Truth, Fraud, and Culpability: How 'The Dropout' Team Dramatized Elizabeth Holmes' Theranos Saga

There is a male-female duo in Hulu's The Dropout, the eight-episode limited series about the creation and fall of Theranos, that change the course of blood technology advancements and are of service to countless patients, but who are not introduced until the end of the season.

Tyler Shultz (played by Dylan Minnette) and Erika Cheung (Camryn Mi-young Kim) were the whistleblowers who noticed the company was diluting patients' blood, working off of another company's machinery, and altering test results. They may be the heroes of the story. But they are not the protagonists of The Dropout.

The duo at the center of The Dropout, which is based on the podcast of the same title, is Elizabeth Holmes (Amanda Seyfried) and Ramesh "Sunny" Balwani (Naveen Andrews), the CEO and COO, respectively, of Theranos (who were also a couple). They were the ones who first tried to change the course of blood technology advancements, through an invention of a finger prick test that would perform 70 medical tests with a single drop of blood. But Theranos' technology could never actually do what Holmes was promising. As the show explores, when the machine did not work, she faked results to get investors on board. When it was years laters and she had raised hundreds of millions of dollars but the company could still not produce a consistently-working prototype, she allowed her employees to continue to fake it, ultimately putting real patients at risk. Shultz and Cheung did not see any moral (let alone legal) gray area there and spoke out, but the psychology behind what compelled Holmes to act as she did is what made her such a compelling character for those dramatizing her at the center of eight hours of The Dropout.

One-part origin story and one-part the crumbling of an empire, The Dropout dissects what happened, even if who these players are, at their core, still remain up to debate.

"The way that Elizabeth Holmes was portrayed in the media was as a hero and then as a villain, and there wasn't much in between. So, hopefully, the limited series provides more shades in areas where the media storyline didn't touch," showrunner Elizabeth Meriwether tells Metacritic. "I really tried to go into the telling of the story [and] not think about culpability. I tried to not put value judgments on them and just tell try to tell the emotional truth of the story as much as I could."

The Dropout starts with a recreation of Holmes being deposed in 2017, accused of fraud after promising investors, retail partners, and the public that her company would be able to perform 70 medical tests with a single drop of blood. By that time, the whistleblowers had already helped The Wall Street Journal reporter John Carreyrou (played here by Ebon Moss-Bachrach) publish an exposé on Theranos, and the company settled a lawsuit with the State of Arizona over the misrepresentation of these blood tests. However, the show then immediately flashes back to Holmes' younger years, including meeting Balwani while living in China and her short time at Stanford, to begin to peel back the layers on how a young woman with great ambition, enviable drive, and a genuinely game-changing idea ended up a convicted criminal. (The real Holmes is currently awaiting sentencing on the four counts of fraud she was found guilty of in January 2022, while the real Balwani's trial is set for March 2022.) 

Holmes dropped out of college to pursue her passion of becoming a billionaire through Theranos, so she did not hold a medical degree. Similarly, Balwani did not have a biological science background. (He is a former software developer with a business degree.) Seyfried and Andrews did their own research into the science within the story, with Andrews pointing out he specifically wanted to understand "the depth of [Sunny's] ignorance."

That ignorance led to a lot of insecurities for Balwani, in Andrews' view, which led to tension in his mind and body. Andrews was very cognizant of capturing his character's "ego and aggression and surface presentation, which they were both into," on both a psychological and physical level. For the latter, he gained 25 pounds for the role and also wore a prosthetic stomach to add even more weight for the more modern-day scenes.

When it came to tapping into Balwani's mind, he tells Metacritic that "the most interesting or least perplexing and fascinating part of him, to me, was how deeply besotted he was with her."

"It added a dimension, a romantic aspect to the story, which was like, 'How how will you go if you love somebody that deeply? What would you do? And he went all the way," he continues. "I think we both instinctively felt there was a fundamental imbalance in the relationship and an acknowledgement that, if that's the case — if there is that imbalance — the doors open for certain toxic behaviors that can be practiced by both partners at different times to undermine the other."

Seyfried, too, had to transform, playing Holmes from high school age in the early-aughts through near-modern day as her company rose and then crumbled. Holmes slipped on a uniform of a black turtleneck, gripping a green juice, and deepened her voice to be taken more seriously, which Seyfried had to find a way to capture.

"The shape of my mouth isn't the same as hers, but I can make sounds somewhat or pretty close to what she did," she explained during a Television Critics Assn. press tour panel for the show. "In terms of the depth of it, I had to work really hard to get there because I speak at such a higher level than she does naturally. So, even though she was deepening her voice more and more to what we all understand is for power's sake, to make an impact, I still couldn't get all the way there. There were some different breathing tricks; I don't think I nailed it 100%, but I think I did what I needed to do for the audience to come with us, and that was really my only concern. ... At the end of the day, I am an actor, and I'm not her, [but] I did my best to capture the oddness of it."

While the team behind The Dropout was working on the show, years of text messages between the real Holmes and Balwani became available as part of the trial documents. Meriwether immediately read through them to incorporate even more nuance and detail about their relationship into her version of the story.

"There was a moment in one of the text messages where they talked about taking care of a baby bird together that really stuck out to me and I actually tried to incorporate that into the show and then was told that we just didn't have money to make a VFX baby bird," she says with a laugh. "They had a real intensity to their relationship. Seeing it down in black and white on the page, the way they spoke to each other, it felt really intense and dramatic."

The text messages were where Meriwether learned about Holmes calling Balwani "Tiger," which she then started putting in later episode scripts to shed light on the dynamics within their relationship. Similarly, when Meriwether learned that Holmes' 30th birthday party featured masks of her face for her guests to wear, she not only wrote that moment into the show, but took it a bit farther by having the couple bring the masks home.

"I was very interested in, at that point in the story, her image and her awareness of her image and the idea of a mask and how they're both supporting that image while also stuck in it," says Meriwether.

"It was a very odd situation, and a unique one, where events are happening in real time as you're shooting," adds Andrews. "We'd be shooting a scene and then have a break and go and see what was happening in the trial. In terms of the decisions that me and Amanda made very early on about the depth of intimacy in their relationship, that was a huge relief because you're taking a gamble — you make certain decisions and hope that they're the right ones — and it turned out we actually were in the ballpark."

The show wrapped well before Holmes' trial concluded and will stream its season while Balwani's trial gets underway. Therefore, although the criminal part of this story will be on full display, the legal woes will be limited on screen. As the episodes unfold for the audience that may also be following along with emerging news headlines, Meriwether just hopes The Dropout will challenge people to examine the characters while also "examining ourselves and the culture of these startups in Silicon Valley and the way we all buy into the myths of a lot of these CEOs and the ways that the truth can become something fluid."

"We have to try to put the focus back onto objective truth," she continues. "The truth is not what somebody tells you it is."

The Dropout premieres with its first three episodes March 3 on Hulu.