One Tiny Drop of Blood, a Deluge of Brand Deceit; How Elizabeth Holmes and Theranos Weaponized Design

From atop a 700-acre hill in Silicon Valley, two heads have rolled. Specifically, Elizabeth Holmes and Ramesh “Sunny” Balwani, the co-conspirators behind the once-lauded blood-testing tech brand, Theranos.

Early this year, Ms. Holmes was found guilty of federal fraud, and Mr. Balwani is currently mid-trial. They’re both in a heap of trouble for deceiving and lying to investors—and the world—about Theranos’ capabilities to raise a small fortune for a brand that was more performance art than performing. 

And the cost of this deceit? Over $700 million in investment dollars, health scares including false positives for cancer and STDs, the tragic suicide of Theranos’ Chief Scientist Ian Gibbons, and a fall from grace so rich in controversy it's now entertainment (and streaming on Hulu). What's more? An extreme twisting of design and branding reality, like a snake coiled around a stick. 

Which, as it happens, composed a portion of the original Theranos logo. That wordmark, set in a soft serif with a white inline, and a snake curling up the T, borrows from the medical field’s use of the Rod of Asclepius as a symbol for healing. Based in Greek mythology, Asclepius offered medical attention to all, regardless of background. 

Like many brands, Theranos experienced a glow-up—after the Rod of Asclepius, the logo shifted to a quadratic leaf-like shape pierced by the negative space of a brilliant star. Eventually, the Theranos logo settled into a trustworthy design rooted in the sleek simplicity of Massimo Vignelli’s enduring 1972 NYC transit map graphics and the inspiring humanity of Apple’s “Think Different” campaign, created by Chiat/Day art director Craig Tanimoto. 

And that’s the balance Theranos Chief Creative Officer Patrick O’Neill (who was poached by Ms. Holmes from Chiat/Day) struck in developing the design pillars for Theranos—simple, human, optimistic. Pillars evident in its lowercase gray sans serif wordmark, with the “o” of Theranos pared down to a perfect teal circular gradient drop. For Ms. Holmes, the teal drop represented a minimal “flower of life,” a sacred geometric pattern symbolizing creation, alchemy, connection, and perfection. 

By the time Theranos adopted this clean and approachable design pioneered by brands like Apple (and before that Dieter Rams’ iconic work at Braun), Ms. Holmes had achieved full tech-star status, gracing the covers of Forbes, Fortune, Bloomberg Business, and T Magazine. 

That’s around the time design and art director M (who requested to remain anonymous for this interview) was hired by CCO Patrick O’Neill in 2014 as an independent designer for eight months. M focused on spec work and design touchpoints for Theranos’ Walgreens partnership and wellness centers. At the time. M was also the only designer really working on that particular project, so they touched everything from the test sheets and what was on those to what a traveling wellness center would look like and the branded band-aid you'd get on your finger after dropping off some blood.

Anyone involved with Theranos from a design or marketing perspective has likely wrestled with whether or not this would remain a case study in their portfolio, including M. That group is composed of incredibly successful and renowned folks, like the aforementioned Patrick O’Neill, but also Academy Award-winning director Errol Morris and Anna Arriola, the former Apple senior product line manager on the original iPhone team. Most have been outspoken about their experience at Theranos. However, as a self-described “bleeding heart hippy,” M’s resolve to remain publicly private is understandable. 

“I was getting the same Kool-Aid to drink as everyone else was," explained M about their knowledge of the Theranos brand going into the project. "This was going to change the world. This was going to be this major thing. At the time, I wouldn’t have known there was a good side and a bad side to Page Mill Road [Theranos headquarters in Palo Alto] in terms of venture capital and who's supplying it. I didn’t understand that who they should have had on the board is not political agents who are military but doctors.”

So, M used the same measuring stick many of us would use and thought, “How cool, I hate having my blood drawn too!”

“It was a novel idea in 2014 to Apple-ize medicine," M explains. "The idea of taking something that people hate—getting their blood drawn—there is a need that it was addressing. It’s just that, behind the curtain, the magnificent Oz was a Stanford dropout who thought because the idea was good, it could convert into some good reality, but it doesn’t always work that way.”

In Ms. Holmes’ hero-worship of Steve Jobs, including the black turtle neck, she manages to skip all the steps that required rigorous expertise, disciplined and honest testing, and research and design with morality. Though she was quick to point out in an interview, “I do have to disclose that I’ve been in a black turtleneck since I was 7,” her calculus in adopting particular brand attributes of Apple is glaring. 

Ms. Holmes also once paraphrased inventor Thomas Edison saying, “There are no shortcuts to really hard work.” Audaciously, in the same breath as naming the Theranos’ blood testing machine Edison, she admits in her trial that she decided to swap in commercial blood analyzers from Siemens (another tech giant) in place of the Theranos Edison device. 

There is one shortcut she found, however—weaponizing design. From the prototypes for the Edison blood-testing device to the prototype for the Nano-tainer that collected “just a few drops” of blood, down to the brand’s visual identity and marketing touchpoints, Theranos legitimized itself through successful design and clean serifs that ultimately made heartfelt human connections.

Even the color teal, with its alchemical mixing of blue and yellow pigment, played a role. A deep teal is calm, sophisticated, and knowledgeable, similar to the dark greens you see in old libraries. Teal’s positive traits are healing, friendliness, invigoration, clarity, creativity, and calm. And lighter shades feel younger, clearer, and more invigorating because they remind us of the shallow waters of tropical islands. Or teal scrubs. Or Siemens’ primary brand color.

As M created specs and touchpoints at Theranos, they point out that a designer's brain focuses on one goal—“If it’s clean, if it communicates well, and gets the point across.” For as clinical of a brand as Theranos was, the design system has a warm, human quality; watch one of Errol Morris's films created for Theranos. It’s hard to detect the dark reality behind the brand.

“In terms of the weaponization of design, design is like any tool," M explains. "It can be used for good things, or it can be used for bad things. Whether it’s military psyops on the extreme end to doing volunteer work for a charity. There's a huge gamut.” 

What occurred to M was that Ms. Holmes weaponized youthful hubris. "She figured out people want to hear this story of this Steve Jobsian person who is this mythical unicorn," M says. "The difference is that, when Apple started, he had a Steve Wozniak that actually knew how to figure out the hardware.” 

“The human body is not hardware," M adds. "You can’t push the limits and try things because there are physical realities that can’t be massaged. At the end of the day, it’s your blood, and if there aren’t enough blood cells to do this test, you’re not going to know.”

Going back to the symbolism of Theranos’ final, minimal ”flower of life” logo, the bottom line is that Elizabeth Holmes' success lasted as long as it did due to her own alchemy. By mixing very convincing branding (that copied the homework of tech’s biggest powerhouse, Apple) with our own willingness to believe in her breakthrough blood testing technology, she was able to weaponize branding with impressive, albeit deceptive, precision.

“If they were able to make the technology work, we’d be having a totally different conversation," M points out. "It’s a great idea that is not possible. And no amount of magical thinking was going to make that the case.”

The question is, could this happen again? In 2022? Sure, if we’re not careful.

“People are learning through forced design literacy how to spot red flags,” M acknowledges. How to think about things in terms of abuse of that language is critical when it comes to the silver lining: there is less credulity amongst us today because of the Theranos fraud and conspiracy. 

“If she knew it wasn’t physically possible and was pushing for all this branding work for something that wasn’t real, she already knew it was bunk," M concludes. "But she was still trying to build the brand anyway, and that to me is the crux of where design has the potential for being particularly harmful.”

Hopefully, odd design moralities like this will go less unnoticed when it comes to what M calls “that combination of glossy approachability, and being able to apply it to something that makes people so uncomfortable.” Medicine, and the medical industry have historically been clinical, trustworthy, and cold aesthetically. Add technology to that, and patients can feel even more alienated. 

But this well curated, warm, Apple-driven aesthetic is new thinking as we see more and more brands in the med-tech industry pivot towards humanizing medicine and making what can be scary more hospitable. With the rise of brands like Tia and One Medical, which blend personal attention with tech that makes wellness collaborative and connected, Theranos’ creative direction was applaudable and spot-on while the idea was simply implausible. M illuminates that what Theranos “ultimately did is craft a visual identity that was shorthand for comfortability.” 

Theranos' technology inevitably flopped, but the fallout isn't all bad. We now have a sharper eye for the full picture—design acumen is not always shorthand for brand competency.

Images from PTO Creative unless otherwise noted.