Why the human genome could be health care’s holy grail

I'm really interested in what 23andMe is working on at this point in its life, but you have said you see the world through the lens of genetics. What is this world telling you right now? Oh, well, genetics, I should say, we're on the 20th anniversary of when the first human genome was sequenced. And it's a big milestone of when it cost billions of dollars to get a single person sequenced and what you could learn from that to where we are today, where 23andMe has over 13 million people. You can learn a tremendous amount from your genome and you can start to account for all of this incredible diversity we see in life and all of the variation we have in our health and why some people do so well on a treatment, why some people don't, why some people get a disease, why some people don't. So I'm excited about the 20th anniversary and where it can go from here. But I do look at everything with that perspective of genetics because it's almost like a digital code way of looking at all of the diversity that we see in life. And I look around a room and I do think about, like, I look at your eyes right now and I'm like, ah, I know he's an A.G. What's A.G.? It's just me. Like, you have, like, greenish eyes. Huh. What does that say about my DNA? Well, just like you're not a G.G. Okay. Is one better than another? No, no. It's all. No, that's the thing about diversity. Like, it's not, you know, the diversity that we have of humans is about our story of survival, which is like a really beautiful story of, like, how we as humans are made to keep living on this planet. Like, some people are made for cold, some people are made for hot, some people have darker skin and that protects them from sun, some people are fairer skin and they can absorb more sun. Like, it's just, like, diversity is amazing. I wasn't going to go here, but are you, when you go into a room, are you assessing people like this? I didn't even realize anything you just told me. We're not lying. Um, I mean, I do, I do sometimes see people and I'm like, and they'll say, they're like, oh yeah, I haven't done 23andMe yet and I'll be kind of chomping at the bit. I'll be like, I'm dying to see your DNA. Wow. Okay, let me get back on topic here. We're at the Milken Conference and there's so much focus on healthcare because of the efforts by Michael Milken. I went to the doctor recently, just a checkup, didn't tell me anything about my genetics. Didn't even tell me where I can go, what I can do, what I may not do. Is it, is it interwoven in healthcare right now or is there something missing here? No, I mean, again, I'd say that's the disappointment I have of the 20 years having been around when they first sequenced the human genome, that it's not broadly adopted. And I think part of that reason is that genetics tells you a lot about what you're at risk for and it doesn't necessarily financially pay to get you that preventative information and to intervene in that way versus just treating people once they have a disease. And so that's, frankly, it's my disappointment here is that we don't look at genetics for instance when you're getting a prescription and say like, are you likely to respond? Should you have a different dose? You look at the epidemic of depression, there's all kinds of, you know, you can look at your genetics, look at a number of the drug, you know, interaction genes and see what medication you're likely to most respond to. It's a tragedy to me that people are not first tested before they are prescribed something. I think also there's all kinds of other conditions like hereditary, you know, colon cancer. People should actually know whether or not they have something like that and they can have increased screening. Familiar hypercholesterolemia is where you have like really high, you know, cholesterol levels and you need to get screened. So things like that you could actually really start to screen yourself. All of that makes a lot of sense to me. What's the biggest roadblock preventing healthcare from adopting these things? It's a good question. I'd say there's two things. Like one is it's not in the workflow, so meaning like when you go to your doctor, it's not necessarily part of the workflow, the processes. Like if you said you're interested in having children, is it necessarily part of that workflow for actually how your doctor would follow up, how insurance would be paid, is the doctor educated about genetics and what, you know, why they should do it, what you're potentially going to learn, how to potentially deal with the results if they get them. I think for a long time we were really just used to genetic counselors and saying like, hey, it's going to be put on a genetic counselor if you have this particular issue. And more and more it's going into the mainstream, it should be your primary care physician really integrating it with primary care. So I think that insurance and payment is a big obstacle and I would say that physician education is a significant obstacle as well as like being part of the workflow. Last time we talked to you around the time of the IPO 2021, you were just starting, I guess, getting going on with a partnership with GSK and drug development. Where is that now? And when is that first drug from this deal coming to market? Well, that is thriving. GSK, I'd say, is actually, it's done extraordinarily well. We have over 50 programs underway with GSK. We do have one that is in a phase one study that GSK now controls. It's co-developed, but they're taking lead now. So and there's a huge number of programs behind it. 23andMe also has our own wholly owned program. It's an immunotherapy program. So super excited about it. It's definitely exciting to see that you can go from understanding the genetic variation that makes me so excited to saying, wow, some people are, you know, genetically not likely to develop, you know, a certain kind of condition. And then can I understand that and turn that actually into a drug to help either treat people who have that condition? Is that the holy grail in healthcare, looking out over the next decade, the ability to match up your genetics with figuring out the cure for cancer or some other disease? I look at all the explosion of all these new technologies with gene therapy, with CRISPR, with RNA technologies, and understanding the human genome. And I think what 23andMe can really bring to the table here is the understanding of the human genome. So for instance, one thing that we can do really well is we study healthy people, meaning that you might have a particularly interesting mutation that the scientific world thinks like they don't know. Maybe it's potentially disease causing. But because I can study you and I can say, okay, you have potentially a knockout mutation, you're doing really well, you have no other health issues. We potentially know that that like changing that or modifying that gene is not going to create any other kinds of issues. So it's a way to help the pharmaceutical industry study essentially what's naturally going on in humans. So we find like studying huge populations in huge numbers helps us just understand that natural variability in people. How do you go about championing this in the educational system? Do you see the things you're talking about today being embedded in our education system? I think that genetics to be really successful. I think it needs to be part of medical school training and it needs to be integrated not as a single subject, but throughout all aspects of the curriculum. So when you're doing cardiovascular health, that it's part of that. When you're doing renal health, it's part of that. That everything, every aspect of healthcare has a genetic component and helping realize the personalization that comes with it. Every patient that is coming also is unique and different. And so we're all going to metabolize drugs in a different way. You're going to have potentially like your blood values are naturally going to be different than my blood values based on your genetics. There's just a lot of variability that we're going to understand from your genetics and that's going to manifest in different ways in each of us. So what your baseline is is going to be different than what my baseline is. So I do see that it needs to be integrated throughout all aspects of healthcare, not just as a specialty in genetics. Lastly, what's next for your company? I'm excited. There's the two big areas. One is consumer, which is really about helping. You know, we have over 13 million people and helping them do more with the information that we already provided. So one thing that we've gotten the feedback from our customers is that it's almost an overwhelming amount of information. So how do you translate all of this into a care plan? And there's a lot of lifestyle information we're also collecting from our customers about how they eat, how much they sleep, how much they walk, exercise, happiness. So helping people understand their health in the context of what they've self-reported, their genetics, and then all of their lifestyle information so that then you can know what things should you change. And some of that might be more proactive screening in the medical system. Some of it might be changing how you sleep. Some of it might be changing how you eat. So I see a real opportunity for us to deliver a type of personalized prevention that's grounded in your genetics, but we take all that other information about you and we really help you be as healthy as you can. I think the second side, I think we see this from the work that we've done with GSK. Having a large, you know, a large amount of genetic information with really, really broad phenotypic data is incredibly powerful for drug discovery. And the end of the GSK collaboration comes in July, and it opens up all kinds of doors for us to, you know, start to do more partnerships with more companies. And I feel a responsibility to my customers that if you're somebody who has a family history of Alzheimer's, it's on me.