Anne Wojcicki The 2020 MAKERS Conference

Please welcome Ann Wojcicki and Ann Fullenwider. Hi. So amazing to share the stage with so many inspiring women today. I was in the green room with Gloria Steinem and Anita Hill. I also have a new goal, which is to learn the McTwist before I die. But I'm so happy to be here with Ann Wojcicki for many reasons. One is that we share a common first name and two of the hardest to pronounce last names in... That is true. That is very true. We always love, I always love the advantage of having a hard last name is that you always know when there's someone who's just spamming you on the phone. Like, miss, whoa, whoa. And I just hang up. We have so little time and you have done so many great things with your company 23andMe. So I'm going to, Dylan was just poking me back there like you're going to be good on time, right? So I've got basically three questions for you. One is, and I know the answer, so I'm going to skip to the story that I want you to tell. Why did you start 23andMe? Which I think you started because you wanted people to own their own medical information. I always, I worked on Wall Street for about 10 years and I always, I was always a very proactive consumer of healthcare. And in part, you know, one of the stories that was there is my mother had a little brother who unfortunately ate a bottle of aspirin when he was 18 months old and they took him from hospital to hospital to hospital and they couldn't get him care. No one was getting him. Everyone kind of brushed him aside and they finally got someone to take him and then in the morning they called and they said, oh, he's in the morgue, he died. And so my mom was always super proactive about her health. And it actually, I love this, when I did actually get my medical record from Kaiser Permanente, it actually said, had a warning on the top of it that said, this mother can be very difficult as all of us in pediatrics know. And which we, my sisters and I, like we framed that. We're like, mom, like such a seal of approval, so good. So we'd always been super proactive and I joined Wall Street and I was investing in healthcare because I was so excited. Like there's so many cool opportunities. I could get money, I could start these genetics companies and these biotech and like we're curing cancer and lupus and there's so much awesome potential. And the longer I was in it, the more I realized that the incentives about what I wanted as a consumer did not match what the industry was providing. And I would have discussions with CEOs where they'd be like, oh, it's so great. We get kids on Adderall in their youth and hormone replacement or birth control pills and hormone replacement, they like, their whole life is just covered. And I remember a hospital CEO telling me one, she's like, oh yeah, we got margin expansion. I'm like, how? He's like, oh, we get people when they're on the gurney in the emergency room. And I kept thinking like, this is like not, this is not what I want. Like this is not the healthcare that I want. And I would have calls sometimes with, you know, with scientists and hospital administrators and they'd all be arguing about this data and the medical records and patients. But the person that was missing from the call was always you. And I started to realize at some point that the healthcare system kind of flies above us. There's this like incredibly complicated world that you are not part of. And in some ways, the healthcare system looks down upon all of you and says you are incapable of getting a prescription or a blood test. You have to get a prescription. You have to get a physician order to get a blood test. And don't you have a story, sorry, about getting your, was it your amniocentesis, where you asked them for your own? Oh yeah, so part of what I've learned is like, I want my own data. I want to be in charge. I want to own my information. I want to be part of the conversation and I have a right to it. So I did have, when I had my first child and I had my amniotic cells, or my second child and the amniotic cells, and I requested from Stanford, I was like, well, I want to get them and I'm going to genotype them. And I remember they're just staring at me like, you what? And then they're like, you know, there could be unforeseen risks with that. And I was like, I'm perfectly capable of handling them. But people, it was a lot of work to try to get that. And I've always had to advocate for myself. So 23andMe really came about as this idea that I actually want to give voice to people to own their own information, like own your genetic information. And the beauty of genetics is it gives you an opportunity to know what your risks are and to think about how you could potentially prevent. And frankly, the only people who care about prevention is you and your family. Like, it's not part of the medical system, except for in pediatrics and vaccines and stuff. But like, it's fundamentally not really part. Like your doctor is never going to come with you when you go and you buy food and be like, hey, here's the right kind of exercise. How are you cooking your food? So I really like 23andMe came out as this idea is that the only way we're going to change health care is if there's a consumer uprising and we actually all wake up and we recognize we're actually in charge of ourselves. And it's not necessarily you don't actually have to ask permission for all these aspects from your physician that you're actually you own your medical record. You own your information. If you want to do something, you have the ability to do it. And so I'm routinely like my dentist just kicked me out of their chair. I routinely get kicked out of doctor's offices because I start asking for a lot. And I kept asking my dentist. I was like, why do I have to get x-rays? And she's like, for legal reasons. I'm like, well, that's not a great excuse. And she's like, well, get out of my chair. And so you have to be comfortable in some ways. But it's not part of you know, it's an uncomfortable part of the system. But it's such an important part of 23andMe, the idea that we actually want to empower the individual to own their genetic information and to really take ownership of their health. So one of the best parts of the 23andMe story, I think the most interesting part about you as a leader, is that you always had in mind this medical idea for 23andMe. And this was about therapeutic research, right? And then the, was it the FDA who walked in, shut you down? We have one of the ideas, again, it's like part of the way you make discoveries is with data. You know, like we're kind of stuck in this issue right now, because you have Facebook, and you have Google, and you have all these big companies, and you know, Target, and everyone has all kinds of data about you. But, and they're using that to like really understand you. And what we found out is like, I can really understand you with that data. But sadly, we don't have a lot of that data in healthcare. So what 23andMe has tried to do is say, if you want to opt in to research, 23andMe is creating a research platform. You have the ability to opt in, you have the ability to opt out, but we're going to all come together. And if people who want to all try to understand lupus want to try to understand it, we're going to help them do it. If you are genetically high risk for Alzheimer's, and you want to try to understand, is there something you can do? We're all going to come together in that. And the people who are high risk for Alzheimer's can be controls for the people who are high risk for type 2 diabetes. So with all this information, with the 10 million customers we have, and all of the self-reported information our customers have given us, we're doing a ton on drug discovery. Because what we found is like part of the mission of the company is to help people access, understand, and benefit from the human genome. And the best way I can help my customers benefit from the human genome is to actually provincially come up with a cure. Because some people will get sick, some things are inevitable, and you will get ill. And so if we can actually use this crowdsourced community to come together and say, we found a cure, I think it's the number one way we can help people benefit from the human genome. But that was... Oh, and so with the FDA. So that, I just ignored that part. Well, there's this great story about basically they came and shut you down. Well, in 2013, it's been sort of, it's one of those things, 23andMe had a lot of controversy around it. And in 2013, the FDA sent us one of the nastier warning letters that's ever been out there, and told us that we had to stop returning health results. And it was a moment where we had to like really look to say, like, how much are we going to pivot? And I remember one of my, someone in the company was like, Ann, you know, at this point in time, this is when you fold. Like, you just turn off the lights. And I remember thinking like, what? Like, you should get out of here. Because there's no way. Like, of course, like, there's always a solution. Like, I'm a huge believer, there's always a way. And I spent a lot of time going around and talking to people, and I finally realized after a lot of conversations that the way forward was long and hard, but it would ultimately make us a much better company in the long term. And that what we did is we put our head down, and frankly, we're still digging out of that hole that we, you know, went through and we said, we are actually going to work with the government, we're going to work with the FDA, and we're going to prove to you that all the things that you were worried about are not things to worry about. And my approach, again, was like, we speak, like scientists speak in data, and so we drowned them in data. Enough so to the point where they came back and they're like, can you stop giving us so much data? And that's when I was like, oh, wow, I feel like I hit my goal. And so, but at that point, you had to sort of stop the health operations for your consumer at that point. We had to stop the health. And pivot to this or amplify, or the only way forward for the consumer was to do the sort of, oh, how funny, I'm related to someone and the genetic, the ancestry. We had to stop for a couple of years doing the health side. And that's actually where ancestry started to really take off. And frankly, ancestry, people, health is regulated. But in some ways, ancestry, it's just as important because it's people's identity. And what we have found is that I can, if I tell you you're genetically high risk for Alzheimer's, that can really change a lot of things for you. But it can also really change a lot for you if you thought that you had a Native American story, and then you don't. Or you thought that you're 100% Ashkenazi Jewish, and then you find out you're half. Or in my case, I always complained, my uncle never had children. And then I was like, oh, guess what? You did. And so now I have another cousin. It's amazing. I love him. But it happens. It's amazing how often, how much that ancestry side has had an impact on society. There was a Wall Street Journal series of articles in the fall after I last saw you about all the different familial impacts, the good and bad that have happened with that piece of it. I think it's one of those things, it's always a shock. But a lot of people, it opens eyes. And people, the beauty that I find, and again, I'm always a silver lining person, people are finding connections in ways that they never thought they were going to have a connection. And one of my friends, even, who was really sad, both her parents have passed away, and she's like, I'm so lonely. And she just found that she actually has two half-siblings and that there was actually another person in her father's life. And she's like, it's so great. We're all going on a trip together. There's things that are a shock, but I think people can handle it. And like I said, it's made people forge these connections. And the thing that I'm most happy about is I never expected to have an impact on the conversation on race. And we're really helping redefine it and show people that we're actually all one. We're all one. We're humanity. We're all humans and we're all connected. And that each mutation that makes me, there's a 0.5% difference between any two of us. We're all pretty much all the same. We're all pretty much the same. 99.5. But each mutation that's different between us tells a story of survival. That the reason why people got lighter skin is a story of survival. And the reason why some people can eat lactose is a story of survival. Like each mutation that makes us slightly different is really beautiful and should be celebrated. It's like, oh, people went this way and they had to evolve in a certain way. And these mutations enhance their survival for those reasons. OK, let's get back for a second to the data. I've got to interrupt her. She's so interesting. And I'm just going to go on. And we have like 30 seconds left. I'm sorry, Jill. I'm going to go a teeny bit over. Let's get back to the data for a second. Because this is like the conversation around everywhere. You have a great term. And I think it helps differentiate between the different kinds of data that are out there. The Facebook effect, is that what you call it? Why is everyone all of a sudden terrified that they're going to be named the Golden State Killer? I actually don't think that people are worried about the Golden State Killer. I think that core to 23andMe, I had a talking to about privacy when we were starting this company. And the head of the Electronic Freedom Foundation, EFF, he sat, I think it's Freedom Foundation. He sat me down. He's like, Ann, people don't understand privacy. What privacy means is it means choice. If you want no one to ever see your data, we need to honor that. If you want to have access to your data and you want to move it around and you want other people to see it, you want your parents to see it, we need to honor that. So privacy means choice. And from day one, the way we've set up 23andMe is we want to be transparent with our customers and we want to give them choice. If you want to be part of our DNA relatives and find relatives, we give you that choice. We don't make the choice for you. You have to make an intentional opt-in or opt-out. If you want to learn your health information, you have that choice. You have to opt-in or opt-out. So I think what's disturbing for people right now is there's a sense of a lack of control. And frankly, when I look at GDPR and CCPA, and I look at all these things, every single day there's an article where I'm like, holy cow, I didn't know that I made a choice for my information to go in these ways. And I think that people need transparency and they need choice. And frankly, some of the worst offenders on this right now are hospitals. When I go into Stanford or I go to any hospital and I sign the consent form, there's not a choice to say, I don't want to be part of research or don't use my information in this way. It's like, do you want to be in the hospital? Yes or no. And if you're in, you get one option. So I'm a huge advocate that privacy means choice and that people want transparency and they want to know what is happening and they want to be able to change things and customize it based on their preferences. Since I last saw you, you had to lay off 100 people at your company. How was that as a CEO and a leader? How challenging was that? It's awful. We made the decisions that the consumer market is slowing. We have to regroup. We saw things, we weren't going to hit the volume that we anticipated. And so in a very strategic way, we can say, okay, these teams, we have to reduce in this number. And then when it came time to stand up, the way we did, we had an all hands meeting. We stood up and I cried. And I almost want to cry now. I love my employees. My team, 23andMe is like a family. We're in this thick and thin. And so it was hard because I really, I think culture matters so much in a company. It's not like, I remember one of my best friend's dad saying, he's like, you got to do something every day. You might as well just love it. And so I have that approach with a company. I invest in people. We hire great people, but you're great over the long term. You're not great every single day. And it's so important to have the right culture. So it was heartbreaking. And so again, there's the business side of it's awful. I'm disappointed that the market is slower. But I run my company, it's in my other family. And so to have some of these people go and some people who were with me for seven, eight years, I adore them. And so I will do everything. Like I said, my first boss, the Wallenberg family, they treated me like family. And they're the ones who taught me how good it can be. And so I will always treat people in that way. And I'm super loyal. One piece of advice for anyone in this audience who is thinking about starting a company. All the women, there are a few men in here. The reality that I have had to face is it's persistence. A company is, I think successful companies come when it's so close to your passion. It's never been a chore for me every day to come in. So I think there's people who start coming because they're like, oh, this is a good idea. I can make money and I can get out. And then what I love to mentor and help is people who are like, I'd take a sword for this. Like I'm passionate. And when you do that, my advice always like, it's just the road is always longer and it's hard. But like you just, again, there's always a way forward. And I'm always, one thing I've learned also in life is that you never know who's gonna be helpful to you when. And so like people that I babysat in high school, I was just at a Stanford party and I was talking to these people and they were super interesting and helpful in all these ways. And then he's staring at me and he's like, you don't remember me, do you? And I was like, uh-oh. And he's like, oh yeah, you babysat my kids when you were in high school. And I was like, was I flaky? Like, I was like, I hope I was responsible. But you never know. And I think part of it's important. Like always like, I love meeting people. Always be kind to people because you never know who's gonna be helpful in the future and who you're gonna run into in the future. And like I said, the path is always gonna be longer. But there's a lot of amazing people who wanna help. And so cultivating those relationships will make you successful. Dylan's gonna kill me. Thank you, Anne.