make her own decisions. "Ms. Holmes plans to introduce evidence that Mr. Balwani verbally disparaged her and withdrew ‘affection if she displeased him’; controlled what she ate, how she dressed, how much money she could spend, who she could interact with – essentially dominating her and erasing her capacity to make decisions." Holmes may also be preparing a "mental defect" defense, to explain why she was dominated by Balwani.[71]

In October 2019, The Mercury News reported that Cooley LLP, Holmes's legal team in a class-action civil case, requested that the court allow them to stop representing her, stating that she had not paid them in a year for services, and that "given Ms. Holmes's current financial situation, Cooley has no expectation that Ms. Holmes will ever pay it for its services as her counsel."[72] In November 2019, The Recorder reported that Senior District Judge H. Russel Holland, who was overseeing the civil case, indicated that he would allow Cooley to withdraw.[73]

In February 2020, Holmes's defense requested a federal court to drop all charges against her and her co-defendant Balwani. A federal judge examined the charges and ruled that some charges should be dropped: since the Theranos blood tests were paid for by medical insurance companies, the patients were not deprived of any money or property. Prosecutors would hence not be allowed to argue that doctors and patients were fraud victims. However, the judge kept the 11 charges of wire fraud.[74][75]

In August 2020, prosecutors filed a third superseding indictment, adding a twelfth fraud charge relating to a patient's blood test. Holmes and her legal team reacted by claiming the new indictment violates her rights because the grand jury that handled it was created during the pandemic and not selected at random from a fair cross-section of the community, and they requested access to the jury selection records. Subsequently, prosecutors urged the court to deny Holmes's request, saying she was asking for too much by suggesting "without basis" that the jurors were improperly selected.[76][77]

In late August 2020, Holmes's legal team filed new motions seeking the dismissal of seven of the 12 felony fraud charges, claiming that Judge Edward Davila had made a mistake about her obligations to the Theranos investors.[78]

In September 2020, Bloomberg News reported that Holmes was exploring a "mental disease" defense for her criminal fraud trial when the judge overseeing the case ruled that government prosecutors can examine Holmes.[79][80]

In February 2021, federal government prosecutors accused Holmes and other executives of destroying evidence in Theranos's final days in business. The attorney for Holmes argued the government was to blame for their failure to preserve critical evidence. The specific evidence in question concerned the company's history of internal testing, including the accuracy and failure rates of Theranos's blood-testing systems.[81]

U.S. v. Holmes, et al.[edit]

Main article: United States v. Elizabeth A. Holmes, et al.

The criminal trial of Holmes in the case of U.S. v. Holmes, et al. (5:18-cr-00258-EJD) is being held in the United States District Court for the Northern District of California. It began on August 31, 2021,[82] after being delayed for over a year due to the COVID-19 pandemic and Holmes's pregnancy.[83] If convicted, Holmes faces a maximum sentence of twenty years in prison, and a fine of $250,000, plus restitution, for each count of wire fraud and for each conspiracy count.[82][84] The case is being prosecuted by the United States Attorney for the Northern District of California, with Holmes being defended by premier white-collar crime litigation firm Williams & Connolly. A jury was selected on September 2, 2021, composed of 7 men and 5 women who are residents of Santa Clara County.[85] The trial is expected to last at least 13 weeks.[85]

Promotional activities[edit]

Holmes partnered with Carlos Slim Helú in June 2015 to improve blood testing in Mexico.[86] In October 2015, she announced #IronSisters to help women in science, technology, engineering, and mathematics careers.[87] In 2015, she helped to draft and pass a law in Arizona to let people obtain and pay for lab tests without requiring insurance or healthcare provider approval, while misrepresenting the accuracy and effectiveness of the Theranos device.[16][88]

Connections[edit]

Theranos's board and investors included many influential figures.[16][89] Holmes's first major investor was Tim Draper – Silicon Valley venture capitalist and father of Holmes's childhood friend Jesse Draper – who "cut Holmes a check" for $1 million upon hearing her initial pitch for the firm that would become Theranos.[90][91] Theranos's pool of major investors expanded to include[89] Rupert Murdoch, the Walton family, the DeVos family including Betsy DeVos, the Cox family of Cox Enterprises and Carlos Slim Helú. Each of these investors lost tens to hundreds of millions of dollars when Theranos folded.[89]

One of Holmes's first board members was George Shultz.[16][90] With Shultz's early involvement aiding Holmes's recruitment efforts, the 12-member Theranos board eventually included:[92] Henry Kissinger, a former secretary of state; William Perry, a former secretary of defense; James Mattis, a future secretary of defense; Gary Roughead, a retired U.S. Navy admiral; Bill Frist, a former U.S. Senator (R-TN); Sam Nunn, a former U.S. Senator (D-GA); and former CEOs Dick Kovacevich of Wells Fargo and Riley Bechtel of Bechtel.[citation needed]

Recognition[edit]

Before the collapse of Theranos, Holmes received widespread acclaim. In 2015, she was appointed a member of the Harvard Medical School Board of Fellows[93] and was named one of Time magazine's "Time 100 Most Influential People".[94] Holmes received the Under 30 Doers Award from Forbes and was ranked number 73 in its 2015 list of "The World's Most Powerful Women".[95][96] She was also named Woman of the Year by Glamour and received an Honorary Doctor of Humane Letters from Pepperdine University.[97][98] Holmes was awarded the 2015 Horatio Alger Award of the Horatio Alger Association of Distinguished Americans, making her its youngest recipient in history.[24][99] She previously had been named Fortune's Businessperson of the Year and had been listed in its 40 Under 40 feature.[100][101]

Following several journalistic and criminal investigations and civil suits, regarding Theranos's business practices, she was charged with "massive fraud" by the Securities and Exchange Commission.[60] In 2016, Fortune named Holmes one of the World's Most Disappointing Leaders.[5]

Personal life[edit]

Holmes at Stanford University, April 17, 2013

Holmes was romantically involved with technology entrepreneur Ramesh "Sunny" Balwani, a Pakistani-born Hindu who immigrated to India and then the US.[16][102] She met him in 2002 at age 18, while still in school; he was 19 years older than she was and was married to another woman at the time.[103]

Balwani divorced his wife in 2002[104] and became romantically involved with Holmes in 2003, about the same time Holmes dropped out of college.[103] Although Balwani did not officially join Theranos until 2009, when he was given the title of chief operating officer, he was advising Holmes behind the scenes before then; the couple moved into an apartment together in 2005.[103] Holmes and Balwani ran the company jointly in a corporate culture of "secrecy and fear".[103] Their romantic relationship was hidden for much of the time they jointly ran the company.[105] He left Theranos in 2016 in the wake of investigations. The circumstances of his departure are unclear; Holmes has stated that she fired him, but Balwani says that he left of his own accord.[103]

Before the March 2018 settlement, Holmes owned half of Theranos's stock.[15] Forbes listed her as one of America's Richest Self-Made Women in 2015 with a net worth of $4.5 billion.[39] In June 2016, Forbes released an updated valuation of $800 million for Theranos, which made Holmes's stake essentially worthless, because other investors owned preferred shares and would have been paid before Holmes, who owned only common stock.[4] Holmes reportedly owed a $25 million debt to Theranos in connection with exercising options. She did not receive any company cash from the arrangement, nor did she sell any of her shares, including those associated with the debt.[106][107][108]

In early 2019, Holmes became engaged to William "Billy" Evans, a 27-year-old heir to Evans Hotels,[109] a family-owned group of hotels in the San Diego area.[110] In mid-2019, Holmes and Evans married in a private ceremony.[111][112] The couple lives in San Francisco.[110] Holmes gave birth to a boy in July 2021.[113]

In the media and influences[edit]

Holmes has been credited with creating a negative stigma for other women entrepreneurs, particularly in the sciences and health care industries, who are often compared to her; writing in The New York Times, technology journalist Erin Griffith commented that "Holmes continues to loom large across the start-up world because of the audacity of her story, which has permeated popular culture", with women entrepreneurs reporting that "the frequent comparisons are pernicious".[114] Investor and executive Ellen Pao wrote in a New York Times opinion piece that Holmes was targeted for prosecution because of "sexism", and that her trial was a "wake-up call for sexism in tech".[115]

Holmes has been featured in a number of media works:[116]

  • In May 2018, author John Carreyrou released the book Bad Blood: Secrets and Lies in a Silicon Valley Startup, describing the life of Holmes and the inner workings of Theranos.[117] The film rights to Carreyrou's book were purchased by Legendary nearly two years before the book was published.[118]

  • In January 2019, ABC News, Nightline, and Rebecca Jarvis released a podcast and documentary about the Holmes story called The Dropout. It included interviews and deposition tapes of key figures, including Elizabeth Holmes, Sunny Balwani, Christian Holmes (Elizabeth's brother), Tyler Shultz (Theranos whistleblower and grandson of Board Member George Shultz), Theranos board members Bill Frist, Gary Roughead, Robert Kovacevichz and others. The series also featured an interview with Jeff Coopersmith, the attorney representing Balwani.[119][90]

  • On March 18, 2019, HBO premiered the documentary The Inventor: Out for Blood in Silicon Valley, a two-hour documentary film first shown at the Sundance Film Festival on January 24, 2019. It portrays the claims and promises made by Holmes in the last years of Theranos and how ultimately the company was brought down by the weight of many falsehoods. The documentary ends in 2018, with Holmes and Balwani indicted for multiple crimes.[120]

  • On April 10, 2019, Deadline reported that Hulu would launch a TV series based on The Dropout podcast, also called The Dropout.[121] In March 2021, Amanda Seyfried was cast to star in it.[122]

  • Season 7, episode 12 of the US comedy-drama Younger (first broadcast on June 10, 2021) features a musical number about famous scammers, in which Elizabeth Stanley portrays Holmes.[citation needed]

  • On August 8, 2021, the Australian newsmagazine 60 Minutes featured the Theranos story and Holmes's upcoming trial.[123]

References[edit]

Further reading[edit]

External links[edit]


Wikimedia Commons has media related to Elizabeth Holmes.




Annals of Innovation

December 15, 2014 Issue

Blood, Simpler

One woman’s drive to upend medical testing.

By Ken AulettaDecember 8, 2014

Elizabeth Holmes says that her test can help detect ailments from just a few drops of blood.Photograph by Jenny Hueston

One afternoon in early September, Elizabeth Holmes took the stage at tedmed, at the Palace of Fine Arts, in San Francisco, to talk about blood. tedmed, a part of the Technology, Entertainment, and Design enterprise, is an annual conference devoted to health care; its speakers span a range of inquiry from Craig Venter, the genomic scientist, discussing synthetic life, to Ozzy Osbourne discussing his decision to get his entire genome sequenced. The phrases “disruptive technology” and “the future of medicine” come up a lot.

Holmes, who is thirty, is the C.E.O. of Theranos, a Silicon Valley company that is working to upend the lucrative business of blood testing. Blood analysis is integral to medicine. When your physician wants to check some aspect of your health, such as your cholesterol or glucose levels, or look for indications of kidney or liver problems, a blood test is often required. This typically involves a long needle and several blood-filled vials, which are sent to a lab for analysis. Altogether, diagnostic lab testing, including testing done by the two dominant lab companies, Quest and Laboratory Corporation of America, generates seventy-five billion dollars a year in revenue.

Holmes told the audience that blood testing can be done more quickly, conveniently, and inexpensively, and that lives can be saved as a consequence. She was wearing her daily uniform—a black suit and a black cotton turtleneck, reminiscent of Steve Jobs—and had pinned her hair into an unruly bun. As she spoke, she paced slowly, her eyes rarely blinking, her hands clasped at her waist. Holmes started Theranos in 2003, when she was nineteen; she dropped out of Stanford the following year. Since then, she told the audience, the company has developed blood tests that can help detect dozens of medical conditions, from high cholesterol to cancer, based on a drop or two of blood drawn with a pinprick from your finger. Theranos is working to make its testing available to several hospital systems and is in advanced discussions with the Cleveland Clinic. It has also opened centers in forty-one Walgreens pharmacies, with plans to open thousands more. If you show the pharmacist your I.D., your insurance card, and a doctor’s note, you can have your blood drawn right there. (The sample is then sent to a Theranos lab.) From that one sample, Holmes said, several tests can be run—all less expensive than standard blood tests, sometimes as much as ninety per cent below the rates that Medicare sets. A typical lab test for cholesterol can cost fifty dollars or more; the Theranos test at Walgreens costs two dollars and ninety-nine cents.

In conversation, Holmes speaks in a near-whisper; onstage, her voice drops an octave and takes on a formal instructional cadence. The tedmed crowd listened intently as she spelled out what she sees as the shortcomings of the existing blood-testing business. The tests are too costly, are available at inconvenient times or places, and involve unpleasant syringes. Holmes has an aversion to needles, and her mother and her grandmother fainted at the sight of them and at the sight of blood. Recently, she told me, “I really believe that if we were from a foreign planet and we were sitting here and said, ‘O.K., let’s brainstorm on torture experiments,’ the concept of sticking a needle into someone and sucking blood out slowly, while the person watches, probably qualifies.”

Holmes thinks that getting a blood test should instead be a “wonderful” experience, and the aim of Theranos is to lower the barriers. She told the crowd that between forty and sixty per cent of people who are ordered by their doctor to get a blood test do not. Diabetes, sexually transmitted diseases, and other common medical conditions could be diagnosed and treated earlier if the tests were less onerous and more accessible, she said. “We see a world in which no one ever has to say, ‘If only I’d known sooner.’ A world in which no one ever has to say goodbye too soon.”

Theranos, which is privately held, is both a hardware company and a medical company, and for many years it has operated with a stealth common to many Silicon Valley startups. “For a long time, I couldn’t even tell my wife what I was working on,” Channing Robertson, a chemical-engineering professor at Stanford and the company’s first board member, told me. In recent months, Holmes has been giving similar versions of her tedmed presentation in talks and interviews around the country. Investors have valued the company at more than nine billion dollars, comparable to the two major diagnostic labs. Holmes owns more than fifty per cent of the company; she was profiled last spring in Fortune and subsequently featured in Forbes as “the youngest self-made female billionaire in the world.” The board of her company is stocked with prominent former government officials, including George P. Shultz, Henry Kissinger, Sam Nunn, and William H. Foege, the former director of the Centers for Disease Control and Prevention. Dr. Delos M. Cosgrove, the C.E.O. and president of the Cleveland Clinic, is an avid supporter. “I think it’s potentially a breakthrough company,” he told me. “It represents a major change in how we deliver health care.”

The company’s rise comes at a time when consumers are increasingly eager for access to their personal data. The plummeting costs of DNA-sequencing technology have made it possible for companies such as 23andme to provide individuals with their genetic information directly, rather than through doctors, empowering nerdy customers and self-motivated patients. Smartphone apps let users track their heart rates, their sleep cycles, and the number of steps they’ve taken, and share the data with a doctor or with friends. In her talk, Holmes said, “My own life’s work in building Theranos is to redefine the paradigm of diagnosis away from one in which people have to present with a symptom in order to get access to information about their bodies to one in which every person, no matter how much money they have or where they live, has access to actionable health information at the time it matters.” Cosgrove predicts that blood tests for many common health issues, including high cholesterol and diabetes, will be initiated by patients as well as by doctors. “The CVSs and the Walgreens and the Walmarts of the world are going to be taking a lot of things that currently go to primary-care physicians,” he said. “The impact of that on our industry will be enormous.”

But unfiltered medical data aren’t a pure virtue. Last year, the U.S. Food and Drug Administration barred 23andme from disseminating some information out of concern that consumers might misunderstand or misuse it. Some observers are troubled by Theranos’s secrecy; its blood tests may well turn out to be groundbreaking, but the company has published little data in peer-reviewed journals describing how its devices work or attesting to the quality of the results. “It’s trying to apply the Steve Jobs way of keeping everything secret until the iPhone was released,” Lakshman Ramamurthy, a molecular biologist and a former associate director at the F.D.A., told me. “But a health test is more consequential than a consumer product. It needs to be clinically valid and provide useful information.”

Holmes counters that Theranos is only trying to protect itself from competitors while it tries to do something unique. “There isn’t a company that does what we do,” she told me. “We’re creating a new space. We’re in a market for people who don’t like having a needle stuck in their arm.”

The day after her tedmed talk, I met with Holmes in a conference room at the Theranos headquarters, a single-story building two blocks from the Stanford campus. (In November, Theranos moved its main offices to a larger space a few miles away.) Her home is a two-bedroom condo in Palo Alto, and she lives an austere life. Although she can quote Jane Austen by heart, she no longer devotes time to novels or friends, doesn’t date, doesn’t own a television, and hasn’t taken a vacation in ten years. Her refrigerator is all but empty, as she eats most of her meals at the office. She is a vegan, and several times a day she drinks a pulverized concoction of cucumber, parsley, kale, spinach, romaine lettuce, and celery.

Growing up, Holmes was in constant motion. Her father, Chris, worked for government agencies, including, for much of his career, the U.S. Agency for International Development and the State Department, often travelling abroad, overseeing relief and disease-eradication efforts in developing nations; today, he is the global water coördinator for U.S.A.I.D. Her mother, Noel, worked for nearly a decade as a foreign-policy and defense aide on Capitol Hill, until Elizabeth and her brother Christian, two years younger, were born. The family moved several times, which meant there was little opportunity to develop lasting friendships. Holmes describes herself as a happy loner, collecting insects and fishing with her father.

“I was probably, definitely, not normal,” she said. “I was reading ‘Moby-Dick’ from start to finish when I was about nine. I read a ton of books. I still have a notebook with a complete design for a time machine that I designed when I must have been, like, seven. The wonderful thing about the way I was raised is that no one ever told me that I couldn’t do those things.”

Chris Holmes’s great-grandfather Christian Holmes emigrated from Denmark, studied engineering, settled in Cincinnati, and became a physician. When Elizabeth was eight, she was given a tour of the local hospital where he worked and which was named in his honor. He had married the daughter of a patient, Charles Fleischmann, who pioneered packaged yeast and built a baking empire around it. (A nephew, Raoul Fleischmann, started this magazine in 1925, with Harold Ross.) Not all of Fleischmann’s children shared his entrepreneurial drive, and this was a common subject of conversation in the Holmes household. “I grew up with those stories about greatness,” she said, “and about people deciding not to spend their lives on something purposeful, and what happens to them when they make that choice—the impact on character and quality of life.”

In 1993, when Elizabeth was nine, her father took a job in Houston, as executive assistant to the C.E.O. of Tenneco, which was then a manufacturing and energy conglomerate. She knew that her father felt guilty for uprooting the family, so she wrote a letter to console him: “What I really want out of life is to discover something new, something that mankind didn’t know was possible to do.” She reassured him that Texas suited her, because “it’s big on science.”

For several years in the nineteen-eighties, Chris Holmes spent two weeks a month in China, helping American companies invest in large-scale development projects. Soon after the family moved to Houston, Elizabeth started studying Mandarin; by the summer following her sophomore year of high school, she was intent on taking summer classes in Mandarin at Stanford. She repeatedly called the admissions office for information, only to be told, each time, that the program did not enroll high-school students. One day, her father recalls, the head of the program became so annoyed that he grabbed the phone from the employee who was talking to Holmes. “You’ve been calling constantly,” he told her. “I just can’t take it anymore. I’m going to give you the test right now!” He asked questions in Mandarin; she answered fluently, and he accepted her on the spot. She completed three years of college Mandarin while still in high school.

“O.K., one last big rhubarb score. But then I’m out of the pie game for good.”

In 2001, in her senior year, Holmes applied to Stanford, was accepted, and then was named a President’s Scholar, which came with a small stipend to select her own research project. Her parents sent her off with a copy of Marcus Aurelius’ “Meditations,” her father said, “to convey to her: Live a purposeful life.” Holmes elected to study chemical engineering. She was drawn to the work of Channing Robertson, the chemical engineer and, at the time, a dean at the engineering school. Robertson is seventy-one and fit, with thinning hair and a relaxed smile; I visited him in his home on campus. Holmes’s first class with him was a seminar on devices designed to control the release of drugs into the human body. One day, in her freshman year, Robertson said, she came to his office to ask if she could work in his lab with the Ph.D. students. He hesitated, but she persisted and he gave in. At the end of the spring term, she told him that she planned to spend the summer working at the Genome Institute, in Singapore. He warned her that prospective students had to speak Mandarin.

“I’m fluent in Mandarin,” she said.

“I’m thinking, What’s next? She’s already coming into the research group meetings at the end of her freshman year with my Ph.D. students. I find myself listening to her more than to them about the next experiments to be done and the progress that’s been made. I realized she’s different.”

That summer, at the Genome Institute, Holmes worked on testing for severe acute respiratory syndrome, or sars, an often fatal virus that had broken out in China. Testing was done in the traditional manner, by collecting blood samples with syringes and mucus with nasal swabs. These methods could detect who was infected, but a separate system was needed to dispense medication, and still another system to monitor results. Holmes questioned the approach. At Stanford, she had been exploring what has become known as lab-on-a-chip technology, which allows multiple measurements to be taken from tiny amounts of liquid on a single microchip. “With the type of engineering work and systems I had been focussing on at Stanford, it was quite clear that there were much better ways to do it,” she said.

Before returning to Stanford, Holmes conceived of a way to perform multiple tests at once, using the same drop of blood, and to wirelessly deliver the resulting information to a doctor. That summer, she filed a patent for the idea; it was ultimately approved, in November of 2007. Once back on campus, she went to see Robertson in his office and announced that she wanted to start a company. Robertson was impressed by the idea but urged her to at least consider finishing her degree first.

“Why?” she responded. “I know what I want to do.”

Holmes was consumed by the idea of developing a company. “I got to a point where I was enrolled in all these courses, and my parents were spending all this money, and I wasn’t going to any of them,” she said. “I was doing this full time.” Her parents allowed her to take the money they had set aside for tuition and use it to seed her company. In March, 2004, she dropped out of Stanford; one month later, she incorporated Theranos (the name is a combination of “therapy” and “diagnosis”). She persuaded Robertson to spend one day a week as a technical adviser to the company and to serve as her first board member. Eventually, he retired from his tenured position, and began working at Theranos full time.

Robertson introduced Holmes to several venture capitalists. She insisted that they abide by her terms, which included an understanding that she would retain control and pour the profits back into the company. By December of 2004, she had raised six million dollars from an assortment of investors. As she and the chemists and engineers dug deeper, she became convinced that they could accomplish five objectives: extract blood without syringes, make a diagnosis from a few drops of blood, automate the tests to minimize human error, do the test and get the results more quickly, and do this more economically.

A key to the company’s success was the hiring of Sunny Balwani, a software engineer, now forty-nine, whom Holmes had met in Beijing the summer after her senior year of high school. At the time, he was getting an M.B.A. from Berkeley. He had worked at Lotus and at Microsoft and been a successful entrepreneur, and in 2004 he began graduate studies in computer science at Stanford. He and Holmes spoke often, and they shared a belief that software, not just chemistry or biology, mattered. If Theranos was going to be able to analyze a few drops of blood, engineers would have to develop the software to do it. In 2009, Balwani joined as C.O.O. and president. “Our platform is about automation,” he says. “We have automated the process from start to finish.”

Theranos has managed to keep its technology a secret for much of its decade of existence in part because it occupies a regulatory gray area. Most other diagnostic labs, including Quest and Laboratory Corporation of America, perform blood tests on equipment that they buy from outside manufacturers, like Siemens and Roche Diagnostics. Before those devices can be sold, they must be approved by the F.D.A., a process that makes their tests’ performances more visible to the public. But, since Theranos manufactures its own testing equipment, the F.D.A. doesn’t need to approve it, as long as the company doesn’t sell it or move it out of its labs. Holmes said that the company has long resisted discussing how its technology works or how it makes money in order to avoid tipping off potential competitors.

The company employs seven hundred people and, in addition to its headquarters, has a two-hundred-and-sixty-five-thousand-square-foot facility, in Newark, California, that manufactures the blood-testing devices. Holmes says that Theranos has a positive cash flow; it is clearly expanding. For many years, it has earned income from large pharmaceutical companies, including Pfizer and GlaxoSmithKline, which use its tests when they are conducting clinical trials on new drugs. It also earns revenue from the “wellness centers” that it has set up in Walgreens stores, its hospital work, and the U.S. military, although Holmes would not discuss the company’s arrangments with the latter.

In 2013, Theranos announced a “long-term partnership” with Walgreens that will eventually establish its wellness centers in most of the eighty-two hundred Walgreens stores. The Walgreens in Palo Alto has one, as do forty Walgreens pharmacies in Phoenix. Holmes envisages wellness centers in most Walgreens and Duane Reade stores, which would put Theranos “within five miles of every American.” Theranos also could sign up the rival drugstore chain CVS, which has seventy-eight hundred outlets.

One morning, I went to the Palo Alto Walgreens to get my blood tested. A trained phlebotomist wrapped my finger in a warming sleeve to help the blood flow and then swabbed it with alcohol. Then, with a slight pinch from a small, square lancet containing a pricking pin, she drew two drops of blood, which she siphoned into a dime-size container. This took about two minutes. The container, marked with a bar code, was placed in a refrigerated box to be picked up and delivered to a Theranos lab a couple of miles away; the box pickup and return takes place three times a day.

The lab is a large, labyrinthine place bustling with chemists and technicians, and housing rows of machines, each easy for a single person to lift, in which the containers of blood are placed. What exactly happens in the machines is treated as a state secret, and Holmes’s description of the process was comically vague: “A chemistry is performed so that a chemical reaction occurs and generates a signal from the chemical interaction with the sample, which is translated into a result, which is then reviewed by certified laboratory personnel.” She added that, thanks to “miniaturization and automation, we are able to handle these tiny samples.”

Theranos owes its success in part to its high-powered board, which Holmes corralled with the help of George Shultz, a Palo Alto resident, who, in his long career, has held four Cabinet positions, including Secretary of the Treasury and Secretary of State. Shultz is ninety-three and a fellow at Stanford’s Hoover Institution; Holmes first met him in 2011. “It was one of those scheduled ten-minute meetings that turn into a two-hour meeting,” she said.

Shultz agreed to join the board, and he meets with Holmes weekly. He introduced her to several other current board members: Bill Frist, a trained cardiac surgeon and former Senate Republican Majority Leader; Henry Kissinger, the former Secretary of State; Sam Nunn, a former Democratic senator and chairman of the Armed Services Committee; William J. Perry, the former Defense Secretary; and Richard Kovacevich, a former C.E.O. and chairman of Wells Fargo. All receive stock options from the company, among other forms of compensation. Kissinger, who is ninety-one, told me that Holmes “has a sort of ethereal quality—that is to say, she looks like nineteen. And you say to yourself, ‘How is she ever going to run this?’ ” She does so, he said, “by intellectual dominance; she knows the subject.”

Board members are clearly charmed by Holmes. She is a careful listener, and she is unnervingly serene; employees say that they can’t remember an instance when she raised her voice. “She has sometimes been called another Steve Jobs, but I think that’s an inadequate comparison,” Perry, who knew Jobs, said. “She has a social consciousness that Steve never had. He was a genius; she’s one with a big heart.”

Holmes said that she had looked for “different kinds of people” for her twelve-member board. I pointed out that the membership includes no women. “Hopefully, I qualify,” she said. Equally notable is the fact that eight members are former elected, federal, or military officials. Aside from Frist, the one other board member with a medical license is William Foege, the former C.D.C. director. Holmes has established a medical task force, chaired by her and Dr. David Helfet, the director of the orthopaedic trauma service at New York’s Hospital for Special Surgery and New York-Presbyterian Hospital. I asked Holmes if the board was designed to attract government contracts.

“We don’t have any government contracts,” she said. “I’ve never applied for one, and I don’t plan to.” Theranos has conceded that it does earn revenue from the military, which Holmes calls “a really important area in terms of potential” for saving lives. But she said that the company’s policy has been to make its testing available “for far less than the government is willing to pay us.” She added that it would be “insulting” to suggest that her board members function as lobbyists. She views them as partners who are helping her to chart strategy. Kovacevich said that he brings business experience to the board. “I know most of the major retail-company C.E.O.s,” he told me, including Gregory D. Wasson, the C.E.O. of Walgreens. Kissinger advised Holmes to concentrate on building up Theranos in the U.S. before launching it in developing nations, he said, so that “it would not look like we were experimenting on them.”

Holmes and her board members like to emphasize how technologically advanced Theranos is; the implicit comparison is with the existing diagnostic behemoths such as Quest Diagnostics. The blood-test business is “dictated by the people who make the big machines,” Frist said, and they “obviously have a vested interest in keeping their technology out there.” He added, “You don’t need four tubes of blood” for a range of tests, or “this 1940 technology.”

Nigel Clarke, Quest’s senior scientific director for mass spectrometry, immunology, and automation, disagreed. I met Clarke in late September during a visit to Quest’s main lab center, near Teterboro Airport, in New Jersey. Quest runs about thirty full-service laboratories around the country; it performs six hundred million tests of all kinds annually—Theranos’s aim is to hit one million blood tests in 2015—and owns four thousand vehicles for picking up samples. The samples are delivered to an assembly line of machines, some larger than an S.U.V., that process vials of blood as they move along on conveyor belts. Instruments on the machines then identify the amount and the characteristics of chemicals present in a blood sample, using a technique called mass spectrometry. Clarke maintains that these blood tests are as comparable to those of 1940 as a Lamborghini is to the Model T. He says that, over the past decade or so, the amount of blood needed has been reduced from two full vials to one-fifth of one vial.

The process is more automated than Frist suggests, but it is labor-intensive. Samples from hospitals and doctors’ offices are labelled and packed in sealed plastic bags by phlebotomists. The samples are then picked up and delivered by drivers to a central lab, where they are manually sorted into various bins and then placed on the conveyor belts by hand. Holmes says that Theranos’s operation is more automated, but it doesn’t run itself. The partnership with pharmacies and hospitals will entail opening labs within easy distance of participating centers. The blood samples are much smaller than what Quest requires and are labelled digitally, but they still need to be picked up, and delivered, and handled by a technician—no small logistical task, and not free of the potential for human error.

Quest takes issue with several other of Theranos’s claims. Holmes has argued that people want their blood tests to be more convenient; as evidence, she often states that between forty and sixty per cent of patients who are asked to get blood tests fail to do so. Theranos has developed these numbers internally, in part, Holmes said, through consumer surveys. Dermot V. Shorten, Quest’s vice-president of strategy and ventures, told me the figure is lower. “The number is thirty per cent,” he said, citing Quest’s own figures. He added, “It is a huge number.” He also said, less plausibly, “I don’t think we’ve ever heard that fear of needles was a reason.”

Clarke argues that finger-stick blood tests aren’t reliable for clinical diagnostic tests; because the blood isn’t drawn from a vein, the sample can be contaminated by lanced capillaries or damaged tissue. Holmes strongly disagrees: “We have data that show you can get a perfect correlation between a finger stick and a venipuncture for every test that we run.” When I asked for evidence, I was sent a document by Daniel P. Edlin, Theranos’s senior product manager, titled “Select Data.” It purported to show favorable results from numerous comparison tests. I asked Edlin if the tests had been conducted by an independent third party. He replied by e-mail: “The clinical tests were conducted by a combination of Theranos and external labs,” but he wouldn’t say which ones.

When I asked Holmes for evidence that her tests were independently audited, she said that there have been “tens” of audits and “external third-party comparisons” of Theranos’s tests, including those done by the hospital groups that are adopting its finger-prick tests and the pharmaceutical companies that have contracted with Theranos for testing their products. Holmes says thatTheranos is certified in forty-eight states, with two more applications pending, under the federal Clinical Laboratory Improvement Amendments of 1988. Under the amendments, laboratories like hers must be certified before they can perform tests for the general public, and their performance is evaluated three times a year by the College of American Pathologists. Holmes also pointed me to a pilot study published by Hematology Reports, an online-only peer-reviewed journal; she is listed as a co-author. The report, released in April, concluded that Theranos tests “correlated highly with values obtained” from standard lab tests.

The company’s reluctance to share its results or display its devices has prompted wariness among some physicians and medical officials. Lakshman Ramamurthy, the former associate director at the F.D.A., is concerned. “The technology should have peer review,” he said. To claim, as Theranos does, “that with a finger stick you can do hundreds of tests, your technology has to be different.” He added, “Does that not need some peer review?”

Technically, it doesn’t. “Typically, laboratories are not required to disclose data on how their tests work,” Alberto Gutierrez, the director of the F.D.A.’s office of in-vitro diagnostics and radiological health, told me. The F.D.A. imposes rigorous standards on companies seeking approval to sell new drugs. But most blood tests aren’t monitored by the F.D.A. and don’t receive the same level of pre-approval scrutiny. The labs are effectively left to police themselves. Gutierrez said that the F.D.A. is in the process of developing new guidelines for oversight of tests that labs develop for their own use in-house.

Holmes says that she welcomes government monitoring. She says that Theranos has submitted all its lab-developed tests for F.D.A. approval—a step that isn’t required and that no other diagnostic company has taken. “We believe that to realize our vision we must operate at the highest levels of excellence,” she told me. “And the F.D.A.’s stamp of approval is seen as an indicator of the quality of a product.” However, it’s unclear whether the F.D.A. has a mechanism for responding to the company’s request. The agency did not indicate if or when any kind of approval might be granted.

“When Theranos tells the story about what the technology is, that will be a welcome thing in the medical community,” Eric Topol, a cardiologist and geneticist and the director of the Scripps Translational Science Institute, in La Jolla, California, said. “Until it does that, it can have the big labs saying Theranos is not real, or is not a threat. I tend to believe that Theranos is a threat. But if I saw data in a journal, head to head, I would feel a lot more comfortable.”

Theranos has raised more than four hundred million dollars from numerous investors, including the founder of Oracle, Larry Ellison. Holmes believes that the seventy-five-billion-dollar testing marketplace could grow to two hundred billion dollars, as more people take it upon themselves to go to a pharmacy and request blood tests for pregnancy, high cholesterol, and other common medical issues. At the moment, most such blood tests require a doctor’s note; Holmes says that this would have to change, and could. “There are states in the U.S. where citizens can order tests directly,” she said. “The fact that in some states it’s illegal for someone to be able to get basic data about their body—for example, you’re pregnant or you’re not, you have an allergy or you don’t. Not a lot of sophistication has to go into the interpretation of that test.”

For all of her practice at presentation, Holmes still sometimes has an engineer’s difficulty in clearly articulating how Theranos will advance the cause of preventive medicine. At tedmed, she noted that diabetes, which is a major source of health-care costs, can be reversed through changes in life style. “Yet today there are eighty million Americans who are pre-diabetic,” she told the crowd, “and ninety per cent of them don’t know that they are.” Holmes figures that pre-diabetics aren’t gaining this knowledge either because they don’t visit the doctor or because they avoid the blood test, or both. Instead, she assumes that Theranos will make getting a blood test so simple and painless that it will become something that we do before visiting the doctor, or that we think to do on our own; the results would be forwarded to the physician, as a basis for further discussion.

Holmes insists that Theranos would be serving doctors, not replacing them. “If a test is abnormal, most people will want to have some type of treatment,” she told me. “People say, ‘What does Theranos mean?’ The simplest way to explain it is detection at the onset of disease in time for therapy to be effective. The detection piece”—Theranos’s role—“is half of the equation. The therapy piece is the other half.”

Prescriptionless blood tests raise a host of questions. “Will insurance be willing to pay for patient-ordered blood tests?” Bruce Deitchman, a dermatologist and pathologist, said. Deitchman has served as an alternate member of the American Medical Association’s expert panel that recommends reimbursement rates to Medicare. “Will Theranos insist that test results be sent to physicians, and will patients want their doctors to know?” He noted that doctors are legally obligated to follow up and address abnormal blood tests with patients. In the absence of a doctor, will Theranos be held to that standard? Still, Deitchman added, getting patients involved in their own care “can lead to better health outcomes.”

Some experts see the changes to health care such as those envisaged by Theranos as inevitable, and mostly for the good. “Regardless of how doctors or anyone else may feel about it, this type of innovation is going to happen, and probably needs to happen,” Andy Ellner, a physician and the co-director of the Harvard Medical School Center for Primary Care, said. “There is going to be a big shift in power, control, and authority of health data from doctors to patients.” But Ellner added that there is “very little evidence” that paying more attention to blood tests, or doing more tests over all, will have an impact on people’s health. Of diabetes, in particular, he said that there is only “modest evidence that screening for it in particular populations helps us intervene earlier in a way that benefits people. The main value of knowing that someone is pre-diabetic is that it confirms what we already know: that people should be eating a better diet and exercising more.”

Holmes faces a number of challenges as she pursues her vision for Theranos. One is logistical. Holmes’s brother, Christian, a Duke graduate and former management consultant who joined the company three years ago and is now the director of product management, says, “You’ve got to be able to scale this. If we can’t, we’ll get killed.” Another challenge is the competition. As miniaturization becomes the standard, researchers are finding ways to bring medical tests directly to patients. Many companies are exploring a range of tests that don’t require needles, relying instead on lasers, oximetry, biosensors, and medical imaging, such as MRIs.

Holmes says she is acutely aware that technology could disrupt Theranos. “We focus all the time on disrupting ourselves, and that’s one of the core tenets in the way we operate,” she said. “Silicon Valley is a great symbol of disruptive technology being able to, one, change the world, and, two, obsolete itself.”

Late one afternoon in September, Holmes was driven from Palo Alto to the San Francisco airport, where she boarded a seven-seat Gulfstream 150 for a flight to Chicago. She would be speaking at a panel; from there she would fly to Cleveland to attend meetings at the Cleveland Clinic. She was travelling alone. Members of the Theranos board sometimes worry about Holmes. “My wife and I feel that one of our jobs is to bring her out,” George Shultz told me. They invite her to the theatre, and this year threw her a thirtieth-birthday party at their home, which was attended by her parents, her brother, Balwani, Robertson, and several members of the board and their spouses. Henry Kissinger and his wife, Nancy, have tried, without success, to fix her up on dates. Her mother told me, “As a parent, I do hope that at some point she will have time for herself.”

This concern is lost on Holmes. The plane had reached cruising altitude, far above a bank of clouds, and another green vegetable drink had materialized in her hand. “I have done something, and we have done something, that has changed people’s lives,” she told me. “I would much rather live a life of purpose than one in which I might have other things but not that.” Also, she said, with a smile, “I think I’m very young. Still.” ♦

This article appears in the print edition of the December 15, 2014, issue.

  • Ken Auletta began contributing to The New Yorker in 1977 and has written the Annals of Communications column since 1993.Read more »