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Breaking the Code: Anne Wojcicki on Genetics, Reinvention, and Rewriting Consumer Health · Breaking Precedent

• BP_Anne Wojcicki_Basecut INTRO Speaker: [00:00:00] Hi, everyone. I'm Leah Solivan and this is Breaking Precedent. Not only did I found TaskRabbit, one of the pioneers of the gig economy, I'm now a venture capitalist [00:00:10] backing the next generation of rebels through Precedent VC. In this podcast we dive deep into the stories of innovators who are pushing societal boundaries, challenging precedents and [00:00:20] setting new ones in their fields. Speaker: Today's guest built a company that did something no one had done before. She put your most intimate biological [00:00:30] information directly into your own hands, bypassed the traditional medical gatekeepers entirely and dared to suggest that you, the consumer, [00:00:40] have the right to know your own genetic code. Then she watched the company she built go through bankruptcy, fought off a competing buyer And she bought it [00:00:50] back for $305 million through her own nonprofit and is now rebuilding it from scratch with a single mission: To become the world's leading [00:01:00] genomic research platform. Speaker: She did all this while carrying the DNA data of 15 million people and treating that as the most serious [00:01:10] responsibility she has ever been given. The precedent Anne Wojcicki has been breaking since 2006 is simple and radical; That your [00:01:20] health belongs to you not your doctor, not to a pharmaceutical company, not to a regulator. Speaker: That you deserve to know every letter of the [00:01:30] code in your body was written in. Let's dive in. Leah: [00:00:00] Anne Wojcicki, thank you so much for joining me here on Breaking Precedent. Anne: Of course. Good to see you. Leah: It's so good to see you. Um, I wanna actually start by telling [00:00:10] a quick personal story about 23andMe, okay, because this is when I first experienced your company, and I was eight and a [00:00:20] half months pregnant with my first baby, we just talked babies, and now she's- Yeah Leah: 13. Anne: Wow, yeah, yeah. Yeah. Leah: And, um, you know when you're, like, eight and a half months pregnant, you can't sleep, right? You're, like, up all [00:00:30] night. So I was up in the middle of the night, I was on the computer, I had done the little spit, spit, spit into the tube, right? Sent it off. And at that moment, at, like, [00:00:40] 2:00 in the morning, I got my results back, but I was, I was scared to open it because specifically I was looking to see if I had the BRCA2 gene. Anne: [00:00:50] Oh, interesting. Yeah. Leah: And I was, like, eight and a half months pregnant, and I knew it was a girl, and I was like, "Do I open this right now?" Mm-hmm. "And, and consume it [00:01:00] at 2:00 in the morning or do I just, like, you know, find, like, the right time to process?" Anne: Yeah. Leah: So what do you think I did? Do you have a guess? Anne: I think you opened it right away. Leah: Of course I did. [00:01:10] Yeah, yeah. I opened it right away- Yeah, yeah ... at 2:00 in the Anne: morning. Yeah. Leah: And it was a relief because I did not have the BRCA2- Yeah ... gene. Yeah. And knowing that I had my first baby [00:01:20] girl in my belly and I wasn't gonna, like, pass this on to her, because my mother had breast cancer as well, um, was such a relief. Leah: Oh my [00:01:30] God, right? So, like, what you have done is just absolutely outstanding. I, like, I cannot wait to dive into all of it, but that is a moment [00:01:40] that, like, sits with me a... And I think about it a lot. Anne: Yeah. Yeah. This, I remember when my sister, when she was pregnant, and, um, I [00:01:50] mean, it's remarkable 'cause you go to the doctor a lot and, when you're pregnant, and they... Anne: Like, I remember she went, she, and she was, again, she's obviously w- she was the pioneer for the, for the sisters. So she went and she's like, "We're [00:02:00] of Jewish descent. I need to be screened," and it turns out there's an Ashkenazi p- panel and there's a expanded Ashkenazi panel, but they only first tested her on the Ashkenazi [00:02:10] panel. Anne: But then later it turns out that she found in her third pregnancy that she was a carrier for Bloom syndrome. And, and then there was this panic of, [00:02:20] like, "I need to know You know, do I, like, does my husband have it? Did I, like, pass this down? So there was ... And so we could very [00:02:30] quickly do the analysis for her. Anne: Um, but, but you, it is, it is one of those things. Like 23andMe started largely because we wanted to make it very easy and empowering for people, and [00:02:40] comprehensive, to be able to get screened and, and to see, and to educate people about genomics. And we're not gonna have the answer for everything, but we're 100% the, the gateway, [00:02:50] the, the opportunity for people to learn about genomics, and then learn whether or not they wanna get even more testing. Leah: Yeah. I also made my husband do it before we got married, just to- Yeah. ... you know, [00:03:00] like weed out any, any weird genetic things. Anne: So long as it wa- Yeah ... the, the marriage wasn't contingent upon Leah: it. Yeah. Of course not. Of course not. [00:03:10] So I wanna start with a little icebreaker. I always start with an icebreaker, but this one's, it's not gonna be a softball, okay? Leah: It's gonna be a big one. Anne: Okay. Leah: Okay. So you grew up on Stanford's campus, [00:03:20] surrounded by people, including your own father, whose entire job was to ask questions about how the universe works. So the icebreaker is, what is the most important [00:03:30] question you still don't know the answer to? Not necessarily about genetics or healthcare, but about yourself. Anne: Oh, [00:03:40] about myself Um, about myself. That's a very broad, theoretical type of question- Yeah ... that could go in almost any direction. Any Leah: [00:03:50] direction. Any direction- Um- ... you wanna take it. Anne: I mean, look, I think that we, as a child of particle physicists, um, we spent... And [00:04:00] my dad studied neutrinos, which my friends always made fun of us, where they would say, like, "Okay, neutrinos are not... Anne: They don't make up... Like, they're not in a- important for [00:04:10] humans. They're not important for Earth, but they're important for the universe." And so they're like, "Okay, what, what... You spend your whole life studying this. Like, why?" And he's like, "Well, 'cause, like, it's very [00:04:20] important for the universe." Um, I mean, I am always appreciative, and, like, almost on a daily basis I wake [00:04:30] up and say, like, the fact that I'm alive is just extraordinary. Anne: And the fact that, you know, and, and now that I have a seven-year-old, and my [00:04:40] seven-year-old has all these, like, big theoretical questions. Like, like at least once a week she'll, like, be in the shower and she'll be like, "I don't understand. Like, who... Like, what was the first life? [00:04:50] And, like, who are the first humans?" Anne: And, like, those big questions about why, like how did everything evolve, and the magic of the fact that you get to be [00:05:00] alive is, um, you know... It's part of the reason why I love DNA, is like, like the fact that you have this code that has essentially been [00:05:10] responsible for all of life is extraordinary. And, um, again, that ties in just with my passion for understanding it. Anne: Like, it's a very academic pursuit of, like, let's try [00:05:20] to understand, you know, this very basic code that has given, you know, like such spectacular diversity in this universe. Leah: Yeah. I love that. [00:05:30] So I wanna go back and start before 23andMe existed- Mm-hmm ... because someone who builds the something that audacious is- audacious has gotta have this incredible backstory, and [00:05:40] I know you do. Leah: So you have talked about your early experiences with your mom teaching you to advocate, to question, to find the right doctors who actually matched you. Can you [00:05:50] share a little bit more about that? Take us back there, and what was actually happening at the time? Anne: Yeah. I... It's funny 'cause it's, it's only now that we [00:06:00] kind of recognize that it was unusual. Anne: Um, and it was one of those moments, my sister and I were early in 23andMe, and I remember I was creating a talk for, um, I [00:06:10] think Wired. And, um, and I said something about like, oh, like we were always advocating for ourselves. Like, "I should pull my medical record to see what that's like." And so I pull my medical [00:06:20] record from Kaiser, and my sister picked it up and she calls me, and she's like, "You're not gonna believe it." Anne: And I was like, "What?" She's like, "Our medical record comes with a warning on [00:06:30] the top. And that warning said, 'As all of us in pediatrics know, this mother can be uncontrollable at times.'" And I was like [00:06:40] My ball, like my medical record has a warning label? Like this is the best thing ever. Wow. Yeah. And so- Right Anne: um, I, I mean, I think that [00:06:50] I... My mom has this story that I've talked about. Like my mom's little brother ate a bottle of aspirin, and they couldn't, um, they couldn't get anyone to take him at the hospital, and so they went from s- um, [00:07:00] hospital to hospital, and eventually got someone to take him. And, um, they had originally told them just to, you know, um, take him home and let him sleep it off, and [00:07:10] he ended up dying in the hospital, and the family called in the morning, and they just said, "He's in the morgue." Anne: Um, so my mom always had this mindset is like, "I have to... Like if you don't take care of yourself, no one [00:07:20] will." And I think ultimately, like even as, as much as the world has changed and even like going through, you know, my dad's care when he was end of his life and Susan, [00:07:30] if you weren't there advocating every moment, you didn't get great care. Anne: Like it's just, it's just, it's 100%, it's an issue in the system. [00:07:40] Um, and so my mom, as kids, like my mom was a fierce advocate. You know, like even like when I was chatting with you, my son had just called, like, "Hey," you know, [00:07:50] he knows. Like, you know, "Do I X-ray my mouth at the dentist or not?" I'm like, "No." Leah: Yeah. You don't need that- Anne: I heard you. Leah: I was Anne: like- Yeah ... Leah: wow, Anne: okay. You don't, you don't need that X-ray. Like- Yeah ... like there's things like... Or, [00:08:00] or like question, like why? Um, and so my mom was really good about always questioning, and there's like multiple times where I remember, um, her arguing [00:08:10] with the pediatrician and they wanted to do something, and she was like, "No, I'm not doing that." Anne: And it was like just so normal for us to have this mom who was like very clear. [00:08:20] Um, I mean, she was also so focused on prevention. Like she was, um, so focused on diet, so focused on exercise, like really [00:08:30] clear about like, um, you know, get some of the things that the whole world is talking about in terms of longevity. Anne: Like she was so early with all of that. And, um, and I'm also [00:08:40] really grateful. I was, uh, born in Kaiser Permanente, and Kaiser I think did a really phenomenal job of emphasizing prevention and lifestyle and [00:08:50] understanding that, you know, like sometimes when you feel frustrated, like go for a walk around the block. Anne: You know, like after a meal, like walk to your friend's house. Like always take the stairs. [00:09:00] Like my mom was like, "Okay, you know, exercise." Like vacuuming, like it's a exercise. Like k- move, you know? Get things done. Like my mom was always really clear about the importance [00:09:10] of, um, taking care of yourself and advocating and never just walking into a doctor's office and being sort of like an obedient lamb. Leah: Yeah. It's [00:09:20] amazing. I mean, the world calls your mother the godmother of Silicon Valley for how she taught. This, this, this side of her, is this something that the rest of [00:09:30] us get to see too? Or how do you reconcile these two sides that fit together with your mom? Anne: Uh, look, I think that she... My mom was a very [00:09:40] rebellious teacher as well. Anne: Um, so I think people don't realize, like, my mom, um, you know, started teaching and then she got in a lot of trouble and she got [00:09:50] fired, and then she sued the school district and there was war. Like, my my- Yeah ... I, I, like, there was a lot. Like, my mom [00:10:00] was very controversial. Like, back, like, we live in an era now where everyone's very used to like, "Oh, my child has ADHD and they need, you know, accommodations," and this and that.[00:10:10] Anne: My mom was so super early in that. She's like, "Oh, like, I have these kids and they, you know, they can't sit still, so I..." Like, she brought in the exercise bike into the classroom. [00:10:20] And I remember, like, my mom did all these inappropriate things. She'd be like, "You, you need 10 minutes on the bike." I, I mean, like, stuff. Anne: Wow. And my mom would, like, show up at students' hou- My mom was really clear- [00:10:30] Love it ... of like, "You're full of potential and I believe in you, and you're gonna rewrite that essay." Like, she was also all about, um, you know, my mom [00:10:40] was spectacular at believing in people and giving them chances to improve. And I look at, like, in some ways that concept should be [00:10:50] adopted in healthcare because right now you go to the doctor and they're like, "Oh, I'm so sorry. Anne: You're, like, overweight, you're hypertensive, and you have a family history of heart disease. [00:11:00] Like, wow, it's really bad. Good luck. Bye." You know? Versus, like, someone, like, like I always said, like, where's the Nike? Like, just do it, like, I believe in you [00:11:10] of healthcare, where it's like my mom. It's like, "You're overweight and you're hypertensive-" Anne: but you can fix it and you can do it." Get on that Leah: bike. Yeah, Anne: you can do it. Yeah. Like, you can make these [00:11:20] changes, and I think- So Leah: good ... Anne: my mom has always had that mentality of just, like, this opportunity to, like, I believe in you and you're in charge of your [00:11:30] life, and you can make changes and it's feasible. Leah: So good. It's so good. And both of your parents raised you to be free thinkers, where don't be afraid if someone [00:11:40] disagrees with you was an actual household principle. What did that actually look like day to day in your household? Anne: I mean, we spent a lot [00:11:50] of ... I mean, we definitely, we argued all the time. Like, there was just, um, I mean, it w- I remember in the early days of 23andMe, one of my co-founders was like, "It's, [00:12:00] it's shocking to see how much you and your siblings fight with each other and argue." Anne: And I was like, "What are you talking about?" And she was like, "It's just overwhelming [00:12:10] because there's, like, nonstop, um, debate." And I think that was ... Well, the thing that I really appreciated about my parents is that there was [00:12:20] never this dictatorial sense of like, "I'm the parent, and that's it." Like, you always had that ability to negotiate. Anne: And if I was saying like, "Oh, [00:12:30] I wanna go and do this trip," or, "I wanna go somewhere," like, my parents would work with me to figure out like, okay, well, what is the best way to make that happen? [00:12:40] And, um, I never, I never felt like I had rules that I didn't understand. That's, I think, one of the key principles. And I think that [00:12:50] concept that you should never follow something you don't fully understand also, like, then follows down into healthcare. Anne: Like, it just seems totally logical. Like, well, why would I [00:13:00] get a blood test, or why would I X-ray my mouth, or why would I do a procedure if I don't know why I'm doing it? Like, it, it's just like it's a core principle of, like, everything in my [00:13:10] life. Like, why do you do things if you don't understand it? And so I think that pursuit of questioning is really important in [00:13:20] all aspects. Anne: And so I think the arguing was, was good, but it was also just kind of that element to push and be like, "Have you really thought through [00:13:30] your decision process?" And oftentimes, I, I always say it was like I, I, I love to argue, and I'm like the first to admit when I'm wrong. Yeah. So I'm wrong all the time. Leah: Yeah. And are you [00:13:40] quick to change your position? Anne: I mean, it depends on how compelling the argument is. Leah: Okay. Okay. Anne: You know? Yeah. It, uh- Fair ... hangs on, [00:13:50] um... I mean, like for instance, it happens all the time. Like it, with- within 23andMe, I will bring ideas to my research team all the time, and they will [00:14:00] point out to me, I would say with like 90% success rate, why my idea is wrong or like why we should not pursue it, and they're very good, but it's like very logical. Anne: Like, I think academics are [00:14:10] very used to that kind of, you know, argument. Um, so it kind of depends. Like, there's aspects I'm very stubborn with. Like, um, there's many [00:14:20] people in this world who believe... In the first 15 years of 23andMe, there was this mindset that direct to consumer was wrong [00:14:30] And that you should not be selling directly to patients. Anne: And I would say that was something where, like, no one ever had a convincing argument to me as to why that was true. So I [00:14:40] just, I feel very strongly, like, on a consumer empowerment, so something like that, um, no one has successfully convinced me otherwise yet. Leah: So take me back to [00:14:50] being a kid growing up on Stanford's campus. Leah: Mm-hmm. Do you think there are things that you absorbed there that you didn't even know at the time, that you look back and you're like, "Wow, that was really formative for [00:15:00] me"? Anne: Yeah. I, I, Stanford was incredibly formative in every capacity, and I... Whoever did the land planning for Stanford campus de- [00:15:10] deserves huge credit for what they did. Anne: So they created a community. Like, I look back at the early pictures of Stanford campus, and we were the first residents there. Like, they had a plot of land, [00:15:20] and a bunch of us came in, and we built our houses. And so they had this community of people who were all professors [00:15:30] and, you know, pursuing knowledge and had a passion, who all lived together, and everyone had kids in a similar age. Anne: And it was really lovely because we all got to, [00:15:40] um, I could walk to people's houses. We had a real community. Like, everyone went to the Stanford campus. Um, uh, and you know, we all did swim team. We all did [00:15:50] tennis team. Like, my tennis coach is still there. Like, we still see- That's ... like, all these things, like like, there was such a level of stability and consistency. Anne: And I [00:16:00] think that, you know, everyone always talks about it takes a village to raise children, and what was really unique there is that everybody, um, you ran [00:16:10] freely from people's houses, and everyone had a like-minded sense of pursuit of knowledge. And it was also unusual in that [00:16:20] capacity. I didn't know anyone who had a regular job. Anne: Like, it was totally normal for me to see people, like, middle of the day, [00:16:30] parents were home sitting by the pool and reading, and because, like, that was part of their job. Or, like, one of my best friend's parents, he constantly was [00:16:40] changing his career. He was in the, he was in the law school, but he could pursue international work, and then he could pursue environmental work. Anne: And you know, you, you [00:16:50] had a passion, and then you had that ability to pursue it. And I think that collective community of people who were so passionate but also [00:17:00] following their interests, um, and constantly evolving what those interests were, was a really inspiring environment for us. [00:17:10] Leah: Yeah. And your ancestors' story is absolutely incredible. Leah: So on your father's side, your grandfather was imprisoned by Stalin. [00:17:20] Your father fled Poland at 12 years old in the middle of the night on a charcoal boat. I mean, I have a 12-year-old. I'm like, like, it's unthinkable, right? And on your mother's [00:17:30] side, your grandmother came to America alone at 16, and these are just like, these are not distant family stories. Leah: Like you've said explicitly, when things are at the hardest, at the lowest [00:17:40] moments, you've thought about your ancestors and realized you were luckier than all of them. Can you talk a little bit more about how that empowers you and drives you in, [00:17:50] into what you do every day? Anne: Yeah. I mean, look, I think that, um... Anne: I mean, we, we came, we were raised really with an [00:18:00] immigrant mentality. And, um, like my dad, my sisters and I always talked about it, like my dad never fully understood, or in some ways I think he could never fully grasp [00:18:10] society and like what life had become like. And he was the only person where I would buy him, I would upgrade his economy ticket to business class, and he would show up at the airport [00:18:20] and he would downgrade. Anne: And, um, he, and he wasn't offended by money, but it just like, it was, he just wasn't [00:18:30] interested in like, like those things. Like, there was nothing worse than buying him like new clothes. Like, he just was like, "Why do I..." Like, like excess. [00:18:40] Like, um, and I think that, um, you know, I think that for my grandparents and my parents, I think there was that [00:18:50] sense of appreciation of like we're so lucky to be alive that, you know, in some ways like that simplicity of life and pursuing [00:19:00] what you're interested in and the beauty of the human experience, um, it just far outweighed anything that was material. Anne: Like, I [00:19:10] never... Like we were really, really naive to like celebrities and fashion and expensive things. Like [00:19:20] I just, it didn't, um, I, I... Like it w- it was, it was beyond foreign to me. Like I just, like I remember w- we had one friend's father who used to buy an [00:19:30] Armani suit and, and like we all talked about it. We were like, "Can you believe?" Anne: And w- he was like, "Well, it was at, it was at the warehouse in Italy." And we're like- Yeah ... "Oh, phew." Um- [00:19:40] Leah: Yeah. That makes a big difference. And- Yeah. Anne: Yeah. So I think that my parents always had a little bit- Mm ... of that sense as like, wow, like every si- you're so lucky and you don't even know it. [00:19:50] Um, and I think that today, you know, even, um, like we were playing a game, um, with the kids last night, um, where it's [00:20:00] this, it's a, like an iPhone game, and you, it, uh, it puts you in a different region of the world. Leah: Oh. Anne: And you have to guess where it is. Leah: Okay. Okay. Anne: Have you ever heard of this? I [00:20:10] forget. No, I haven't. It's like Global something. Leah: Okay. Anne: It's actually really interesting, and I think in some ways it's good for kids. And, and one of the teenagers was like, "I think that one of the true purposes of this game is to make [00:20:20] people in the US realize how lucky they are." Anne: Because it sh- you're like dropped in all these places and you're like, wow. It's like we're just so immensely lucky, and we need to be [00:20:30] thinking about that every day. And I think also part of the immigrant mentality, and I look at, um, you know, my dad's dad, who was a judge. He was a judge. He was part of the [00:20:40] Polish Peasant Party. Anne: He went into hiding during, um, you know, World War II. And like that whole pursuit is like he, he felt like his [00:20:50] Like, the, the pursuit that he was working on was bigger than himself, and there was that responsibility to having an impact on the world and, like, the [00:21:00] moral pursuit versus just yourself. And I think that that has, uh, really stuck with me and my sisters. Anne: Like, I think that was always a very [00:21:10] driving component is that we need to, um, you need to leave the ... You need to improve the world with your life. Leah: Yeah, and that, that obligation, that feeling of, [00:21:20] like, it's w- we're obligated to. I, yeah, that resonates totally. Yeah, and it's not- Yeah ... and I don't think, like, the word about obligation, I Anne: feel- Mm-hmm ... like, puts pressure because I think- Yeah ... that's, um ... In [00:21:30] some ways it, it wasn't- Mm ... I don't like that pressure for it. Mm-hmm. But it was more that if you, if you have a passion, you know, like, there's this [00:21:40] opportunity. Like, life is an opportunity, and you should, like, find the things that, you know, make a difference. Anne: Or even if you're ... It doesn't have to be ... Like, like, Susan and I, we never pursued [00:21:50] trying to be well-known. Like, fame w- was never part of it, or being a CEO was never part of it. But having a pursuit that you care about and that you love, and it could be really [00:22:00] simple, but, like, it should be something that brings you real meaning, and I think that was, like, the most. Anne: And I think the number one thing for us was, like, it was a v- ... I mean, again, it's like it ... I [00:22:10] struggle 'cause, like, I live in a different world now, but, like, a very anti-material world. And, um, that it just, like, wasn't worth it accumulating all these items, that it was more [00:22:20] important to, um, you know, pursue, um, pursue purpose. Leah: Yep. Yep. So you go on to become a biology major at Yale and a competitive [00:22:30] ice hockey player. I wanna know more about the hockey. Okay? You know- Anne: It's funny, um- Leah: Yes ... Anne: I- Tell me ... so I grew up, I grew up figure skating. [00:22:40] Leah: Oh. And- Wow, okay. Anne: Yeah, so for those- Yeah ... of you in this area, like, I don't know- Yes ... if you've ever been to the Winter Lodge Leah: I, it, it's- Have you been to that? Leah: We're obsessed with the Winter [00:22:50] Lodge. My kids love the Winter Lodge. Anne: Okay. Leah: You, you skated at Winter Lodge. Anne: So, so I grew up... Yeah, so because again, we're from here, so the guy who started the Winter Lodge, Mr. [00:23:00] Williams, was this like lovely, like really lovely man, and he created a real community. And so I think one of the things that you'll see as a theme in [00:23:10] my life is like I had real community. Anne: Stanford campus was a real community. Ice-skating was a real community. And Mr. Williams created this, like it was a non- [00:23:20] it, like Winter Lodge specifically, it's a non-competitive rink. It's fun. It's like meant to be super supportive. And my ice-skating teacher, Linda, still [00:23:30] runs it, and Sam who, um, you know, sharpens my skates and opens it, he still opens it. Anne: So like I'm 53 [00:23:40] and- Yes ... like these people are still there. Um- Leah: They are OG over there. They are. Anne: They're OG. Yes. Yeah. But it's, it's also that continuity, like the community- Mm-hmm ... has supported them, and they're- Yeah ... doing something that they [00:23:50] love. So again- Mm ... like one of my themes is like finding people who like love what they do and that they're building a community. Anne: And so I grew up figure skating, and I loved it, [00:24:00] and um, again, I didn't have the money to pay, so I often was sneaking in. And they kind of tolerated me. Like Sam, Sam would let me [00:24:10] come at like, come in in the morning before it was officially open, and there was all kinds of ways like that, which is why like I like to donate and support them 'cause I feel like they supported me. Anne: [00:24:20] Um, so I love figure skating. Like I absolutely love it. I wrote my college essays about it. Like I felt like there was something for me also of the silence, particularly in the morning, of like when you're [00:24:30] skating, it's by yourself. It's like beautiful. You have the ice, and you have the steam that comes up. Anne: So I love skating. When I went to college, I did the first year with the precision [00:24:40] ice-skating team and not with Yale, but like with the local community and, um, and was really fun, but it, it was, it was just like, it's [00:24:50] so- some things that are not as much. It was like precision ice skating. It was like at the national level. Anne: It was really fun, but um, I realized I wanted to do something that was like part of Yale. And so, um, they had the [00:25:00] hockey team. I'd never played hockey, and they, they let me join, um, because I could skate. So offsides was like a novel concept to [00:25:10] me. Um, it wasn't my strength, um, but it was really fun. Wow. And it was the first time I'd ever worn like pads, and I was like, "Hey," All stoked up. Anne: "Like I've been skating my whole time like essentially naked-" [00:25:20] Right. "... and I could've had pads?" Like you could run into walls. This is so nice. Yeah. I was like, "It's amazing." Yeah. So I had- It Leah: is Anne: amazing ... I had a really good time [00:25:30] I had a really good time playing with them. And so I only did it for one year. Um, but it was- Leah: Was there anything that, was there anything that hockey taught you that biology class could not teach [00:25:40] you? Leah: Or what did you learn- Oh ... on the ice there? Anne: Uh, listen, I... Hockey in some ways was culture shock to me. Um, and I stay in touch with, like, a few of the people [00:25:50] from the team. Um, one of my best friends was, was on the team, and she, she's the one who, like, really brought me into it. Um, it was culture shock because as I [00:26:00] said, um, Winter Lodge was, like, this lovely community, like, very supportive, and hockey is very much East Coast prep [00:26:10] school. Anne: I, and I... Like, again, I grew up in, like, this academic environment where my dad studies part- like, neutrinos. And I remember going to one person's [00:26:20] house, and I was l- looking at her painting on the wall, and I was like, "That looks just like a Monet." And she was like, "Well, it is." Leah: Okay. And Anne: I was like- Leah: Okay. Okay. Anne: I was like, "Oh my [00:26:30] God." Anne: Like, I remember calling my mom. I was like, "Mom- ... they had, like, a popcorn maker, and they had a Monet." Like, both of them were, like, exceptional to me. [00:26:40] Like, I just- Right ... like, couldn't believe that these- Mm-hmm ... people Had so much. And so the hockey culture, like prep school culture, I, [00:26:50] like I didn't know. Like, all these, like the Andover, Exeter comm- Like I had... Anne: It was a, it was a shock. Like, like and California girl playing [00:27:00] hockey was, I was, um, I was not like the others. So it took me... Like, there was, it, the number one thing I took from that was like my eye-opening experience. I was like, "Wow," like, "This [00:27:10] is, um," there's like really, really different cultures here. And in some ways, like, that helped me. Anne: Like, I lived in New York after college, and I worked in Wall Street, and [00:27:20] that was like sort of the beginning of my education of like, wow, there's some really different communities out there. Leah: Different comm- Yeah. Let's talk about Wall Street for a moment, because [00:27:30] you ended up there after Yale for about 10 years or so. Leah: Uh-huh. And it seemed like a period, I mean, you described it as like a period you partly regret. Um, talk a little bit- [00:27:40] No, I- Yeah, yeah. Talk a little bit more about that. Anne: I actually, um... I mean, I, okay, so one, I, it was like a total accident that I got. Like, it's one of the things I always tell kids [00:27:50] to do is they shouldn't... Anne: Like, I drove, I drove cross-country. I thought I wanted to do an MD-PhD, um, but I was kind of hesitant. Like, medical school seemed so [00:28:00] structured, and my mom encouraged me just to like go and apply for random jobs. So I went to a job fair. And I just, and I always encourage [00:28:10] people, like, you know, I took temp jobs and job fairs. Anne: Like, our, again, we don't do job fairs anymore, but like now you have LinkedIn and stuff. But like just taking in some ways, [00:28:20] um, like having experience with different opportunities or different types of industries is like really helpful. So I got a temp job working at Montgomery Securities, [00:28:30] and like my number one memory of that was that they had these chairs, like the Aeron chairs that were like $1,000 each. Anne: And you have to remember, like I'd, like a [00:28:40] $1,000 was like inconceivable to me, and the fact that they bought like $1,000 chairs, I was like, "Who are these people?" Like, "What are they doing?" Um, the money and the amount of money they could spend [00:28:50] was like overwhelming. So I temped at Montgomery Securities and I realized, like it was not for me. Anne: Like, working in private clients, or like it was not for me in any capacity. Um, but they [00:29:00] sent my resume to someone, and I was kind of irritated at first. I was like, "Why? Like, you sent my resume without me knowing?" And so I only took the job interview 'cause I wanted [00:29:10] the frequent flyer miles. And- Leah: Oh my gosh, that's hilarious Anne: I, and I remember, because they put me up at The Waldorf in, um, in New [00:29:20] York. And again, I'd like never had such a nice hotel. Yeah. And I remember I felt this incredible guilt because I made- Mm ... a local phone call, and it was like $2, and I was like, "I'm so sorry that I put charges on [00:29:30] the bill." Um- Yeah, you did not Leah: touch the minibar, did you? Anne: Oh, the, like, no. No. I would never have touched the minibar. Leah: No, Anne: no. Like, d- um, so I- I b- [00:29:40] I was really lucky 'cause I was hired by the Wallenberg family in Sweden, and I can't say enough good things about Marcus Wallenberg and that whole empire. Like, they were [00:29:50] ethical. Um, they taught me. They invested in me. Um, they were a community, and to this day I consider like Marcus Wallenberg like one of my, [00:30:00] uh, you know, good friends from that time period, where I just, I admire them so much, and I admire them and what they did. Anne: And Johan Forssell, who was my office mate, who went on to become [00:30:10] the CEO of, um, Investor AB, like, it was just, it was community again. And it was, it's a lovely community, and I feel so lucky to still be [00:30:20] part of that, and that they trained me, and that they trained me in, um, in such a, in such a great way of like, like really understanding finance and, [00:30:30] um, and how they thought about everything. Anne: So I felt really lucky. I left and I went to the hedge fund world, and in some ways, like '99, 2000, it was almost just [00:30:40] impossible. It was irresistible to, um, not become part of that hedge fund ecosystem. And, um, and that's when I saw [00:30:50] dirtier sides of healthcare, and I think that's where, like when I expanded beyond just like the biotech space and looking at [00:31:00] the entire healthcare ecosystem, and that might have been, like, oxygen. Anne: You know? Like, there was, like, a lot, there was a lot of corruption. Like oxygen and [00:31:10] dialysis and, um, you would ... I remember, again, there was, um, you know, stories in the press about people doing unnecessary open heart surgeries [00:31:20] and people who were, you know, delivering half the dose of chemotherapy, but charging full the foot- full dose. Anne: Like, there was just, there was, like, such an ick factor. [00:31:30] Um, and I remember doing, um, some of the sort of, like, long-term care facilities and the reimbursement codes. Oh, and nursing homes. Nursing homes, like, [00:31:40] all went under in that timeframe. Like, how ... Like, the business of operating all of these, which I understand, it's like they're businesses, but at the end of the day you had a [00:31:50] human component to it. Anne: And it's one thing if I, like, you know, sold you a bad toy or if I, you know, I'm taking advantage of you for, like, you know, like, you know, my [00:32:00] kids are obsessed with Labubus right now. Like, how many of these can I have? Like, I, I, I under- Like, there's, like, a marketing element and it's painful, but it's, like, a Labubu. Anne: Um, like, to [00:32:10] dupe someone in healthcare It w- it was like a different, it was like a different ethical arc. And [00:32:20] I, I had real moral qualms about, like, what I saw, how people acted. Um, and people would say really, really awful things, and, like, they [00:32:30] were kind of, like, proud about it. Like, "Oh, margin expansion here and this." Anne: Like, "Oh, I cut these services." Like, you know, I- it just, it was like, it was awful. And, um, [00:32:40] and so I remember at nighttime I started volunteering at Belvedere Hospital in New York, and I kind of felt like, okay, I'm like hedge fund person by [00:32:50] day, and I'm, like, gurney scraper by night. And I was, like, unpaid. Like, I, I felt like I needed to have a little bit of this moral [00:33:00] cleansing, and I wanted to be with patients again. Anne: Like, I felt like I needed to go back a little bit to my origins. And, and I remember, like, there was this one, um, [00:33:10] nursing home in, um, I forgot the name of that island that's in between Queens and Manhattan, but there was, like, a bunch of long-term care nursing home facilities, and we [00:33:20] always got patients from there. Anne: And I was sitting with this one woman, and sh- her mom was there, and her sh- her mom had had a tube in her stomach, and it had got infected and was, [00:33:30] like, full of maggots. And, um, I remember the doctor sent me to go have this woman sign a do not resuscitate. And, like, I was like, here was a, [00:33:40] I'm, like, a Wall Street person, like, getting people to sign, like, a do not resuscitate form. Anne: And so again, like, there was, like, all kinds of craziness, and it was, like, kind of a callous, like, "Ah, like, this woman's not gonna make it. [00:33:50] Get her to sign it." And I remember talking to that woman, and she was just like, "What am I gonna do on Sunday?" Like, "I call my mom every Sunday night." [00:34:00] And, um, and I still think about that. Anne: Like, I think, like, I think it's eventually 'cause I have these stories, and every Sunday night I actually think about her. Um, but I think about, like, the, the reality of [00:34:10] the, the poor care that this woman got in the nursing home impacted this life in all these ways and, and, and there's real consequences [00:34:20] to it. Anne: Like, there's real consequences to profit cutting or, you know, like, profit maximizing in that kind of scenario. And, and I don't have, like, the right solution, and it's [00:34:30] not for me. Like, there's realities of business, but I just felt like I didn't wanna be the one that was saying, like, "I'm seeing a great hedge fund growth because of this industry."[00:34:40] Anne: And, um- So part of what inspired me, like on the upside, what inspired me was the HIV community. And I would see the, [00:34:50] you know, Gay Men's Health Crisis Center. There was a group called Project Inform. Um, there was this activist in San Francisco named Martin Delaney. And, [00:35:00] um, I would go to these meetings and, and it was like these were my people. Anne: And it reminded me, they were all like my mom. Like they were all advocates and... [00:35:10] But they were probably, like, slightly more sophisticated in health and, like, more aggressive. But the HIV advocates were really clear, like, "I'm gonna [00:35:20] die, and you are sitting on this policy that makes no sense, and you're not delivering accountability." Anne: And I sudden- like, [00:35:30] and the fact that you'd have this layer of, like, people who were out there demanding action, and then they would come back and they would educate the masses, and the information system going [00:35:40] from the top down to the bottom and then back up, and it was, it was so, it was so remarkable, the partnership then between industry and [00:35:50] patient advocates. Anne: And I remember thinking, "This is so utterly different than the pink ribbon Whereas like all these people, like I, I always ask people with the pink ribbon, like, [00:36:00] "Okay, you donate, you walk every single year. Where did that money go?" And like, "I don't know. To Komen." And I was like, "Okay, well, like what's happening? Anne: What are like the initiatives? Like what do you wanna see?" [00:36:10] And that's where I feel like it was amazing with the HIV community. And so I got inspired by them, again, in sort of like early 2003 of saying like, "I wanna do [00:36:20] something that's like that. I want to create a platform for people to advocate for themselves." Anne: And how is it that, you know, if [00:36:30] the entire healthcare system has, unfortunately, this for-profit incentive that's, you know, it just doesn't align with [00:36:40] what's in the best interest of you. And, you know, and most importantly, like no one's thinking about, no one makes money when you prevent disease. And so how [00:36:50] is it that we can create a more balanced system? Anne: And the core element for 23andMe was like how do I give a platform to people to be able to come together [00:37:00] so that they can balance out the entire for-profit industry? And if you think about research, research is like a really complicated area because the people who are putting all the [00:37:10] money in it have an objective. Anne: Like you have Lilly, like they're funding tons and tons of research on GLP-1s. Totally makes sense and you wanna do that, [00:37:20] but no one funds some of the world of prevention. Like how are there things that you can do in your life to prevent disease? Like and again, I'm obviously doing a lot of work in lung [00:37:30] cancer. Anne: Like people fund treatments of lung cancer, but there's this massive rise in never smoking women in lung cancer. Who's, who's [00:37:40] funding that environmental work? Like that just doesn't happen. And so the reality is 23andMe kind of came out of this idea as like I actually don't need [00:37:50] industry to do research. Anne: I can create a platform for everyone to come together, and I don't have to have the industry involvement. Like we the people, we can make this [00:38:00] happen. Leah: You had this mission, you had the idea, you left Wall Street to go actually do it, and then I think like what you just said, the key to your story here, which is so audacious, is you went [00:38:10] directly to the consumer with the most sensitive biological information a person can own, and you said, "You all should own this, and you're gonna help me build [00:38:20] this, and I'm gonna empower you." Leah: S- can you talk about like those early days when you and Linda, A- Avy? Avy? Anne: Mm-hmm. Yeah. Yeah. O- And Paul Cosenza. Leah: Okay. There's three. Yeah. Talk about the, talk about the [00:38:30] early days when you and Linda and Paul got together to co-found- Mm-hmm ... 23andMe. It's 2006. You're 33 years old. Talk about that founding partnership [00:38:40] and the three of you coming together to, to attack this goal. Anne: Mm-hmm. We-- So I was working on Wall Street, and Linda and [00:38:50] Paul were working at Affymetrix. And they, uh, got in touch because they were also trying to do a study with Michael J. Fox [00:39:00] Foundation. And so, um, Sergey had recently... His mom had Parkinson's, and, um, and so they were, they were [00:39:10] looking to do some genomic studies also with Proligen. Anne: Um, so the three of us had multiple discussions in different ways, um, coming [00:39:20] together with this opportunity that you could actually, you know, the, the Affymetrix had just launched this 550K chip, so it was the first time that there was like a whole [00:39:30] genome scan. And you could potentially get people engaged in their own genetics. Anne: And it's interesting 'cause I think back on those [00:39:40] moment, and there was no point in time where any of the three of us thought it was necessarily so shocking to be direct to consumer. Um, I think all [00:39:50] of us felt like, obviously- ... everyone's gonna need their genome. Like, obviously. Right. Right. And, and I think the thing that we also [00:40:00] did that was unusual, we all brought a different piece to the story because of our backgrounds. Anne: And, you know, as a result, 23andMe [00:40:10] became about ancestry, and it was fun, and it was health, and it was research. And so, um, we kind of all [00:40:20] agreed the genome should be about you holistically. It shouldn't be pigeonholed into any one aspect. It shouldn't just be an ancestry [00:40:30] test. It shouldn't just be a, you know, a BRCA test for breast cancer. Anne: It should be reflective of you, and that we should pull you in. Like, we're gonna [00:40:40] keep doing research on the genome, and it's gonna con- continuously evolve. Like, we should get you involved in all of that. And, [00:40:50] um, so in some ways, like we just started with this idea as like, let's, let's, let- let's see like how people respond to it. Anne: And that early... I [00:41:00] think like the most important principles was like we just launched, and we wanted to see how people reacted, and it wasn't pigeonholed in any one specific area. And I think [00:41:10] those areas really defined it for us. And I think all of us really fundamentally agreed that the genome should [00:41:20] be in the hands of the people, and it shouldn't be blocked. Anne: And I think what was also nice, all of us had a bit of that rebellious [00:41:30] spirit with respect to, you know, watching companies like Millennium and Hum- Human Genome Science and Celera coming and patenting [00:41:40] those genes. Like, back in the day, there was, like, this question about could you go and patent genes, and, like, information blocking around your whole genome. Anne: And we were [00:41:50] kind of like the rebels coming in and saying, "We're just gonna give you everything." Like, you can't tell someone they're not allowed to see their own information. It's like [00:42:00] charging a royalty on a mirror. I was like, "Oh," like, "you, you can't see your eyes without paying so-and-so." Like... So we were, like, we totally aligned [00:42:10] on, like, a bit of that rebellious mission. Leah: I love that. Yeah. Was there anything you underestimated about making the consumer understand [00:42:20] why they should wanna own their own genetic data? Was that a hurdle? Anne: 100%. Um- Yeah. I [00:42:30] think- Okay. I think there's a number of things that we underestimated. I think- Leah: I was like, "Sign me up. I'll spit in the thing. It's all good." Anne: I think that [00:42:40] for us, we were probably too nerdy of like, "Ooh, you want your genetics." Like, we've... And most of the world was like, "Why would I ever want my genetics?" [00:42:50] And, you know, I think that first launch we sold, like, 1,000 kits the first week, and then it trickled down to, like, 15. We also have to say, we, [00:43:00] we didn't have anyone on marketing for, like, five years. Leah: Oh my gosh. Anne: Like, in re- Wow ... in retrospect, I- How? We were really, really- ... [00:43:10] um, naive Leah: to this. You're a direct to consumer product with no marketing. Anne: We had no... It was, like- It was us. It was, like- Yeah ... me and Linda doing the marketing. Yeah. Leah: [00:43:20] Wow. Anne: Um, and we would come up with, like, kind of wacky ideas, and we were good with press, but we didn't have any... Anne: I mean, I, for a [00:43:30] while, like, I ran the ads. Um, so yeah, no, we didn't have any... And in some ways our, our thought process on it was, like, it should be really [00:43:40] focused on... Like, we, we didn't wanna go too big because we wanted to really understand how people were going to use this information. So we had [00:43:50] this woman, Joanna Mountain, who did a lot of the ethics work for us, and, um, she was a very, uh, like, senior, um, professor [00:44:00] at Stanford, and she, like, she led up, like, a lot of the ethical, legal, social, and she helped sort of pioneer. Anne: Like, we recognized this was [00:44:10] an industry people were gonna write, wanna write about. Like, what were the effects of giving people their genetic information? What's the consequence? And that we did have a moral responsibility to [00:44:20] do it in the right way. So part of the purpose of not having marketing was to say is, like, we need to first understand how the early adopters are using it, and once we feel confident with [00:44:30] that, then we will come out. Anne: And also, I think the other thing, I think the, the things that surprised me was, one, um, you know, no one [00:44:40] knew why they'd ever want their genetic information. Um, and then I th- And you Leah: were like, "I don't understand. Wouldn't, like wouldn't you want your genetic information?" Isn't it obvious? Yeah, isn't it obvious? Leah: Yeah. Anne: Yeah. [00:44:50] Leah: But- Is that what you were hoping for? Were you hoping people... It would like click for people, and they'd be like, "Of course I'm gonna wanna know"? Anne: I think, no. I mean, I think the things that we thought about in those early days [00:45:00] in some ways haven't really materialized. Like, what changed, ancestry became so much more powerful and interesting than we ever could have expected.[00:45:10] Anne: Like, I remember at one point we were like, "Maybe we'll be lucky enough to reunite a family," a family. And the fact that it's like every [00:45:20] day, like every... Like, the, the number of stories of like, you know, adoptees and missing people and surprises and [00:45:30] people looking to say like, "What is my true ancestry? And am I African? Anne: Am I Jewish? Am I, you know, uh, from a native population?" Like, people, [00:45:40] people are constantly learning surprises, and they want to learn that. And I think in those early days, like, we had No idea. Like we [00:45:50] were, and, and I think that's been one of the things that's been a surprise is like 23andMe never... Like we set out as a genetics company. Anne: Like I never planned to be in the debate on [00:46:00] race. And like suddenly we were like, okay, what's the definition of being Jewish? What's the definition of being African American? If you're 5% African, 10% A- like what's that [00:46:10] definition? And so suddenly we were thrust into this debate about what does that mean to be X. Anne: And, um, and that's where I, again, [00:46:20] I'm, I'm grateful for, again, the Joanna Mountain and like the early research team, and the, in some ways the fact that we didn't have a big marketing group. The fact that we... Like the [00:46:30] foundation of 23andMe was responsible sc- or is responsible science. Like 23andMe is like very much focused on like we deliver a product that's [00:46:40] innovative and accurate for our customers, and we do it in a responsible way. Anne: And we're doing research that's gonna continuously [00:46:50] improve genetics. Like after all of that was we're gonna focus on mass distribution. Like So like- Leah: Right. Right ... Anne: the, the first areas, [00:47:00] and it, which is why like for us now as a nonprofit it- Yeah ... resonates so much more- Yes ... because we were always- Yes ... so focused on those ethics and not on- Yes Anne: just pushing the product out. Leah: And it's, it's [00:47:10] such a powerful tool. I mean, we've talked about the incentive structure, right, in healthcare and how it is so misaligned for patients, and 23andMe is a way to, [00:47:20] to have, you know, a system that focuses on prevention. I'm curious from your standpoint, how do you think about building this [00:47:30] prevention, you know, system inside a healthcare system that is run by incentives and that monetizes based on treatment and by sickness and by [00:47:40] illnesses? Anne: Well, I would say that one of my surprises, if we go back to sort of the surprises, is [00:47:50] the, the resistance in many ways by the medical world. Um, 23andMe is 20 years old, and I would say [00:48:00] most people still are not offered a genetic test through their provider And you still don't have [00:48:10] broad adoption of genetic testing. Anne: It's, like, remarkable to me, and I kind of look at, like, you know, I'm, I'm of Jewish descent as well, and I like very [00:48:20] clear, like, for me it's like shame on the Jewish community that we know there is, there are heritable conditions that are being passed down generation to generation. [00:48:30] Like, why are we not rising up and saying like, "We're the generation that prevents this." Anne: Um, I think all over the place you have people... Like, for [00:48:40] me, I look at it, it is a, um, it, it should be malpractice in my mind of like anybody who's finding out late that they have a BRCA variant, [00:48:50] and that they're dying from it, and that they have, you know, hereditary cardiovascular disease, and they're finding it late. Anne: Like, genetic testing is [00:49:00] cheap, and it's like you can then change your behavior and, or you can change your management, and you can prevent. Like, I, I [00:49:10] find it shocking how hard it has been to drive adoption of genetics. Um, so when I look at for us, you know, two [00:49:20] things really changed in the last five years. Anne: Um, first, COVID like really ushered in the era of, um, online care. You know, [00:49:30] like back in 2017, '18, 23andMe had talked a lot about, like, should we do an online pharmacy? Should we do online blood? Should we do any of these things? Like, [00:49:40] and we always came back to no. Like, we already pioneered one industry, and like that was enough brain damage for us. Anne: Like, we sh- Like, let's, like it's [00:49:50] gonna be really hard. And then within six weeks of COVID, like the, like all the doors flew o- like all of that suddenly became feasible. Um, and, [00:50:00] um, and so, you know, I think so that was like one area that really opened up. Then the second thing that's really changed is AI, and the fact that you [00:50:10] have... Anne: I mean, it, all of these, you know, LLMs are extraordinary with returning health information. And so one of the big things always [00:50:20] was like people get, they find out they have, you know, TTR amyloidosis genetics. What do they do? You know, before it was always a question. It's like, okay, [00:50:30] well I'm like stuck. Like, what, how am I getting the right information? Anne: All of these LLMs, like it's remarkable the quality of care now that you can get in this. And they're [00:50:40] not perfect, but the fact that they're so good today, in 12, 24 months it's gonna be extraordinary. Yeah, with Leah: all this data. Yeah. Anne: I know. Yeah. So I look at [00:50:50] now this like huge opportunity that, one, it's no longer weird to get your care online And two, you now have [00:51:00] amazing platforms to partner with your genetic information that can really help you get the right kind of care and know what to do with it. Leah: Mm-hmm, mm-hmm. [00:51:10] Let's talk a little bit about the nonprofit structure because it feels like the nonprofit structure has given you a way to operate that wasn't [00:51:20] possible, right, as a public company. How has that benefited, you know, moving the mission forward and what you're able to provide? Anne: Yeah. I think that [00:51:30] I mean, I think now as a nonprofit, you know, kind of again as if you, if you Anne: Like, the points that I was making before in terms of, like, we were very focused on, [00:51:40] you know, doing what we do responsibly, um, you know, making sure that, um, you know, people are getting the right information and that we're pursuing [00:51:50] research that's truly in the best interest of our customers, not necessarily research that is just, um, you know, monetizable. Anne: And [00:52:00] as a nonprofit, it allows us to lean in more and more heavily into our mission. And, you know, we think about things ... [00:52:10] You know, one of the most important things for us is, like, how do we ... Like, I have a, I have a community of 14 million people. You know, 85, 90% of people have opted into [00:52:20] research. We should be powering the entire industry with discoveries. Anne: And so as a for-profit company, those incentives were not as [00:52:30] aligned to say, like, "Let's..." 'Cause then you're always trying to think about, like, "Well, what should we monetize?" And in this capacity, we have this ability to say, like, "We should just really [00:52:40] make that happen." And we always did research. You know, we did an RP process where we would give out a number of free research projects every year. Anne: Um, but [00:52:50] now we wanna ... Like, our, our goal now is to lean into that and scale that and say, like, we should be helping every single group think about how you can leverage [00:53:00] genetics and, um, leverage this community of information that we have to make discoveries. Um, more and more as well, I wanna lean into prevention. Anne: [00:53:10] You know, prevention is that industry that again, who's gonna pay for it? And I think as a nonprofit now, we can really lean in more and more. Like, how do you use [00:53:20] genetic information to prevent? You find out you're high risk for atrial fibrillation, you're ... or, you know, you know, um, type 2 diabetes or a kind of cancer. Anne: What are some of those [00:53:30] steps you can take now to really prevent? And I think that's where I think the sweet spot for 23andMe really is, is helping us, like, being the world's best in risk [00:53:40] prediction, and then helping you know what to do with it. Leah: Yeah. It's so, so powerful. And I mean, let's talk about the pharmaceutical industry as well, because you've talked about the model of drug [00:53:50] development. Leah: It's, it's fundamentally broken. It becomes more and more expensive every year to develop a drug, and now with the nonprofit structure, the data you have with the AI, [00:54:00] what is the opportunity for drug discovery here that you feel like you can help be a part of a breakthrough? Anne: I think there's a lot. [00:54:10] I should say I am, um-- The thing that's interesting for me about drug discovery is that it taps into human biology, which I think no one [00:54:20] should ever estimate-- No one should ever underestimate. Anne: Like, human biology is spectacularly complicated, and the smartest people [00:54:30] in the world get caught up and tripped over by, um, you know, complexity in, in, in like a biological system that they, they can't-- we just [00:54:40] can't fully understand yet. Um, so I love like everything that's happening in AI and drug discovery, I think is very exciting, but I don't know [00:54:50] yet whether or not that's gonna meaningfully move the needle in outcomes yet. Anne: So maybe. I think the areas that 23andMe can be [00:55:00] very helpful, um, is the areas when we were doing our own drug discovery. So that's two areas. One, um, more and more you want to [00:55:10] understand who is the right patient to enroll in a clinical trial or the right patient to take a drug. And so helping clinical trials enroll [00:55:20] faster and finding the right person to put in that study has the potential to be really helpful, and then knowing genetically who is it that should really be [00:55:30] taking that drug. Anne: Because if you can identify a smaller population of the right people, then you can do a smaller, faster, cheaper clinical trial, [00:55:40] and you have a very targeted population that you should try to sell to. So I think there's some of those areas. Second, 23andMe is very strong on targeted identification, meaning [00:55:50] that if I'm looking at a disease area, if you said, "I wanna go and look at like what are some of the interesting areas to go after for macular degeneration?" Anne: We can be [00:56:00] very effective at looking at all the information that we have, all that data, and finding new targets for drug discovery. And so one of the issues that people don't [00:56:10] realize in, in therapeutics is that you get, um, target crowding. Meaning, for instance, like right now everyone knows GLP-1s work well, [00:56:20] and so everyone is working on their own GLP-1 strategy. Anne: So having a new target means more risk. So people are focusing on [00:56:30] GLP-1, so we're not necessarily at a point where everyone wants new targets because a new target means that there's a lot more risk, and it's gonna be more money before it's actually proven out, [00:56:40] versus like GLP-1s is like, like the best thing ever. Leah: Right. Right. Fascinating. So we've talked about the fact that economic [00:56:50] incentives in healthcare don't reward keeping people healthy, but if you could change one incentive, maybe a payment rule, a structure in the system so that [00:57:00] the system finally paid for prevention instead of just treatment, what would it be? Anne: Look, I, I think genetic testing is the [00:57:10] best ROI you have, and I think that there should be an opportunity that everyone, everyone who turns 18, like part of that is [00:57:20] being offered genetic testing. I think there should be a huge initiative between 18 and 25. You should know your genetics. Um, you can then, you know, have the [00:57:30] opportunity to understand, like, do you... Anne: You know, when you're at a reproductive point in your life, like, do you want to... Are you at risk? And then you either go in with your eyes wide open [00:57:40] or not. So that to me is like one. Second, you have people who understand, okay, are you at risk of infer- infertility? Are you at high risk [00:57:50] for prostate cancer, for breast cancer? Anne: Do you need to have screening starting in 30s? Like, some people might decide to have children in their 20s. You have more aggressive screening. [00:58:00] Um, I think there's all kinds of ... Knowing that you're high risk for, um, osteoporosis, do you really then invest in those people and say, "You really need to have weight training"? Anne: Like, you need [00:58:10] to do like, you know, uh, uh, you know, box jumping and, you know, actually like squats and, and have like real, like real weight training Um, [00:58:20] so I think the ability for us to identify people young gives us this opportunity then to change the entire course of their healthcare. And I think that there's enough [00:58:30] information now where you could really start to prioritize people and say, you should get screened more often for colon cancer. Anne: You should get screened more often for breast cancer. You know, you [00:58:40] people might need it not as often. Like, there's actually interesting studies happening now in breast cancer looking at people who you just use genetics to decide [00:58:50] screening frequency, and some people don't need it as often. Leah: Yeah. Anne: And so no one's rushing to go and get a mammogram as often as they can. Anne: Right. Like- Right ... if you Leah: can get it every two years- So that the others who need it, right, [00:59:00] like, can get it- And Anne: let others who- ... Leah: through the Anne: system. Yeah. Correct. Leah: Totally. Correct. Yeah. Makes Anne: sense. So I think if there's... I'm very mindful that- Mm-hmm ... you know, prevention, like, there's a, there's a pot of money. You have to figure out how [00:59:10] best to spend it. Anne: Mm, mm-hmm. Yep. And the best way to spend that is to understand who is it who has those risks, and then target them to prevent. And I [00:59:20] think that's where... The other thing about this is I, it- I go back to sort of that Nike mentality of like, you can do it. Like, just do it. Like, there- there's this w- [00:59:30] there's an opportunity in healthcare by being direct to consumer to encourage and to be more positive and to get people to change their behaviors. Anne: And I [00:59:40] think the number one thing that I think 23andMe, to this day, still disagrees with the healthcare system about is I believe in people, and I believe that they can change. I believe [00:59:50] that given the right kinds of tools, you can impact the outcomes, and I think that's fundamentally very different than a lot of clinicians out there that are just like, "Oh, hypertensive, [01:00:00] obese, you know, never gonna change." Anne: And I think that we just haven't given them the right tools to do that, and I think that's where if I can get people hooked on [01:00:10] Instagram and doing all kinds of other things, I believe I can get people to change their behavior. Leah: Yep, yep. Well, it's 20 years later now, [01:00:20] and you are rebuilding. This is a nonprofit with the right structure in place for long term. Leah: What do you wanna say to the 15-plus million people whose [01:00:30] genetic data you are holding in this nonprofit trust, and, and, you know, what are, what are we looking at next? What's the next step for 23andMe? Anne: Well, I think [01:00:40] we're getting into a really- exciting era. And what's fun about, like, for the 15 million people, I mean, the thing that I'm most grateful for is that they've been along [01:00:50] on a, like, a very interesting journey. Anne: And there's been ups, and there's been downs, and, um, those 15 people have, 15 million people have stuck with it. [01:01:00] Um, I think the thing that I hear a lot from customers is that people will say, "Oh, I looked at this, and I, you know, I [01:01:10] learned I'm high risk for celiac," or, "I'm high risk for Crohn's," um, and then I forgot about it. Anne: And the most exciting aspects for [01:01:20] us in the future is our subscription product, which is really about how do I get your genetic information, integrate it with your medical record, integrate it with your [01:01:30] self-report data, your wearables, and then contextualize everything so that you have the latest information, and it's up to date about you. Anne: And so [01:01:40] the opportunity going forward is the integration of AI with your genetic information with a regular kind of prevention focus from [01:01:50] 23andMe. And I think that there's finally, I do see more of a push from the, from the, um, from the traditional medical world that wants [01:02:00] genetic information. And I think there's massive disruption happening, and so I think that there's gonna be an opportunity to partner in all kinds of ways. Anne: So the number one thing I look at [01:02:10] for me is, like, the subscription product that helps people get that ongoing value from their genetic information because our understanding of genetics is changing so rapidly, [01:02:20] and really being able to help people and guide people and coach and enthusiastically coach people about how they can change. Leah: Yeah, the just do it mentality. [01:02:30] I love it. Anne: Yeah. Leah: I love Anne: it. Yeah. I mean, listen, it's like my mom. Like- Yeah ... my mom's like a little, you know- So good ... like some, like fun, like believe in people. Yeah. Like the most important thing is just, like, believe in people. Leah: [01:02:40] Yeah. I love it. Well, Anne, this has been such a fun conversation. Leah: You certainly believe in people, giving us the data, us the power, not just our doctors, [01:02:50] of our own genomes. So thank you so much for sharing the whole journey and all the stories with us today. Of course. Yeah. Anne: So fun. So fun. Leah: That was Anne Wojcicki, a [01:03:00] founder who didn't just build a genetics company. She challenged the assumption that your most intimate biological information belongs to your doctor, your insurer, [01:03:10] or your pharmaceutical company rather than you From a childhood on Stanford's campus and a mother who taught her to advocate, to question, and to demand a [01:03:20] voice in her own care, to a Wall Street career she couldn't stop complaining about, to a company that changed how 16 million people understand their own bodies.[01:03:30] Leah: Anne's story is really about one thing, the stubborn belief that information is power and that power should belong to the people. She reminds us [01:03:40] that the most important precedents are often hidden in plain sight. Rules that look like common sense until someone asks, "Does it really have to work this way? Leah: [01:03:50] Who decided that you need a physician to understand your own DNA? Who decided that the consumer is not capable of handling the truth about their own health risks?" And what happens [01:04:00] when you stop accepting those decisions as inevitable and start treating them as choices that someone made and someone else can [01:04:10] unmake? Leah: If you know someone who's rewriting the rules in their own industry, I wanna hear their story. You can reach out to me on my website, breakingprecedent.com. Until next [01:04:20] time, I'm Leah Soliva.