tag:theconversation.com,2011:/us/topics/elizabeth-holmes-55085/articlesElizabeth Holmes – The Conversation2023-12-01T16:10:14Ztag:theconversation.com,2011:article/2187422023-12-01T16:10:14Z2023-12-01T16:10:14ZSantos, now booted from the House, got elected as a master of duplicity – here’s how it worked<figure><img src="https://images.theconversation.com/files/562816/original/file-20231130-15-kdugvt.jpeg?ixlib=rb-1.1.0&rect=9%2C9%2C6508%2C4319&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Rep. George Santos in the U.S. Capitol on Nov. 7, 2023. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/rep-george-santos-r-n-y-leaves-a-meeting-of-the-house-news-photo/1769554374?adppopup=true">Tom Williams/CQ-Roll Call, Inc via Getty Images</a></span></figcaption></figure><p>U.S. Rep. George Santos, a Republican from New York, was expelled on Dec. 1, 2023, from Congress for doing what most people think all <a href="https://theconversation.com/all-politicians-must-lie-from-time-to-time-so-why-is-there-so-much-outrage-about-george-santos-a-political-philosopher-explains-197877">politicians</a> <a href="https://journals.sagepub.com/doi/abs/10.1177/0261927X8800700204">do all the time</a>: lying.</p>
<p>Santos lied about his <a href="https://www.nytimes.com/2023/01/04/opinion/george-santos-jewish-heritage.html">religion</a>, <a href="https://www.advocate.com/politics/2022/12/22/george-santos-hid-marriage-woman-says-hell-explain-alleged-lies">marital status</a>, <a href="https://www.cnn.com/2022/12/26/politics/george-santos-admits-embellishing-resume/index.html">business background</a>, <a href="https://www.vanityfair.com/news/2023/01/george-santos-facebook-comment-hitler-jews-black-people">grandparents</a>, <a href="https://www.nytimes.com/2022/12/26/nyregion/george-santos-interview.html">college</a>, <a href="https://nymag.com/intelligencer/article/guide-george-santos-lies.html#:%7E:text=He%20lied%20about%20where%20he%20went%20to%20high%20school%20%E2%80%A6&text=But%20a%20spokesperson%20for%20the,a%20high%2Dschool%20equivalency%20diploma.">high school</a>, <a href="https://www.washingtonpost.com/politics/2023/01/11/santos-lies-volleyball/#:%7E:text=George%20Santos%20lied%20about%20being,star%2C'%20county%20GOP%20chair%20says&text=George%20Santos%20allegedly%20told%20a,he%20claimed%20to%20have%20played.">sports-playing</a>, <a href="https://www.justice.gov/usao-edny/pr/congressman-george-santos-charged-fraud-money-laundering-theft-public-funds-and-false">income</a> and <a href="https://ethics.house.gov/sites/ethics.house.gov/files/documents/Committee%20Report_52.pdf">campaign donation expenditures</a>.</p>
<p>Santos’ fellow members of Congress – a professional class <a href="https://www.pewresearch.org/politics/2023/09/19/evaluations-of-members-of-congress-and-the-biggest-problem-with-elected-officials-today">stereotypically</a> considered by the public to be littered with serial liars – apparently consider Santos peerless and are kicking him out of their midst <a href="https://www.nytimes.com/interactive/2023/12/01/us/politics/santos-expulsion-vote.html">on a 311-114 vote, with two members voting present</a>. </p>
<p>How could a politician engage in such large-scale deception and get elected? What could stop it from happening again, as politicians seem to be growing more <a href="https://www.washingtonpost.com/politics/joe-bidens-long-running-no-apology-tour-hits-the-metoo-era/2019/04/04/caf47bdc-56e7-11e9-9136-f8e636f1f6df_story.html">unapologetically</a> <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/psq.12809">deceptive</a> while evading voters’ scrutiny? </p>
<p>Santos’ success demonstrates a mastery of something more than just pathological lying. He managed to campaign in a district close to the media microscope of New York City, in one of the richest <a href="https://datausa.io/profile/geo/congressional-district-3-ny">districts</a> in the state, and get elected and stay in office for a year, despite making a mockery of any <a href="https://nymag.com/intelligencer/article/guide-george-santos-lies.html">semblance of honesty</a>. </p>
<p>I am <a href="https://scholar.google.com/citations?user=50tVKogAAAAJ&hl=en">a scholar of political deception</a>. <a href="https://doi.org/10.1080/03637751.2023.2244030">Experiments I conducted</a> have revealed how the trustworthiness of politicians is judged almost entirely from perceptions of their demeanor, not the words they utter.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/t8zU8yX0TcA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Politicians lie, as this compilation shows.</span></figcaption>
</figure>
<h2>Misleading with a smile</h2>
<p>I have found that voters are drawn in by politicians’ demeanor cues, which are forms of body language and nonverbal communication that signal honesty or dishonesty and yet have no relationship to actual honesty. For example, looking nervous and fidgety or appearing confident and composed are demeanor cues, which give impressions of a politician’s sincerity and believability. Someone’s demeanor cues might signal that they are trustworthy when they’re actually lying, or could signal lying in someone who is actually telling the truth.</p>
<p>The <a href="https://doi.org/10.1111/j.1468-2958.2011.01407.x">most authoritative index</a> of demeanor cues that affect people’s perceptions of honesty and deception was developed <a href="https://www.uab.edu/cas/communication/people/faculty/timothy-r-levine">by Tim Levine</a>, a professor of communication at the University of Alabama, Birmingham. Demeanor cues that convey sincerity and honesty include appearing confident and composed; having a pleasant, friendly, engaged and involved interaction style; and giving plausible explanations.</p>
<p>The insincere/dishonest demeanor cues include avoiding eye contact, appearing hesitant and slow in providing answers, vocal uncertainty in tone of voice, excessive fidgeting with hands or foot movements, and appearing tense, nervous or anxious. </p>
<p>Empirical research has long revealed that <a href="https://doi.org/10.1111/j.1460-2466.2007.00362.x">voters are overwhelmingly influenced by politicians’ nonverbal communication</a>. <a href="https://doi.org/10.1162/rest.91.3.523">In one experiment</a>, participants were shown 10-second clips of unfamiliar gubernatorial debates. The participants were asked to predict who won the election. </p>
<p>Participants who saw muted 10-second clips – making their judgments solely on nonverbal cues – were able to predict which candidate would go on to win. But those who watched the video with the sound were no better at picking the winner than if they picked randomly without ever watching or listening to anything. Voters make their <a href="https://doi.org/10.1126/science.1110589">judgments of a politician’s competence</a>, it turns out, based on a 1-second glance at the politician’s face. </p>
<p>Another <a href="https://doi.org/10.1016/S0140-1750(86)90190-9">study</a> also found that politicians’ facial expressions have the power to move us, literally: People watching clips of Ronald Reagan looking friendly adjusted their facial muscles accordingly and mimicked his smile, and people watching clips of Reagan looking angry tended to furrow their brow, too.</p>
<h2>How Santos does it</h2>
<p>Santos <a href="https://www.youtube.com/watch?v=wYmCx2eaTRE">speaks with certitude</a>. He has a <a href="https://academic.oup.com/hcr/article/37/3/377/4107525">charming, friendly and interactive manner – all</a> sincere demeanor cues. He makes intense <a href="https://youtu.be/wYmCx2eaTRE?si=uKIPFcqkJcbWNtcy">eye contact</a> without fidgeting. He <a href="https://www.nytimes.com/2023/01/17/style/george-santos-style.html">dresses well and is pleasant</a> looking. </p>
<p>He was able to make up <a href="https://www.nytimes.com/2022/12/19/nyregion/george-santos-ny-republicans.html">lies</a> out of whole cloth and have them believed – a feat rarely accomplished by liars. He exudes <a href="https://nymag.com/intelligencer/2023/10/george-santos-baby.html">confidence</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1712908983403462691"}"></div></p>
<p>Santos dresses with sartorial elegance. He wears chic <a href="https://static01.nytimes.com/newsgraphics/2023-04-21-santos/4fbfc343e7ce7b04bd6d4d593ba08e0a5781cc29/_assets/stantos_desktop.jpg">eyeglasses</a> and <a href="https://www.youtube.com/watch?v=gU8evnkPLcg">sunglasses</a>, accessorized with bright but not tacky jewelry. All this is complemented by one of his signature <a href="https://static01.nyt.com/images/2022/12/15/multimedia/00ny-santos3-1-d66d/00ny-santos3-1-d66d-jumbo.jpg?quality=75&auto=webp">fleeces</a> or <a href="https://apnews.com/c89bf18bcd7e4133ad2794bfe863460b">sweaters</a>, typically worn over a collared dress shirt and under a smart <a href="https://pyxis.nymag.com/v1/imgs/03c/0df/28f256688a0f26500d713b0930eb4c6e52-GettyImages-1734001031.rhorizontal.w700.jpg">jacket</a>. Santos even bought his campaign staff Brooks Brothers <a href="https://www.nytimes.com/2022/12/19/nyregion/george-santos-ny-republicans.html">shirts</a> to wear. </p>
<p><a href="https://doi.org/10.1080/03637751.2023.2244030">In my experiments</a>, which have shown that voters base their judgment of politicians’ trustworthiness almost entirely from perceptions of demeanor, I found that Republicans are especially susceptible to demeanor cues. Republican voters will disbelieve their own honest politician if they perceive that the politician’s demeanor is insincere. But they will believe their own politician if they perceive sincerity. </p>
<p>Santos’ believable demeanor follows in the lineage of other con artists who could deceive absurdly yet adroitly. Disgraced financier <a href="https://www.theguardian.com/tv-and-radio/2023/jan/04/netflix-bernie-madoff-monster-of-wall-street">Bernie Madoff</a> dressed well, looked dignified, acted <a href="https://youtu.be/Or3xOfemMEE?si=yuA0YqLyuuJauP3A">friendly and cordial</a>, and his resting face was a smiling expression. The <a href="https://www.netflix.com/title/81035279">Fyre Festival</a> fraudster Billy McFarland also had a resting face that was a smiling, aw-shucks <a href="https://www.cnbc.com/2019/08/18/how-fyre-festivals-organizer-scammed-investors-out-of-26-million.html">expression</a>, and acted harmless and friendly.</p>
<p>And Elizabeth <a href="https://www.nytimes.com/2023/05/07/business/elizabeth-holmes-theranos-interview.html">Holmes</a> of <a href="https://www.cnn.com/2022/07/07/tech/theranos-rise-and-fall/index.html">Theranos</a> – who became the youngest female billionaire in <a href="https://www.wsj.com/news/collection/theranos-coverage-ea13b200">history</a> – faked a deep voice, walked upright with perfect posture, smiled and conveyed unrelenting confident poise, and maintained an unblinking gaze. All this enabled her to tell lies to some of the richest, most accomplished, intelligent titans of <a href="https://www.wsj.com/articles/theranos-whistleblower-shook-the-companyand-his-family-1479335963">industry</a>. </p>
<p>Madoff, <a href="https://www.cnbc.com/2018/03/06/billy-mcfarland-organizer-of-disastrous-fyre-festival-pleads-guilty-to-misleading-investors.html">McFarland</a> and <a href="https://www.bbc.com/news/world-us-canada-63685131">Holmes</a> could look people in the eye and steal their money – swindling largely through the same sorts of demeanor cues that Santos exhibits. </p>
<p><a href="https://youtu.be/T1NkZ41zjUg?si=LDqLiJWSIN2lwqpS">McFarland</a>, <a href="https://youtu.be/rGfaJZAdfNE?si=DYur3J8AJtqwvXB5">Holmes</a> and <a href="https://youtu.be/wYmCx2eaTRE?si=_Y9BJkfIsPfbAiqZ">Santos</a> have the ability to smile with their upper teeth showing while they are answering tough questions in interviews, which <a href="https://doi.org/10.2307/2111127">research shows</a> exudes trustworthiness.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/562734/original/file-20231130-27-gptkfv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A brown haired man with glasses, wearing a white shirt and blue vest, fistbumps another man." src="https://images.theconversation.com/files/562734/original/file-20231130-27-gptkfv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562734/original/file-20231130-27-gptkfv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562734/original/file-20231130-27-gptkfv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562734/original/file-20231130-27-gptkfv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562734/original/file-20231130-27-gptkfv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562734/original/file-20231130-27-gptkfv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562734/original/file-20231130-27-gptkfv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Republican candidate George Santos, left, fist-bumps campaign volunteer John Maccarone while campaigning on Nov. 5, 2022, in Glen Cove, N.Y.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/Election2022NewYorkHouse/58045c130be64798a4eed98ed7a1e93c/photo?Query=George%20Santos%20campaigning&mediaType=photo&sortBy=arrivaldatetime:asc&dateRange=Anytime&totalCount=103&currentItemNo=4">AP Photo/Mary Altaffer</a></span>
</figcaption>
</figure>
<h2>Fool me once …</h2>
<p>Just because someone speaks confidently, dresses well and acts friendly does not mean the person is honest. Pay attention to what people say – the content of their verbal messaging. </p>
<p>Don’t fall prey to <a href="https://www.thewrap.com/george-santos-snaps-at-oan-host-caitlin-sinclair/">body language or seemingly sincere behavioral impressions</a>, which actually have no correlation to actual truthfulness. As my <a href="https://doi.org/10.1177/0261927X211045724">research</a> has shown, the appearance of sincerity is misleading. It is a <a href="https://psycnet.apa.org/doi/10.1037/1076-8971.13.1.1">myth</a> <a href="https://journals.sagepub.com/doi/abs/10.1177/0261927x14535916">that eye contact means someone is telling you the truth</a> and that a roving gaze or elevated blinking means they are lying. </p>
<p>Some people just <a href="https://journals.sagepub.com/doi/10.1177/0261927X14528804">look honest</a> but they are pulling the proverbial wool over your eyes. Some people <a href="https://psycnet.apa.org/doi/10.1037/0033-2909.134.4.477">look sketchy</a> and appear unbelievable, but what they say is truthful.</p>
<p>Santos’ disgrace is a teachable moment for citizens. As the proverb goes: Fool me once, shame on you; fool me twice, shame on me.</p><img src="https://counter.theconversation.com/content/218742/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David E. Clementson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A scholar of political deception says there is something especially deceitful about George Santos, and his success getting elected demonstrates mastery of something more than just pathological lying.David E. Clementson, Assistant Professor, Grady College of Journalism and Mass Communication, University of GeorgiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1779612022-03-03T13:27:38Z2022-03-03T13:27:38ZWhat’s behind the obsession over whether Elizabeth Holmes intentionally lowered her voice?<figure><img src="https://images.theconversation.com/files/449303/original/file-20220301-17-otvuzn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Was the way she spoke another strand of deception in the web of fraud spun by the former Theranos CEO?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/elizabeth-holmes-dropped-out-of-stanford-in-2003-as-a-19-news-photo/1359151393?adppopup=true">Karl Mondon/MediaNews Group/Bay Area News via Getty Images</a></span></figcaption></figure><p>There is a scene in Hulu’s new series, “<a href="https://www.imdb.com/title/tt10166622/">The Dropout</a>,” where Theranos founder Elizabeth Holmes, wearing a white blouse, stands in front of a mirror and practices saying, “This is an inspiring step forward.” With each iteration, her voice deepens.</p>
<p>As the world has learned about Theranos’ <a href="https://www.wsj.com/articles/the-theranos-fraud-elizabeth-holmes-convicted-trial-blood-testing-start-up-11641330471">web of deception</a> – whether through John Carreyrou’s bestselling book, “<a href="https://www.penguinrandomhouse.com/books/549478/bad-blood-by-john-carreyrou/">Bad Blood</a>,” Apple’s podcast series “<a href="https://podcasts.apple.com/us/podcast/the-dropout/id1449500734">The Dropout</a>” or Hulu’s streaming series of the same name – Holmes’ <a href="https://www.mercurynews.com/2022/02/09/elizabeth-holmes-voice-the-dropout-devotes-an-entire-episode-to-her-odd-baritone/">supposed attempt to alter her voice</a> is a detail that captivates audiences. The behavior might strike some people as bizarre, even sociopathic.</p>
<p>But because of my training <a href="https://doi.org/10.3109/14015439609099196">in vocology</a>, which is the study of vocalization, and my interest in <a href="https://theconversation.com/tiktok-bamarush-and-the-irresistible-allure-of-mocking-southern-accents-166324">speech biases</a>, I’m intrigued by why Holmes may have felt compelled to change her voice in the first place. I see the story of her voice as part of a broader cultural fixation on the way women speak and sound.</p>
<h2>Reactions to Holmes’ voice</h2>
<p>Whenever Holmes is in the news, some questions always come up: </p>
<p>What’s with <a href="https://www.youtube.com/watch?v=AI_a-B6F1Eg">that distinctively low voice</a>? Is she faking it? </p>
<p>I have not been able to find definitive proof, in the form of video or audio recordings, to show that Holmes’ voice is noticeably different in its current form than at some previous time. </p>
<p><a href="https://youtu.be/lEArFDFcLZM?t=88">One video</a> claims to capture Holmes shifting between two very different voice modes. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/lEArFDFcLZM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">During this interview with Elizabeth Holmes, commenters highlight a vocal switch between the 1:28 and 2:08 marks.</span></figcaption>
</figure>
<p>However, it could have been easily edited. And dramatic, sustained pitch changes in speech can be associated with heightened emotional states without indicating a put-on voice. At the same time, <a href="https://www.thecut.com/2019/03/why-did-elizabeth-holmes-use-a-fake-deep-voice.html">people who know Holmes have claimed</a> that she changed her voice in order to cultivate a persona as a Silicon Valley wunderkind.</p>
<p>Only a clinician like a <a href="https://voicefoundation.org/health-science/voice-disorders/voice-care-team/otolaryngologistlaryngologist/">laryngologist</a> can make a voice-related medical diagnosis. But since I can’t definitively answer if Holmes’ voice changed intentionally, it is worth considering what natural or medical processes could cause a similar effect. Hormones <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592446/">directly impact</a> the voice, including pitch and the perception of roughness or hoarseness. Women’s voices tend to <a href="https://lithub.com/vocal-effects-how-hormones-change-the-way-we-sound/">decrease in pitch range during menopause</a>. </p>
<p>Holmes’ young age at the time she became known for her voice may rule out an age-related hormonal voice change, but a similar effect could be found with <a href="http://www.vocapedia.info/_Library/JOS_files_Vocapedia/JOS-069-5-2013-571.pdf">certain hormone therapy</a>. There are also several <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/voice-disorders">voice disorders</a> that impact pitch range. </p>
<h2>If she did it … how?</h2>
<p>There are all sorts of reasons people seek voice therapy or coaching to address vocal insecurities. Whether they’re concerned about their voice range or simply seeking skills to become better communicators, the voice is resilient and can be developed with training. There are also wonderful resources available for <a href="https://www.asha.org/public/speech/disorders/voice-and-communication-change-for-transgender-people/">gender-affirming voice</a> support for transgender people. </p>
<p>So what is the physiological process at play when someone intentionally lowers their voice? </p>
<figure class="align-center ">
<img alt="Woman wearing mask seated in back seat of car." src="https://images.theconversation.com/files/449300/original/file-20220301-13-1yth1oh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/449300/original/file-20220301-13-1yth1oh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/449300/original/file-20220301-13-1yth1oh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/449300/original/file-20220301-13-1yth1oh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/449300/original/file-20220301-13-1yth1oh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/449300/original/file-20220301-13-1yth1oh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/449300/original/file-20220301-13-1yth1oh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Elizabeth Holmes leaves a San Jose, Calif. courthouse after testifying in her defense in November 2021.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/theranos-founder-and-former-ceo-elizabeth-holmes-sits-in-news-photo/1236759223?adppopup=true">Ethan Swope/Getty Images</a></span>
</figcaption>
</figure>
<p>Engaging a tiny laryngeal muscle called the <a href="https://med.umn.edu/ent/patient-care/lions-voice-clinic/about-the-voice/how-it-works/anatomy">thyroarytenoid</a> causes the vocal folds, which are housed inside the larynx (or “voice box”), to relax and become shorter and thicker. Imagine decreasing tension on a rubber band. These shorter, thicker folds vibrate at a lower frequency, resulting in a lower-pitched voice, just as a thicker or more lax <a href="https://www.yamaha.com/en/musical_instrument_guide/acoustic_guitar/mechanism/mechanism003.html">guitar string</a> has a lower pitch.</p>
<p>It is likely the singular nature of Holmes’ voice is related not only to its low pitch, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591156/">but also its resonance</a>, the unique tonal quality and placement of the voice. Holmes might adjust her resonance by consciously lowering the larynx. Doing so creates a longer space above the larynx, which boosts the <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0132193">deeper, darker tones</a> in the voice. </p>
<h2>Women’s voices subject to scrutiny</h2>
<p>In my role as a theatrical <a href="https://www.rsc.org.uk/about-us/how-we-make-theatre/voice">voice coach</a>, I’m sometimes asked to help women actors lower their voices. I’ve encountered directors and producers with significant distaste for higher-pitched women’s voices, especially when this pitch range is combined with <a href="https://www.asha.org/practice-portal/clinical-topics/resonance-disorders/">nasal resonance</a>. </p>
<p>In movies and on TV, characters with high-pitched voices are often portrayed as comical, dim-witted and generally undesirable. Think of Lina Lamont, the character from “<a href="https://www.imdb.com/title/tt0045152/?ref_=fn_al_tt_1">Singin’ in the Rain</a>” memorably played by Jean Hagen. Her high, piercing voice became a source of consistent laughs. </p>
<p>Might sexist attitudes about women’s voices cause <a href="https://doi.org/10.1371/journal.pone.0051216">women in leadership roles</a> to feel pressured to adjust their pitch range down?</p>
<p>Former British Prime Minister <a href="https://www.workingvoices.com/insights/busting-the-margaret-thatcher-voice-coaching-myth/">Margaret Thatcher</a>, nicknamed the “Iron Lady,” famously <a href="https://decider.com/2020/11/15/the-crown-season-4-gillian-anderson-margaret-thatcher-real-voice/">down-shifted her voice</a> to burnish her stature. <a href="https://www.americanscientist.org/article/how-voice-pitch-influences-our-choice-of-leaders">Research on perceptions of pitch</a> in women’s voices shows higher ones are associated with physical attractiveness, while lower voices are associated with dominance. </p>
<p>Meanwhile, many women <a href="https://youtu.be/JfgBgpFJYto">radio and podcast hosts</a> are barraged with negative listener feedback about “<a href="https://www.wired.com/video/watch/accent-expert-breaks-down-language-pet-peeves">vocal fry</a>,” the creaky mode of speaking made famous by Kim Kardashian. </p>
<p>Yet physiologically, to create this sound, the vocal folds must vibrate at a low frequency, associated with low pitch. This much-maligned vocal feature is at one end of the pitch spectrum. But there’s another equally hated speech feature that is achieved at the other end: the high-rising terminal intonation pattern, or “<a href="https://www.bbc.com/news/magazine-28708526">uptalk</a>.” This feature is noted for the dramatic upward pitch at the end of each thought, which <a href="https://www.youtube.com/watch?v=z756L_CkakU">can make</a> statements sound like questions.</p>
<p>The insistence that women in media change the pitch of their voices often comes with little concern for the <a href="https://doi.org/10.3109/14015439.2011.587447">anatomical and physiological factors</a> that will limit how much pitch change is ultimately possible. My current research is investigating perceptions of women’s speaking voices in the performing arts and considering whether it’s time to part ways with some old aesthetic preferences.</p>
<p>Either way, the delicate dance of trying to strike a happy medium – the Goldilocks voice profile, where one can be taken seriously as a leader without being perceived as inauthentic, grating or patronizing – seems to be elusive. Women’s voices are the subject of endless scrutiny at both ends of the range – it seems they just can’t win. </p>
<p>If everything about this story were the same except the gender of Theranos’ CEO, I wonder whether his voice would even be remarked upon. If it were, might the <a href="https://www.scientificamerican.com/podcast/episode/deeper-voice-gives-electoral-advant-12-03-14/">same vocal qualities</a> be perceived as positive traits befitting a capable, serious-minded leader? </p>
<p>Elizabeth Holmes undoubtedly lacks the practical skills and moral compass to be a great leader. But all the noise about her voice, and the potential that she changed it to get ahead, just may reveal a sexist double standard that women seemingly can’t escape.</p>
<p>[<em>Get the best of The Conversation’s politics, science or religion articles each week.</em><a href="https://memberservices.theconversation.com/newsletters/?source=inline-best">Sign up today</a>.]</p><img src="https://counter.theconversation.com/content/177961/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathryn Cunningham is a member of the Pan-American Vocology Association (PAVA) and Voice and Speech Trainers Association (VASTA). </span></em></p>A speech expert wonders what this says about the pressures women in leadership roles feel – and the broader cultural impulse to police the way women speak and sound.Kathryn Cunningham, Assistant Professor of Theatre, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1680502021-10-05T12:27:24Z2021-10-05T12:27:24ZHow Theranos’ faulty blood tests got to market – and what that shows about gaps in FDA regulation<figure><img src="https://images.theconversation.com/files/424551/original/file-20211004-15-x221jy.jpg?ixlib=rb-1.1.0&rect=0%2C159%2C4951%2C3573&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Theranos promised that a drop of blood could yield many health secrets.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-on-drop-of-blood-at-finger-tip-royalty-free-image/185216828">RapidEye/E+ via Getty Images</a></span></figcaption></figure><p>One of the most <a href="https://www.wsj.com/articles/the-theranos-trial-elizabeth-holmes-the-charges-and-what-else-to-know-11625865236">high-profile trials</a> of the year is underway to decide whether Theranos founder Elizabeth Holmes defrauded patients and investors. </p>
<p>Her blood testing startup, <a href="https://www.sfgate.com/bayarea/article/Elizabeth-Holmes-Theranos-trial-date-judge-16377101.php">once valued</a> at almost US$10 billion, was based on a seemingly revolutionary premise. Company executives promised investors, and later business partners and patients, that their technology could run <a href="https://www.wired.com/2014/02/elizabeth-holmes-theranos/">hundreds of tests</a> off a single drop of blood. It could not. </p>
<p>While the ongoing trial focuses on the specific wrongdoings of Theranos and Holmes, as <a href="https://www.slu.edu/law/faculty/ana-santos-rutschman.php">a researcher on health technology regulation</a> I believe it also offers an important cautionary tale about problems with how certain medical devices are made available to patients in the United States.</p>
<h2>The story of Theranos</h2>
<p>Holmes <a href="https://www.businessinsider.com/the-history-of-silicon-valley-unicorn-theranos-and-ceo-elizabeth-holmes-2018-5">founded the company that became known as Theranos</a> in 2003 with a plan to develop a new blood testing technique. </p>
<p>The technology was two-fold: It involved a device called a <a href="https://www.cnbc.com/2015/10/16/wsj-reports-holmes-theranos-uses-nanotainers-for-just-herpes-test-after-fda-warning.html">nanotainer</a>, which was used to collect blood through a finger prick. The blood would then be tested by another device, called the <a href="https://www.refinery29.com/en-us/2019/03/224904/theranos-edison-machine-blood-test-technology-explained">Edison</a>. Theranos claimed that it could perform a wildly <a href="https://web.archive.org/web/20160622193253/https://www.theranos.com/test-menu">large number of tests</a>, such as measuring glucose levels and detecting different types of antibodies, or even marijuana and opiates.</p>
<p>Despite a <a href="https://www.newyorker.com/magazine/2014/12/15/blood-simpler">lack of transparency about how the technology actually worked</a>, investors <a href="https://www.yahoo.com/now/theranos-investors-lost-millions-164453131.html">poured money</a> into the company, which <a href="https://www.forbes.com/sites/brucejapsen/2016/06/12/walgreens-finally-cuts-ties-with-theranos/?sh=4e59f36464e4">made its tests available to patients</a> in 2013, including through a partnership with Walgreens.</p>
<p>As a result, <a href="https://www.wsj.com/articles/theranos-whistleblower-shook-the-companyand-his-family-1479335963">more people began to suspect</a> what studies would later show: The limited number of tests Theranos was able to offer <a href="https://www.jci.org/articles/view/86318#SEC3">did not provide reliable results</a>. To give but one example, <a href="https://www.cnbc.com/2021/09/21/theranos-test-gave-false-miscarriage-diagnosis-witness-testifies.html">recent court testimony revealed</a> that a Theranos test indicated a patient had suffered a miscarriage when, in fact, she had not. </p>
<p>While the ongoing trial is primarily about the company’s wrongdoing, the fact that faulty tests became so widely available – <a href="https://www.theatlantic.com/health/archive/2021/09/theranos-and-covid-19-are-connected/620082/">Theranos was generating as many as 890,000 results a year</a> – also reveals problems in how this type of medical device is regulated. </p>
<figure class="align-center ">
<img alt="Elizabeth Holmes arrives at court wearing face mask and staring straight into camera as a few other faces and heads are blurred" src="https://images.theconversation.com/files/424554/original/file-20211004-27-xae2ne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/424554/original/file-20211004-27-xae2ne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424554/original/file-20211004-27-xae2ne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424554/original/file-20211004-27-xae2ne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424554/original/file-20211004-27-xae2ne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424554/original/file-20211004-27-xae2ne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424554/original/file-20211004-27-xae2ne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Elizabeth Holmes founded Theranos with a revolutionary promise but failed to deliver.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TheranosFounderFraudTrial/e2e8488b5c3c4d6591c1b8c33a55e652/photo?Query=Elizabeth%20AND%20holmes&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=111&currentItemNo=27">AP Photo/Nic Coury</a></span>
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</figure>
<h2>A gap in medical device regulation</h2>
<p>Typically, medical devices are <a href="https://www.fda.gov/medical-devices/device-advice-comprehensive-regulatory-assistance/overview-device-regulation">among the most highly regulated</a> products in the modern economy. The U.S. Food and Drug Administration regulates any products that match the <a href="https://www.law.cornell.edu/uscode/text/21/321">legal definition</a> of <a href="https://www.fda.gov/medical-devices/classify-your-medical-device/how-determine-if-your-product-medical-device">medical devices</a>.</p>
<p>The FDA <a href="https://www.fda.gov/medical-devices/consumers-medical-devices/learn-if-medical-device-has-been-cleared-fda-marketing">assigns medical devices to one of three categories</a> based on risk. Class I devices, such as manual stethoscopes or toothbrushes, are considered low-risk. Class III encompasses the riskiest devices, such as implantable pacemakers. The higher the class, the greater the number of <a href="https://www.fda.gov/medical-devices/overview-device-regulation/classify-your-medical-device">requirements</a> a company has to meet before making the device available to consumers.</p>
<p>The FDA <a href="https://www.fda.gov/media/94712/download">concluded in 2015</a> that the nanocontainer was a Class II device, which requires special labels, certain performance standards and post-market surveillance. But Theranos claimed it was Class I and for two years was <a href="https://www.fda.gov/media/94712/download">shipping it without proper clearance</a> from the FDA. </p>
<p>In addition to the wrong class categorization, there was a loophole that the company was able to exploit. The Theranos tests fell under the regulatory category of laboratory-developed tests, <a href="https://www.fda.gov/medical-devices/in-vitro-diagnostics/laboratory-developed-tests">which refers to</a> “a type of in vitro diagnostic test that is designed, manufactured and used within a single laboratory.” </p>
<p>The FDA has long decided not to enforce pre-market review of this type of test, meaning Theranos was not required to have its tests evaluated by regulators before offering them to patients.</p>
<h2>A problem larger than Theranos</h2>
<p>The concerns raised by the lack of regulatory oversight over lab-developed tests extend well beyond the case of Theranos.</p>
<p>Commentators have identified several <a href="https://www.theverge.com/science/2015/11/11/9706356/fda-theranos-health-diagnostics-cancer-tests-regulation-loophole-ldt">other companies</a> that take advantage of the regulatory loophole and offer tests that have never been subjected to review. Many of these tests, including cancer tests, are being offered <a href="https://www.theverge.com/science/2015/11/11/9706356/fda-theranos-health-diagnostics-cancer-tests-regulation-loophole-ldt">without the support</a> of any kind of publicly available research report or data. </p>
<p>The FDA <a href="https://www.fda.gov/medical-devices/in-vitro-diagnostics/laboratory-developed-tests">has long admitted</a> that the lack of pre-market review of laboratory-developed tests can lead to a host of problematic outcomes. These <a href="https://www.fda.gov/medical-devices/in-vitro-diagnostics/laboratory-developed-tests">include</a> patients being over- or undertreated for heart disease; cancer patients being exposed to inappropriate therapies; incorrect diagnoses of autism; and a high potential for data falsification.</p>
<p>For example, a test for Lyme disease claimed a 97% “true positive rate” – a phrase with no clear public health meaning – but <a href="https://quackwatch.org/wp-content/uploads/sites/33/quackwatch/ldts.pdf">actually yielded mostly inaccurate results</a>, according to a 2015 FDA review. A false positive for Lyme disease could mean unnecessary medications and a delayed diagnosis of true underlying conditions. </p>
<p>Genomic Health began offering a test in 2008 as part of one of its breast cancer screening options. But in 2015, the <a href="https://quackwatch.org/wp-content/uploads/sites/33/quackwatch/ldts.pdf">FDA said the test has poor sensitivity</a> and resulted in several false negatives. The consequences of that can be dire, meaning a patient may not receive the right medication in time and could lead to a higher risk of disease progression. The FDA estimated the cost of misdiagnosis at nearly $800,000.</p>
<p>In 2018, the FDA <a href="https://www.fda.gov/news-events/press-announcements/jeffrey-shuren-md-jd-director-fdas-center-devices-and-radiological-health-and-janet-woodcock-md">warned the public</a> about using lab-developed genetic tests that didn’t undergo its review, noting that many rely on faulty science. The agency singled out tests being used to treat depression based on links that have never been scientifically established. </p>
<h2>A ‘wake-up’ call</h2>
<p>Since 1976, FDA <a href="https://www.govinfo.gov/content/pkg/STATUTE-90/pdf/STATUTE-90-Pg539.pdf">has had legal authority</a> to regulate medical devices. </p>
<p>The law covers diagnostic tests, but the agency chose not to impose a review system or other type of pre-market scrutiny on those devices because at the time they were considered “<a href="https://www.fda.gov/medical-devices/in-vitro-diagnostics/laboratory-developed-tests">relatively simple lab tests</a>.” But despite recognizing that they’ve become much more complex, the FDA has chosen not to fundamentally change the way it regulates them. </p>
<p>That may be beginning to change, albeit slowly. In 2014, the FDA <a href="https://www.federalregister.gov/documents/2014/10/03/2014-23596/framework-for-regulatory-oversight-of-laboratory-developed-tests-draft-guidance-for-industry-food">proposed</a> the regulation of these tests through a “risk-based framework,” which would introduce some degree of pre-market review, and sought “public discussion” on the issue. </p>
<p>However, proposals for more regulatory oversight <a href="https://academic.oup.com/clinchem/article/63/10/1575/5612690">have faced industry pushback</a>. And so far, at least, the Theranos scandal hasn’t prompted the FDA to change the process – though there is a <a href="https://degette.house.gov/sites/degette.house.gov/files/VALID_Signed.pdf">bill in Congress</a> that would direct the agency to regulate laboratory-developed tests more closely. </p>
<p>Medical professionals have called the Theranos incident a “<a href="https://www.theguardian.com/technology/2021/aug/30/elizabeth-holmes-trial-theranos-silicon-valley">wake-up call</a>” for the FDA that exposed the current regulatory weaknesses. However, the public in general – and patients in particular – may still easily use lab-developed tests without fully knowing the inherent risks.</p>
<p>With barely any pre-market checkpoints, faulty tests can cause profound damage – and deeply affect the health and life of patients – as testimony in the Theranos trial is a reminder. </p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/168050/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ana Santos Rutschman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The FDA has chosen not to regulate lab-developed tests like the ones at the center of the Theranos trial.Ana Santos Rutschman, Assistant Professor of Law, Saint Louis UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1459222020-09-14T19:50:17Z2020-09-14T19:50:17ZThe Inventor tells a story of a fraudulent female billionaire. Where are the films starring successful women entrepreneurs?<figure><img src="https://images.theconversation.com/files/357579/original/file-20200911-24-o10f4y.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1920%2C1279&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">HBO</span></span></figcaption></figure><p><a href="https://www.hbo.com/documentaries/the-inventor-out-for-blood-in-silicon-valley">The Inventor: Out for Blood in Silicon Valley</a>, now streaming in Australia on Binge, depicts Theranos founder and former CEO Elizabeth Holmes as a bewitching sociopath. </p>
<p>Holmes wanted to revolutionise health care by providing a simple and cheap way to perform blood tests using only a finger prick. In 2003, she founded Theranos, with a vision of the company’s machines in every home in America. </p>
<p>But, as the Wall Street Journal’s John Carreyrou <a href="https://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901">revealed</a> in 2015, Holmes created an intricate web of deception. Even as machines found their way into chemists and were being used by medical insurance companies, they never actually worked.</p>
<p>Holmes put patients’ lives at risk and cost investors millions of dollars.</p>
<p>The documentary is compelling viewing, but as it enters a very slim field of movies about female entrepreneurs it is worth questioning the impact of the stories we choose to tell.</p>
<h2>Fall from grace</h2>
<p>The journey Holmes took from young idol to spectacular failure is a story about systemic issues and the <a href="https://knowledge.wharton.upenn.edu/article/silicon-valley-work-culture/">sometimes toxic</a> culture of the world of start-ups. </p>
<p>Prior to the scandal breaking, Holmes was <a href="https://www.newyorker.com/magazine/2014/12/15/blood-simpler">celebrated in the media</a>. She was portrayed as a Stanford University dropout with a vision for changing the world. She raised hundreds of millions of dollars from powerful men in a start-up landscape known for its <a href="https://hbr.org/2020/01/how-the-vc-pitch-process-is-failing-female-entrepreneurs">discriminating funding practices</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/wtDaP18OGfw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>She made the <a href="https://www.forbes.com/profile/elizabeth-holmes/#338f337c47a7">cover</a> of Forbes magazine in 2014 as the world’s youngest self-made female billionaire. Holmes represented a heady mix of tech, science and business. She was the golden girl of the start-up world.</p>
<p>This made her fall from grace even more spectacular.</p>
<p>But compare Holmes’ portrayal with another well known example of a deceitful male entrepreneur: <a href="https://www.theguardian.com/film/2014/feb/28/wolf-of-wall-street-jordan-belfort-sex-drugs">Jordan Belfort</a>, the “wolf of Wall Street”.</p>
<p>Belfort ran an elaborate crime scheme linked to manipulating the stock market and was jailed for 22 months for securities fraud. Nonetheless,
his <a href="https://www.goodreads.com/book/show/522776.The_Wolf_of_Wall_Street">autobiography</a> and Martin Scorsese’s 2013 <a href="https://www.imdb.com/title/tt0993846/">film adaptation</a> depict Belfort’s story as celebration of wealth and power, rather than a critical review of his fraudulent behaviour.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/iszwuX1AK6A?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<h2>Where are all the good stories?</h2>
<p>Feature films about female entrepreneurs are few and far between.</p>
<p><a href="https://journals.aom.org/doi/abs/10.5465/AMBPP.2020.21276abstract">Research</a> from one of the authors examined English-language films from 1986 to 2016 with female entrepreneurs as the central character. Over the 30-year period, only 11 films about women entrepreneurs were identified – fewer than the number of <a href="https://www.macworld.co.uk/news/apple/steve-jobs-movies-documentaries-to-watch-3786148/">films about Apple co-founder Steve Jobs</a> alone.</p>
<figure class="align-center ">
<img alt="Movie still. Diane Keaton and a baby at a desk." src="https://images.theconversation.com/files/357786/original/file-20200914-20-1551xdm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/357786/original/file-20200914-20-1551xdm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/357786/original/file-20200914-20-1551xdm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/357786/original/file-20200914-20-1551xdm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/357786/original/file-20200914-20-1551xdm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/357786/original/file-20200914-20-1551xdm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/357786/original/file-20200914-20-1551xdm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In Baby Boom, JC (Diane Keaton) goes from corporate executive to starting a baby food company.</span>
<span class="attribution"><span class="source">MGM</span></span>
</figcaption>
</figure>
<p>From <a href="https://www.imdb.com/title/tt0092605/">Baby Boom</a> (1987), where Diane Keaton’s character starts a baby food business, to Melissa McCarthy’s brownie empire in <a href="https://www.imdb.com/title/tt2702724">The Boss</a> (2016), these films overwhelmingly depicted female entrepreneurs as running small-scale kitchen table businesses in female-dominated industries.</p>
<p>These movies told stories of cleaning, as in <a href="https://www.imdb.com/title/tt2446980/">Joy</a> (2015) and <a href="https://www.imdb.com/title/tt0862846/">Sunshine Cleaning</a> (2008); fashion, as in <a href="https://www.imdb.com/title/tt2361509/">The Intern</a> (2015); and not-for-profit work, as in the <a href="https://www.imdb.com/title/tt0116313/">First Wives Club</a> (1996).</p>
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Read more:
<a href="https://theconversation.com/spoiler-alert-old-man-power-trumps-a-successful-young-woman-in-the-intern-49240">Spoiler alert: old-man-power trumps a successful young woman in The Intern</a>
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<p>Businesses depicted typically had low numbers of paid employees. The entrepreneurs were resource-poor, and most often it was a supporting male character who helped the female entrepreneur succeed. </p>
<p>Additionally, the study found a woman starting her own business is seemingly not enough to hold audience attention: all films included a parallel romantic storyline.</p>
<h2>The female entrepreneur as role model</h2>
<p>Celebrating successful female role models <a href="https://www.sciencedirect.com/science/article/pii/S0167487011000353">encourages women</a> to dream big and succeed in male dominated arenas.</p>
<p>Role models provide a source of inspiration and contribute to self-belief. As the quantity of entrepreneurship related media increases, so does the amount of <a href="https://link.springer.com/content/pdf/10.1007/s11365-006-0018-8.pdf">entrepreneurial activity</a>. </p>
<p>However, negative portrayals of careers may <a href="https://psycnet.apa.org/record/1997-04591-001">prevent</a> people from considering a profession.</p>
<p>The case of Holmes and Theranos is damaging for the <a href="https://www.bloomberg.com/opinion/articles/2018-03-14/theranos-misled-investors-and-consumers-who-used-its-blood-test">betrayed</a> customers and investors, but also for the field of entrepreneurship, which only in recent decades has seen its reputation overhauled. </p>
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Read more:
<a href="https://theconversation.com/elizabeth-holmes-theranos-scandal-has-more-to-it-than-just-toxic-silicon-valley-culture-114102">Elizabeth Holmes: Theranos scandal has more to it than just toxic Silicon Valley culture</a>
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<p>Entrepreneurship was once the <a href="http://cup.columbia.edu/book/a-brief-history-of-entrepreneurship/9780231173049">domain of racketeers</a>. Over time, it has evolved to be the domain of tech celebrities, socially conscious founders and a vehicle for upward social mobility – but still, too often, a domain of men.</p>
<p><a href="https://www.taylorfrancis.com/books/e/9780429279836/chapters/10.4324/9780429279836-26">One study</a> investigated how female entrepreneurs are featured on the cover of Entrepreneur magazine. Women were vastly outnumbered by men on the cover, and were often portrayed in a stereotypical female fashion. </p>
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<img alt="Karlie Kloss on the cover of Entrepreneur." src="https://images.theconversation.com/files/357787/original/file-20200914-16-e27i7r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/357787/original/file-20200914-16-e27i7r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=752&fit=crop&dpr=1 600w, https://images.theconversation.com/files/357787/original/file-20200914-16-e27i7r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=752&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/357787/original/file-20200914-16-e27i7r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=752&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/357787/original/file-20200914-16-e27i7r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=945&fit=crop&dpr=1 754w, https://images.theconversation.com/files/357787/original/file-20200914-16-e27i7r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=945&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/357787/original/file-20200914-16-e27i7r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=945&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Cover women on Entrepreneur are much more likely to get the glam treatment than their male colleagues.</span>
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<p>Words surrounding images of women tended to be about nurturing, health, beauty and fashion. Wording accompanying images of male entrepreneurs talked of power, innovation and risk taking.</p>
<p>Women were “glamified” in full make-up and focus given to their face, while men were more likely to be standing and set against a corporate colour palette.</p>
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Read more:
<a href="https://theconversation.com/covid-19-may-turn-back-the-clock-on-womens-entrepreneurship-139961">COVID-19 may turn back the clock on women’s entrepreneurship</a>
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<p>How we tell stories of female entrepreneurs matters. </p>
<p>In order to achieve equity in entrepreneurship, we need to acknowledge the role of the media in filling the entrepreneurship pipeline.</p>
<p>Positive depictions of innovative women act as a mirror, showing girls and women what they can achieve. We need more, and better, stories about female entrepreneurs so stories about female innovation aren’t limited to failure and fraud.</p><img src="https://counter.theconversation.com/content/145922/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Inventor: Out for Blood in Silicon Valley is compelling viewing – but why have there been more films about Steve Jobs alone in the past 30 years than about successful female entrepreneurs?Bronwyn Eager, Lecturer Entrepreneurship, University of TasmaniaLouise Grimmer, Senior Lecturer in Marketing, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1141022019-03-27T17:53:12Z2019-03-27T17:53:12ZElizabeth Holmes: Theranos scandal has more to it than just toxic Silicon Valley culture<figure><img src="https://images.theconversation.com/files/265930/original/file-20190326-36252-1rt85vg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>The story of the rise and fall of Elizabeth Holmes has captivated the public imagination. Her story is now the basis of a <a href="https://www.nytimes.com/2018/05/21/books/review/bad-blood-john-carreyrou.html">bestselling book</a>, a <a href="http://abcradio.com/podcasts/the-dropout/">podcast series</a>, an HBO <a href="https://www.hbo.com/documentaries/the-inventor-out-for-blood-in-silicon-valley">documentary</a> and a <a href="https://www.theguardian.com/film/2016/jun/09/jennifer-lawrence-elizabeth-holmes-theranos-movie">future film</a> – with Jennifer Lawrence cast as Holmes. </p>
<p>For those not in the know, in 2004 at the age of 19, Holmes dropped out of her chemical engineering degree at Stanford University to found Theranos – a company which promised to revolutionise healthcare. Its technology was said to be able to diagnose a range of conditions from a single drop of blood. Holmes succeeded in convincing many to back her promises, acquiring millions of pounds of investment and leading to her company being <a href="https://www.theguardian.com/commentisfree/2018/jun/03/theranos-elizabeth-holmes-media-emperors-new-startup">valued at $10bn in 2014</a>. But it transpired the claims <a href="https://www.vox.com/science-and-health/2018/3/14/17120606/theranos-sec-charges-fraud-elizabeth-holmes">were false</a>. The testing didn’t work. There was no product.</p>
<p>In March 2018, the US Securities and Exchange Commission <a href="https://www.sec.gov/news/press-release/2018-41">charged Elizabeth Holmes and Theranos</a> with “a massive fraud”. It is claimed she and Theranos’s ex-president <a href="https://en.wikipedia.org/wiki/Ramesh_Balwani">Ramesh “Sunny” Balwani</a> had lied for years about the company’s technology, and fooled investors into giving Theranos hundreds of millions of dollars. Holmes, now 35, and Balwani, have both pleaded not guilty. And while a trial date has not yet been set, if convicted, they could both face decades in prison.</p>
<p>The scale of <a href="https://abovethelaw.com/2019/03/elizabeth-holmes-and-the-great-patent-scam/">this scam</a> has left many wondering how such high-profile investors were duped. People are blaming the “toxic”, “fake it till you make it”, “<a href="https://tech.newstatesman.com/guest-opinion/move-fast-break-things-mantra">move fast, break things</a>” <a href="https://www.independent.co.uk/voices/theranos-elizabeth-holmes-scam-silicon-valley-a8835886.html">culture of Silicon Valley</a>. </p>
<p>This is perhaps inevitable for the story of a smart, ambitious woman who dropped out of university to change the world – <a href="https://theconversation.com/is-theranos-a-tech-revolution-in-healthcare-or-marketing-hype-cloaked-in-secrecy-53709">quintessential to the ethos of Silicon Valley</a>. But passing this off as just “toxic culture” risks missing something much more pertinent about the Holmes case – <a href="https://www.tandfonline.com/doi/abs/10.1080/14759551.2015.1104682">the myth of the “dropout entrepreneur”</a>.</p>
<h2>The ‘dropout entrepreneur’</h2>
<p>From business heroes including Bill Gates, Steve Jobs and Mark Zuckerberg to pop-culture icons such as Kanye West, “dropout entrepreneurs” are the latest formation of an ideal that can be traced back to the US in the mid-19th century. This was a time when the US was transitioning from a largely agricultural economy to an emerging industrial and market-based one.</p>
<p>It was during this time that the notion of the “self-made” person became associated with material success rather than the concern for civil good or moral character. Central to this idea was a “rags-to-riches” story which measured an individual’s success against the ideals of self-reliance and hard work. </p>
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<p>In recent years, this narrative has become central to the trend in bright students dropping out of college and foregoing the promise of secure employment to instead make their own way in the world. In this way, by dropping out of Stanford, Holmes was conforming to a mythical archetype of our age, of which the late Steve Jobs thought of as the embodiment.</p>
<h2>‘The Apple of healthcare’</h2>
<p>A key aspect of the Theranos story is the fact that as the <a href="https://www.cnbc.com/2015/09/23/worlds-youngest-female-billionaire-next-steve-jobs.html">world’s youngest female billionaire</a>, Holmes was heralded as being “<a href="https://www.inc.com/magazine/201510/kimberly-weisul/will-the-next-steve-jobs-be-a-woman.html">the next Steve Jobs</a>”. This association was embraced by Holmes, who made concerted efforts to style herself on Jobs’ public persona. She wore black turtlenecks, recruited Apple employees and, crucially, aligned her own story to the fact that she <a href="https://www.youtube.com/watch?v=pIXAmjUFSso">dropped out from university to pursue her dream</a>.</p>
<p>Her narrative from “dropout” to “self-made billionaire” is all the more fascinating in relation to the wider myth of entrepreneurial success, because the university she dropped out from was the one which Steve Jobs gave his inspiring <a href="https://www.theguardian.com/technology/2011/oct/09/steve-jobs-stanford-commencement-address">Graduation Commencement Address</a> in June 2005. The speech <a href="https://www.forbes.com/sites/carminegallo/2015/06/12/why-steve-jobs-commencement-speech-still-inspires-10-years-later/">emphasised triumph over adversity</a> and doing what you love:</p>
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<p>Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it.“</p>
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<p>When the suggestion of fraud was first reported in a <a href="https://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901">Wall Street Journal article</a> in 2015, Holmes <a href="https://www.youtube.com/watch?v=rGfaJZAdfNE">responded publicly</a> by paraphrasing Apple’s famous 1997 ”<a href="https://www.forbes.com/sites/onmarketing/2011/12/14/the-real-story-behind-apples-think-different-campaign/#2772053f62ab">Think Different</a>“ campaign, <a href="https://www.businessinsider.com/elizabeth-holmes-fires-back-at-her-critics-2015-10">stating</a>: "This is what happens when you work to change things. First they think you’re crazy, then they fight you, then you change the world.” </p>
<p>This response says as much about Holmes’ belief in the myth to which she was conforming as it does the culture in which she was operating. And, in this way, Holmes’ self-styled eccentricities can be seen as a desperate attempt to be “a round peg in a square hole”.</p>
<h2>The risk of perpetuating the myth</h2>
<p>Most reports on this story frame Holmes as disillusioned – a fraudster, or a <a href="https://www.inc.com/peter-cohan/6-warning-signs-that-elizabeth-holmes-is-trouble-says-psychiatrist-who-has-known-her-since-childhood.html">calculated psychopath</a>. But this simply runs the risk of mythologising Holmes and her narrative further. </p>
<p>By calling her “crazy” we risk playing in to the very narrative on which her initial success and fraudulent claims were based. In 2015, Holmes’ self-belief and ambition were unwavering when she told the <a href="https://www.forbes.com/sites/sarahhedgecock/2015/10/05/elizabeth-holmes-on-using-business-to-change-the-world/#7f349ad665dd">Forbes 30 Under 30 Summit</a>:</p>
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<p>You’ll get knocked down over and over and over again, and you get back up… I’ve been knocked down a lot, and it became really clear that this was what I wanted to do, and I would start this company over 10,000 times if I had to.</p>
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<p>To say we must reject the “fake it till you make it” culture of which Holmes’ narrative has become so central a part, is simply too easy. Despite it going some way to explain the climate in which the fraud could take place, there will always be an element of speculation and risk in any entrepreneur’s pitch to acquire capital. </p>
<p>And with Silicon Valley’s culture being premised on a spirit of nonconformity and anti-regulation, calls for regulation and change will only perpetuate more of the aggressive self-belief and blind ambition that Holmes’ narrative represents.</p><img src="https://counter.theconversation.com/content/114102/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Watt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Elizabeth Holmes conformed to a myth of entrepreneurial success. This was ultimately her downfall.Peter Watt, Senior Lecturer in Management and Organisation, York St John UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/979642018-06-18T09:42:18Z2018-06-18T09:42:18ZTheranos founder fooled investors with the promise to revolutionise healthcare – it offers three big lessons for companies<figure><img src="https://images.theconversation.com/files/223035/original/file-20180613-32334-1vww5nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Theranos CEO Elizabeth Holmes.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/fortuneglobalforum/22718256482/in/photolist-ABx1ah-ADJ9Av-zFD12f-ADHE3i-Am53Js-ADEd1V-ACJgMe-ACJdKx-ADJn1a-zFRgWM-ACFcta-AArv2Y-ADJmhX-Am4R9d-AAnSsw-Am527Q-AAnR1y-ACEXei-zFRjCi-Am4TCb-yWg8Kd-zFR8K6-pzDHqR-zFGGJm-ADHZZ2-zFR4QH-pxTrQw-qhG442-pirkc8-pirtiD-q18uTd-q18o9m-pxT5AN-piqCvG-qhCzof-q1fDqv-pkGLd5-piqHam-q19gro-pzU4sh-pipDnH-pzDG66-pzTYj1-pzVz42-q1fwBv-pkGWCU-qhCRC9-q18Bos-qfpX4m-q1heei">Fortune Global Forum</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Less than three months after being <a href="https://www.sec.gov/news/press-release/2018-41">charged by the US Securities and Exchange Commission</a>(SEC) with “massive fraud” and barred from being the CEO of a public company for ten years, entrepreneur Elizabeth Holmes is <a href="http://uk.businessinsider.com/theranos-founder-elizabeth-holmes-new-startup-report-2018-6?r=US&IR=T">reportedly</a> on the hunt for investors for a new company. </p>
<p>She is still allowed to be the CEO of a privately held company – but would-be investors should heed the lessons from Holmes’ last venture, Theranos.</p>
<p>In 2003, 19-year-old Holmes dropped out of Stanford and founded the health tech firm, Theranos. It worked in “stealth mode” for a decade while developing new technology to perform many standard medical tests using only a single drop of blood. After unveiling the company’s device and its plans to revolutionise the healthcare industry, Holmes was <a href="https://www.inc.com/magazine/201510/kimberly-weisul/the-longest-game.html">heavily profiled</a> in the media and embraced the role of guru. </p>
<p>Holmes had a US$4.5 billion share of the company, which was valued at US$9 billion at its peak in 2014. But, in March 2018 the SEC <a href="https://www.sec.gov/news/press-release/2018-41">charged Holmes and Theranos</a> “with raising more than US$700m from investors through an elaborate, years-long fraud in which they exaggerated or made false statements about the company’s technology, business, and financial performance.” </p>
<p>Neither Holmes nor the company admitted (or denied any wrongdoing) but agreed to a settlement that effectively stripped Holmes of control of her company and she was fined US$500,000.</p>
<p>There are lessons that we can learn from this spectacular fall. At first glance, it raises concerns about the role of board members in carrying out their clear fiduciary duties. For a US corporation this includes, but is not limited to, “the duty of care”: to exercise one’s independent judgement with skill and diligence. </p>
<p>Theranos’ board seemingly overlooked a systemic and long-term fraud. And yet its <a href="http://fortune.com/2015/10/15/theranos-board-leadership/">members</a> were preeminent public figures – three former cabinet secretaries, two former senators, as well as retired high-ranking military officials. While Theranos’ board has been criticised for not including industry experts, its members were highly knowledgeable about governance, and would have been aware of their fiduciary responsibilities.</p>
<p>There are three insights from Theranos’ failure, which apply to any new company – and would-be board members of Holmes’ next venture. </p>
<h2>1. The danger of sticking to what you know</h2>
<p>We know from the study of <a href="https://www.spring.org.uk/2009/08/why-groups-fail-to-share-information-effectively.php">group dynamics</a> that groups talk about what they know. Members of any group – including boards – discuss topics such as what they accomplished together, the good old days, common friends and the familiar. The dark side of this underlying, subconscious force is that groups do not talk about what they do not know. </p>
<p>So, while the Theranos board members could add value to Theranos – they were knowledgeable and competent in their fields – they, too, were subject to the forces of group dynamics and we can speculate on whether they might have avoided discussions of the unknown. Did they, for example, deeply interrogate Holmes’ technological tool box to understand the company’s main product? You simply cannot talk about what you do not have the knowledge base for.</p>
<h2>2. Watch out for fairy tales</h2>
<p>Theranos was a Silicon Valley fairy tale. A young, charismatic CEO proposes a revolutionary, industry changing idea that will heap rewards on all involved. These seductive, too-good-to-be-true stories do become real in Silicon Valley – think Facebook, Google, Apple. </p>
<p>But Theranos had the elements of a modern Rumpelstiltskin – with the false promise of gold being spun from nothing. Holmes – a college dropout, visionary and charismatic entrepreneur – <a href="https://www.youtube.com/watch?v=ho8geEtCYjw">claimed</a> Theranos would revolutionise the healthcare industry with its ability to perform 240 common blood diagnostic tests with a single drop of blood. It’s the role of the board to truly understand their company’s product and ask the difficult questions – we therefore have to question whether Theranos’ board might have enabled or failed to stop the creation of this particular fairy tale.</p>
<h2>3. Spot self-deception</h2>
<p>Finally, as CEO, surely Holmes knew that her company’s technology did not perform as promised. Yet she repeatedly, convincingly and passionately <a href="https://www.youtube.com/watch?v=rGfaJZAdfNE">maintained</a> that it did. This begs the question: at what level was she deceiving herself?</p>
<p>It also raises the issue of how our culture likes to <a href="https://www.hbs.edu/faculty/Pages/item.aspx?num=11408">create heroes</a> so much that some become completely invested in their own hype. Still, neither Holmes nor Theranos admits any wrongdoing. Holmes’ behaviour as CEO of Theranos is similar to that of disgraced <a href="http://www.philly.com/philly/entertainment/20131129__The_Armstrong_Lie___An_epic_of_betrayal__self-deception.html">cyclist Lance Armstrong</a> in that they both were unshaken in their belief in themselves despite being exposed to the public.</p>
<p>Ultimately, all groups – boards, teams, families – are subject to unconscious processes. The decisions that boards make are the outcome of just such group processes. Therefore, members need to build their awareness of unconscious dynamics within their group. </p>
<p>Developing this kind of insight takes work, and is extremely uncomfortable. But doing so can help the board carry out its fiduciary duties more effectively. It can also help board members spot self-delusion in leaders.</p><img src="https://counter.theconversation.com/content/97964/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Elizabeth Holmes has been charged with ‘massive fraud’. She maintains her innocence but what lessons can boards take away from the whole affair?Anand Narasimhan, Shell Professor of Global Leadership, International Institute for Management Development (IMD)Nancy Lane, Research Associate, International Institute for Management Development (IMD)Licensed as Creative Commons – attribution, no derivatives.