We’ve put together discussion questions for Bad Blood by John Carreyrou that you can use with a book club, a class at school, or a team at work. We include sample answers, book club activities that will help you get more out of what you’ve read, and recommendations for more reading if you like this book.
Table of Contents
Book Synopsis
Bad Blood tells the true story of Theranos, a Silicon Valley startup founded by Stanford dropout Elizabeth Holmes, who claimed to have revolutionized blood testing. Holmes promised that her company’s proprietary technology could run hundreds of diagnostic tests using just a few drops of blood from a finger prick, making testing cheaper, faster, and more accessible. At its peak, Theranos was valued at $9 billion, and Holmes became the world’s youngest self-made female billionaire, gracing magazine covers and winning prestigious awards.
However, investigative journalist John Carreyrou uncovered that the technology simply didn’t work as advertised. Through interviews with whistleblowers and meticulous reporting, he revealed that Theranos was using traditional blood-testing machines for most tests, producing unreliable results that endangered patients, and engaging in a systematic campaign of deception involving investors, partners, and regulators. The book chronicles how Holmes and her COO Sunny Balwani maintained the fraud through aggressive legal threats, secrecy, and a culture of intimidation, ultimately leading to the company’s collapse and criminal charges against both executives.
Read Shortform’s comprehensive guide to this book.
Bad Blood Discussion Questions & Sample Answers
Along with discussion questions for Bad Blood, we include sample answers you can use as prompts.
- What do you think initially attracted so many powerful and wealthy people to invest in Theranos despite the lack of peer-reviewed data or FDA approval?
- Sample answer: I think Elizabeth Holmes was just incredibly charismatic and sold a vision that people desperately wanted to believe in. She had this Steve Jobs mystique going on with the black turtlenecks, and her board was filled with impressive political figures who lent credibility. Plus, the idea of revolutionizing blood testing was so appealing—who wouldn’t want easier, cheaper healthcare? Investors got caught up in the hype and didn’t do their due diligence because they didn’t want to miss out on the next big thing.
- How did the culture of secrecy at Theranos enable the fraud to continue for so long?
- Sample answer: The secrecy was absolutely crucial to keeping the whole thing going. Employees were siloed so they couldn’t talk to each other about what they were working on, and everyone signed these intense NDAs. Holmes convinced people that they were protecting trade secrets from competitors, but really it just prevented anyone from seeing the full picture and realizing nothing actually worked. If people had been able to compare notes, the whole thing would have unraveled much faster.
- What role did the media play in both building up and eventually bringing down Theranos?
- Sample answer: The media totally helped create the Elizabeth Holmes mythology at first—all those glowing profiles about the youngest female billionaire, the next Steve Jobs, a genius dropout changing the world. They didn’t ask hard questions early on. But then Carreyrou and The Wall Street Journal did real investigative journalism, and that’s what ultimately exposed everything. It’s a good reminder that we need skeptical, thorough reporting—not just cheerleading for the next tech unicorn.
- Why do you think whistleblowers such as Tyler Shultz and Erika Cheung came forward despite the personal and legal risks?
- Sample answer: I really admire their courage, honestly. Tyler especially had so much to lose—his relationship with his grandfather (one of the most respected statesmen in America), and he faced hundreds of thousands in legal fees. But I think they both reached a point where they saw patient results going out that were dangerously wrong, and their consciences wouldn’t let them stay silent. They put doing the right thing above their own comfort and careers, which is pretty rare.
- How did Elizabeth Holmes’s youth and gender both help and hurt her in building Theranos?
- Sample answer: It’s complicated. Being a young woman in tech definitely made her story more compelling and unusual—she got tons of media attention partly because she was such a novelty. But I also think some older male investors and board members underestimated her or treated her differently, maybe gave her more benefit of the doubt or wanted to be her mentor. On the flip side, she clearly faced real sexism in Silicon Valley, which she talked about, though she also seemed to weaponize that sympathy to deflect criticism.
- What do you make of Elizabeth Holmes’s behavior and persona—the deep voice, the black turtlenecks, the intense stare? Was this calculated or genuine?
- Sample answer: Oh, it was definitely calculated. There’s reporting that her voice was actually much higher naturally, and people who knew her said she affected that deep voice to be taken more seriously. The Steve Jobs cosplay with the turtlenecks was so obvious. Even the not blinking thing seemed like something she practiced to seem more intense and focused. She was creating this character of what she thought a visionary Silicon Valley CEO should be, and it worked on a lot of people, which is kind of disturbing when you think about it.
- How culpable is Sunny Balwani in the Theranos fraud, and how would you characterize his relationship with Elizabeth Holmes?
- Sample answer: Balwani was absolutely just as guilty, maybe even more aggressive in threatening employees and maintaining the toxic culture. Their relationship was deeply weird—he was nearly twenty years older, they kept it secret, and he seemed to have this Svengali-like influence over her. But I don’t think that absolves Holmes at all. She was the founder and CEO, and portraying herself as under his control would be a convenient excuse for her own choices. They were partners in the fraud, full stop.
- What does the book reveal about the problems with the “fake it till you make it” culture in Silicon Valley?
- Sample answer: There’s a huge difference between being optimistic about your startup’s potential and outright lying about whether your product works, especially when people’s health is at stake. Silicon Valley has normalized the idea that exaggeration and “reality distortion” are just part of being a visionary, but Theranos shows where that goes wrong. Software bugs are one thing; fraudulent medical tests that give people wrong diagnoses are literally life-threatening. The stakes matter, and the culture needs to recognize that.
- Why do you think George Shultz chose to believe Elizabeth Holmes over his own grandson for so long?
- Sample answer: That was one of the most heartbreaking parts of the book. I think Shultz was elderly, his legacy was important to him, and he was deeply invested—both personally and reputationally—in Theranos. Admitting Tyler was right would mean admitting he’d been fooled, that his judgment failed him. Holmes also clearly manipulated him, playing on their relationship and probably his ego. It’s sad that it took him so long to see the truth, but at least they reconciled before he died.
- How did Theranos’s partnerships with Walgreens and Safeway fail to catch the problems with the technology?
- Sample answer: Those companies were so eager to get in on what they thought was groundbreaking technology that they didn’t do proper due diligence. Walgreens especially seemed desperate not to lose out to CVS, so they rushed into the partnership. Theranos controlled what they could see during demos and site visits. When Safeway or Walgreens executives asked questions, they were stonewalled with claims about trade secrets. Corporate FOMO is real, apparently.
- What responsibility do the Theranos board members bear for not providing proper oversight?
- Sample answer: The board was a joke, honestly. It was full of these famous political and military figures—Kissinger, Mattis, Shultz—but not a single expert in blood testing or medical diagnostics. They were there for their names and connections, not their ability to evaluate whether the technology worked. A functional board would have demanded proof, insisted on transparency, and asked hard questions. Instead, they were dazzled by Holmes and collected their fees while providing zero meaningful oversight.
- How does Bad Blood illustrate the potential dangers when healthcare meets Silicon Valley’s move-fast culture?
- Sample answer: Healthcare can’t work on the “move fast and break things” model because, when things break in healthcare, people get hurt or die. Silicon Valley is used to releasing beta products and iterating, but you can’t beta test blood diagnostics on real patients. The regulatory process exists for good reasons—to ensure safety and efficacy—but Holmes treated regulations as obstacles to “disrupt” rather than necessary protections. The book really drives home why we need different standards for medical technology.
- What do you think motivated Elizabeth Holmes—was she a true believer in her vision, a conscious fraudster, or something in between?
- Sample answer: I go back and forth on this. Part of me thinks she started out genuinely believing she could make it work and just got in too deep, kept lying to cover up failures, and couldn’t find an exit. But some of her actions (like forging pharmaceutical company logos on reports) seem like conscious fraud, not self-delusion. Maybe she convinced herself the ends justified the means—that, if she could just keep the company going long enough, they’d eventually crack it. But, at a certain point, continuing to deceive investors and endanger patients crosses a line regardless of what she believed.
- How effective were Theranos’s legal threats and intimidation tactics, and what does that say about the legal system?
- Sample answer: Way too effective, unfortunately. They hired David Boies, one of the most feared attorneys in the country, and he sent threatening letters to journalists, whistleblowers, and anyone who questioned them. Tyler Shultz’s family spent around $400,000 defending him legally. The message was clear: Speak out, and we’ll bury you in legal fees even if we don’t win. It shows how the wealthy and powerful can weaponize the legal system to silence critics, which is really troubling. The fact that Carreyrou and the Journal had resources to fight back was crucial.
- What role did ambition play in the Theranos story, both for Elizabeth Holmes and for the people around her?
- Sample answer: Ambition drove everything. Holmes wanted to be the next Steve Jobs so badly she literally dressed like him. But the people around her were ambitious too—investors wanted massive returns, board members wanted to be part of something revolutionary, Walgreens wanted to beat CVS, employees wanted to work at a hot startup. Everyone’s ambition made them willing to overlook red flags. There’s nothing wrong with ambition itself, but the book shows what happens when ambition isn’t tempered by ethics or reality.
- How did reading Bad Blood change your view of the healthcare and tech industries?
- Sample answer: It definitely made me more skeptical of health tech hype. Now when I see some startup claiming to revolutionize healthcare with an app or device, my first thought is, Where’s the peer-reviewed research? I also realized how much the tech industry values storytelling and vision over proof, which works fine for some things but is dangerous for healthcare. And it reminded me how important regulatory oversight is, even though it’s not sexy or “disruptive.” Sometimes we need those guardrails.
- What do you think is the most important lesson from the Theranos scandal?
- Sample answer: For me, it’s that we need to demand evidence, especially when health is involved. It’s easy to get swept up in a compelling narrative or charismatic founder, but extraordinary claims require extraordinary proof. “Trust, but verify” should be the standard, particularly for investors and board members. And whistleblowers need better protection; if it weren’t for people like Tyler Shultz risking everything, Theranos might have continued harming patients even longer.
- Do you think the consequences Elizabeth Holmes and Sunny Balwani faced were appropriate?
- Sample answer: Well, Holmes got eleven years and Balwani got thirteen, which seems significant compared to a lot of white-collar criminals who get slaps on the wrist. But some people lost their life savings, patients got wrong results that could have affected their health decisions, and the damage to trust in healthcare innovation is huge. I don’t know if any sentence really accounts for all that. I guess I’m satisfied they faced real prison time, but the whole thing never should have gotten that far in the first place.
- How did John Carreyrou’s investigative journalism compare to other forms of accountability in the Theranos case?
- Sample answer: Honestly, the journalism was the only thing that worked. The board didn’t provide oversight, regulators were slow to act, investors didn’t do due diligence, and legal threats silenced a lot of people. It took Carreyrou’s dogged reporting—protected by The Wall Street Journal’s resources and lawyers—to really expose what was happening. It’s a powerful reminder of why we need strong, independent journalism and why attacks on the press are so dangerous. Without that investigation, Theranos might still be operating.
- After reading Bad Blood, how do you think we can better prevent similar frauds in the future?
- Sample answer: We need several things: better whistleblower protections so people can come forward without destroying their lives financially, boards that actually have relevant expertise instead of just impressive names, investors who do real due diligence instead of chasing hype, stronger regulatory enforcement with more resources, and a cultural shift away from hero-worshipping founders without evidence. Basically, more skepticism and accountability at every level. And maybe less secrecy; legitimate trade secrets are one thing, but the lack of transparency at Theranos should have been a massive red flag to everyone.
Book Club Activities for This Book
Discussing Bad Blood can be just the beginning! Use these activities to get even more out of the book and create unforgettable experiences.
Activity 1: Red Flags Analysis
- Create a timeline of Theranos’s history, and identify all the warning signs that appeared along the way. For each red flag, note who should have caught it (investors, board members, regulatory agencies, partners, media) and what actions they could have taken.
- Discuss:
- Were there particular moments when intervention could have prevented the fraud from escalating?
- What patterns of red flags are worth watching for in other companies or situations?
This exercise helps readers develop their own critical thinking skills for evaluating bold claims and charismatic leaders, whether in business, politics, or other areas of life. Groups can divide up different time periods or stakeholder perspectives and share their findings.
Activity 2: Ethical Dilemma Role-Play
Choose key decision points in the story, and role-play different characters facing ethical choices. Examples:
- You’re Tyler Shultz realizing the tests don’t work. Do you speak up and risk your career and family relationships?
- You’re a Walgreens executive seeing concerning signs. Do you delay the rollout or forge ahead to beat CVS?
- You’re a journalist receiving an anonymous tip. How do you verify it when facing legal threats?
- You’re a lab employee told to run tests on unapproved devices. Do you comply or refuse?
After acting out each scenario, discuss:
- What made these decisions difficult?
- What you would hope to do versus what you might actually do under pressure?
- What support systems or protections would make ethical choices easier?
This activity builds empathy for the people involved while highlighting the complexity of real-world ethical decisions.
Activity 3: “Verify the Vision” Challenge
Find a current tech or healthcare startup making ambitious claims (there are plenty in the news). Using lessons from Bad Blood, create a due diligence checklist to evaluate the company’s credibility. Include questions such as these:
- Is there peer-reviewed research supporting their claims?
- Does the leadership have relevant expertise?
- Is the board qualified to provide oversight?
- Are they transparent about their technology or hiding behind “trade secrets”?
- What do former employees say?
- Have regulatory agencies weighed in?
Then research the company, and try to answer your questions. Discuss what information was available, what was hidden, and whether you’d invest in or trust this company. This practical exercise helps readers apply the book’s lessons to real-world evaluation of innovation claims—developing healthy skepticism without becoming cynical.
If You Like Bad Blood
If you want to read more books like Bad Blood, check out these titles:
- The Smartest Guys in the Room—This definitive account of the Enron scandal by Bethany McLean and Peter Elkind shares many parallels with Bad Blood. It chronicles how Enron executives created an elaborate fraud—deceiving investors and employees while building a corporate culture of arrogance and deception. Like Theranos, Enron was once a Wall Street darling praised for innovation, with charismatic leaders who manipulated financial reporting to hide the fact that their business model didn’t work. Readers who appreciated Carreyrou’s investigative journalism and were fascinated by how corporate fraud operates at the highest levels will find this equally compelling. The book also examines the failure of gatekeepers—auditors, analysts, and board members—who should have caught the problems, a theme central to the Theranos story.
- Empire of Pain—This meticulously researched book by Patrick Radden Keefe tells the story of the Sackler family and their role in the opioid crisis through their ownership of Purdue Pharma, maker of OxyContin. Like Bad Blood, it reveals how a healthcare company prioritized profits over patient safety, used aggressive tactics to silence critics, and manipulated medical science to support false claims. Keefe’s narrative shares Carreyrou’s investigative rigor and ability to make complex business dealings accessible and gripping. Readers interested in the intersection of healthcare, corporate malfeasance, and the human cost of deception will find this devastatingly powerful and similarly infuriating.
- Billion Dollar Whale—Tom Wright and Bradley Hope tell the wild true story of Jho Low, a mysterious financier who orchestrated one of the largest financial frauds in history, stealing billions from Malaysia’s 1MDB sovereign wealth fund to finance a lavish lifestyle of yachts, parties, real estate, and even funding The Wolf of Wall Street. Like Elizabeth Holmes, Low was a master manipulator who cultivated relationships with powerful people and created an illusion of legitimacy while running an audacious scam. Readers who enjoyed the thriller-like pacing of Bad Blood and were amazed by the scope of Holmes’s deception will be equally stunned by Low’s brazen fraud. The book shares Carreyrou’s talent for turning complex financial crime into a page-turning narrative.
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Bad Blood: 23 Book Club Discussion Questions & Activities
