A conversation with the Co-founder and President of 23andMe.
Topic: Partnerships in business
Anne Wojcicki: I would always recommend a partnership because for me it seemed like – when Linda and I first met, we came together and said we have no ego, we really just wanted to make this happen. And we worked at an amazing schedule where I tend to go to bed late, Linda wakes up really early. So we actually worked almost 24/7 for years. And we got an amazing amount of stuff done. And the contacts, I had a tremendously different number of contacts than Linda had and we were really able to, I think, get the kind of marketing reach and the kind of publicity because we came from different worlds, but had such similar ideas. So, it’s perfect. It’s really – to do a start up when you only have five people and you need to make such an impact and especially with genetics, personal genetics, there are so many people to talk to. So, I have to say, I’m really proud of what we did. And it was a lot of fun. We had a really great time. And I’m actually very excited about the idea of working with Linda in the Alzheimer’s initiative that she is taking on because I think it’s the culmination of exactly what we’ve done. We both have personal interests about what we want to do and now, 23andMe has built this platform to do consumer-directed research initiatives and Linda’s executing on that. And Alzheimer’s is going to be her first initiative, she has other diseases that she wants to go after and I think, to me, it’s a great moment the fact that you actually feel comfortable enough to leave and say I’m going to take on my own personal health issues that I really want to work on.
In terms of being two women, I think neither of us really thought about it that much, we both worked in industries where it has been either male-dominated, or a mix. The questions come up and we never really thought about it that much. It’s more that people ask us about it a lot and that there are conferences like the Fortune Most Powerful Woman’s Conference. It’s really fun. But I find that people then end up talking a lot about, what’s it like to be a woman? For me, the biggest change was that there was a line in the bathroom. So, but other than that, it was great when we had more people who were all pregnant at the same time and everyone can commiserate about breast feeding, which I guess is unique, but we never really thought about it that much.
Topic: Embracing a radical idea
Anne Wojcicki: I’d say 23andMe, as much as we have the reputation for being the consumer-oriented company and we are consumer-oriented, we are so heavy on the science that, to us, it was sort of obvious. Of course you’re going to want your genetic information. We all want our genetic information. Why would you not want genetic information? And I think that’s probably something that we underestimated in terms of the effect that people don’t really necessarily know exactly what do they want to do with the genetic information. Why would they want it?
I think about other industries where it’s been a big technology shift. TIVO was a big shift in how people watched TV, but everyone understood the concept of TV. No one really understands the concept of, well why would I want my genetic information? And I think one of the other big challenges that we have is that healthcare is not a true free market because you are used to going through a doctor and saying you want X, Y, and Z, and not paying for it. And so for that reason, I was telling people, wow, you can get access to your genetic information, it’s much cheaper than some of the other ways you could get it and its all within your control. That’s actually a hard leap for a lot of people because they are not used to paying for anything for healthcare. So, it’s one of the things that we’ve discovered that we have to educate people a lot more about preventative care, why they should actually invest in that, and what are things they should do with the information and the fact that they actually are going to have to take a lot more responsibility for their health. And that’s a pretty big adjustment for people.
Topic: Ethical questions
Anne Wojcicki: I think there are huge questions to deal with. It was funny. Early on in the company we engaged with a number of different bioethicists and we actually talked about employing someone, and then we actually couldn’t get anyone to join because everyone found that this topic was so interesting that they felt this was going to be pivotal to their academic career. So, we’ve engaged with a number of people and we’ve gotten them to always give us feedback on it, but fundamentally one of the things we’ve realized, it is an incredibly interesting area for the ethics community to talk about. Fundamentally, what 23andMe believes is that it is really about choice. And if you want to get access to something that is fundamentally yours, we believe it’s your right to get access to it. It’s not for everyone, that’s abundantly clear to us, and those people should not have to do it. And so, 23andMe really wants to encourage the debate, we want to be a participant in it, we want to be supportive of it, and I think we remain very firm in that we believe that individuals should have the right to get access to this information and how it’s going to be used and what are the good things and what are the bad things that society really needs to have that debate and 23andMe will be there, but that society should put the limits on it.
Topic: Parkinsons and 23andMe
Anne Wojcicki: We launched the Parkinson’s initiative with Michael J. Fox and the Parkinson’s Institute out here. And we have individuals with Parkinson’s were given a discounted version of the 23andMe. We’ve designed the 23andMe site so that individuals can get access to their data, they can fill out surveys specifically about Parkinson’s as well as about their general health, and they get all the other access – so information about their ancestry, they can connect and share with individuals, there’s a community portion, they can learn from people. So, we want to have a really engaging experience for people so that we can keep getting information from them. We have one Parkinson’s survey now. We will plan to have additional Parkinson’s surveys because the long-term goal is, how do I get information about you today? So, let’s say I want to know how does your Parkinson’s progress in 12 months, in 24 months, in 48 months, because that information will be really valuable to correlate with your genetic information.
So then in comes 23andMe on the backend. Our researchers in-house are actually analyzing all of the data. All the information that we’re collecting through the surveys, they then compare to the genetic information and what we’re finding is we’re actually making really interesting discoveries on all the different questions that we’re asking about. We’ll hope to announce soon information about – because this Parkinson’s community came together, what are some of the discoveries that we have made? And what are those discoveries – what kinds of discoveries will benefit that community? So that might also integrate with a lot of the clinical trials that are happening where clinical trials are happening either on drugs where we can put in and help to figure out why some people respond, why some people don’t respond, where’s there’s toxicity, or there’s not toxicity. And a lot of the Parkinson’s patients are eager to participate in clinical trials. So we might be able to help make sure that they can find a clinical trial that makes sense for them.
Topic: The problem with clinical trials
Anne Wojcicki: I think the biggest problem in clinical trials is that they are underpowered. And that fundamentally the studies are just too small. And because they are so expensive, they are designed in such a way that there just is a small cushion. And so, they are expensive to run. If you need 1,000 patients to really get the power you are looking for, or maybe you have 1,100, but what we are finding that those are actually are still underpowered. So, the advantage of 23andMe, what we can do is we can actually have huge datasets where we’re not looking to collect a hundred people with cancer, or 1,000 people with multiple sclerosis. We want tens of thousands. The Parkinson’s initiative we’ve announced that we have over 3,000 people with Parkinson’s and on a relative basis, one of the largest cohorts out there now. We’re looking to develop the large cohorts and keep asking questions. I think one of the other advantages that we have is that we can ask these Parkinson’s patients about their Parkinson’s but we are also learning about all of these other aspects of them. So, we ask the general health survey and then we’re asking about commonly used drugs. Do they get a stomach ache when they take Advil. How do they respond to Benedryl? Things like that. So, it’s a cohort where we can keep learning more and more things from them.
Question: Describe how genetic testing has affected your life.
Anne Wojcicki: To me it’s very interesting that it’s so controversial the fact that is it not deterministic. Because throughout my life in medicine, I very rarely get a test back that is so deterministic. So, even when I was pregnant and I get a variety of tests back and they say, okay this is cutting your risk down for having a Down Syndrome baby, but it’s never 100 percent, unless I did the amnio, which I did not do. And even things like cholesterol, if I find out I have high cholesterol, again it’s a risk base. It means I have a risk factor for heart disease, but it didn’t tell me anything specific. Some people even do very well with having high cholesterol. It doesn’t say specifically you are going to die of heart disease. So, in my opinion, I’ve been very comfortable with having diagnostic tests that tell me that I might be at higher risk, or lower risk based on some information. So for the LRRK2 example that my husband has, he already knew that he had a family history of Parkinson’s disease and now he knows that there is a genetic basis for it and that he carries that genetic basis for it. He already knew that there was the family history, he has that there, and he has gone through a lot of the literature. One of the things that he’s found is that it’s not that well studied just yet because there was a relatively recent discovery, but there is information there about things you can do to prevent Parkinson’s. So, that could be changing your diet, exercising more, and potentially drinking coffee. And those are all three things that he does.
And again, going to the critics. All three of those things are great for his health regardless. So, he has lost weight, he is much more vigilant about eating vegetables and he is trying to drink a little bit of coffee. So, I’m really happy that we got that information because even if it comes out later that, oh, he has other genes that decrease his risk, and therefore he’s sort of an average risk for Parkinson’s; one, I am used to getting that kind of information and that kind of change in healthcare, and two, I’m happy because he made a lifestyle change that fundamentally made him healthier.
Question: What have you learned from watching the birth of Google?
Anne Wojcicki: I think that the moral values and the ethics that Google has definitely influence. I think, once again, Larry started the company, they weren’t in it for the money. They started it because they really wanted to create something that; one, they wanted, and two, they thought was going to change the world. And I think that that really held up with 23andMe where we say all the time, we’re not here just to be – it would be very easy for us to say, oh we just want to be another kind of diagnostic company, we come out with something very simple. We really want to change the landscape. Every single day, we want to take on the hard problems. We don’t want to just find a solution and make money and leave it at that. We really want to keep evolving and take on those hard problems. So, I think that Google has been really inspiring in that way in that even all these things that they are doing, I am continuously impressed by the challenges that they take on. And I hope that the same thing happens with 23andMe.
Question: What drives your enthusiasm these days?
Anne Wojcicki: I think the amount of information. I think we are definitely suffering from an information overload, but I believe that there is going to be better and better ways of organizing that information and processing it so that it will enhance your daily life. So even things we were playing – we were having this habit of once a week I’ll go through on Google Earth and fly into a different city. And we have this large monitor at home and it’s amazing resolution and I was in Tibet in 2000 and I could just walk around the streets. And it’s things like that. Now that I have a small child and I can’t travel as much, that’s phenomenally interesting for me, it’s fun. And I think that’s how information and technology just are going to impact our lives more and more on the personal and on the fun side, and more and more I think also on the serious. I think on the medical side I’m really excited about radiology. There’s a conference in Chicago every October and the stuff that is happening in radiology is fascinating. And the stuff you can do with imaging. I just think that technology and information, it’s overwhelming at the moment, but it’s really going to make life better.
Question: What keeps you up at night?
Anne Wojcicki: To be honest, since being a new mother, my biggest concern becomes the health. If I was diagnosed with something that was fatal in the next couple of years, I can’t imagine anything more terrifying. And so for me, we know a lot about technology and we know a lot about the world, but I think health is the one area where there’s so much data, but it’s chaotic and that it’s still a big black box. So, understanding really what is going to make me healthy and what is going to allow me to live the longest life is definitely keeps me up.
Question: Who are your heroes?
Anne Wojcicki: I had a very unusual childhood in that I grew up on Stanford campus and I never moved. And almost all, like 80 percent of my kindergarten class is all still friends. And so, I have to say, it’s the people on my street. My next door neighbor is this guy, George Danzic, who passed away a few years, but he was 90 and he sued Stanford because he wanted to keep teaching. And he had the same beat up car and his house was cluttered with books and stuff and he would write me long letters. He was actually really interested in genetics and the biotech industry and how that was the next big area. But people like that who are just so interested in the world and I have to say, I was lucky to live in an area where I was surrounded by such great people. And those people really made me. So, it’s a lot of local heroes. But it’s the people who impacted me the most.
Question: What is the worst career advice you have ever received?
Anne Wojcicki: It’s interesting, the worst advice I’ve probably ever got is when I was done with Wall Street in 2000. I took off a year to travel, I was going to go to Med School, and I got a job offer to go back to Wall Street, and I was like well, I can make enough money to pay for Med School, it will be easy. And everyone was really supportive of that. Wall Street was sort of at the height of the fame, everyone thought it was really cool, and I think taking that job, doing something probably more for the money was probably the worst thing I think I’ve ever done.
Question: What is the best career advice you have ever received?
Anne Wojcicki: When I was investing in it and then I would complain, no stop, I’m investing in this industry that I feel like is just turning out products that are not necessarily benefit us. It was actually Larry Page who at one point was so irritated, he was like, “Just stop. If you’re going to keep complaining, just go and do something. Go and fix it.” And it was really – wow, yeah, you’re right. I should stop complaining and I should just try to fix it. And I think having that mentality – it’s so easy to be in a work situation where you complain and finally, it’s your responsibility. It’s the really fun thing about starting the company. If you want to change this world, this community that we all live in, then get up and do it. And just start something. And if it fails – every time we get criticized, I was like, well that’s great, that means I am actually doing something and I am pushing buttons. And so every time there was something critical, I feel proud.
Recorded on September 30, 2009
