Establishing a Quantitative Method for Evaluating Nasal Valve Collapse to Guide Surgical Outcomes; Deception by Design: How Silicon Valley Paved the Way for the Theranos Fraud

Author:
Oscherwitz, Gia, School of Engineering and Applied Science, University of Virginia
Advisors:
Cottler, Patrick, MD-OTLY OTO-Dept, University of Virginia
Oyer, Sam, MD-OTLY OTO-Dept UPG-MD-OTLY OTO-Dept, University of Virginia
Laugelli, Benjamin, University of Virginia
Abstract:

My technical and STS research projects are connected by a shared focus on innovative healthcare technologies and the challenges of bringing them into clinical practice. Though the two projects examine different cases—developing a surgical evaluation tool for Nasal Valve Collapse (NVC) and analyzing the failure of the biotech startup Theranos—they are thematically linked by an emphasis on the intersection of technical design, clinical validation, and sociocultural forces in the healthcare space. While my technical work and STS research approach healthcare innovation from different angles, both explore how engineering decisions are shaped by ethical, clinical, and systemic considerations.

My technical project focuses on improving surgical outcomes for patients with NVC, a condition typically evaluated subjectively, which can lead to inconsistent treatment and frequent revision surgeries. To address this, my capstone team identified a novel metric for evaluating repair success, developed a database to support a long-term study tracking treatment outcomes, and modified a prototype caliper to intraoperatively measure nasal valve geometry. We collaborated with an otolaryngologist to refine the prototype, ensuring that both the device and data collection support real-time surgical decision-making. Our goal is to create a more objective and reproducible framework for NVC evaluation and treatment to improve patient outcomes and increase surgeon confidence.

While my technical project centers on the development of a clinically useful and validated tool, my STS research examines the risks of marketing healthcare technologies without transparency or rigorous evaluation. Specifically, my STS research evaluates the sociotechnical failure of Theranos, a biotechnology company that promised rapid, low-volume blood tests but failed to deliver valid clinical results. Using Actor-Network Theory (ANT), I argue that the company’s unethical behavior cannot be attributed solely to individual leadership. Instead, its legitimacy and success were sustained by Silicon Valley’s startup culture, a network of aligned actors—including charismatic executives, permissive regulators, sensationalized media coverage, and eager investors—that crafted a compelling narrative of credible technological disruption, despite a lack of peer-reviewed scientific evidence to support these claims. When investigative journalism and whistleblower testimony disrupted this network, the absence of clinical validation could no longer be overlooked, leading to the company’s collapse.

Simultaneously working on these projects pushed me to look beyond the engineering-focused challenges of healthcare innovation and toward a deeper understanding of the ethical, clinical, and systemic dimensions that shape the real-world impact of medical devices. My technical work gave me firsthand experience with the collaborative, iterative nature of medical device development, reinforcing the value of evidence-based design and clinical feedback. In turn, my STS research highlighted the risks of prioritizing market success over patient safety and technical rigor. Theranos serves as a powerful example of how technological legitimacy depends not just on engineering, but on ethical accountability and network stability. These projects reshaped my understanding of engineering in healthcare and underscored that successful innovation requires transparency, clinical relevance, and ethical responsibility. Moving forward, I am committed to developing technologies that are both innovative and functional, as well as reliable, transparent, and grounded in real clinical needs.

Degree:
BS (Bachelor of Science)
Keywords:
Theranos, Nasal Valve Collapse, Nasal Valve Width Measurement, Life Science Innovation, Healthcare Innovation
Notes:

School of Engineering and Applied Science

Bachelor of Science in Biomedical Engineering

Technical Advisor: Sam Oyer, Patrick Cottler

STS Advisor: Benjamin Laugelli

Technical Team Members: Julia Denys

Language:
English
Issued Date:
2025/05/07