Biotech World: You Can't See Everything

Introduction: Reflections Sparked by a Documentary

Earlier this week, I attended a screening of You Can See Everything—a new documentary about infamous former biotech CEO Elizabeth Holmes that is generating considerable buzz. I deliberately avoided all spoilers (and this article won't reveal any plot points either), walking into the theater with curiosity: after so much reporting and so many film and television adaptations, what new information could this movie possibly reveal?

Yet the experience exceeded my expectations. It wasn't merely a retelling of a fraud—it forced the audience to confront a more fundamental question: in the world of biotech, how much can we truly "see"?

Elizabeth Holmes is the founder and former CEO of the blood-testing company Theranos. Founded in 2003, the company claimed to have developed a proprietary device called Edison that could rapidly perform hundreds of tests using only a finger-prick of blood, at a fraction of the cost of traditional laboratories. In 2015, Wall Street Journal reporter John Carreyrou published a series of investigative reports exposing serious flaws in Theranos's technology, noting that most of its device's tests actually relied on third-party commercial instruments and that results were unreliable. The U.S. Securities and Exchange Commission (SEC) subsequently launched an investigation, and Holmes was charged with fraud in 2018. In 2022, she was sentenced to more than 11 years in prison. The case has become a landmark example of Silicon Valley's "fake it till you make it" culture and corporate governance failure.

The Cognitive Boundaries of Biotech

The documentary's title is itself a clever metaphor. In the biotech world, you can't see everything—this isn't a pessimistic pronouncement but a sober description of the industry's nature. From molecular mechanisms of drug action to population heterogeneity in clinical trials to uncertainties in commercial translation, every stage is filled with variables that cannot be directly observed.

Holmes's story is thought-provoking precisely because she exploited this cognitive limitation. She claimed her company's technology could perform hundreds of tests from a single drop of blood—it sounded like a breakthrough but was in fact an overpromise about a domain that remained "unseen." Investors, partners, and even regulators found it difficult to verify the authenticity of her technology in the short term, because the complexity of biological systems is itself a natural barrier.

A biomarker is a biological indicator that can be objectively measured and evaluated—such as protein concentrations in blood, gene expression levels, or imaging characteristics—commonly used for disease diagnosis, prognosis, or monitoring drug response. However, the discovery and validation of biomarkers is an extremely lengthy and uncertain process: many markers that show associations in early research often fail in large-scale clinical trials due to population heterogeneity, sample handling differences, or statistical false positives. According to statistics, the conversion rate from candidate biomarkers to approved clinical tests is extremely low, and a large number of research findings cannot be reproduced. This characteristic of "seemingly visible yet difficult to confirm" is precisely the core manifestation of biotech's cognitive limitations—and it provides fertile ground for overpromising.

The Invisibility of Truth and Human Weakness

The documentary delves into how Holmes exploited humanity's desire to "see." In biotech, data visualization, biomarkers, and imaging examinations—all of these give us a sense of control, as if everything were observable. But the reality is that in the translation from lab to clinic, a large number of failures quietly disappear from public view.

According to interviews in the documentary, many internal employees had doubts about the technology's feasibility, but their voices were drowned out by the fervent narrative of "changing the world." This reveals a deeper problem: when scientific narrative intertwines with commercial ambition, truth often becomes invisible—not because it is deliberately hidden, but because the entire system tends to focus on visible successes rather than invisible risks.

In biotech, "pseudo-success" is often not active fraud but a systemic bias driven by incentive structures: success stories are widely disseminated, while failed projects are quietly shelved due to commercial confidentiality, reputational concerns, or publication preferences. This phenomenon is known academically as "publication bias" and "survivorship bias." In the Theranos case, although internal employees harbored doubts about the technology's feasibility, the company suppressed dissenting voices through confidentiality agreements, legal threats, and hierarchical culture, rendering scientific peer review and internal inquiry mechanisms—which should have served as error-correction mechanisms—virtually ineffective. This organizational behavior failure is more instructive than mere technical flaws.

Industry Reflections: Transparency and Science Communication

The value of this documentary lies not only in reconstructing history but also in raising an urgent industry issue: how should biotech companies balance innovation narratives with scientific transparency?

After the Holmes case, regulators strengthened scrutiny of diagnostic technologies, and the investment community became more focused on the rigor of technology validation. But real change needs to start at the cultural level—scientists, media, and the public all need to cultivate a reverence for the "invisible." As one interviewee put it: "In biotech, acknowledging what you don't know is more important than claiming what you do know."

In terms of diagnostic technology regulation, the U.S. Food and Drug Administration (FDA) long took a relatively permissive regulatory approach to Laboratory Developed Tests (LDTs), allowing some tests to enter clinical use without premarket approval. Theranos exploited exactly this gray area of LDT regulation to bypass the traditional medical device approval process. Since then, the FDA has gradually tightened oversight of LDTs and pushed for legislation to clarify their status as medical devices. This regulatory evolution reflects the ongoing tension in biotech between "speed of innovation" and "rigor of validation": overly permissive regulation may enable fraudulent technologies, while overly strict approval may delay genuinely valuable innovation.

Conclusion: What Is Seen and What Is Unseen

The title You Can See Everything ultimately becomes an irony. In the world of biotech, we truly cannot see everything—but perhaps acknowledging this is the beginning of truly seeing. For technology professionals, this documentary offers a rare mirror: while pursuing breakthroughs, never forget the complexities and uncertainties that lie beyond our field of vision.