Anne Wojcicki: "Co-Founder and CEO of 23andMe" | Talks at Google

I'm, Jonathan Rosenberg, and I ran product management here for ten years and I. Don't usually come. And introduce speakers, but and. Is. Special, and so. I came to tell you why. Since. 2002. When I joined Google my. Favorite days were, Mondays. For. Ten years Monday morning was Eric and Larry staff, meeting and I was surrounded by smart people with, a mission that mattered and, in, the, afternoon I would run my staff meeting and my. Staff meeting was sundar, and Salah and Marissa, and the. Second, smartest was, icky sister is, this being recorded. Susan. I loved you and. In. 2011. When, all of that ended and I moved out of an operational, role I thought. I'd never have, exciting, mondays again, then. Susan introduced, me to Ann and I, started going to 23. And means staff, meeting and helping. Over there so, now on Mondays, once again I'm surrounded. By smart people and, I'm. In a company, where, the mission that we're the mission matters bringing. Personalized, medicine, to like make, us healthier like, we. Care about being healthier, so. The mission is terrific the. Team is brilliant, it's, a little bit different because more. Than half of the faces in the room are women and the. CEO is a woman and Katie, and Jessica, here's some of the people who are in the staff meeting in fact more than half of the faces in the room are women even when I'm there. I've. Been doing pretty well so. Rather. Than kind of go through all the yada yada of a traditional, introduction, you know like Ann is special, and she went to Yale and she spent 10 years doing like. Medicine. And health care. Investing, and it's, very googley look, at the way she's dressed for her Google Talk. So. Listen. To Ann listen. To her vision listen. To them talk Anna Jordan, talk about some of the great challenges that she's faced building 23andme, and many, of the googley values, that she's infused, in this wonderful company and and. You're. The reason I get out of bed on Monday, mornings I love you. Okay. I'll turn things over to Anna and Jordan. Alright, can you guys hear me okay. Thank, you for joining us here really appreciate it and. Thank you for joining us of. Course after an intro like that. Can't. Beat that. So, for the first 45, 50 minutes I'm, gonna go with questions that I took from the dory so thank you all first million Dory questions and then, for last ten minutes we'll do mixture. Of live questions, and Dory questions, but. I wanted to start off first with your relationship, here with Google and your story that you were telling me about you and the cafe yeah so, I honestly I've. Known Google since the very earliest days it started in my sister's garage. So. It. Was one of those things in in the early days we'd be doing dishes and we. Could see Sergey and Larry coding, in, like the other bedroom and, I would always say I was like it's really weird that, you have these guys like just sitting in the other room coding, what we're doing dishes it's like it was a really unusual, so, obviously, I've spent a lot of time at the company and I was saying how I'm 23. Me used to have an office on. Shorebird. So just around the corner and we're, you know like we're startup or scrappy and so. It was very apparent that you know Google had a lot of food so we. Used to make our way over here, and you. Know back when there was burritos, right downstairs, there, was great burritos and so, they're easy to carry so, I would walk over every. Other Thursday, and we'd have these team lunches and I just, get like 10 burritos. And so I was walking out carrying, like my mom, mind burritos, and I, opened the door and I look and it's Eric Schmidt and Steve, Jobs and. Like oh. Hi. You guys like, what are you doing and Eric's like what do you have to have like I'm just getting lunch and Steve had just launched the iPhone and was like have you seen the iPhone do you wanna see it I'm like yeah, great.

So. So. I've had a lot of great experiences. I'm obviously such a huge fan of Google and in, a lot of ways it's had a huge influence on 23, me and I think a lot of the values that I. Saw, especially in the early days have. Really influenced, how we've run the company, now. You're mentioning about your values in 23andme, and you, were telling me about your your relationship your grandmother and her, experience. Of the healthcare system can you talk a little bit yeah, you. Know I think. So. As a background I used to invest in healthcare companies and. You. Know healthcare is a really complicated industry. And it's not necessarily always doing the right thing for the consumer and I, used to always. Complain. Like, I actually the last fun the last hedge fund I was at was a fun that we nicknamed death watch and. We used to just short everything because, it's really easy to predict failures in biotech but it's hard to predict successes, and so I was like kind of just like this really negative, like everything sucks in healthcare it's all bad it's all failing it's like all about like how do I just take advantage of the consumer, and I, remember Larry turning, to me one day and he's like and you're, either part of the solution, or you're part of the problem right. Now you're part of the problem I was. Like oh like, that's true, like in some ways it was a good slap of like you, have to if you when you see problems you, need to do something to change it and one. Thing that we've always my family has always been really passionate about is health care and. Part of this came from the fact that my mother. Was. You, know she was very poor growing up and she had a little brother and when he was 18 months old he, got into a bottle of aspirin and he ate that bottle of aspirin and he, was clearly lethargic. They took him from hospital hospital hospital my mom was five at the time and, they. Were refused, treatment because, they couldn't show proof of payment they, finally got some hospital to take him and, they. Took him and then when my grandmother called in the morning they. Said he was dead and, it. Had a huge impact on my mom, would have on any family and my mom at this time was like you, know very clear if you don't take care of yourself no one will and you. Have to be responsible, for your health care so when. I pulled my Kaiser medical, records at some point, my, sisters and I discovered, that our records, actually had an asterisk. At the top that said as all, of us in Pediatrics, know this, mother can be very irrational, at times and, as. Jonathan has had some some lovely times also working with my mom my, mom is, a, force, and. Especially in health care like we routinely, get fired from doctors we routinely are told people don't want to work with us and I. Think it's one thing I've learned is like in some ways good, health care comes to those who complain and you have, to be really proactive so, it was one of those things like we were always a super proactive, family you, know understanding, our health and it was one of the things that I think really, bothered me when I was investing, in health care as I realized, how much the system is not, set up for your success, like no, one makes money if you, if, you live to be a hundred and, you never are sick no, one makes money you.

Know In health care is 18%, of our GDP like, clearly, lots of people are making money off you being sick but it's a real problem. And so, a lot of my passion for 23andme, when I started the company came. From how much I said like I want, to do something that's genuinely, right that, allows people to be active in their health and proactive, the way my mother has always been proactive, for me and that she's taught me to be proactive with my health, can. You talk about the first years of you building 23, me the challenges he went through. So. We got lucky you know I think a lot of founders like in felt like Sergey and Larry used to say this like they got lucky they at the right place like time I. Happen. To be when I was investing, in. On. Wall Street I happen to realize like genetic information, it. Was suddenly cheap to, get access to a broad amount of information on your genome and. You. Know I was really lucky noticing, like one you could get suddenly. Individuals, could access to your genome and then there was this whole convergence. Of like web 2.0. Like there's gonna be social, networks, and you're gonna find each other and it was like hot it was so interesting, and it was my space and, and. It suddenly realized. One. Of the things that's a big issue in healthcare is there's a lack of data so. I like routinely my, sister other sister does nutrition. Research and routinely you look at those studies and it's like 200, patients here 200, here and my. Dad who's a part of a physicist would be like anyone who knows about statistics. It was like you can't find anything in this like you need lots of data and clearly, the Google world had taught me like the value, of like lots of data and what you can do so. I got lucky sort of with this idea of why. Do I need Stanford, why do I need Pfizer to go and do all this research I can, just allow all these people to learn about their genome like it's so cool learn about your genetics, and then we're gonna bring everyone together in this whole new research model it's gonna be like crowdsourcing, we're gonna have the world's data I don't need to Stanford, and Pfizer and all these other people I don't want you to be a human subject I want you to be a live participant. Excited. In research so. We have this idea of really marrying, like this idea of cool technology, with like this concept, of like health you know web 2.0, and we. Launched the company and. You. Know initially I, had. This. Enthusiatic, I think genetics is so cool like, I think there's nothing cooler than the idea is like you have a genetic, code everyone, in this room is 99.5%.

The Same yet. We clearly have all this diversity and. We don't understand, it like, it's like that it's it's like it's a code like how does it how do people sleep at night like it's so interesting, and we don't understand, it and so, so. I have this enthusiasm. But. I started, to realize that the, rest of the world's not quite as passionate, about genetics, as I am and. So we launched, and we had a you know we had this big spit parties we had all kinds of press, and. Then we, sold probably a third a thousand, kits the first day and then, we were selling like 15, to 20 kids a day and as. Everyone realizes, like 15 to 20 kids a day is not a lot of money like that yes that, is and that's not even gonna be a ramen profitable, company like that is that, that's, rough so, it made me realize, like we have to do a lot to help people understand, like what our genetics like, most people. Like really smart people would come to me and be like oh I don't want to know my DNA I don't want to know the day I'm gonna die I was, like if I can tell you the day we're gonna die charge you a lot more like. Like. No it's like risk like and you realize, like most people don't understand, risk and. So. The thing that I've been lucky with is I have a team of people who. Join. 23andme, because, they're really passionate and, you. Know my love for science like I said my father's a particle physicist and has. Kids my sisters and I grew up always like. Realizing, like we tell people like oh my dad is like he studies neutrinos, he's searching for mass and people, were like wow like, what is he doing and and, I just realized like I in, some way it's like it, always bothered, me I think physics is the most beautiful science, out there but like most people don't understand, it and I also. Like in genetics is similar like I really didn't want the fate that my father went through with physics of like you know lack of funding and all this like I wanted that average individual, to like see, the beauty of the DF DNA and see it within their own lens and capture. This idea of like we're almost interested, in ourselves and, so your DNA is really interesting, to you so. The, people I hired in those early days a lot, of them are still at the company and they're. Really passionate, about this idea that like you, want people to unlike you want people to see that beauty, and. And. So I'm lucky because the. Fact that like it was hard those first years and like we didn't have huge sales it didn't, deter people cuz. They're like again scientists, are used to failure like wow you know we just have to try this we have to try that we have to like try other strategies. So, it. Was you. Know I'm lucky with that and also the science, you, know one of the things that we did with the company that was unusual is. We, weren't excessively, marketing, because. We decided, like we wanted to really make sure that we had the science, down. Before. We did a lot of marketing and the, one marketing thing we did this is another funny story Sergey. At this time I don't know who's been here for how long Sergey. Was really interested, in Zeppelin's, you know blimps and so there was a there was a Zeppelin, for a while and Sergei. Didn't want to stick like a Google stickler on it so he's like I don't know you could put 23 me on it so we put cuz he wanted to sell advertising on it so we put 23 me sticker on it and it. Got a lot of press that, there was like a giant Zeppelin, flying around town like.

TechCrunch, Had all these articles so that was like my one attempt before we had a marketing team I had. The blimp I'm. No longer part of the marketing team. But. We really focus like as a company, to in those early days we, recognized, like we have no business if we don't have a scientific foundation and, that the core of the company like I needed to win over the scientists, and make sure that they understand, what we're doing and that their app read that they're supportive, of what we're doing before, I go big and start going on TV and start advertising and. In. Some ways that also really benefited the company because, when, there was controversy, I never, had to worry about my core like. I always knew the foundation, of the company was really strong I didn't have to worry like I understood was misunderstood, in all these ways but, scientifically, I was always solid and I, knew that, excellent. And when you proposed a bleep idea did you have to bring it up your board or something no. I think I think I just did it you know that's the beauty of a start-up is like you don't even think about these things I don't know like I just I just put it up there now I mean my board has. Always been pretty. Small and and, I just like, you, know again, when you're a 10 person company or a 15 person company you just like do things all the time that are kind of crazy like this, when we launched our spit party in New York we had Barry Diller, host. And like Rupert Murdoch like all these people host the spit party and it. Was on the cover of the Style section on, the sunday Style section I, remember. Like steeped like people like Eric Lander like serious scientists, who are like it, is so disrespectful. To, have science, on like. The Style section like, this is not appropriate and and. I was like no like more people read this science sect where more people read the Style section then, they read science Tuesday like this is great so, we were always kind of doing things, that. Were a little bit different like we wanted to do things not, to say like the blimp but the blimp was fun but. We wanted to do things that were going to be a typical of what the traditional. World, does because like most people are not out reading New, England Journal in science magazine like we want to bring science to the masses excellent. When. I had Ben Horowitz here we talked about the struggle, but CEOs go through where it's a really challenging time yeah, and you have to really fight through it to survive. It. Seems like the struggle for you as during that whole FDA period, can, you talk to us about that and then also what kept you going during that time you know I think um, I think, I've had two struggles in the company so the FDA one was clearly, an. Important. One and it was in some ways it was the most public, and it forced us to really change our strategy, and. You. Know we got what happens we got the letter we got the FDA warning letter on a, Friday and I was at a team off-site we're at a strategy off-site, we were like talking about like we have massive growth we were really excited we were going for a million people and. My. Assistant, at the time texted. Me and she said you got a. Special. Like the, FDA, is trying to curry or something to you and I was like well don't sign for it. And. Bring. It to me and, and. Then. We read it you know and we were like we've gotten a lot of warning letters in the past like we were kind of used to it by then we're like yeah you know whatever we got them all the time. But. This one was like a lot more, serious.

And. And. To be honest like Silicon, Valley is not known for its interaction, with regulators. So. I was, like I think we were relatively, naive like I get this question a lot like where we just like so arrogant, we'd kind of give him the finger to the FDA or were we just incompetent and I. Think it's not we were just uneducated, like we, like. It took me a while even after getting that letter because then it was made public on Monday morning and. And. People, would, read it and they're like wow this is like like, this is probably one of the most serious. Warning. Letters that's ever been, put out there and it was actually one of the former heads of the FDA who called me and was like and like. They're not messing around like you have to stop, and. And. It was a it was it definitely it halted a lot with, the company and that first week I think I just spent the entire week in my pajamas, calling lawyers like I just I didn't move from my desk I just called and for me I've always been very dated ripped like I just wanted all the information, so I was just pulling information, like what do I do and. We've. Always historically been really good at finding loopholes so for, instance in New York where we were not allowed to sell we, discovered, that, it. Wasn't that you weren't allowed to sell you just weren't allowed to physically, spit, in the state and, I was like that's great people, can spit in New Jersey and, so we'd found kind of this loophole like customers, used. To have to attest that, they had not physically, spat, in the state. And. So I spent, a lot of time figuring out like what's the like how do I work around this and to. Be honest like one of the workarounds, today is that you put, what we call sort of a dock in the box like you, have a telemedicine, doctor, where, you just can call or. So it's just like they're kind of like on the back end like you not even necessarily see it and they order it for you and when. You have that you can kind of Sur commit you can become a laboratory, developed tests and there. Was one regulator, in particular, who I, met, with and. She goes you know and like, what you're trying to do is fundamentally really, disruptive, like you're trying to allow consumers, to get. Direct access, to care without having to go through a medical provider and if. You succeed in that you, can really have an impact a real positive, impact on the system but, doing that is not a workaround, it's, hard work like either, you decide you want to put your head down and you want to just like really get that work done or. You, find if you want to sell this company in a couple of years like you do this workaround and you're just like, whatever you're just circumventing the system but, but you can change the system and that. Conversation had, a huge impact and I said is it look like what I meant for the next you know I'm in it for life so. I'm, willing to do the hard work and you. Know it took us, you. Know from that moment it was a couple years before we actually got our first approval, and the. Way we did that people always asked like what you do and in. Some ways when you're in a hole like that no. One trip like the regulators did not trust and so, the way that you win back trust especially with an organization. Like the FDA is they speak in data like, you guys probably all work with people who like like they understand data like show us the data and like then we can make a decision and so, we did.

You. Know one the other things I learned with the FDA - I, always tell my kids if I learned obedience, I. Learned, that when you go to the DMV you know you don't argue about standing, in line or, you don't argue about doing a vision test you just do it you don't try to say like oh I just had one last week here's the report you. Just do it and similar. To the FDA. You. Have to recognize they, sometimes know more than you do because they're seeing the whole picture and you, just do it you like you negotiate, but you do the product you do what they ask you to do and. In. Some ways by showing that we could be obedient and we could follow directions and that we, had the data to. Prove it and, we had to change a lot of things within the company to be a regulated. Company, and there's a lot, that. We had to do from an engineering and product and design perspective to, document, how everything's happens, and. It so again it's been a ton of work but it's fundamentally made us a much better company because our processes, are much stronger. So. It, was, it. Definitely was rough and there was a lot of. Controversy. Within, the company about whether or not this was the right path and I. Think as a leader, of the company when the most important thing is to do is to allow controversy. You. Know allow people to hat to voice their, questions like invoice it like I think Google is one thing I learned with Google is like you want to let people debate debate, is really good but. Once you make a decision everyone's, on board and if you don't agree then it's not the right place but. We had we, have a fair amount of debate and before, like we I encourage that as a leader I encourage that debate and then, once we make a decision and, you can set a vision for the future and, say look like, were we're. Trying to fundamentally, change the system or we're like trying to empower consumers like, my, next date like why do you have to go and get a doctor's order to get a blood test do, you always need it for a prescription like.

All These like the whole you, know patriarchal, system like why do you actually need like. Why do you need this physician or medical. Involvement. Before you can actually get some of this information so we're, really out for that bigger picture of like trying to change the system so. For your current offerings you offer the ancestry. Test and then you can get the health test correct so for two years we, we. Just kind of we all we did was offer ancestry, and we focused, on pulling, out the health information we've, gotten we have three FDA approvals now or authorizations. So we have carrier status we, have genetic, which is things like cystic fibrosis we. Have genetic, health risks, which is things like Parkinson's, disease and Alzheimer's and. Then, we have now the breast, cancer variants the three most common in, Jewish women or. Jewish individuals that we test for those variants. Are. You playing to offer more extensive testing like such as metabolic. Imbalances. And enzymes, like. What like because. I you're asking family. Members has chronic, pain I. Think. So, no I mean we're focusing on DNA like if it's if it's a genetic, variant of a test that we could detect like we're focusing just on DNA right now, so, we, definitely think about partnerships, that we could do that would have you. Know especially anything that we could do that's potentially at home where. We could allow, you to have at home collection. And think about other tests that you're getting but right now it's just focused like we're definitely looking to expand, the the tests that we're offering but. Everything will be just based on genetics, excellent. So, given the large corpus the data you're putting together are. You how, have you been able to use this like for, promoting cures or, new developments, in the field we, do so that was part of the hypothesis, of the company is that if I collect all of this information and all of this data can. I then, more, effectively. Make discoveries, academic. Research, discoveries, as well as can I translate this information, into, drug therapy DEQ's so the. Drug industry, again when I was running this this when I was investing in companies and running that fund that I called Death Watch part. Of the reason why I could do something like that is statistically. 90%. Of everything fails in. Biotech. So if 90% of everything feels like you're just short everything like there's like you don't have to do that much math for, just like you can predict failures. So, in in the drug discovery business. It. The farm a lobbying group is the only group I know that like would actively promote every year how, it's more more expensive to. Create a drug so, like when I started, investing, it was seven hundred million dollars to make a drug and today it's close to three billion dollars so, it's, only getting worse so the idea with all this data is can I in some ways more effectively. Use. This data to to, translate, it into drug hypotheses, and then do I have a higher success rate, for, making therapeutics. So, we, are doing that now we hired Richard Scheller who was the head of research and development at Genentech we, have over ten programs in, development, now we've been doing this now for three years we. Work with a ton of pharma partnerships, so. We are actively trying to say can you turn data. Into. Curative, therapeutics, so, we are actively working on that now and my hope is like again because, we're a scientific. Team like I can. Say this is my hypothesis. And I but I can't make any claims yet but my hope is in ten years I can come back and say like look here's, our success rate compared to industry averages and we believe that that success rate will come because we're, starting with something that's data-driven, based on genetics. Now. Is that possibly a new business model for, the users. Of 23, me also like if I provide you with health data it leads to some type of cure it's. Hard to translate. The. Reality, with drug development is that drug development, is. It's. A really long and complicated process so, at what point in time can I. Identify. That like your participation, made.

Such A huge difference so what, we tried to do is say like we learning from our customers, so for instance in depression. We, did a study where we had 400,000. Customers participate. And thanks to the participation, of so many individuals. We. Were able to make discoveries in depression and then, you potentially, can analyze. All those genetic variants, and say these, are these this is one where we think this is potentially a druggable target. So. It's really hard to do the micro attribution. To say hey these individuals, and plus, it's like a ten to fifteen year process. So, you, might come back and say hey fifteen years later what. We have found is what people really care about. Like. We had a community, of individuals actually, if someone from Google actually who we worked with who had sarcoma, just. Like I don't care it like what I care about is a cure, like, I've, sarcoma, like I have a lethal disease like I would like to live and I. Find, people with serious illnesses like that they care about two things like does this impact my children and I would like to survive but. Me coming to you and saying here's a check for $100. I'm sorry you're gonna die soon like it's, not it's, like it like, we want to do the right thing and everything. At 23andme. All. Of our decisions that we make are about what is in the best interests of our customers, and my customer, is always the individuals, who, signed up and, so we always think about everything from the perspective of like you just participate, in research like what is it that is in, the best interest for you and if you tell me for instance that you have you have migraines, and you have you. Know you. Know Crohn's, we. It's our job then to help you figure out the best ways that you can participate in research or for us to actually move those things forward to, have some kind of impact in your life and then you could potentially help be a control, there might be somebody here who's like oh I'm high you, know I have a family history of prostate cancer and we have depression and, you can say I can be a control for you and in, that way everybody's, actually helping each other so, it's hard to then point to well, who exactly, is responsible, because, the reality it's really a community asset that makes sense um for, the survey aspect, when you remember 73, me they ask you questions.

Sometimes. You probably might get data that is just erroneous, like do you use like multiple data points to figure out we do one of the things we found so this is a good example in we. Asked we put out questions, to our customers so we asked we have a pretty comprehensive survey, that we first asked, everyone, to take. And. Sometimes you have to refine the question so in, this day and age everybody, thinks they have celiac disease, but. Very, few people have actually gotten a biopsy so, if I ask people have you had celiac, disease the. Genetic, associations. Previously. Known to, occur with that don't replicate but. If I ask you do you have celiac and have you had a biopsy to confirm it, then I can actually hit, the replication, I like get the I can, find in the genetic studies the, known the known findings, so we do find that we have to triangulate, questions, quite a bit, again. It's one of the things that I learned from Google and sort of like Big Data people is. That it's much better to have like. Massive, amounts of dirty data and. For. Us you know we have now five million customers, we have over 1.5, billion data points on those customers, we. Have the potential to do a lot of research it's without a doubt there's it's, not perfect like not everybody. You. Know, reports. Everything perfectly, but it's pretty good and if I ask you for instance like do you have epilepsy, you, can probably report. That pretty accurately, and so, what we find is that there's almost. You. Know it's it's almost a false truth that like Oh a clinical, trial is perfect data it was one thing I learned when I was on Wall Street is how much when, you have a multicenter, trial if you have 20 different centers, trying. To diagnose, a partial response in cancer it's really controversial, so, a. Lot, of aspects, of medicine like defining, a phenotype is controversial, and in some ways the best thing that 20 through me does is we have it all in a very standardized, form and we, always have the ability to go back to our customers and ask and say okay if you said you had asthma now we're gonna go back and ask you and ask you more about like your medications, you're like when does it occur and you can start to weed out when, something doesn't look real now. I'm sure people have seen the information and they might have overreacted or whatnot have. You considered, like a me connecting 23andme like genetic counseling or, providing. People information on how to talk, about these results with the primary care physician right we do actually connect people so. We don't the, main thing that we try to do that we feel really strongly about is, that health care and forth like a physician. Involvement, or a genetic counselor is up to you and so, we never use that as a bottleneck, for access, to your information but, if you find out for instance that you're positive, for breast cancer. The bracha mutation, you.

Know You want, to follow up with a physician or genetic counselor and so, we have had partnerships, in the past and we look at doing that more and more as we're you, we might at least give you advice like hey here's resources, where you can go to but. We don't ever we feel again philosophically. As a company, we feel really strongly that it's, never a bottleneck, for, access, but we do provide resources, for people so they know how to follow up. Um. For, my friend to have convinced to try and use 23andme, some of them have told me well the reason why I want to do it is because I know that I be sent a little heart attack or some other health. Problem, I rather, like be left to them not, knowing the situation and then I have heard people who have said well, now that I know I could possibly have a health issue and, might stress, me out or something have, you done any research about like the psychological, aspects we have um, we have done a lot of research and actually one of the best studies that was out there there was a guy named Robert Greene who's at Harvard and he did the original studies on Alzheimer's, and looking. At people as a series of studies called reveal where. He was able to see that people like Alzheimer's, is one of the more extreme so, people, find out they're genetically high risk for Alzheimer's what. Do they do and he found that initially, there is anxiety, but. After three months you return to baseline and for, a lot of these individuals they already know there's a family history so. For instance for people who have again. The Alzheimer's, variant, if, there's a high genetic risk, factor like you probably have someone. In your family network, who's had Alzheimer's, so you, know that you have some kind of genetic risk factor already so. What. We find and for me the story of genetics the reason why I was so interested in genetics, is that, you, do have genes and environment, so. Your, genetics, are not unless. It's Huntington's, like it's not deterministic, it's. Not a hundred percent you, have this whole beautiful world of your environment, and so, to. Me the environment, is your responsibility. Like that's what you can do like you can do something every, single day to influence, your environment, so without, a doubt there's Genet there's people who are genetically high risk for Alzheimer's but. They don't get it and so, why like, that's one thing I'm really past passionate. About personally, is looking at who are the people who are genetically high risk for diseases who, ever get them and what, was it in their environment and the reality, is like goes back to so the original premise of the company like one of the issues is like being really healthy doesn't make money in the system but, 23andme, is really uniquely, set up in large in many, ways to, do research on prevention, so, it's one of the things we're really passionate, about is like look at the people who have Alzheimer's and say okay, is it interval training is it like extreme exercise, like what is it that really has an influence on your, life and can we then help people take, responsibility on.

A Daily, basis, to, try and actually help prevent diseases everyone. Knows you're everyone gets sick at something like every, like it's one of the things I always say people would say oh you're, just gonna have all these healthy people and I was like there's no such thing as a healthy person everyone. Has something it's, like it could be depression it could be migraines, it could be you know stomach, problems, silly I like anything, there's no such thing as someone who's like 100 percent healthy so like for, me part of it was like helping, people realize that. Like. Your health is really a sum of your actions every day like and for us to be able to do that research I'm like what is it in our environment, that we can really do and the. Thing that I take most pride in is like rather than us creating, any kind of anxiety or other issues is what, people do is like people are looking to make, change like. People get their genetic information and it's something in black and white and then they're looking to make a change and I think the the the number one disservice that the healthcare industry has right now is there's, not great support. For. Changing your behavior and, people. Don't know how so, often like we heard this with, Alzheimer's, I had. One doctor he could stood up at a conference and complain he goes you know when the biggest pronzo 23andme, is you generate non-billable, questions, and. And. The reality is like you show up when you say I'm genetically high risk for Alzheimer's and, the like will come back when you have Alzheimer's like, that's what we do. But. The reality, like when. You think about where do you go to prevent, the. Number one place where people go to prevent any kind of disease in this country is realistically, Walmart, like. It's a behavior, like the average American, goes to Walmart three times a week or in this day and age is gonna be Amazon, like, it's, it's, it's you're shopping it's your consumer, it's like how you are living your life every day. And one of the things I really try the helm in on our, customers a hammer in our customers, is like your health is a sum of what you do every single day and so, again going back to the gene and environment pitch, like it, is like you can control your environment you can't control your genes but you can control your environment and we are trying to make those discoveries about, what in your environment is, potentially, gonna influence your genes the most, so. For people who are fearful about putting their information, into the system. One. Thing, one hearing is how, do I know that my genetic information will, not fall into the wrong hands like recently we heard about another genetic company I guess they were hacked or whatnot so for, someone who's fearful about sharing information to, 23mm what would you say to them it was one that things early on for. People who were privacy, we spent a lot of time with privacy experts in the early days and it was one of the things I concluded or that I was like for people who are like really care I was like don't do it just. Don't like like spend the time I get comfortable with it, you. Know what, we can do as a company, because. There's a lot of irrational fears and that's why we used to say that as a company, we. Have to do everything we can to protect, privacy like there's fundamentally, no business model like I'm totally. Dependent, on my customers participation. And their trust and what, to do the research and to do the types of things we want to do so I have, no business model if I can't protect the privacy of my customers, so. We do a lot like from a database infrastructure, how we set it up to. Even the fact that it's not a swab it is, 2, mils of saliva we reject, samples, if we don't get enough saliva so, you can't be accidentally, swab while. You're sleeping, like it's a lot you'll never drool that much in your sleep and, so, we, set up the company and also we don't have what we call like the legal chain of custody so, if you order five kits I have, no idea if you spat or if you gave them a way to five random people in this room so, I don't have the direct tracing, back to two individuals, from.

Our Terms of Service as well we've we've you know specifically, said it's not to be used for law enforcement, and. And, we've set up the company in such a way to make sure that it is really hard that we have not gotten a subpoena on this we've, put out a transparency. Report we, would do everything we can to fight a subpoena, it. Hasn't happened for us but those are the types of things where. For, people who are really really, concerned like just don't do it for, people who, like are comfortable, with being on the web we. Do everything we can to protect their privacy. And one of the core elements like one of the leading privacy, experts one of the things he taught me was like look and what, privacy people really want is they want choice and they, want transparency they, want to know so, if you're a 23andme, and you, don't want to share your data like. Don't share it and we we have to respect that so if you don't want to participate in research you don't have to participate if you, don't want to share your genetic, data with me don't, share it if. You want to share it with you know five people in this room we, allow you to share it so we've given you a lot of controls, and that's also one of the things that's relatively, atypical, in healthcare like if you want to share your medical record with me it would be almost impossible. So. We do a lot to make sure that we're like, empowering, people to have. That privacy, and. Then have also the ability to to. Compare when they want one, of the things I just say about there is like when when people in general talk about privacy. Like. If I picked, anyone randomly, in this room like I'm sure your genetics would be really interesting, and I would love to see them but. Your bank account is always much more interesting and so. From a desire, to hack, in to, you. Know one or the other your, bank is just a lot more interesting, and so when.

I Look at like everyone's, DNA. And, when I think about privacy. It's it's significantly. Less on, a mass area, but what you see is like within, a family people, will say I want to see if my brother is really related like is he really my full brother, and. So you get some of those intra-family, privacy. Questions rather than necessarily a, broad, sweep, on, a policy level are, there things that 23, are there policies, or legislation that, 23 me is backing on the federal level that's, we backed in the early days there was something called the genetic information non-discrimination, Act, and it passed unanimously. Bipartisan. It, is, a, it's, the it prevents, it. Prevents, insurance companies, health, insurance companies and employers from. Using genetic information, for discrimination, so, that. Was a huge step for us it does not it leaves health insurance, outside. I'm. Sorry it leaves life insurance outside, but, that was a that was a pretty. Significant, step forward in terms of giving federal protection, to, help people feel comfortable that they can keep their genetic information to, themselves, regarding. The life insurance aspect, is there other legislation. That's gonna be proposed in the future I haven't, seen anything. Now, and it's interesting to me because it's been 10 years and there hasn't really been any movement or any interest necessarily. From life insurance on it the. Reality we find to as genetic information is complicated, like it's not well understood yet so exactly how would you like we already know like some of the biggest risk factors obesity, smoking. You, know like those are those are the biggest out there so other, than like okay you're genetically high-risk, for a condition, that we just don't fully understand, yet. Like. I'm much more optimistic about like, in my dream world that we would actually have. Insurance. Companies embracing, it and says okay you're, genetically high-risk, for a blood clot and you're a woman you, potentially, are higher risk than for miscarriage and pregnancy, we're gonna try to like mitigate, those risk by you know X number of measures like there's, things I wish the healthcare system would adopt with genetic information rather. Than being reactive, but. That hasn't really happened yet, so. Going forward for like the next ten, years of 23andme, like where, do you see yourself the company I think. One. Of the most interesting things I see happening finally is, that, there, is an interesting world of virtual healthcare, so, you. Know like Vic who used to run Google Plus here who's now at a company called a live core, you. Know my dad has afib and, he has a little device on his phone that measures. Your EKGs and it will tell you whether you're in atrial fibrillation like that's amazing, it's totally, amazing like you don't have to go in it's. Like you can get instant, real-time information we're on the beach in Hawaii and he's like oh I'm, in a sub like. It so. It's. Utterly amazing and I, think that there is. There's. Genuinely. That is coming where you're gonna be able to get a lot of your health care on your phone and is. It taking a picture of your mole and then sending it in you can get multiple opinions is it someone like Grand Rounds where, you get multiple opinions online like there's. There's, like one of one of the things I'm really hopeful for is that, healthcare, becomes less about the art of medicine and much, more data-driven where, you get some you know a number, of people a number of opinions looking at a case and, and. You can have like again on the thing like a mole you, can really apply machine learning to that and so, what, are ways like I see a whole new world that is really, cropping up and. Whether it's gonna be you know some kind of chat bot that's, telemedicine. Like there's, a lot that's happening, there so when I think about twenty three Emmys role I think, that we become the hub in a large part like we, are but. Your genetic information is the core it's like the genetic code of you it's it is it's like the kites the digital representation of you and so, we're the epicenter. Of it and then helping. You figure out all the different ways that you can navigate that information, and what can you do with that information and, we. Can't do that alone like that's where we need partners, like I need ways that, you could potentially analyze, your blood at home instantly, or that you could get you know you could you know take a picture of your mole and have it analyzed like a whole, way that you can actually start to think about measuring, yourself at, home not in like like the quantified self movement is is more extreme but like ways, like the average individual, wants, to just like be, healthy and proactive, so I think that there's a whole new world that is coming up which is almost virtual healthcare and I.

Think The brick and mortar is. You. Know we'll always have hospitals, and we'll always have brick and mortar but you. Know the same way there's blockbusters, out there still, there's. Not a lot, and. I think that more and more you're gonna see that like I don't think that you doctor's visits, are gonna be very different in the future and and, I think that's where. My. Hope is like the research that 23, me can do is that we will make a number of discoveries about, you, know what does what is the meaning of a genetic information and then, also what, are really meaningful ways that you can prevent and and. That's like when I think about my ultimate success it's you know I would like to have I'd love to have a cures for parkinson's, and other diseases and that is a high priority and we're, on that but, I'd also love to be able to tell a 20 year old like this. Is what you need to do to be able to live to be healthy at 100 and and. To me that's like that's that's, real success so. It's kind of goes into life extension. I. Think my life extension extension. Is like it's it's again there's a lot of Silicon Valley discussion. Of like I want to live to a 500, I think. It's like, my goal is like very like I would just like to be healthy at 100, like. When I read. Stories about, you, know like hundred year olds running the marathons, and, like doing things like that's, what you want to do I don't want to be like in a critical. Care unit like supported. At, a hundred like no I, want to be healthy like I don't want to be diabetic, and have congestive heart disease like, no like. Just let me be healthy and tell me how and. Again it goes back to this like mantra, of like health is what you do every single day like, I dress like this because like I'm googley, but. Also because I exercise, all the time like I biked here I'll bike back I'll bike home like I'm, always like I love to humiliate, people in the office when they take the elevator, I'm like why like why would you do that why, would you do it in front of me too. So. I, think it's really important, to like get some of those types of messages out excellent. So, now we're gonna go to audience questions so if anyone has a question please. Head, over to the mic, just. There's a mic right there you can use. Yeah. I'm. Going to check for online questions, to. Me. Hi I'm from Argentina and. Then. When I go to the, doctor with the 23andme. Report, the. Doctor typically, they tell. Me something, like hey why why, do you did this as if I did, something wrong like, why did you did it without asking, a doctor first and so my one, of my question is related it if. You're doing something to educate. Them in that, sense and also when. I see them, the. Possibilities. To get, a disease they are all taken, we, into, account compare. It with a people, Co classic people in Europe. Because. Most researches are done there but I'm from Latin America so I don't feel represented, I know that, my. Question is if. You're going to. Do something to have more samples. From that region so I know. That my, test the results are more. Accuracy. And. Also. For something Argentina you don't have that I mean you, can't use 20m you have to come here. Yeah. So first question on physicians and second on international, so. Physicians, are definitely the last mile like, it's painful, for us and. And. It's disappointing to me because we get a lot of people who take their reports to physicians, and the physician says like, this is not worthwhile so. You're not alone in that and we've tried some initiatives, and early initiatives to work, with an educators. And I always joke if I took a thousand kits to, Stanford Shopping Center, and, I was like these are free they, would be gone in five minutes if, I took a thousand, kits to ASCO the big oncology, meeting I would come home with 990, of them like. We've literally tried to give away kids to doctors and they're like oh no, so. There's a huge like there's a lot of work that we have to do to engage the. Medical community. One. Thing that I have found is that there's, like there's. A new crop of physicians like a lot of doctors who are online in, the telemedicine, and it's something that we're thinking about is how do we cultivate the, physicians, who, are trying to embrace a world of prevention, and like, what could you do with this and it's, hard because like it's not it's not a big reimbursements, like anyway, you can go to any dermatologist and.

Get Botox like today in the next hour and if you said I want to get a mole check they'll, be like oh in, October. I have time at 9:00. The. Mole check doesn't reimburse but, Botox, is you know three hundred dollars in 15 minutes so. So. I think that's where like we have a lot to do to try to work with the physician world we're hiring someone like that's that's like a big initiative for me on the team is how do we engage the, medical world I'm, second, on international. The. Same way we had regulatory, issues here, the rest of the world is pretty complicated and there's, a lot of misunderstanding about genetics. So each country, has laws about how to enter, into those countries, and. They're pretty complicated. And it's almost like we just haven't had like, I think a lot of startups fail because they try to do too much too early so. We think about International, and honestly like again, going back to the love of hacks one. Of the ways I've thought about just hacking it is just like just. Be in like JFK in, Miami and like, tried it because, then you can actually pull a lot of diversity in without, necessarily, having so, or like in the reality is like the u.s. is this like beautiful melting, pot where. If I want you know instead, of going into China which is really complicated like I can go to San Francisco and, so. Like for me part of it is making sure that we're recruiting the right populations. And so we are looking specifically, at targeting, different, groups if we have a big african-american, initiative, you, know we have a. Whole. Global, initiative, of like countries where we're trying to get specific populations. Both. For the ancestry, testing so we can improve, our product but also then for having the diversity, in health research thank. You so I'm gonna take it online question, yeah who owns the IP produced, from an individual's, genotyping. Data when, they use 23andme. So. There's, no IP, in. That capacity so like if you you, own what, happens like if you spit you own your data if. You consent for research you're, consenting to be part of this aggregate, so for instance if I discover, that. You. Know here's a JIT like I talked about 400,000. People participated. In the. Depression study and so. There's. Not I pee on. On. Jeans so we're not filing patents. For instance on like oh this genetic Association, is part, of parking of you know depression so there's no IP on that we, might say oh this, this this, mutation, looks. Like it's potentially in a in an area where it's potentially druggable we, then make a small molecule or, an antibody and we're gonna target that that, is our IP because, like in some ways it's so far downstream from. Everything, our hope is like we are publishing and putting out into the public world like. All of the genetic associations. That we're finding so we'd like to publish a lot we have over a hundred publications, out there but. We really look at like the long-term downstream. Like we're owning that IP because we're putting in like. Again what's gonna end up being hundreds of millions of dollars of work into trying to make successful. Discoveries. Excel, be cures, and. Thank you so much for coming I'm really inspired I'm, no ma'am to Google Doodles p.m. I wanted. To ask about how you attract, and retain so, many women i from, everyone I talk to in your company they're so happy they're how do you do it especially you know really. Especially yeah that so many women are feeling like they can't, stay in tech dr. I, you. Know we had a problem for a while where. We. Quote was like we were trying really hard to hire a man for the management team. It. Was like they. Were looking for a head of engineering at one point I remember we just like we had this woman and we're like no no we need a man like we need well at least one. So. I think, I. Mean. I think it's like all aspects, of divorce like I think we've tried really hard to have a, supportive. Environment and, for. Me like. I've worked I always say I was like I've worked for really bad people I worked for like some really complicated. Funds. Like I was, like who in the room has anyone, who's been in jail like I have bosses who've been in jail so like I've worked for like some really. Challenging. Individuals, so I know what it's like. And. I'm, trying to do the exact opposite, like the first job I ever had, the, Wallenberg family in Sweden they were amazing, like I've never like they treated me so well so I know what it's like to have a bad job in a bad environment I know what it's like to have a great environment and in. Sweden for instance like this woman showed up one day and I, was like who are you and she was like oh I'm newly promoted partner, I've been on maternity leave for two years and I was like.

So. It's like it was one of those things like culturally. It's set to me like, here's a group of people the wall I'm like who, promoted this woman who's like been on maternity for, two years it was amazing, and so, I really, try to create a culture where we support people through their lifecycle, and. You. Know a lot of people been at the company who they. Get, married they've had kids they get divorced like like, there's a whole life cycle and not, everyone, is awesome, everyday and, so. Like you could be awesome for a while and then you have a kid and it's like and the kids sick for a while and you have takeoff time like I can't, be the asshole boss it's like oh my god you're out like, I hat like I have to support people, and I look at people for, the sum of like I hope people stay for 10 years and I. Look at people for this um like what can you can you contribute in that in that period and like how do we also support, you. We're. Really very much like. Your family is your family but, like we're your family away from home and, so, like I have to support people in a good way and I have to listen, and. And, I think it's like there's a level of humility like, the number one thing we have for hiring is humility like. You, need really smart people but like I just the. Culturally. Like you, got to fit in with the humility and we have to support people. Thank. You. Hey. Thanks for doing this, so. I know, there might be some liabilities, associated with, the idea I'm about to mention but is there, some time when this, would, be an opportunity, finding, tool, as well that your, DNA seems like you would be perfect for pole-vaulting, so you know. Waiter. You. Know I don't know if we'll ever get down to those types of specifics. Like I think. You. Know I think that there's like force printing you, know there's genetic variants, associated with like do you have the double twitch, will. It ever refine, enough, to be able to say like. Oh you know you're really great at this specific sport, I think again it goes back to the world of genes and environment like, you you, need, passion to, be great at anything you need passion like the the the, most important, aspect for me out of that movie Gattaca was. That this. Guy has a genetic like, he's genetically not likely to survive, for some reason but he has the passion and, like. Passion, accounts for so much, so, I think without a doubt you'll hear things like if you are we. Did some research at one point on. In. Like being toned that were like having a musical. Ear and you. Know you could imagine at some point like would you say okay. Like hey you know you're just not like you just if you want to be a pianist, you're, gonna have to work that much harder so I think it's you know we and we're do it like we did a study for the instance in weight loss like we, might hope one day is to be able to say if you're, overweight you.

It's, Only gonna take you four weeks to lose weight you, it's gonna take you seven weeks like you're just genetically, more likely, to, not be able to lose that weight and I think that's where it will help people not say notnot like oh you're not gonna be great at this but like you just might have to work harder instead, of the famous ten thousand hours you need twelve thousand hours. Thank. You. Hi. Thanks for coming this is very interesting so. I was wondering I noticed that I mean so, there's 23andme, but there's also lots of other, lots. Of others sort of similar cone companies. So if you're looking at sort of ancestry. Yeah you get to link, and find out your relatives, who, are with 23andme, but then there's people who are with, other companies it seems like everything's kind of siloed, have you thought, about talking to other companies and seeing if there are ways that you can connect across each other's databases, to help people find relatives. Yeah I think. We. Did a promotion, for instance on DNA day where we allow people from ancestry.com, to upload their data, you, know the companies are pretty competitive right now so there hasn't been, any. Specific. Initiative. To like try like, you can always download and, I think upload. So. So. No I mean I it's it's a problem like it's not in the best interest of customers, for sure to not allow like, I would think that that would actually be something that's great but like I think there's a lot of competition right now so that hasn't that hasn't happened. But. Without a doubt like we know that people who are looking for family members oftentimes, will do both services, yeah. Okay. So and again we might do more in the future and. In some ways this goes with some of the privacy issues like we had, so. Again talk, about the go and say killer like one of the things that's important, for us to do from a privacy perspective is, not, allow. Relative. Matches from DNA that's uploaded, right because, if you allow that, then you open up the door for things, like the Golden State Killer and, so we, had like for instance when we did this promotion, with you, know anyone could upload their DNA from other places we, would tell you if there was someone within, your close circle but we wouldn't identify who it is and we, did thus and you would have to spit again and we did that specifically, so that you like. From a privacy perspective we. Think a lot about privacy. Well. Thanks. Hi. And so say I have submit, my spit. And then I get it back and then it tells me about like, my ancestry, and all. My health, prospects. Say. I have like like, what would be like is there a way I could prevent myself from, having like cancer in the future like just, off of that we. Don't have so the the, cancer report we have right now is the breast cancer report that is associated, with. Typically. You. Know Ashkenazi, Jewish. Descent, and, and. It does have a high penetration, of cancer so, meaning. Like those people are likely to get cancer what, we found people have done is they go and they get either mastectomy, or they, take out their ovaries. So. There's. Ways that you can potentially like, it's extreme to. Prevent, you. Know the other thing that's out there is there are for instance there's people who are genetically high risk for colon cancer and in, that capacity you know right now I think the recommendations, are Kol colonoscopies.

At Forty five in, that, case you could start having colonoscopies. Earlier so a lot of it there's not necessarily known, specifics. About okay, if you want to prevent cancer these are the things that you do in. Every. Disease area you can say you. Know don't smoke exercise. And eat. Better and what, we find that having something that is a risk factor in black and white in your DNA, motivates. People to actually do all those things but, those are the biggest swing factors you have always is your exercise and, your diet, and your environment okay. Thank you. My. Name is Julia and I'm an intern in Google brain genomics, mm-hmm, and looks, like Google is also looking into like, genetics, and predicting. Disease. From from, genetics. Connecting, to healthcare yeah I know that also Microsoft, is looking, into, health. Care in genetics, so, what do you think about this like do you think, that you, will cooperate, with Google. Microsoft at, some point or you. Will be competitors, or, 23m. Is so far ahead in this research that I, think, so, I've, spent a lot of time like in in the early days like back when we were starting the company like Google, Microsoft others. Like Microsoft, had to had, RFPs. Out for a while doing genetic research they've had a great you know they have they had a really great team. You, know Google, brain team is amazing I know Jeff Dean Wow like it's an amazing group of people that are there the. Number one problem, in healthcare I find, is nobody has the data set I love, going to Big Data meetings, and everyone's like talking about Big Data and I'm like but. You don't have any data like. I mean it's just it's, fascinating I'm, like, it's, like the emperor has no clothes people

2018-07-14 21:38

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