Elizabeth Holmes – the subject of an HBO documentarybook, movie, podcasts, TV series, thick media coverage and commentary about her clothes and voice– continues to fascinate so many, I included.

Her recent court appearance, as she faces charges of fraud and conspiracy including lying to doctors and patients, resulted in the delay of her trial concerning her company, Theranos. She faces up to 20 years in prison if convicted.

But as a nurse, drawing blood and interpreting lab results for over 10 years, I have wondered how such a ridiculous idea based on blood testing could grow into a company valued at $9 billion, for several basic reasons.

I disagree with Holmes’ founding assertion that a fear of blood draws leads to people refusing to get much needed tests in diagnosing life-threatening conditions. Although needle phobia is real, most patients fear the result most– not the test. Many of my patients say, “I would rather not know,” when it comes to stating a reason for fearing testing for diabetes or kidney function. A different blood test that requires less blood will not eliminate that barrier. Nor would a different type of blood test address needle phobia.

Recently many quality interventions for blood draws have become available. A vein finder makes it easier to find veins to prevent more than one poke. Buffered lidocaine injected using pressure numbs the skin and works so well that children can sleep through their blood draws. And if you ask any diabetic who has to check blood glucose at least twice a day, likely the person will remark that a finger poke is one of the most painful and dreaded things they experience. Getting a drop of blood from the tip of a finger full of nerve endings is much more painful than a venous blood draw in the bend of the elbow or even an injection of insulin.

Holmes claims her uncle was the inspiration behind Theranos, but it appears he died from metastases from skin cancer, which is diagnosed via a skin biopsy, not a blood test. Her origin story is based on easily disproven falsehoods.

Many have theorized how Holmes’ ludicrous idea was given so much credence by so many.

One answer is the Abilene Paradox. That is when a group is in agreement, but then acts contrarily to their best interests. It is a phrase created in 1974 by Jerry B. Harvey, now Professor Emeritus of Management at The George Washington University, in an article attempting to explain “group think.”

Harvey named this phenomenon after an anecdote of a family proposing a 50-mile trip to Abilene, Texas for dinner. No one really wanted to go, they all went, they had an awful time and they each said it was a good trip.

Just like the members of this family, many of us may have been in meetings where an idea is proposed which is clearly unfeasible. You might agree with everyone else, often thinking, “They must know something I don’t.” In school and professional trainings, we are taught it is not optimal to be the naysayer in the group. We need to support each other’s ideas.

As I learned in improvisation classes, this rule is called, “Yes, and…” You agree with the premise of the scene and add to it. Improvisers are taught the opposite is called “blocking” where you deny your teammate’s suggestion. For Holmes, the Abilene Paradox seems to have been at work since was a student at Stanford University.

In the podcast “The Dropout,” Holmes, 19, brings her idea for a “patch” to her professor, Phyllis Gardner. Dr. Gardner tells Holmes her idea is based upon flawed logic, but Holmes finds another professor, Channing Robertson, who supports her. From there, she dupes various venture capitalists, including the DeVos family, General James Mattis, members of the Walton Family, Rubert Murdoch and more. To be sure, many found her claims dubious and did not invest. Yet, many went along with her idea.

Hiring the best and brightest in the tech world, Holmes was hoping to insulate them from outside skepticism, and perhaps continue to validate the Abilene Paradox. Some noted that there was a fear of speaking up in this company culture. Still, many people continued to attempt to find a way to make Theranos’s claims truthful, even though it was clear the task was hopeless. The fear of speaking up, fear of confrontation, created the opportunity for members of the team to act in collusion with each other, even though there was a universal agreement in the fruitlessness of the project.

Unfortunately, the aftermath of Theranos is not as simple as avoiding group embarrassment in a meeting, nor is it as harmless as saying you enjoyed a family road trip to Abilene when you didn’t.

The tragedy here is that Holmes took employees, investors, doctors, patients, and believers in her idea for a ride. And they suffered more than getting car sick.

Terry Gallagher is an assistant professor and family nurse practitioner at Rush University College of Nursing, a fellow of the Duke-Johnson & Johnson Nurse Leadership Program, and a Rush Public Voices Fellow through The OpEd Project. Follow her on Twitter @AprnTerry

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