Anne Wojcicki: How 23andMe is Disrupting the Healthcare Industry | E246
Anne Wojcicki: How 23andMe is Disrupting the Healthcare Industry | E246
Anne Wojcicki is a biologist, entrepreneur, and the co-founder and CEO of the personal genomics company 23andMe, which provides genetic testing for individuals curious about their ancestry and genetic makeup.
In this episode, Hala and Anne will discuss:
– Anne’s disillusionment with the U.S. healthcare system
– The power of the human genome
– The challenges of direct-to-consumer DNA tests
– The real reason 23andMe was so controversial
– Handling FDA concerns
– Challenges of achieving transparency and privacy
– How people’s lives have been changed by taking the 23andMe test
– Integrating genetics into patient care
– How large datasets are helping solve health mysteries
– Building a direct-to-consumer healthcare movement
– Combining genetics with drug discovery research
– Expanding 23andMe’s non-European databases
– How AI will change the medical landscape
– And other topics…
Anne Wojcicki is a biologist, entrepreneur, and the co-founder and CEO of the personal genomics company 23andMe. She has been on Forbes’ list of the World’s 100 Most Powerful Women and has been named “The Most Daring CEO” by Fast Company. Her company 23andMe provides genetic testing for individuals curious about their ancestry and genetic makeup, but it is doing a lot more than that, including helping to revolutionize how we think about drug discovery and the genetics of health.
Anne’s Website: https://blog.23andme.com/tag/anne-wojcicki
Anne’s LinkedIn: https://www.linkedin.com/in/annewojcicki/
Anne’s Twitter: https://twitter.com/annewoj23?lang=en
Anne’s Instagram: https://www.instagram.com/annewoj23/?hl=en
Where you can order a 23andMe Health and Ancestry Kit: https://www.23andme.com/dna-health-ancestry/
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[00:00:00] Hala Taha: Young and Profiters, we have a very special guest today. Anne Wojcicki is an innovative biologist and entrepreneur and the co founder and CEO of the personal genomics company 23andMe. She's been named by Forbes as one of the world's 100 most powerful women. and has been named the most daring CEO by Fast Company.
Her company 23andMe provides genetic testing for individuals curious about their ancestry and genetic makeup. And you may have already taken one of their tests. But 23andMe is doing a lot more than that, including helping to revolutionize how we think about drug discovery and the genetics of health.
And I'm thrilled to have you on here. Welcome to Young and Profiting Podcast.
[00:02:23] Anne Wojcicki: Thank you for having me. Excited to be here.
[00:02:26] Hala Taha: All right. Let's talk a little bit about your own genetic material to start. You came from a family of very high achievers. Can you talk to us about what it was like growing up for you in an environment like that?
and around the Stanford campus where I understand you spent a lot of time as a child And how did that influence you as a person and your career trajectory?
[00:02:45] Anne Wojcicki: You know, what's interesting is our childhood was obviously extraordinary in some ways in retrospect, and it was extraordinary while, while we were growing up, you know, not everyone has particle physics as parents and the campus where we grew up was unusual, but I did like there was, we had a amazing peer group of other people who, you know, I always like to point out like all the, the friends that I grew up with have gone on to do extraordinary things, slightly less public than what we have done, but I really do credit in many ways.
the community as a whole for raising a whole community of children that were really raised to think big and think creatively and not worry about making money, but really to follow your passions. And I would say another thing that was also very aligned with this community, being an academic community, we were very much aligned with how to not spend money.
And so, because again, we were all on academic budgets. There wasn't that luxury of actually spending a lot, like we all had sort of a common sense of thriftiness of actually how you were going to make small amounts of money and be able to still enable yourself to do lots of interesting opportunities.
So my parents, my father is a particle physicist at Stanford. My mother was a high school teacher at Palo Alto High School. And, you know, the thing that was interesting, you know, I'm a child of immigrant parents. And so my parents really. brought that work ethic and like this appreciation for the country.
And overwhelmingly, you know, my father is a particle physicist who was studying whether or not neutrinos have mass. That's a very academic pursuit. I was always envious of people who had parents where it was like, Oh, you work on fruit loops. That's something you can really understand. Searching for mass was not necessarily something people could relate to.
And then my mother, she taught high school journalism. Was unusual in how much she was a believer in children's potentials and really in that importance of self advocating. And my mother was definitely unusual in our area for her community activism when she wasn't happy about something. She was extraordinary at driving change.
She was extraordinary at seeing an idea and then making it happen. You know, I grew up, my mom was also sold Encyclopedia Britannica's door to door. So I grew up also kind of with that mentality is like, you were kind of doing whatever you needed to do to make things happen. And obviously I have my two older sisters who've both gone on to do extraordinary, interesting things.
But again, kind of all at that, with that same upbringing that we were encouraged and to really follow our passions. And academics was definitely prioritized in our life over sort of everything else. But really, I'd say the number one thing was finding your passions.
[00:05:47] Hala Taha: I love that. And I love to see three powerful women, all three of her sisters, like you said, very successful.
One of your sisters was a former CEO of YouTube and you're the CEO of 23andMe. Like, it's just pretty incredible that all of you became so successful. So, when I did my research, I found out that you went to wha uh, Yale, you went to Yale. Yep,
[00:06:06] Anne Wojcicki: yep. My old boss used to say, I went to jail, so, I'd rather go to a whale than to jail, so.
[00:06:14] Hala Taha: You studied biology at Yale, and then you ended up working on Wall Street for about a decade. And you worked on some hedge funds in healthcare, but then you ended up becoming disillusioned eventually. What was the problem with you working on Wall Street? Why did you feel unaligned?
[00:06:30] Anne Wojcicki: I You know, I took a job on Wall Street.
I didn't even know what it was. I knew what stocks were. I knew the stock market. I always loved, you know, playing in, in, with stocks and understanding the stock market. But I didn't know that you could actually have a job on Wall Street, like a banking job.
When I graduated college, frankly, it was like a huge surprise that I was even asked to interview at this company and I really only took the job interview just because I wanted the frequent flyer miles, not because I was actually interested in the job going back to that thrifty side of the family and my dad is the one who encouraged me to take the job in part because he's like, I don't know.
He's like, it's so outside of our comfort zone. You should totally try this. It's so cool. Unusual. And so I took it kind of on a whim. And I was really lucky because I worked for spectacular people, and I would say one of the most important lessons I learned over time was finding extraordinary mentors in an extraordinary place.
That's really willing to invest in you and the Wallenberg family and an investor. A B was that kind of place like they really invested in me. They had a mission that I aligned with. It was all about long term investing in health care, identifying the transformative technologies and being a big player in them.
And it was also just, you know, really, really good people over time, as I moved on to hedge funds and I wanted a more kind of aggressive trading experience, I started to also realize the profit making side of health care and not that it wasn't when I was working at investor AB, but it kind of felt like it was aligned with sort of transplantation, Xenotransplantation we're looking at, like the revolutionary change that you could bring with having pig organs going to humans.
Transcribed When I was investing, it was really just about how could I do a roll up of dialysis centers and each dialysis patient is worth a certain dollar amount and how do I maximize the profits there? How do I increase collections in a hospital setting? If I move collections into the emergency department, if I change the protocol for when you ask people for the insurance, what are all those things that optimize billing?
And I became really sort of most disillusioned. I went to this one meeting on billing optimization and I realized that all this data we had and all the new analytics power was really going into not how to keep me out of the hospital, but really into how is it that when I go in for a procedure, I can maximize the amount of money that I'm getting out of billing.
And I'd go to these meetings and I kept thinking, well, What happens if you're 90 years old and you have no health conditions, and you're healthy, no one makes money on you. And I got really interested in the world of prevention and realized that all these people would kind of pat me on the back and they're like, it's so cute that you think about prevention, but no one rewards you for the absence of a disease.
And it's true. If I have a big population and nobody gets diabetes, no one's going to reward you. There's no financial reward with that kind of system. But if you have diabetes and you successfully manage them, there's lots of money. And I used to use this example about the diabetes prevention plan that was started by the CDC and it was funded with 14 million every year for diabetes prevention, and it's an incredibly effective program.
And then I'd compare that to the 200 billion or so that's spent on diabetes and you just realize there's just no comparison. There's overwhelmingly an incentive to just have people manage their disease once they have it. I became also really at the same time inspired by the HIV community and back when I was in high school, you had that passion that penetrated even high school kids of, you know, silence equals death and the quilts project.
You couldn't avoid the activism of HIV activists. Like it was just an, you knew that community. If you watch a movie called How to Survive a Plague, it's extraordinary to see the role that those activists had in actually transforming the course of the disease and how much they were a central figure in actually coming up with that plan of like, how are they going to do drug discovery?
How are they going to enroll people? What are those trials going to look like? And I realized I wanted to be part of that kind of movement. I want to be part of that kind of movement where people were standing up and advocating for themselves. And I realized in health care in general, you, the consumer have almost no role.
It's the closest thing I've ever seen to communism. Like if you just think about for all these people, like you had the whole show about profits and et cetera, like you're usually have this relationship between the customer and. The provider, but in this case, you as the individual as a health care consumer, you are never the customer ever.
Doctors go out of the room and they talk about you and then they come back and they tell you where you're not part of the decision process in any way. And so I came increasingly cynical. And at the end of 10 years, I kind of came out more with this mentality. It's like I want to overthrow it. I want to create a system.
I want to create a community Where you're empowered to actually be healthy and where we have a direct to consumer relationship with you and we're all about investing in you as an individual to be as healthy as possible. And I found that the health care system overwhelmingly has given up on you. They kind of believe like, Oh, if you're already sick and you're overweight and this and this.
You're not going to do anything. They just like, ah, we already know. And it's an awful, like when I work in hospitals, it's like, it's an awful experience. There's no other business that fundamentally doesn't believe in their customers. Like imagine if like, you know, your TV shows were like, ah, you know, you're incapable of understanding this.
And it's a totally different kind of world in healthcare where they're kind of betting on your failure rather than betting on your success for any kind of behavior change.
[00:12:37] Hala Taha: Yeah. I have a family of doctors and I've witnessed this myself. I've always felt a little bit unaligned in terms of the fact that people make money off of other people's sickness.
And a lot of doctors are really well meaning. They want to help people, but the system is set up where everybody just profits. off of people's sickness. So to your point, now that there's more direct to consumer options for people to be able to take control over their health, there's an opportunity for some change to happen in the healthcare system.
[00:13:09] Anne Wojcicki: Totally. I always said the healthcare system is full of people who really care, and they're all incredibly well meaning. You don't go and suffer through seven years of medical school just to have the wrong incentives. People are there because they really care. but the incentives of the system are just pointing in a direction that don't align.
And I think there's been all kinds of articles lately about the misalignment between the medical care provider and the institution and what they're doing. For instance, there is the hospital system that was denying payment or like wouldn't treat people anymore if you had outstanding bills. I mean, it was these awful stories of people who they knew couldn't take care of themselves and they were just putting them out on the street.
So I think it's, you do have that issue is like the systems are not aligned and we do, you know, fundamentally. I'm not positive that you can get around that if you don't have a single payer system. So it's just really, really challenging because right now you can't ask anyone to work for free and I completely understand.
There is an economy around healthcare and you can't expect people to work for free. But I do wish that there was a way that we could align incentives so that what is best for you is actually going to be what's best for the entire healthcare ecosystem.
[00:14:21] Hala Taha: Can you just clarify, you said single payer, what do you mean by that?
[00:14:25] Anne Wojcicki: right now we have a health care system where it's very fragmented who's paying the bill. And if I'm employed by GE, and let's say the average employee works three years there, that means GE is paying for my health care, but only for three years. And so why would they pay 10, 000 for something today, that is not going to save them money?
You know, in the next three years, but it's going to save them money over 15 years. So everyone looks at kind of what, like we think about in financial terms, what's your ROI people start to look at their ROI based on how long likely is the employee going to stay. So if you're only going to be there for three years, it has to be an ROI within three years.
If we're going to pay for some kind of preventative investment, otherwise you pass the buck and it's a game of hot potato. And you wait to see if somebody else could have it. So, If in a single payer system, you have a government that is paying for all of health care, but then they're managing risk throughout your entire life, not just in these short segments.
And I think that's the big difference. It's all about risk management. How is it that you can actually manage the risk over your whole lifetime and can you invest in something that is important in your twenties that will pay out then in your forties or fifties. So, right now, no one wants to invest in that way, but if you actually had a single payer system, you potentially have more of a likelihood of actually seeing the return on investment for that institution.
[00:15:57] Hala Taha: Okay. Got it.
So, you were on Wall Street. You started to have a change of heart, so you started to think that you could maybe help start to change things now that you had an insider view of what was going on. And from my understanding, you thought about going to med school, but that didn't end up happening.
What happened next?
[00:16:16] Anne Wojcicki: I'd always thought about going to med school ever since I was a kid, and I would take off time at different times to think, Oh, maybe now is the time I'll go back to medical school. But what was unusual in 2000 to 2003 is that you started to see really the rise of the web and internet and people that I got to know like Katerina Fake, who would explain like web 2.
0. You know, web's not just about flat information, but you're actually going to have the connectivity. And obviously now it's so obvious to all of us that it's hard to imagine that that was even a revolutionary concept at the time, but it was. So I recognized I was like, well, what's really exciting is that there's a technology that is inexpensive enough now that individuals could actually get access to their human genome.
And to me, your genome. is the foundation of your health and your health risks. So if you can understand your genetics, you know whether or not you potentially have a predisposition for a certain kind of condition. Are you higher risk for blood clotting? Are you more likely to not metabolize a certain kind of medication?
Are you higher risk for breast cancer? So if you know what your risks are, then you can actually do something to prevent them. And I also really believed in this concept of big data. How is it that you could crowdsource millions and millions of people to participate in research to really uncover the mysteries of health?
And I realized that All these healthcare is done and healthcare research is done in these little cohorts like Stanford will have a cohort, Harvard has a cohort, you know, NIH has a cohort and occasionally they come together and collaborate, but it's complicated. It's a lot of people. It's not easy. So my idea again was how do you just go direct to consumer?
How do you enable people to say you can get access to this revolutionary technology to learn about your genetics and your genetic health risks? Thank you. And then how do I leverage all those concepts that are coming out of Web 2. 0 to say it's not just about you and your information, but now it's actually going to be a social concept where you're going to learn about yourself, but then you're going to learn from the crowd and we're going to crowdsource research, meaning it's going to have research about breast cancer and what that means for you, but then also a huge community of individuals as well.
Who may have risk factors for breast cancer, may have had breast cancer, or maybe they have no breast cancer in their family. Each individual can be useful in that pursuit of research. So, started the company with this idea that people can get access to their own genome, that it's going to be direct to consumer, and that we're going to create this kind of research community online.
[00:19:03] Hala Taha: And so when you first started 23andMe, it was pretty controversial.
[00:19:08] Anne Wojcicki: 23andMe was very controversial, but for reasons that people don't fully understand.
The reason why we were super controversial in those early days is that health care, again, I I gave that example to me, healthcare is like a communist system. And so, you have a system that decides what's the healthcare for you. And they control information. Today, when you go to the doctor, your insurance company, your PBM, your physician, various academies and those policies, they all decide what you get.
You don't just walk in and say like, Hey, I want this menu of options. Here's what I. Okay. So. 23andMe, everyone has talked about genomics. Everyone talks about, oh, one day every child will have their DNA at birth and it's going to be used in this way, like ever since Star Trek. We've been talking about this for a long time.
So suddenly 23andMe comes in. We circumvented the entire system and we just said like, Hey, guess what? You guys want this information? You can have it. And there was sort of an uproar over, do you have a right to get access to this information? Doesn't it need to go through a clinician? Doesn't it need to be moderated by this system that controls all the other health that you have?
Think about if you want to go and get like a simple iron test, that's a blood test. You have to get a prescription from your doctor. So suddenly something as revolutionary as genetics. Was going direct to consumer and that didn't sit well, the most controversial aspect of us is that we're direct to consumer, not as much as the genetics, but that we're direct to consumer and that we bypassed the entire system.
So in those early days, some of the medical meetings we went to, it was like pitchforks out for us. I had one doctor I remember standing up who was like, I can't even sit at the table with you. And it was interesting. Everyone had different reasons. Some people were like, oh, this information is so controversial, people will kill themselves.
Someone said, you are going to have women all over the country abandoned because you're going to uncover the non paternity rates in this country. We had all kinds of things. And frankly, it was a lot of conjecture about like, what was it that was going to happen? And then obviously the one of the more well known moments for in our company's history was in 2013, when the FDA actually gave us a warning letterthat came out and said, you can no longer deliver the health information.
23andMe at that time had to stop offering our health reports. We didn't have to stop selling, but we couldn't return our health reports anymore.
And a lot of people at that time thought that would kill us. And we would do one of two things. We would either just become an ancestry testing company and not do anything else in the health space, or it would force us into compliance with the rest of the system. And it would force us to go through a doctor.
And I think the path that we took was the one that was the hardest and frankly the most surprising, which is that we said, we are actually doubling down on direct to consumer. And not only are we not going to change, but we're going to prove to you in data that the test we have is safe. And that people are capable of spitting on their own, and that they can understand this information without the supervision of a healthcare provider.
And so it took us years, and we're still getting FDA submissions, like it took us about seven years to get back all the submissions, all the reports that we had had. But we've proven out now over time that you can get really medically meaningful information like your breast cancer risk. or your Alzheimer's risk.
And you can buy that online, you can spit in a tube at home, and we can deliver those results to you, and that you do not need clinical oversight. of that. And I think more and more, like one of the most important things for me, again, as a takeaway from my healthcare days,
if you want to improve healthcare for everyone, it cannot be dependent upon a one to one interaction with a clinician.
So healthcare has to find ways to scale. It has to be about how do you deliver care for many people. With the oversight of just one
so similar to like you are surprised now if you ever have to call a hotel to book a reservation, that's probably hasn't happened in most of your listeners lifetime, but like that used to happen to me like I would have to call the hotel and use it and wait like now you just go online and you book it.
You just can do all these things on your own and healthcare has to transform in that same way.
[00:23:52] Hala Taha: This is so interesting. I have a lot of follow up questions about what you just said. First off, when it comes to people doing a 23andMe test, like you said, you find out about any diseases that you might be predisposed to.
You also find out about your ancestry and you end up maybe indirectly getting information about your parents or your outside family. Talk to us about some of the consequences, I guess, of this data. when it comes to getting insight about other people's data from learning more about your own DNA? Does that make sense?
[00:24:24] Anne Wojcicki: A hundred percent. Yes. So since we started the company, privacy and transparency and choice were top priorities for us. We spent an extraordinary amount of time with ethicists and privacy experts, really thinking through the process. And so for that reason, I actually have an extraordinary privacy team now, an extraordinary ethics team.
Like from day one, we are very different than all the other tech companies because we've had that since our, like it was such a core part of our foundation. Our first scientist that we hired outside of the founding team actually ran our whole ethical, legal, social. interaction. So it's always been a really hot priority and in part because there are so many ethical issues.
So we wanted to be really thoughtful about how you approach them. So one of the most interesting ones that we've really embraced head on is the fact that you share DNA with all of your family. So whose right is it to learn about your DNA? So for instance, you can do 23andMe and you can learn things that impact your entire family, but your family might not have wanted to learn that.
So you might learn that your father is not your biological father. You could learn that you are. of Jewish descent and you didn't know it. You could learn that you have African descent and you didn't know it. You could learn that your father is a sperm donor and you didn't know that. So there's all kinds of things that you could learn that you did not necessarily know about.
So first thing for us was always the consent process, like making sure people really know that there's a lot of unexpected information that they can gather from doing 23andMe. And so some people are specifically coming to us looking for that kind of information. And for other people, it's just, it's a surprise.
Second, we try to make sure people are respectful of the fact that your information will impact family members. And that not all family members want to know. So, I've seen, for instance, people who were adopted, who say, I'm not going to do 23andMe until my adoptive parents have passed away. Out of respect for them.
So, we'll see things like, as well, where people find out, like, Oh, my father, I found additional siblings, but I'm not going to contact them. I don't want to disrupt my parents. So what we have found, and we've taken that position, it's your DNA and you have the right to access what is fundamentally about you, but it's important that we make sure our customers are aware that there are consequences for the entire family and that you learning, for instance, that you also are a carrier, let's say you have two copies of the Alzheimer's, the ApoE4, so you're higher risk for Alzheimer's disease, is If you find out you have two copies, you just found out something.
Like, you know that both your parents. Have a risk factor. So maybe they didn't want to know, but then you find that out. So making sure people are sensitive to that information and that they communicate it directly or they communicate it appropriately within a family. And sometimes that means not communicating it at all.
[00:27:47] Hala Taha: so many more people now have access to their genetic information. I think over 13 million, perhaps more by now, have taken your test. And now they're bringing their results to their doctor, and I don't think these doctors have been formally trained on genetics.
So what issues arise from that, and how do you see that changing in the future?
[00:28:10] Anne Wojcicki: I think what's interesting now, so in those early days, that was 100 percent one of our issues, is that it wasn't just that it was like, okay, There's a group like that's controlled medical information is controlled by this by the population, but also does that population know how to disseminate the information or the guidance of what to do with it.
And there's always been this crisis in the country that we have a complete shortage of genetic counselors. So you can't necessarily like we don't have enough people to train all the clinicians out there. And I think that also fundamentally, we've taken that position that it needs to be all health care providers who understand.
the integration of genetics. They don't have to be experts in all aspects of it, but in cardiology, they should know some of those basics and then be able to refer on to some of the specialists. So in those early days, it was an issue. People did not know. And we took the approach, right or wrong, that we were going to work by educating customers.
We didn't have like most medical device companies and healthcare companies have huge budgets for educating clinicians. And we took the approach that the most effective way we could educate clinicians was to actually have a printout that somebody could take to their doctor's office, but that it would actually speak to the clinician as well as the customer.
So we actually had a physician printout version that they could take in. We had CME courses, continuing medical education courses. We have a physician website so we could train and educate physicians. So we've done what we could within a small budget. To educate individuals, but we've also completely recognized it's an issue where people could take their genetic information and they hit a wall.
So back in 2021, I think it was we acquired a company called Lemonade Health. And the reason why we acquired Lemonade was specifically because I wanted to bring a medical infrastructure into the company where I have access to clinicians. I have telemedicine, I have access to a pharmacy, and I could actually really deploy genomic healthcare.
So my customers then will be able to say, Hey, I've learned about my risk factor for chronic kidney disease, and I'm eager to know what to do. I will have a team of experts who they could call to say, Hey, we want to understand better. How do we actually implement this in our life? So I do agree there's a need for more clinical.
education, and we hope to play a role in that. But I think in the short term, while we realize there is still that gap, we want to offer a complete service so that people have the ability to get direct access to their genetic data. And then I will have a team that will help guide them on how do you actually take advantage of that information?
How do you integrate in your life? And just one other point to emphasize there, and it ties back to some of the things I said before. Again, if you think back why I was interested in genomics, It's because of the prevention elements. So, and again, always recognizing that prevention is often poorly reimbursed or doesn't pay in the health care system.
A lot of the things that our clinical team will help people think about are things that are not necessarily part of the standard system because the standard system is not as focused on prevention in some of these areas. So for instance, you know, if you find out you're genetically higher risk for type two diabetes.
What should you do? And then can our team of clinicians help advise and help coach you to take advantage of that information to get more frequent blood tests to actually teach you what is a hemoglobin A1C test? How can you actually use that to monitor yourself? What are those little diet changes you can make?
So we'll look to actually coach people more. To really drive the outcome of true behavior change.
[00:31:55] Hala Taha: when you started 23andMe, like you were mentioning before, it was sort of like a rocky road. You got this FDA warning letter.I read it was pretty difficult to acquire your first customers because people didn't really understand it.
So there was a lot of controversy with what you were doing, but you kept your head high, you kept going. And now 23andMe is. This really well known company, It doesn't feel controversial anymore when I read back on the history, I was like, wow, it was really that big of a deal.
Like, you know, so what is your advice to entrepreneurs who are trying to do something with good intentions that they think is going to help the world, but getting backlash, what's your advice for them to keep going?
[00:32:36] Anne Wojcicki: Uh, yeah, it's a great question.
We used to always tell ourselves internally that we were on the right side of history.
And I think knowing that the future is going in your direction and that one day your reality will become the norm and knowing that it is going there is how it's really motivating for people for just sort of weathering the storm and treading water.
My head of marketing, who was really a brilliant, brilliant brand.
marketer had the vision. She's like, look, we're going to take the weird and we're going to make it wonderful. And that's really what she did. She took genetic testing from these early days where it was like, why would I want this? It was like kind of an esoteric, interesting gift. People didn't know what would you potentially want to do with it.
And we made it, the brand recognition is extraordinary, and we made it something that is truly wonderful. And again, thinking back to those days where we'd say we're on the right side of history, I am really proud. There's an incredible direct to consumer healthcare movement. And I think overwhelmingly, everyone looks around and says like, healthcare is moving in this direction where you should have rights to your medical record, you should have rights to...
Information about the medications you're taking. You should have rights to getting access to your blood information at the same time as a doctor. Don't wait for a doctor to release it. I'm very proud. Like even in the state of New York, you can now buy oral contraceptives without a prescription, which is crazy like that.
You couldn't do that before. So I think that the world has really moved and I think that we helped it. Shape that. So I do think it's helpful for founders to have a vision. Where is the world going and knowing that it's going to be better and then you stick through it. And I love telling my younger employees that when we started the company, gay marriage was illegal, which is kind of mind blowing to them.
But I'm like Obama even came out and said like he did not support gay marriage. I was like the world was so different, but it was so clear that the world was going to change. evolve. So, you know you're on the right side of history, but sometimes you just have to be patient. So, we took this approach, again, as a team of scientists, you lead with science.
And I don't argue just for the sake of argument. I argue with my data. So now when people come and they would say like, Oh, 23 me is dangerous. People can't understand it. I was like, we'll show me your data. Cause I have over 250 publications that talk about how people can understand it and they're contributing to research and they're understanding it and they're changing their lives and they're, they're saving lives.
So show me your data. So I love, I love having like substantial data behind me in an argument. And that's also one thing I would encourage founders to do is making sure that you know you're on the right side of history, knowing how to tread water, and then making sure that you have that data to support your thesis that like, where is the puck actually going?
[00:35:33] Hala Taha: That's really good advice. So I've never taken 23andMe and I'm actually of Palestinian descent, which is That part of the world has been taken over a million times. So I'm excited for that.
[00:35:45] Anne Wojcicki: We've talked so much in the past about we've had a number of researchers who want to do sort of the Israeli Palestinian genetic testing project because there's so much connectivity, and there's so much familial relationships between those communities. So it's been interesting.
There's been some small studies looking at that, but that's actually it's always an interesting example where you can take. Areas where there's high conflict and actually show that you are genetically family.
[00:36:14] Hala Taha: Mm hmm. I know. I think it could bring a lot of peace, honestly, those studies.
[00:36:19] Anne Wojcicki: Well, the more you start to see that you are all genetically so similar and you can find a genetic relationship with almost anyone.
So being able to find that connectivity between any two people, that would be one of my dreams ultimately is have, you know, all of humanity on a, on a map. And be able to say, here's, there's a single, you know, human tree and you can connect yourself back to anyone within, you know, there's the famous six generations or seven generations back.
You should be able to connect yourself to almost anyone.
[00:36:48] Hala Taha: So talk to us about what is this process going to be like for me? What do I do? What do I get? Talk to me about the process. And then I want to hear about all the stories from these testing that you want to talk about.
[00:37:01] Anne Wojcicki: Oh, yeah. Okay. Well, the process is remarkably simple. You just go online and you buy it. You can buy it through Amazon. You can buy it through us. You go online and you buy it. We send you then a little box. It has a tube. You spit in it. It's a fair amount of saliva that's required. We made that decision in those early days so that way like no one could ever steal your saliva.
Other companies would have like a little buckle swab and we said like, no, we want, we want an intentional amount of saliva. And then you send it back in, we extract the DNA, we run it through our processes and our algorithms and then we send you an email that says your DNA is ready. And in that you have sort of two experiences, well actually three experiences.
The first and the one that gets the most publicity is ancestry. So you ask the questions like, where are you from? How does that break down? We get a lot of customers who are surprised, who find out they have African ancestry, they have Jewish ancestry, they think they're 100 percent Irish, and then they're half Italian, like, we get, you get all kinds of interesting surprises, and it is.
Interesting, because like, no one's really just something. You always have these little bits. So it's really fun. People see that. That's the ancestry composition side. We have another feature where you can find relatives, your DNA relatives, and that is something else. You have to consent into that, but you consent in to see, do you want to see who in the database are you connected to?
And that's where, for instance, like we found that I have a first cousin. So my uncle had a child we never knew about. So I think back on like this, the guy who is now where he's very close to the family, but like the day that he opened up his 23andMe account and he was like, wow, like I'm related to the founder of the, like, and it's funny because we talk about it all the time and he comes out on all of our vacations.
Like it's, it's amazing. And he's one of those stories of he was, um, adopted by an amazing family and. Tried to decide when's the right time to actually spit and again, he's so genetically similar. I mean, he's so similar to us. So it's been an amazing experience having our own 23andMe story and finding family in that way.
So we have that. Then we also have all these fun things like your Neanderthal. So people love to talk about how much Neanderthal they have. We just recently had a paper about ancient DNA. So. You have some of these burial sites where you find individuals who have been buried. So being able to now connect some of those burial sites to customers is a really interesting opportunity, particularly for the African American community.
And then you get into the health world and health world. It can be all kinds of conditions we can let you know about. So if you're thinking about having children, conditions that are more common, like cystic fibrosis, we can tell you if you're a carrier for that. We have some fun characteristics like lactose intolerance, which, you know, it was like when my son started, you know, eating dairy and having issues, I could just look online and I was like, Oh, you're lactose intolerant.
That's it. So a number of those types of conditions to look at and then some of the more serious health related. So breast cancer, Parkinson's, Alzheimer's, prostate cancer, a number of conditions, which again, it can sound scary. When we put together the whole list, but the goal here really is for people to be empowered.
And so if you know your higher risk for breast cancer, there's things you can do to be proactive in terms of monitoring. We have a number of customers who've gone into gotten, you know, mastectomies who do proactive monitoring people who find their higher risk for Alzheimer's I find like are really active.
Well, do I, should I learn additional languages? Do I read a book all the time? Like, what are the things I can do that treat my brain like a muscle so I can keep exercising that? We have a lot of customers then who really take the information and they look to be proactive with it. What is it that you can do and how can you be as healthy as possible?
[00:41:02] Hala Taha: love it. I'm so excited to take my test. I can't wait.
[00:41:06] Anne Wojcicki: The third area I forgot about, which is like, again, one of the big missions of the company is the research side. And so we do ask our customers to take an intake survey when they join, and then we find that every individual has a disease that they care about.
So I might care about Parkinson's because it ran in my ex husband's family. You might care about Crohn's disease. We can be controls for each other. So people we find take all kinds of surveys and they participate in research because those really simple answers help us make discoveries that then can either turn into another kind of test for prevention and helping customers know that they're higher risk for a condition.
Or it can actually potentially turn into something that could lead to drug discovery. So we find the research side is another really important component of the company. It's something that people opt into. It's never defaulted. But you opt in, over 80 percent of customers opt in. But there's this huge opportunity then to really advance science and advance our knowledge about genetics.
[00:42:08] Hala Taha: was an argument at one point that would say that people didn't want their data to be shared when in fact, most people are actually opting in to your point to share their data.
[00:42:18] Anne Wojcicki: I think, again, it goes to that hypothesis about you as a healthcare customer. I think in healthcare, you're just treated so poorly.
People don't want to participate because you're, you're treated like a human subject. You're also treated like somebody who's, you know, we're never going to find you again. You're not going to be responsible. You're not going to come back. Like, we're going to take as much as we can. It's not a consumer experience.
You would never design healthcare in a way if it was actually truly a direct to consumer experience. So what I think we've proven out is that people are actually quite willing to participate in research. They want to be a partner in research. They don't want to be a human subject. And again, part of what inspired me is when I looked at things like Susan G.
Komen and Livestrong, you get incredible enthusiasm of people participating in disease research. So how is it that you can capture that kind of enthusiasm, but frankly, actually make it more data focused and realize, help people realize that the most valuable thing they have is not necessarily their wallet, but actually their data.
So participating in research, using your data, using this information about you. And helping people say, we're all in this together. We're all going to find the cures together.
[00:43:26] Hala Taha: And now how does this data about our genetics help us actually make better drugs?
[00:43:33] Anne Wojcicki: Oh, good question. So when we started the company, that was always a hypothesis.
Would we have enough data? Do we get enough information from our customers? Could you ever get insights that could truly be transformative for drug discovery? So there's a well known example that I'll tell you about. And it's called PCSK9. So that is where there was actually a patient who came in who had very low LDL, which is you want your LDL levels to be low.
[00:44:01] Hala Taha: Cholesterol, right? Correct. Correct. From my dad. Yeah. He always talked about LDL particles.
[00:44:07] Anne Wojcicki: Exactly. So a type of cholesterol. So you want it to be really low, but hers was extraordinarily low. So they started sequencing. They did a, like a research project on her. And they found that she had a mutation actually in this gene called PCSK9.
And because of that mutation, she has very low naturally LDL. Scientists then took that information and they are working to say, can you actually mimic the function that that mutation causes in the body? Can you actually recreate that kind of same process? in other individuals who potentially have high LDL, and can you actually turn that into a drug?
So by understanding natural human genetic variation, you can potentially start to understand, okay, how is it that I could mimic that same biology and translate that then to other individuals so they could have that same kind of health outcome? Another example is actually an HIV, which is interesting where some customers have a mutation that's known if you have that mutation, you are resistant to HIV, you cannot get infected if you have two copies of that variant.
So that's another area where you can study well, what is it? What happens in that mutation? What's that biology? Why do those people not? Are they not susceptible to HIV? And then how is it that you can actually translate those understandings into potentially a clinical program? So we now have, we have a whole therapeutics team and we did a big project with GSK where we spent the last five years actually going through and mining our data to see can we actually turn these insights into therapeutic programs.
And by understanding the genetic variant, how that potentially influences biology, can you then create a version where it mimics that in the human body?
[00:46:06] Hala Taha: So another question about all of your data that you're collecting with this genetics. I understand that about, I think, 60 to 70 percent of that data is European genetics.
Why is it important to have more diverse genetics, and what are you guys doing to work on that?
[00:46:24] Anne Wojcicki: I mean, we are definitely still Eurocentric, and we are constantly working on that. That said, we're over 14 million customers, and so the fact that we are 60 plus percent European means that we're the largest non European databases in the world.
Something that I find amazing is that there's more genetic variation in Africa than in the entire rest of the world. So Africa is really complex. And it's an incredibly exciting opportunity to understand all that variation in the human genome and how it manifests in Africa. So there's a lot of enthusiasm and I think people see that by looking at diversity, you're just going to better understand human conditions and making sure that a finding that occurs in a European population, how is that also relevant in other populations?
So, it's a really exciting research opportunity because when you have different populations, you're getting more diversity, and we're at a point in scale where that additional diversity, it's something that we can actually now effectively mine and actually really effectively learn from. In the early days, people tried to find, for instance, one of the earliest companies that where they just wanted to go into Iceland.
Because it was like such a, in some ways, like a, it's a very concentrated population or the Ashkenazi Jewish population. It's a very concentrated. So now we're at a scale where actually having that kind of diversity could be truly transformational for discovery.
[00:47:58] Hala Taha: Really cool. Okay, so I want to close out the interview talking about the future of genetics and getting your perspective on that.
Before I do that, any stories that just come to mind, because I'm sure you hear so many stories. Based on all the findings that people find about their genetics, anything that's super meaningful or like crazy wild that you could share with our listeners?
[00:48:18] Anne Wojcicki: Uh, I mean, there's so many, we have actually a whole team that would mine for stories.
And the woman who did it was that used to say, she's like, Oh, once a week I sit back and I'm like, Whoa, that was crazy. One of the earliest stories that I used to tell in the company, and this actually kind of goes with sort of our mission about lead with science is that. She was adopted and always wanted to know more about her ancestry and found that she was part of the reindeer tribe in the Arctic Circle.
And she had a sort of high powered Silicon Valley job and she quit her job and she moved to the Arctic Circle to learn about the people up there and joined essentially the reindeer tribe. Living there, breathing it. And she wanted to devote all of her experiences to really bringing publicity to this population and her marketing abilities to making sure that again, this community was thriving.
And she wrote me years later talking about how meaningful the last few years had been, how she felt for the first time in her life. She felt at peace and at home. And that she was incredibly grateful for this information because she felt like she finally found her home. And I took that information, that letter over to my, to the company, and I was like, listen, you guys, like, because we're regulated on the health side, we're not regulated on ancestry.
And I was like, you know, you guys, I read them the letter and I go, you know, you guys better be right. Because this woman just changed her whole life based on our data, and it shows how much our information is impactful and meaningful to people and how important, like sometimes we're different than a lot of tech companies, like we never run fast and break things ever.
We think through that letter, which we got really in those early days about the consequences of every. data release and every set of information and what are those consequences that come out and how are people going to use this? And we have people who write in Ancestry. We get a lot of stories. We'll say, I'm, you know, point four percent Japanese and I started taking Japanese lessons and I was moving to Japan and then suddenly you guys did a refresh of your data and I'm now only point one percent Japanese.
Like where did my Japanese go? And, and that's when you realize like people. They love clinging and understanding that diversity. So the one other story that I do love that's actually was written up in people magazine, which also goes into some of the ancestry side and some of the conversations that we talked about was an individual who is.
Related to a grand Klansman who found out through 23andMe that he had biracial grandchildren and People Magazine does a pretty extraordinary job with the story of talking about the gathering of that whole family of this individual who obviously comes from a family of white supremacy to having children who are biracial and then the father of those children who's like, Let me tell you, it's like, it's not easy, but we're going to make it work.
And it's a really honest story because I think it does show, again, the things that we talked about is that genetics is connecting people who might not have ever been connected, but it has really that opportunity of showing that your differences are fabricated rather than biological. We're all quite similar.
So they're life experiences rather than biological experiences.
[00:51:58] Hala Taha: I could see you guys turning these stories into, like, a book that gives, like, all these life lessons. Oh! Really, it's really entertaining to hear.
[00:52:05] Anne Wojcicki: and I haven't tapped into the hell stories. The thing that is the most rewarding aspect of 23andMe is how much we really do transform lives.
It's a total honor for me to do something that I think is really meaningful because every single customer gets a story that transforms them in some capacity. And there's almost no one like, and if you don't have a story yet, you just sit back and wait, it will come to you. It's remarkable how much it has really changed people's lives.
And so I take that responsibility really seriously, but it's also a real privilege that we can be so eye opening to so many people.
[00:52:45] Hala Taha: Yeah, I mean, you should be really proud of what you accomplished. You created such an amazing company, you're helping so many people, and me as a woman entrepreneur, seeing you as such a successful woman entrepreneur, I'm just really happy that you exist and there's people like you out there.
So let's talk about the future of genetics and we'll close this out because I want to be respectful of your time. I know we're running out of time here. How do you think AI is going to impact everything that you're doing?
[00:53:12] Anne Wojcicki: I think it's so exciting. As a child of a particle physicist, what I used to love talking to my dad about was, and this is like way before I was even working in any capacity.
And again, my dad would think about, okay, the probabilities of a particle being in a certain spot, and that you should be able to predict the function. And you could then translate that into a cell that would be part of a molecule that could turn into a human. So theoretically, you should be able to start to predict.
behaviors and pattern, like, what's your biology going to do? So I think about DNA is so interesting because it's data. You have A, C, G, and T. So you get this endless, the three billion base pairs. And different combinations lead to me, different combinations lead to you, different combinations lead to a banana or a slug.
I think the potential for really understanding the human genome, like this code and understanding how that translates really into your biology, the human body is so complex. It's amazing to me that like we all go to bed every night and all those processes that are just happening in us. All the machinery, unbelievable.
I used to stay awake at night just thinking about what are all these processes? And I'm not in charge of any of them. Like they just happen. So I think that AI will really help us have transformative breakthroughs in biology. And I think that. With that, the downstream consequences for consumers are considerable because part of the reason why biotech, the drug industry is so, like drugs are so expensive and it's so hard is because we have so many failures because we just fundamentally don't really understand biology.
And so the more you can apply AI to some of them, like and establish rules and understand patterns and have become more efficient with the drug discovery process, that's going to really translate into a material benefit for all of us. So, that said, I think it's still a ways out. I think that there's a lot of early academic projects, I think, that are going to be really transformative.
But, I think it's coming, and I think it's, biology is, and genomics, I, it just, it's really exciting. I feel so lucky every day that I work in this area of the world. You want to share anything
[00:55:36] Hala Taha: else in terms of your predictions for the future in
[00:55:38] Anne Wojcicki: your industry? every generation that says this, like they look at the next generation, we're like, Oh, your generation's never going to tolerate healthcare in that same way.
And I think that that is increasingly true. I think that the direct to consumer opportunities in healthcare and with the combination of data and AI, I think it's going to be really transformative. I think the direct to consumer movement has the potential to really break healthcare and make it truly something that is in your best interest.
And I think AI will, for the first times, and I said this early on, like a lot of analytics were applied to billing optimization. So, by having more of a consumer movement, you have more data that's actually applied to keeping you healthy. Like things that are actually in all of our best interest. So I think even all the tech companies getting involved, there's a lot of money out there now that is interested in longevity.
And so how you can actually stay healthier and understand. basic biology, there's just a tremendous amount of opportunity and there's a tremendous amount of money. I would say also the rise of big data, like you've had big data in, you know, broadly, like you look at that with Google and Facebook and all the, and Apple and all these companies, like there's just, there's so much data that's out there.
And I think having large data sets in healthcare could really be used for, you know, incredible good and understanding the mysteries of health.
[00:57:07] Hala Taha: This goes along with the theme of almost everything that we have in our reality right now. Like, for example, in the past, it used to be that only news outlets controlled the news.
Now, like, we as people have the ability to communicate with each other. Same with entertainment. You know, it would be, you'd have to go to the movie theater. Now we have more control. So it sort of just goes along with the theme of basically everything that we interact with in our lives.
[00:57:32] Anne Wojcicki: I totally agree. I mean, I think that's why people are getting used to it.
And I think that's why there's actually a fighting chance that it can happen. The difference with health care is it's regulated. Like, don't forget, like, I was shut down. I was 23 and stupid. For instance, like the fact that telemedicine can't work over state lines is insane.
You can't do a telemedicine visit with somebody in Boston. So there's a lot of regulations that are still there that need to change. again, you look at the right side of history. This is a good example. In 30 years, people are not going to be thinking about like, Oh, sorry, you're in Las Vegas and I'm in California.
And so we can't, like, I can't treat you. It's just crazy. The same way kids today who don't remember, like, I used to wake up in the middle of the night to call a hotel in Paris to book a room. It was a one to one interaction. Now you have Expedia and it's all scalable. And so healthcare has to become scalable.
Like that to me is like one of the most interesting, most fundamental principles. I think AI and the delivery of care, absolutely. You should have your version of AI health delivery for diagnoses. It's like already starting to happen. You can see how much you can actually put this information in. And I have no doubt it's going to be better like for like physicians are people they get tired they have bad days I think you're going to be able to make physicians truly being great at what they're doing which was actually like taking care of people and also some of the empathy that should come with that and like allow the AI to actually be able to become an incredible diagnostic tool for everyone.
[00:59:13] Hala Taha: I'm very excited for the future of healthcare. Thank you so much for all of your insights. This is such a great conversation. I end my show with two last questions. The first one is, what is one actionable thing my young improfiters can do today to become more profitable
[00:59:29] Anne Wojcicki: tomorrow? Don't spend your money today.
Mmm. Good one. The most important thing, my mom taught me, when I was in fourth grade, I had pneumonia and my mom... It was slightly unusual, but she gave me for reading one pager about compound interest. And honestly, it's like all I can think about, like every time I would save money, all I could think about was the future value that I was spending.
[00:59:54] Hala Taha: Love it. Okay. And then what is your secret to profiting in life? And this can go beyond financial. So how do you hope for people to profit in all areas of their
[01:00:02] Anne Wojcicki: life? I think the way you profit in life is by really being passionate about what you do. I feel very rich in the capacity. I love what I do. I'm also a big believer.
I would, I hesitated to also say it like work life balance. My children were in my last call with me. I'm surprised my daughter hasn't joined this one yet, but by being passionate about the things in my life. My children, my environment, my work, my friends, I always feel incredibly fulfilled. I love that.
[01:00:33] Hala Taha: Well, thank you so much, Anne. This was an incredible conversation. I learned so much and I think my listeners did as well. Thank you for your time. Thank
[01:00:40] Anne Wojcicki: you. So nice to see you. I learned so much from this interview with Ann Wojcicki she is such a badass, such a role model. And in addition to leading a successful company. Anne wants to be part of a movement where healthcare consumers are empowered to advocate for themselves. And find healthcare and drug solutions that are created just for them.
[01:01:04] Hala Taha: Here are some of my favorite insights from Anne about her 23andMe journey and where it might go next. Your genome, she says, is the foundation of your health and your health risks. If you can understand your genetics, you can learn everything from what diseases you might be predisposed to have to what types of medications might cause you trouble.
And then once you start pairing your own genetic insights with those from millions of others who have taken the 23andMe test, , you have a powerful dataset that can help you uncover the solutions to all kinds of medical mysteries. These insights have already made the difference in the lives of countless people from those who catch breast cancer early on to the woman Anne mentioned who reconnected with her own tribe roots in the Arctic Circle after learning more about her heritage. And we can expect these transformative breakthroughs to continue in the coming years, especially as AI and big data start to further grow our understanding of how our bodies work. Finally, I loved Ann's point about how genetics is revealing our similarities far more than our differences. It's connecting people who might not have ever been connected and showing us that our differences are far more superficial than biological.
Thanks so much for listening to this episode of Young and Profiting Podcast. If you listened, learned, and profited from this conversation with the incredible Ann Wojcicki, please share this episode with your friends and family. And if you did enjoy this show and you learned something new, then why not drop us a five star review on Apple Podcasts or your favorite podcast player.
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