Thousands of teenagers swarmed out of the towering front gate of Maotanchang High School. Many of them wore identical black-and-white Windbreakers emblazoned with the slogan, in English, “I believe it, I can do it.” It was lunchtime at one of China’s most secretive “cram schools” — a memorization factory where 20,000 students, or four times the town’s official population, train round the clock for China’s national college-entrance examination, known as the gaokao. The grueling test, which is administered every June over two or three days (depending on the province), is the lone criterion for admission to Chinese universities. For the students at Maotanchang, most of whom come from rural areas, it offers the promise of a life beyond the fields and the factories, of families’ fortunes transformed by hard work and high scores. ... Nothing consumes the lives of Chinese families more than the ever-looming prospect of the gaokao. The exam — there are two versions, one focused on science, the other on humanities — is the modern incarnation of the imperial keju, generally regarded as the world’s first standardized test. For more than 1,300 years, into the early 20th century, the keju funneled young men into China’s civil service. Today, more than nine million students take the gaokao each year (fewer than 3.5 million, combined, take the SAT and the ACT). But the pressure to start memorizing and regurgitating facts weighs on Chinese students from the moment they enter elementary school. ... Even as cram schools have proliferated across urban areas, Maotanchang is a world apart, a remote one-industry town that produces test-taking machines with the same single-minded commitment that other Chinese towns devote to making socks or Christmas ornaments.
Elizabeth Holmes rarely slips out of character. When she responds to questions in an interview or on a conference stage, she leans forward, leg crossed ankle over knee in a half-lotus manspread power pose. She lowers her voice an octave or two, as if she’s plumbing the depths of the human vocal cord. Although she hates it being remarked upon, her clothing, a disciplined all-black ensemble of flat shoes, slacks, turtleneck, and blazer buttoned at the waist, is impossible not to notice. She adopted this uniform, as she calls it, in 2003, when she founded Theranos, a company seeking to revolutionize the medical diagnostics industry by doing tests using only a few drops of blood. ... “I wanted the focus to be on my work,” she says slowly and deliberately. “I don’t want to go into a meeting and have people looking at what I’m wearing. I want them listening to what I’m saying. And I want them to be looking at what we do.” ... She was only too willing to let that propel her through the business media’s star chamber, though she refused to let photographers use a wind machine to blow her hair. ... After several years of Holmes telling the largely unchallenged story of how Theranos intends to change the world, a blast of cold air came ... Most blood work in the U.S. is run on analyzer machines made by companies such as Siemens, Roche Diagnostics, and Olympus. The labs that buy these machines don’t need the FDA’s OK to use them, but the manufacturers need it to sell them. ... FDA clearance alone may not be enough to convince physicians that the tests can be used for all patients, according to John Ioannidis, a professor of medicine at Stanford who’s best known for his criticism of the way scientific research is conducted, in particular for a 2005 paper titled “Why Most Published Research Findings Are False.”
The company’s genesis can be traced back to the 1893 World’s Columbian Exposition, a world’s fair that took place in Chicago. A recent MIT electrical engineering grad, William Henry Merrill, was hired by insurers to investigate Nicola Tesla’s work illuminating the exposition, which apparently consumed three times as much electricity as the rest of the city of Chicago at the time. Buildings were catching on fire at the fair, and insurance adjustors wanted to know why. Realizing the myriad potential fire hazards that the burgeoning lighting and electricity industries could pose, Merrill decided to stay in Chicago and set up an organization dedicated to testing electrical products and writing safety standards for them. ... More than a century later, UL is still contending with the same problems Merrill saw at the Columbian Exposition—short circuits, faulty wiring, shoddy manufacturing; anything that can cause a product to catch fire. But for the most part, our electronics and houses don’t spontaneously combust, and, in the US, that’s generally because of the increasingly specific and bizarre tests UL puts products through.