Our Editor Describes Visit to Theranos Test Center

To collect specimens for four tests, Theranos said it required one venipuncture, two finger sticks

CEO SUMMARY: Theranos now operates wellness centers in Walgreens in Palo Alto, California, and Phoenix, Arizona. It continues to claim it is transforming the lab testing experience for patients and physicians. It says it can perform hundreds of lab tests, using a finger stick collection and a micro-specimen vial, and return results in four hours. Last month, our editor visited a Theranos wellness center in a Walgreens pharmacy with a test requisition for four lab tests. He reports here on the experience.

IN THE ONGOING CASCADE of media stories about Theranos and the public speeches of its young CEO, the company continues to describe its proprietary clinical lab testing service as something that consumers will recognize as being friendlier, faster, and cheaper than the lab test services offered by conventional medical laboratories.

Such statements have been met with skepticism by many pathologists and lab administrators. They understand the complexity of diagnostic testing and have questions about many aspects of what Theranos has stated in its media stories and public speeches by its CEO. To date, the secretive company has offered few details about how and why it claims it has the capability to “revolutionize blood testing,” as noted by Phoenix Magazine earlier this month.

For example, in various media stories, Theranos has said there is no need for a venipuncture because a simple finger stick will suffice. There is no need for three to four vacutainers of specimen because a micro-sample will do. Using its proprietary test technology, Theranos says it will provide test results within four hours. And Theranos will charge about 50% of the Medicare Part B lab test fees.

Last year, another member of THE DARK REPORT’S editorial team visited three Theranos wellness centers (two in Phoenix and one in Palo Alto) and reported on one of those visits. (See TDR, August 11, 2014.) To our knowledge, this was the first news report of an independent visit to Theranos/Walgreens to purchase lab testing services.

Assessing Theranos Today

To provide our clients and regular readers with an assessment of the clinical lab testing services Theranos currently delivers to consumers, this editor used a glorious sunny Sunday last month to visit the one Walgreens pharmacy in Palo Alto, California, that offers the Theranos medical laboratory testing service. Here is my report of what transpired.

In the Walgreens at 300 University Avenue, the Theranos sign is clearly visible from the front door. I walked up to the “Theranos Check-in” counter adjacent to two pharmacy counters.

I tell the clerk at the pharmacy counter that I want lab tests done and she asks, “Do you have an order?” Yes, I have printed my order off the Theranos web site by searching for “Theranos requisition.” On the form, I have already written my name, address, birth date, and other personal information and my doctor’s name, address, phone, and fax number.

I leave blank the space for my doctor’s NPI and signature because my doctor has no idea I’m ordering blood tests 3,000 miles from home. I check the non-fasting box and then choose “Microsample” (because that’s one of the keys to Theranos’ technology). I could have selected “Patient’s choice” or “Traditional Phlebotomy.”

When I give her the form, the clerk asks if I will use my insurance or self pay. I’ll pay cash. When she asks for identification, I hand over my Massachusetts driver’s license. To the question, “Do you have a local address?” I say, no, I’m visiting.

Prices for Lab Tests

On my requisition, I’ve ordered a basic metabolic panel (CPT 80048) for $5.38, a complete blood count with differential (85025) for $5.35, a lipid panel (80061) for $9.21, and vitamin D 25 OH (82306 for $20.35).

She transmits my completed requisition by fax and tells me I need to wait for a few minutes. I’m guessing that means someone at Theranos HQ will review my order. Gladys Knight and the Pips are singing over the intercom, “You’re the best thing that ever happened.”

A few minutes later, the pharmacy tech calls me back to explain that my total will be $40.73 and that the vitamin D can’t be done with the microtainer and must be done by venipuncture. “They need more blood for that one,” she says.

So we eliminate the vitamin D test, dropping my total payment to $20.38. I pay with my credit card and she sends me around the corner back to an individual named Sal. The entire interaction with the pharmacy tech-including the time it takes Theranos HQ to review my requisition, discuss my options, and pay-takes less than nine minutes.

In the Theranos drawing station, a large flat screen on the wall shows moving images of a tropical fish tank. It’s mesmerizing. Personable and friendly, Sal asks my name and date of birth and if I’m taking any blood thinners or aspirin? No, I say.

Sal explains that he can take blood from any finger and that he will need to stick two different fingers and he gives me the choice. I select my middle finger and ring finger. He wraps this first finger in a warmer to improve circulation.

Comparing Patient Visit With Advertised Benefits

HOW DID AN ACTUAL LAB TEST EXPERIENCE match the features described by Theranos in its media stories and on its web site?

Last month, our editor visited the Theranos wellness center in the Walgreens pharmacy in Palo Alto, California. Here is a comparison of his consumer experience with the features that Theranos promotes.

  • Relative to the finger stick collection; consumer arrives at Walgreens and presents a lab test requisition for four tests (metabolic panel, CBC with auto diff, lipid panel, and vitamin D 25(OH)D). Theranos rep at Walgreens tells him that a venipuncture is required for the vitamin D test. The other three tests can be performed from a microspecimen collected by fingerstick.
  • Consumer declines the venipuncture, which means he would be “stuck” at least twice for Theranos to collect the specimens it requires.
  • At collection, consumer learns Theranos requires that two different fingers get needle sticks in order to collect the specimen volume required for the three lab tests. This was not disclosed to him during the transaction at the pharmacy window. He assents. He reports that the two different finger sticks were minimally painful.
  • Cost of the three tests performed was, as advertised, about 50% of the Medicare Part B lab test fee schedule. The total price was $20.38.
  • Lab results were reported to the consumer’s physician the next day. It took 10 days for the consumer to get Theranos to send him a copy of his lab test results after obtaining permission from his physician to release those results.

Two Finger Sticks

After removing the finger warmer, he sticks the tip of my middle finger and yet I can hardly feel it. “Does this hurt?” he asks. Not at all, I say. He fills two microtainers from my middle finger, then has me place the bleeding tip of my finger onto a gauze pad. He wraps it in a self-adhesive bandage. Next, he gets out a second finger warmer to prepare my ring finger.

Again, I feel no pain when he sticks this finger. My results will take 24 to 48 hours, he explains, and if I want them by email, I need to call client services. Or, if I download the Theranos app and register on the Theranos site, I can get my results in my phone. “We’re on all the devices. Android, Windows, and iPhone,” he says.

I ask why I couldn’t get the vitamin D test with a finger stick. “If you have a test that requires more blood, then we’ll stick you in the arm and not the finger. Or, if you want it both ways, that’s fine. We give you the option,” he explains.

Then he places my ring finger onto a second piece of gauze and then wraps it in a bandage. “You are all set,” he adds.

Once outside, I check my watch. The entire process from walking in off the street to back out on the sidewalk took less than 19 minutes.

Five days later, my lab test results are not available on my phone and so I call client services at Theranos. I’m told they will look into it and get back to me.

Judging Actual Performance

So, how did Theranos measure up to its own standards? The service was fast and painless and the staff behind the counter and the individual who collected my specimens were friendly.

I consider it significant that Theranos would require two finger sticks and a venipuncture to perform the four lab tests that were on my test requisition. On its website, there is no mention of the fact that a patient or consumer may need to be “stuck” multiple times for Theranos to get all the blood specimens it requires for its proprietary lab test technology.

Also, although the staff at the Walgreens told me that my lab test results would be reported in 24 to 48 hours (and that is much longer than the four-hour reporting benefit that Theranos discusses in media interviews), that did not happen. Instead, five days later, having heard nothing from Theranos, I had to call the lab firm and wait while their representatives investigated why my lab results had not been reported to me. So Theranos has no advantage there. Overall, I would rate the experience pleasant but inconclusive.

Lab Test Requisition

There is another issue that alert pathologists probably picked up. I visited Walgreens with a lab test requisition that was unsigned by my physician and did not include my physician’ national provider number. Yet, Theranos collected my money and performed the tests. As a resident of Massachusetts, I am unaware of how this fulfills California state law, which I understand requires a physician to directly order medical laboratory tests on behalf of the patient.

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