[BostonCard]

For dabigv...

I'm thinking more and more outpatient clinics are not doing their own phlebotomy.  If you are drawing your pre-op CBC's and coags in your office, I think you are part of a dwindling minority; most will just write the requisition and the blood will actually be tested in a centralized facility (maybe attached to a hospital) or an outpatient Quest diagnostics or equivalent (like, you know, a Theranos center).  The convenience of being able to do it at a drugstore, where many people are going anyways would seem to  be a positive.  Plus more and more pharmacies are developing their own Urgent Care-lite "minute" clinics, so to be able to have an NP see a patient, get them blood tested and dispense a prescription is pretty high.

WIM...

A lot of the costs are not in the actual testing (reagents, etc.), but rather in the phlebotomy and handling, which are much more labor intensive. 

The three things that I think Theranos underestimated: 1) The engineering challenge of dealing with small volumes of a viscous substance
2) the FDA.  Holmes may have been able to sweet talk a bunch of VC's to part with hundreds of millions of dollars based on hype and talk of disruption, but the FDA is arch-conservative and very skeptical of hype; the greater the "disruption" the more proof they will want that it works as well.  Her strategy was to shoot first and ask questions later on the thought that it is better to ask forgiveness than beg permission.  That didn't go over well with the FDA.
3) the press.  Holmes took for granted the idea that she could capture them under her spell of a great origins story, and that worked for many years.  But the press also sees red flags with secretiveness, and when they started seeing smoke, it was all over for her; the only thing the press likes more than a heroic origins story is a downfall of hubris story.

[BostonCard]

For dabigv...

I'm thinking more and more outpatient clinics are not doing their own phlebotomy.  If you are drawing your pre-op CBC's and coags in your office, I think you are part of a dwindling minority; most will just write the requisition and the blood will actually be tested in a centralized facility (maybe attached to a hospital) or an outpatient Quest diagnostics or equivalent (like, you know, a Theranos center).  The convenience of being able to do it at a drugstore, where many people are going anyways would seem to  be a positive.  Plus more and more pharmacies are developing their own Urgent Care-lite "minute" clinics, so to be able to have an NP see a patient, get them blood tested and dispense a prescription is pretty high.

WIM...

A lot of the costs are not in the actual testing (reagents, etc.), but rather in the phlebotomy and handling, which are much more labor intensive. 

The three things that I think Theranos underestimated: 1) The engineering challenge of dealing with small volumes of a viscous substance
2) the FDA.  Holmes may have been able to sweet talk a bunch of VC's to part with hundreds of millions of dollars based on hype and talk of disruption, but the FDA is arch-conservative and very skeptical of hype; the greater the "disruption" the more proof they will want that it works as well.  Her strategy was to shoot first and ask questions later on the thought that it is better to ask forgiveness than beg permission.  That didn't go over well with the FDA.
3) the press.  Holmes took for granted the idea that she could capture them under her spell of a great origins story, and that worked for many years.  But the press also sees red flags with secretiveness, and when they started seeing smoke, it was all over for her; the only thing the press likes more than a heroic origins story is a downfall of hubris story.