From Original Disruptor to One of the 0.9% with Anne Wojcicki at D50X Summit

23andme is a public company with Anne Wojcicki becoming part of the less than 1% of companies that have gone public with a FEMA leader and we are so thrilled to have you with us here today as we celebrate 10 years of the disrupter 50. I want to start off by just talking about all the odds that you have defied, particularly when it came to that regulatory challenge. I remember thinking is this company going to make it? Does it make sense to keep trying to navigate these waters? What made you decide to try to work within the FDA's restrictions and find a way to keep operating? That is a great question. I, you know, for one I very persistent and and I think that a lot of founders when you have a vision and you have, you know a vision for what you want to achieve in some ways like these things just look like small obstacles. So for me, the FDA was obviously a significant hurdle. There was the Article 23 and stupid that came out, but for me it was always like there's the. The world is going to evolve where people. All of us as consumers. We have the ability to get more direct access to our health information and what the most important thing that 23 me proved out in that FDA process. Is that the consumer can actually get complicated genetic information without having to have a clinician pre approve it and on the end like help review the results that people are in fact capable of getting this information on their own. So for me it was a win for 23 me, but most importantly, what we really fought for was like a win for the consumer that you are actually more capable than anyone in the health care system believes. Yeah, it's so interesting, because what you're offering used to be something that only very few people could afford to get, or is that sort of elite medical offering? But you're very much interested in having this very broadly accessible, but lower margin business. Talk to me about the importance of really having that broad accessibility. Well, I think a lot of health care. If you want to really change health care, it has to be accessible. So like the core tenants of 23 me, when you look at our mission about help people access, understand and benefit from the human genome was really about like, how do I take this incredible technology being, you know, access to your DNA and how am I going to bring this broadly to individuals? And I saw other models in countries like India and Brazil where they actually had direct access businesses that were lower margins, but they had a much higher volume. And I realized that was something that I think you could potentially do. Like one thing that's very unique about 23 me is there's no middleman in our business. Like I sell directly to consumers like that's all there is. There's no insurance company. There's no PBM. There's no distributor. Like it's just a direct connection. And so for that reason, I can actually have a much more affordable product. But the goal was really to say, how do I make something that's easy for people to understand and is going to be really accessible to everybody so that there's no there's no insurance barriers, there's no economic barriers that, you know, majority of people can afford it and get access to it. Yeah, it's interesting because watching how much the company has evolved since you founded it, I believe 18 years ago, and then also how much you have evolved as a leader running this different kind of company. How have you thought about having 23 and me change for being really a disruptor to more of a partner to the establishment? Oh, that's a good question. I mean, I think that the number one goal I said is like you have no chance of really disrupting health care until you have scale. So I think it's one thing, like even you look at the the partnership between, you know, you know, Amazon and JP Morgan, like all these things are really hard to significantly disrupt until you have scale. So the number one priority for 23 and me was like, how am I going to get enough size and scale that people actually have to look at us as like a real force and a real player in health care? So now we have over 13 million people who all have their genetic information. I know, for instance, that these people are all taking their information to their clinicians. I now I'm forcing the conversation about how is genetics going to be used in a care setting. And so the next phase of the company is really the last part of our mission, that word benefit. How am I going to help millions and millions of people get access to their genetic information and now benefit from that? And that was precisely why we bought the company Lemonade, where we can now have a clinical team. I can have a pharmacy team and I'm going to pioneer really how we're going to be able to connect the 23 and me ecosystem with the traditional health care world. Yeah. Talk to us a little bit about that acquisition, because it really seems like you're moving towards almost like a verticalization of the way you're enabling people to get the information and then go through every part of the process, even ultimately getting pharmaceuticals based on that, based on their genetic data. Where does Lemonade fit in? And how important is that for the company's evolution? I I think it's really important, and I think there's a really interesting big picture question for people to ask, like the genome was first sequenced over 20 years ago. So why is it not part of part of primary care? Like, I think it's a really interesting question for people to ask. Like there's an affordable, inexpensive technology and it's not widely accessible. Yet there's all kinds of really valid clinical reasons why you potentially want to use and look at your genetic information. And that could be pharmacogenetics. It could be the carrier status. It could be, you know, the cancer reports like the BRCA. There's hereditary prostate cancer, hereditary colon cancer. There's all kinds of incredibly meaningful, clinically validated reports that people should be getting access to. And by getting access to those, you are going to save lives and improve lives. So I think there's a huge question about like why it's not being adopted. And one thing I think 23andMe has has recognized over the last 16 years is that people get their genetic information and then they take it to the medical world. And the medical world is not trained about how to use genetic information, exactly what are the right protocols, what to do with it. So we spent lots of time developing like medical courses and working to train physicians. But ultimately, we realized if we want to help our customers really benefit from the human genome, we need to have our own care team. And so 23andMe acquired Lemonade with the idea that we're going to have our own care team who can answer questions, help navigate care, help understand what do you do when you have a variant for the BRCA mutation? Who should you talk to? How should you follow up? Also on pharmacy, if you have a variant and you know you're an ultrametabolizer and you are taking a medication like Lipitor, what should you do? And so that's where the integrated system is really important for us to complete that entire loop. And we decided we had to do that because I found the rest of the health care system was not widely adopting genetic information. So we need to own that. Yeah, it's so interesting. Then, of course, your partnership with GSK is another piece of this. Explain to that how that fits into this broader portfolio of what you're building out. Well, that's another whole fascinating part of I think about consumer empowerment is that all of us recognize that we go to the physician sometimes and we go to the health care system and that you reach a dead end. They don't know how to treat something. They it's like it's not it's a lot of, you know, side effects with a medication. So or they just don't have answers for us. And so the beauty for me with the genome was this has this ability to help us change how we predict, prevent and treat all human disease. And so the idea of 23andMe from the very earliest days was how do I give consumers this choice and an option about opting in to a research experience? So how is it you can say I want to contribute my genetic information and my phenotypic data, meaning all the survey questions that people have answered to this community where we are doing research on all kinds of conditions, thousands of different conditions. And what you find is that you have people who have Parkinson's or autoimmune disease who can help people who have cancer or neurological conditions. So having this database of individuals who have all kinds of different conditions, we can make genetic discoveries on all various areas of diseases. So we now have over 200 publications that have come out. And we decided also in 2015 that there was enough excitement about all that potential for discovery that we should actually start a therapeutics division of 23andMe. So we hired a team from Genentech. We brought people in. We've been looking at all those associations that we can discover. And we now have over 50 programs. We have two that are in the clinic to actually immuno-oncology programs that are in the clinic. And we've had this big partnership now with GSK on how can we actually look at all this genetic data and turn those into therapeutic programs that will ultimately benefit our customers. With what you're talking about with GSK and with Lemonade, what I'm hearing from you is this new vision for what personalized health care should look like. How do you see the health care system evolving or how do you think it should evolve? So 10 years from now, people are really able to get personalized care. What does that look like and where do you fit into that? Well, I think what's exciting is that people now understand this concept of personalization, like all our experience. If you surveyed everyone who's listening about their Netflix account, everyone's going to have a different kind of Netflix experience. So we understand this concept that we're all different. We all live our lives in different ways. And you all have different genetic predispositions. So how is it that we can all have a very unique health care experience? So right now, for instance, if you look at the preventative guidelines, so when should you get a colonoscopy? When should you get a mammogram? All of that is the exact same for every single one of us. So when I think about the opportunities is how is it that we can have really like truly personalized prevention, personalized primary care? So when I walk in and I could say, OK, you're higher risk for atrial fibrillation. How should I be living my life? Like, are there things I could do with how I exercise, how I eat, how I like the environment I'm living in? What are the things that I could do to potentially change? It could be high risk for something like chronic kidney disease. Do you better manage your blood pressure in certain ways to try and prevent that? So or you could have a high risk factor for cancer like the BRCA variant. Do you want to then get screened or do you want to do a prophylactic mastectomy? There's a lot of ways that you'll be able to have very personalized care based on how you're living your life as well as what your fundamental genetic makeup is. And based on that genetic makeup, we're going to be able to give you more personalized recommendations. Well, I do think there's a whole new world that's coming. I'm really excited about it because it will mean that not everyone has to have the exact same set of recommendations. I can't wait for that for that time. I hope it comes soon. And that's my raises my next question. Do you think the pandemic raised awareness and the broader health care community and the biotech community about the importance of doing what you're doing? And do you think that coming out of the pandemic, there's going to be faster change? I think that the most important thing that the pandemic did is it made telemedicine normal. Like when I think about all the changes, I get it raised awareness about, you know, diseases and pandemics and other health related issues. But the most important legacy consequence is that it made people realize that you can get your care in a very easy manner on your phone in a self-service. Like people all want instant like I no longer ever want to go to the grocery store. I want to deliver to me. And guess what? Now I can also get my health care in that same way. I think people saw that opportunity and they are not going back. So that normalization of telemedicine, I think, is like an absolutely chain like game changer for the entire health care industry. And I hope that the entire industry really adopts that kind of like ease and convenience and affordability for people. I think it definitely we saw during the pandemic, people definitely were aware, more interested in their health, more interested in genetics. And I think that's also a huge opportunity for all of health care participants to like leverage that people are suddenly looking around and saying, like, OK, what can I do to be healthy? And how what are those measures and tasks? Like what is science and how do I engage with it? Well, Anne, we've talked so much about the future of health care, but I have to ask about your role running a public company. There are so many CEOs of the Disruptor 50 companies that don't stay on to run the company once it goes public. And oftentimes they either hand the reins over to someone else or they simply aren't interested in that kind of a job of running the company. How once it's public and they're dealing with the quarterly reports, how do you find your role has changed and what maybe would be some advice to other disruptors looking to make that transition as well? I think that the most important thing that I have this incredible luxury and that I love what I do, like hands down, like I I think every single day, like I'm lucky that I I deal with interesting problems. I have a really exciting opportunity. So like I think every day about how lucky I am. And but I couldn't do that without a team that also handles some of the things that I'm less excited about. So having the right team around me has enabled me to then like really think every day about how much I love what I'm doing. So the advice I would have to individuals is like it's all about the team around you and really empowering and trusting those individuals to be able to like, you know, run with their programs and to thrive. It's absolutely about the team. So I do, you know, I have a Wall Street background. It has been a real pleasure for me to now interact with my friends on a different side. And I think that being public is actually it's a great honor. So I don't mind the quarterly earnings. It's really just about making sure that we have the right infrastructure in place to be able to manage it. But the market has plummeted so much since you went public. We've seen all the companies in sectors such as yours suffer. Has that been a hard thing to navigate? Well, I think my training, so I was originally trained as a Wall Street analyst working for the Wallenberg family in Sweden, and I remember them telling me, like, and everything goes on sale once a year and you need to have a long term vision. Like a lot of the great opportunities they had were based on sort of that long term vision. So I try to tell people like when we went public, you know, we we you know, we were doing X number of things and we're doing even more things today. But the markets have changed. And so we're kind of a small ship floating in a sea that happens to be very turbulent right now. So you need to keep employees and you need to keep everyone focused on the long term because the unbelievable opportunity we have with the opportunities with genetics, with like telemedicine care, you know, where you can go with actually data and what you can learn from, you know, large data sets and involving genetics is huge. Like it's a really exciting opportunity that we have in all those areas. So keeping people focused on the long term is really key. And again, for me, everything I do, like I have really a 30 year vision for 23andMe and I'm not going anywhere. I'm super excited about this. Like keep people long term on the vision. And frankly, you know, 23andMe is an incredibly interesting, scientific, you know, innovative place to be. And so that alone is what keeps my employees really motivated.