21 January 2020

5 minutes read time

The gut

Shitty business

Like flies to…. dodgy startups, online influencers and other charlatans have gathered around the microbiome. They’re being found out

By James Kinross

At the turn of the last decade, biotech start-ups began to proliferate as entrepreneurs saw the success of Google and Facebook and emerging consumer health companies like the genomics company 23andme. The business model was based on the concept of grabbing as much data as possible and betting it could be mined for its biological surplus  – which could then be sold back to you. The best bit was that you paid for the whole thing by buying home-testing kits for – just – $99 a sample. It is a more malignant strain of what Shoshana Zuboff would call surveillance capitalism.

Find the real you – or maybe not

By 2012 growing public demand had evolved into crowd-sourced, public-partnership science projects like the American Gut Project, which encouraged people to share information about the microbes in their gut. This enabled scientists to develop new methods to get access to the massive number of samples they needed to study the gut microbiome across populations. Laudable, ethical efforts that inadvertently demonstrated a massive public appetite for this type of data analysis.

One of the most successful of these companies in the microbiome world was Ubiome, which started in the same year. It was founded by Jessica Richman and Zachary Apte. To their credit, they did well, with a $100-million-dollar venture round and stellar growth. They sold home testing “smart gut” kits and data analysis of your faecal microbiome that could be linked, by association models, to a range of chronic diseases. You received a report with graphs and bacterial names and common sense “advice” about how to improve your health largely based on assumptions. No one could understand these reports, so they also sold access to a microbiome “counsellor” who could make sense of it for you.

Jessica Richman, not the future after all

All was going well at Ubiome until the FBI raided its offices in April 2019 because of “problematic business practices”. Among other things, they were accused of routinely billing patients multiple times without consent and pressuring its doctors to approve tests with minimal oversight. These tests cost up to $3,000.

“Smart gut” was built using crowd-sourced samples, and their microbiome faecal genomic database contained data from children, infants and at least one animal. Unforgivably, patient care was compromised. In September 2019, Ubiome filed for bankruptcy and the reputation of microbiome science was tarnished.

Was this just another Theranos? Some have drawn comparisons between Richman and Theranos founder Elizabeth Holmes, but this is probably unfair. Perhaps there was a terrible scientific blunder, although this is unlikely. Perhaps it was all down to greedy venture capitalists (VCs) putting profit before science. But I think the truth is something else.

Theranos founder Elizabeth Holmes

Microbiome science was one of the first new, major, medical scientific fields to have developed in the age of social media. Few scientists had experienced global hype at this level before. Digital media fuelled public interest on a massive scale and under a different set of rules. Microbiome science is complicated and nuanced. It was difficult to explain. Therefore it could be conveniently spun by health vloggers, “influencers” or social outliers to “explain” problems that modern medicine could not.

Start-ups everywhere jumped on the bandwagon and the cart was placed squarely in front of the horse. (Does this sound familiar? It is happening with artificial intelligence right now.)

Silicon Valley and academia is another example of a symbiotic ecosystem that has become unhealthy. VCs certainly did not understand the science, and greed was a component. The difference between this and Theranos was that there was no black box. Academics failed to provide an ethical or analytical counter point.

Ubiome was a medical biotech company masquerading as a “wellness” company. This sleight of hand meant it escaped detailed clinical scrutiny. There were no really robust, prospective clinical trials; there was no peer review other than method development papers and the occasional case report; rigorous interrogation by the medical profession was largely absent. There was no professional consensus because the science was moving just too fast for the medical profession to keep up. No one really understood it, not even the scientists running the company. And so it failed.

All photographs Getty Images

All our journalism is built to be shared. No walls here - as a member you have unlimited sharing