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Markkula Center for Applied Ethics

How Much Overconfidence is Too Much?

Elizabeth Holmes speaks with reporters. AP Photo/Tony Avelar

Elizabeth Holmes speaks with reporters. AP Photo/Tony Avelar

Alondra Torres ’22

Tony Avelar/AP Photos

Alondra Torres ’22  is a senior undergraduate student majoring in biology and public health, and a 2021-22 health care ethics intern at the Markkula Center for Applied Ethics. Views are her own.

On January 3rd, 2022, Elizabeth Holmes was found guilty on four counts of fraud. Though Holmes’ sentencing is still being awaited, the fall of her company Theranos has sparked questions surrounding the culture in Silicon Valley. The area is often known as a hub for innovation. It is home to major companies like Meta, Google, and Apple. The success of these companies has attracted several startups that now reside in this famous region, many of which are a part of the biotechnology industry. Theranos, like many biotech startups, was initiated by an idea. Holmes hoped to revolutionize healthcare by creating a device that would allow blood tests to be performed using only a drop of blood taken from a finger prick. It was a device that, in theory, had the ability to reduce the cost and number of laboratory exams a person would have to undergo. However, it was merely an idea. As later revealed in a series of Wall Street Journal exposés written by John Carreyou, the device never fully worked and was not being used as promoted. This ultimately led to worry and additional costs as patients who had used the device received false positives for acute and major illnesses. A company that once started with the idea to serve patients eventually harmed those very same patients. Therefore, it must be asked whether there is such a thing as too much overconfidence in innovation?

Overconfidence reigns in Silicon Valley, with start-ups and innovators searching for the next big product. Some may even argue that it drives innovation. Innovation that is often celebrated as we want people to improve issues in our society. However, with innovation also comes great responsibility, especially when it comes to the health of individuals. In healthcare, The Belmont Report is often referred to for ethical decision making. The report helped establish the bioethical principles-autonomy, or respect for persons, beneficence, justice, and non-maleficence. These principles are often found at the center of research design and patient care. However, as seen in the case of Theranos, these ethical principles are not always present at the center of biotechnological innovation. The company’s downfall revealed that there is such a thing as too much overconfidence, and if not managed it has the potential to damage its own users.

The biotechnology industry differs from other sectors of business as it directly affects the health of many. There are individuals whose lives depend on the creation of medical treatments and devices. Thus, it is crucial that these companies be held to a rigorous ethical standard. People must be protected. These innovations are ultimately being made to be used on patients. Some devices may be found in hospital settings, others on the shelves of local pharmacies. Regardless of its intended market, it is important that the risks and benefits of all biotech products be assessed. The principles of beneficence and non-maleficence should guide innovators and their companies. These innovations should do more good than harm to a patient. If some harm is unavoidable then it is a company’s duty to minimize the risk of harm. Overconfidence should not cloud these judgements. 

To be overly confident in an idea or product is not an inherently bad judgment. In fact, overconfidence can often spark creativity and passion; however, it should not be the moral reasoning for causing harm to others. This is where Theranos failed. It is possible that Theranos truly started with the intention of doing good. However, Holmes' large amount of overconfidence allowed the company to lose sight of its moral responsibilities. The threshold of overconfidence was crossed once lies and harm were placed on patients. Once, non-functioning products and false results were being provided to patients. Once, the company rejected the patients’ respect and autonomy by not informing them as to what was occurring when they provided their blood to be tested. Through this, patients were no longer seen as individuals, but as a means to reach notoriety and financial success for a company.

As innovation in biotechnology continues to evolve and the influences of capitalism continue to exist, Theranos’ legacy should serve as a cautionary tale for current and future inventors. The company highlights the dangers of too much overconfidence. An overconfidence that was grounded on superstition rather than reality. It calls for biotech companies to consider bioethical frameworks that ensure the wellbeing of patients is protected. 

Mar 23, 2022

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