Using Genetic Information to Help People Be Healthy at 100: Anne Wojcicki, CEO of 23andMe

Shiv Gaglani: Hi, I'm Shiv Gaglani the co-founder and CEO of Osmosis. Discovering your ancestry through a DNA saliva test is commonplace and very popular today. But when 23andMe started offering the service to consumers in 2007, it was breaking new ground. The company has continued to innovate in the space expanding into testing for inherited risks for health conditions, pharmacogenetics, and clinical trials. Our guest today, Anne Wojcicki, has seen it all as the co-founder and CEO of 23andMe and recently, she led the company to its IPO on the NASDAQ stock exchange.

Before we get started. I'd like to thank Esther Dyson, who was also a guest on the podcast, for the initial introduction to Anne Wojcicki. And funny story -- right before we started the podcast, Anne Wojcicki and I were talking about how I randomly met her mother, Esther, who herself is doing an incredible start-up called Tract. We'll have her on the podcast in a couple of weeks. We had a great time, and I think she even sent out a photo of us and I gave her an Osmosis mug as well. 

So, you have a very impressive family Anne and it's an honor also to work with many of your colleagues at 23andMe including Anne Greb and others. So, thanks for joining us.

Anne Wojcicki: Now, we're going to be competitive about who's podcast is better. There's nothing like a family showdown on Osmosis. So, I better get more views.

Shiv Gaglani: (laughs) Yes. That's a really good point. I can't imagine how competitive your household was growing up. 

Anne Wojcicki: It's cutthroat, man.

Shiv Gaglani: I bet. So, I obviously know a lot about you and I bet a lot of our listeners already know who you are and maybe many of them have done the 23andMe test as well. But maybe in your own voice, we'd love to hear what got you interested in health care in general and then starting 23andMe.

Anne Wojcicki: I started my career very randomly investing in healthcare companies and it was amazing. It was super fun and super interesting to be at the forefront of what's happening...seeing the biotech world; meeting with hospital CEOs. It was fascinating. And then as I dug into it more and more, I started to realize that so much of healthcare is really about the optimization of once you're in the system, but almost nothing is about how do you stay out of the system.

And I went to one conference that was really traumatizing for me. It was this giant room filled with people in suits and they were all learning how to optimize billing, which is really about how when you come in for a knee procedure, how do you make sure you get as much money as possible out of it? I just remember thinking, "I want my healthcare system to think about how are they keeping me healthy, and how do I stay out of the system, and what's in my best interest." I just found that it's not set up that way.

I was really inspired by the HIV community in the 90s and how they were activists and they single-handedly really changed a huge part of healthcare. They gave patients a voice. They stormed the FDA. They demanded change. They helped bring about fast-track authorizations. They were just amazing.

There's a movie that I always point people to, called "How to Survive a Plague". It was that activism that I wanted to bring to all diseases and to everybody. What had always captured me with genetics is the fact that genes and environment interplay. So, you can be high risk for something -- people, sometimes, come to me and they're like, "Oh, your genetics are not deterministic" and I say, "Yes! That's the beauty of it all!" It's not!

You have an opportunity to live your life in such a way that you could potentially mitigate risk. I really want to understand what is in your environment that potentially helps minimize risk and then give people the tools to potentially change and really prevent disease.

In 23andMe we started with this mentality of "I want to be an activist brand. I want to empower people with their own genome." Then I want to empower people to essentially come together and be the world's largest community that's driving research forward and that we're going to focus on research on our disease areas, but also research on wellness.

Shiv Gaglani: That's incredible! And I definitely resonate with that story. I was a medical student at Johns Hopkins. My track was to go into surgery and do very expensive robotic surgery. Then, I met a patient in my first year of med school who had a 50-year history of smoking, and they were throwing everything at him. The financial cost and the emotional cost to him and his family was obscene. If we had just been able to get a conversation with him early on and get him to stop smoking or not even start smoking, maybe we would have avoided the cost to him and his family in the health system. So, that's what made me switch to education and preventive medicine. 

I definitely resonate with your story and you all were the pioneers in direct-to-consumer genetics and I think generally direct to consumer health care. How do you feel about -- not only this fourteen-year journey now going public -- but also the other companies that probably started a couple of years after you guys or even more recently like Ro and Maven Clinic that are now part of this huge digital healthcare, direct-to-consumer transformation 

Anne Wojcicki: I love it! I mean, one thing that I've always said is healthcare is really big and it's important for us and other founders to encourage others {{{to come and debate and}}} I think it's really hard to change healthcare. There's a lot of incumbents that have a pretty good gig and are not looking for a change and there are such incredible opportunities with applying technology to healthcare and thinking about building a system in a different way.

So, I'm really happy. I love hearing when people talk about patient-centric or consumer-centric healthcare. And I'm really impressed. You look at Hims and Ro and clinics like Maven, and Folx is another one...there's so much personalization and consumer-centric thought in these companies. So, I love it!

I think about the controversy with 23andMe in those earliest days about like, can you even get your genome? It was controversial. Do you have access? And I remember thinking obviously, it's your body. You can't prevent me from looking in the mirror and it's really great to see people innovating now with these different models. So, yes. I'm so excited about the future of where it's going. In the earliest days, I used to go to the Health 2.0 conference. I don't know if you ever went to that.

Shiv Gaglani: Definitely

Anne Wojcicki: In 2006. 2007, it was kind of scary. The companies that were out then versus today. It's just the sophistication, the thought behind it. The industry has really matured and I love it.

Shiv Gaglani: Yes. No, totally. I think I saw you speak two years ago in Vegas at the HLTH conference and that was pre-Covid so there's obviously been a lot of crazy milestones both professionally and personally for 23andMe since then, but then the broader industry. What are some of the changes you guys have had to address because of COVID? We've had a lot of leaders in telehealth on the podcast and obviously for them, it's been a good year and many of those changes are going to persist. How do you think about this? Is consumer-driven or value-based healthcare here to stay? What do you think lasting changes are for 23andMe and for the system?

Anne Wojcicki: I think that consumer-driven healthcare is here to stay. One of the primary reasons why is that the existing healthcare system really talks down to the individual. I think about the times that I've worked in hospitals. You have a group of doctors who are kind of behind the stand and they're all talking but they stay separate from the patients. You have a white coat. You have to call him doctor so and so. It's kind of structured in such a way that there's a barrier. I think a lot about vaccine hesitancy and why is it that people don't believe scientists? The healthcare world, and a lot of scientists, have really done a disservice by having this hierarchy and by being dismissive to people who don't have a Ph.D. Companies then like Goop, and...I'm forgetting her name, the actress who led the charge in autism and vaccines...

Shiv Gaglani: Yes, Jim Carrey's wife. I forgot her name. Yes.

Anne Wojcicki: So, she's well-known in the healthcare industry. Why is that? It's partly because people are looking for information and they're trying to find people who reach out to them. It's one thing that really aggravates me in the healthcare world. I meet so many physicians who are dismissive of 23andMe because they'll say, "People are never going to change their behavior." Like this example you gave on cigarettes. People are never going to change their behavior. And I think about those experiences when I worked in hospitals when a patient is with a doctor that you probably don't relate to, and they tell you you're overweight and stop smoking. And you're like, "Screw you! You know nothing about my life."

How do you deliver information in a way that's going to resonate with people? One thing that we found with genetics is that when you get something in black and white, there is more of that "Aha!" moment. One of my doctors would say to me, "Anne Wojcicki, you really agitate me. You take red-haired, blue-eyed people and you tell them they're high risk for skin cancer. Anyone could tell them that." And I'm like, "Yes, but I got them to come in and get a skin check. You didn't."

So, the reason why I think consumer health is here to stay is because people are looking for a connection. You now have companies that are responsibly reciprocating. Everything that's happened with COVID has opened up the door of supply and demand. "I have a sore throat and I want to talk to someone right away." If I had an urgent issue, I could call so many different services now. If I need at-home blood testing, I could call all kinds of different services. I could get it.

So I think that supply and demand is now finally starting to be met. It's no longer in the world of Jenny McCarthy. Goop, I think, has evolved more. There's responsible care that's being delivered and suddenly it's all supported thanks to COVID. COVID really forced us to all adopt a different way of thinking about healthcare.

Shiv Gaglani: Yes. I couldn't agree more and this is one reason we were excited to partner with you all with Anne Wojcicki Greb leading the charge as a genetic counselor. Because first of all, there aren't even enough genetic counselors in the U.S. and we aren't training as many that we need to be able to interpret these results. So, we need to go after more healthcare professionals to train them which is again, partially what we've been doing together as organizations. 

This is why we keep talking about "raising the line". How do we improve the healthcare system by getting more people trained to become healthcare professionals, to improve the quality and access. But then there's flattening the curve -- which has failed miserably in recent weeks with COVID -- but flattening the curve isn't just about COVID. It's about diabetes. It's about skin cancer. It's about all these other things because the more you can get patients or consumers engaged in their health doing preventative medicine, you're flattening all those curves so you need fewer healthcare providers, less cost to the health system, etcetera. So I think that's a really, really good place to start.

We know your sister Susan, too, the CEO of YouTube. We'd love to get her on the podcast at some point. YouTube is where so many people get their content...same with Facebook and other places. I'm curious, have you guys ever talked about this issue of health misinformation and ways to address it? Not only by giving people access to their own data, which is what you guys have been leading at 23andMe, but how do you get them to trust people again, trust either science or their doctors? Some of those people don't even trust their doctors, right?

Anne Wojcicki: We talk about this all the time. I think one thing that's important to do is there are a lot more people who are very good at generating bad content than there are people at generating good content. If you ask most doctors, "Do you have a TikTok account?" They're like, "No."

Shiv Gaglani: You know what they're called, by the way, the doctors on TikTok? They're called TikDocs.

Anne Wojcicki: TikDocs? But those doctors are not going to have a voice there. Most are just not necessarily great at social media. But there are lots and lots of other people who are activists spreading misinformation. You think about Joe Rogan and what he's very capable of doing in terms of spreading misinformation. So, this next generation of physicians and healthcare professionals need to be generating content.

I have this one doctor I follow on Instagram and on TikTok and he's hysterical. He does the best COVID impersonation. It's so fun. It's a little 30, 60 seconds of drama. But finding people who are really catchy and creating fun content that people can relate to, or finding people they can partner with...there needs to be more content. You have to, in some ways, drown out the bad content.

Shiv Gaglani: Absolutely! Because it's more engaging, more fun or it's elevated. I don't know if you know this but we work with the CDC and YouTube Health -- I'm sure you know Garth Graham who leads that effort -- and we're doing all this content in our style around that to flatten the curve. Now we're working with Facebook too, because Facebook, I think, has not done as good of a job as YouTube has in terms of battling that.

There are so many things that you guys have done at 23andMe over the last 14 years. What are some of the things that you're most proud of and can you also give our audience a sense of scale? Company size, but also...I think the last I saw, 10 million tests were done or 10 million unique people. It's probably way outdated.

Anne Wojcicki: Yes. There are over 11.6 million people who've done it. And I think the thing that I'm most proud of is that we're still direct-to-consumer. In some ways, it taps a little bit back to your last question in terms of consumer-centric care. Very few other companies are still true direct-to-consumer. They still have a physician intermediary.

Getting back to behavior change and smoking cessation, most of the programs that are focused on smoking cessation or Type 2 diabetes all come through your employer. So, you as an individual can't really buy it yourself, and I think there's something still that is disempowering by having it intermediated by someone else...like, your employer decided this was good for you. It's always really different to market to someone directly versus to market to somebody through an employer.

So what I'm really proud of is we have a true direct-to-consumer brand. I have a brand that people understand, people know. It has an activist angle on it and people are empowered. They learn about genetics on their own. I've gone through the fight to show that you don't need to have a doc in a box that authorized this for you. You're truly capable of getting it on your own. I'm really proud of that.

So, like I said, we have 11.6 million people. We have over 80% of our customers consent for research. We have, by far, one of the largest research communities out there. We get tons of phenotypic data every single day. We're able to do tons of research. We have well over 100 publications -- I can't remember how many -- but tons of papers. It is super interesting stuff.

We just had a blog post on marmite and why some people genetically don't like marmite. I don't. And things like vanilla versus chocolate ice cream. We can do research in such interesting areas as well as obviously in serious phenotypes. We do have a therapeutics division as well now. We are looking to how do you translate all this information and then really help our customers benefit by developing therapies. I do think that we have an opportunity to develop therapies in a different way and then hopefully be able to sell them in a different way so that people feel really good about the process.

I've always found it remarkable that you can have a pharma company like Gilead that cures a disease -- eliminates Hepatitis C -- and people hate them. It's a total tragedy. To me that's a question of process, and that's one thing that we're looking to change. You should have a direct connection to people. When you have that direct connection, I think you can actually really meet their needs better and listen to them. I want to be the first company that develops therapies that people love.

Shiv Gaglani: Yes. I think there was a consumer stat showing that pharma companies and tobacco companies had about the same view by consumers, which is crazy because one makes cigarettes that kill people and the other one, as you said, makes life-saving drugs. I think because of what Pfizer, Moderna, AstraZeneca, and those companies did over the past year and a half with the COVID vaccine...hopefully, their stock is increased -- not just actual stock but their consumer perceptions.

Talking big picture-- which I know you love to do and are capable of -- where do you see 23andMe going in 5 to 10 years? You reached 11.6 million people who've done the test. Is that going to be 100 million? What are you most excited about for the coming years?

Anne Wojcicki: There's clearly a world where every single person has their genetic information. Everyone will benefit from it. I What 23andMe can really lead on in the future is the application of genetics to true clinical care, and through that, also really helping people apply the genetic information to parts of their lives to change behavior to truly prevent disease.

So when I think about the long-term outcome that I go for, I want people to be healthy at 100. I want people to be able to get genetic information and be able to use it and, again, to your example on smoking, really change their behavior and live healthier lives...live to be 100 and don't have any chronically-managed disease.

Shiv Gaglani: I think you'd love meeting, if you haven't already, the person who led our C round, Alan Patricof, who runs Greycroft. Do you know Alan? 

Anne Wojcicki: Yes. We were on a trip together once. I met him in 2003 in Saudi Arabia, of all places.

Shiv Gaglani: Oh, wow! Alan knows everyone, it seems. He's the one who actually introduced me to Esther who introduced me to you. He runs Primetime Partners now. He's 86 and he's just getting started. He wants to live to 114.

I know we're coming up on time. What advice would you give to the audience -- most of whom are healthcare professionals or will be healthcare professionals and other sorts of caregivers?

Anne Wojcicki: I would say two things that I think are totally actionable. One, absolutely embracing technology and thinking about all the ways this could be applied to the practice of medicine. So, whether that's starting to think about online prescriptions or, obviously, I encourage everyone should learn about genetics. There's no better way to learn about genetics than through your own DNA. Really starting to understand some of these behavior change apps. How do they work, and what are some of the limitations and what is some of the potential?

I sit on the board of Kaiser Permanente Medical School, and the dean came to visit and we went to the JPMorgan healthcare conference and I set him up with all these different groups. He came over for dinner after and I said, "What do you think?" He's like, "Holy cow! I have seen the future, and we're not really part of it."

Shiv Gaglani: (laughs)

Anne Wojcicki: (laughs) Sometimes the technology develops without thinking about the healthcare system and sometimes the healthcare system functions without thinking about technology. So, I think it's just important for people to stay involved.

I would say the other thing is that for this generation that is, again online more, there's the responsibility of creating content because you do have to swamp out some of the misinformation. Part of doing that is doing it from the angle where you are approachable and not where you are a superior. If there's anything I could ever do, one of the most important things is trying to eliminate some of that hierarchy in healthcare.

I recently spoke at this genetics meeting and it was all these people who I admire -- all these famous geneticists. I was telling my head of research, "Wow! It's like such an amazing group. I love all these people. But I'm the only one here who has no degree." And she's like, "Yes, and you are the only one that is widely known." In some ways, that's too bad. More people with degrees should make sure that they are accessible.

Shiv Gaglani: Yes. Totally speaking our language. One thing that makes me most proud of the work we do is -- we started this for Hopkins med students when I was in med school -- but we have tons of patients and family members who consume our content because it's approachable. It's the same content. We're not sacrificing any data, any real content in there. If you make it approachable and engaging people will tune in. 

Is that Mark Schuster, by the way, who came over?

Anne Wojcicki: Yes. I love him.

Shiv Gaglani: He's great. He was on our podcast. Actually, all Kaiser Permanente students get Osmosis access. So, it's a great school.

Anne Wojcicki: Oh, good! I love Kaiser Permanente. I have to say, part of what influenced me so much is I'm a Kaiser baby. I love my pediatrician to this day. Like I'm almost 50 and I still...I feel like part of the benefit of having children is I can go see my pediatrician. I just felt like I was trained on prevention. KP absolutely taught me a world of prevention and how to think about "When do I actually need to go in?" I love how I could call people. I could ask them questions. They knew my name. My doctors are super approachable. I never call them doctor so and so. It was such a phenomenal experience in every way. That was part of why I joined that board, because I feel like there's an opportunity for them to train more and more physicians with that mindset.

Shiv Gaglani: Totally! Couldn't agree more. So, my last question for you is, is there anything else I should have asked you or you wanted me to ask that our audience should know about you, 23andMe, or healthcare in general that you'd love to leave them with?

Anne Wojcicki: I would just encourage everybody. Again, it's my own selfish interest, but people should all go and experience what it's like to have their own genome. I'm kind of shocked at how many health experts and how many healthcare people I talk to who haven't done it. There's a really awesome opportunity in prevention that's coming because of watches and your phone and community online and I think that physicians aren't really going to be able to be part of it if they don't have that experience themselves. So, I think there's a ton of opportunity, and I would just encourage everyone to jump in and do it.

Shiv Gaglani: That's awesome! We literally were just on a call with Anne Wojcicki and Katie and Anthony on your team talking about how to do that and get it to our audience of 2.1 million YouTube subscribers and 1.7 million registered users. So, hopefully we can be a small part of that bigger vision.

Anne, I really want to thank you for not only taking the time to join us on the podcast. But more importantly for ushering in this era of direct-to-consumer healthcare.

Anne Wojcicki: So much fun! Great to be here.

Shiv Gaglani: Awesome! I'm sure this will get more downloads or at least I'll tell you it got more downloads than your mom's episode. (laughs)

Anne Wojcicki: (laughs) It's very competitive. Very competitive. Let me just tell you, there will be a lot of smackdown going down in the house if I don't.

Shiv Gaglani: Good to know. Alright. (laughs) I'll be sure to follow up. So, thanks again, and with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show. And remember to do your part to flatten the curve and raised line. We're All in This Together. Take care.