23 Minutes With Anne LIVE Health Edition

We are super excited to be here today. I feel a little bit like we're in a college reunion, because we've worked together for so long. So, Emily Trebek Conley runs our development team and all of our partnerships. She originally joined and was on the research team and was a part of the Ph.D. program. And Shirley Wu has been here, I don't know, ten, nine and a half years, for so long, has survived so many ups and downs within the Ph.D. program and was writing reports and projects. She loves it so much that we just have her left. You guys have her left. And so it really is, like I said, it's great. So today we actually have some, we're going to talk about health and the health product in general. And like I said, I am going to be filling in for the conversation, because I have my subject matter experts here. But first, we're going to have a few fun facts. And just like one of my fun facts about people who work here, I say every day, like I come here every day because it's such a pleasure. And so one of my favorite aspects about people is people who are synchronous. And so one of the most interesting aspects about Shirley is how much she loves to cook, which is very different for me because I can come home at night and I can easily eat a block of cheese and be happy. And Shwu is the one who introduced me to this fancy, portable, slow-cooking, the slow cooker bag. Have you ever seen it? The Wonder Bag. I've eaten food from your slow cooker Wonder Bag before. So I almost feel like it's an Amazon commercial here. But like the Wonder Bag that will like, you can put your pot in and she'll bring it to work. And it's like a giant cozy for your casserole dish. And it slowly cooks all day. And on top of that, Shirley also has a number of chickens. That have really good names. They have really good names. Yes, they are wrapper chickens. So we have Two-Pack, Nifty Omelette, Notorious EGG, and we had... That doesn't peep anymore. No more peeping. So Shirley's also part-time in the marketing team. All right, fun facts. Am I supposed to do a fun fact about you now? A fun fact about Ann. So we had, this was like maybe right after I joined the company. There was a congressional hearing that Ann was attending. And you, I think, didn't pack appropriately. Which is not surprising, knowing you. And so you showed up with one shoe. Oh, no. And then flip-flops. I left the shoe at the hotel. And so I had one shoe. So I had the congressional hearing. And they're like, are you ready? I was like, I'm... How did you leave the hotel with one? Well, because I left in flip-flops. Oh, okay. And then I put the shoe on. And then we got there, and the senator, he's like, are you ready? I was like, I'm ready. I was like, I just want to explain that I only have one shoe. And the other one's coming. You like to keep it fun. Well, I'm obviously not the one who's like tends to be so fun. That's true, that's true. So that's my fun fact. There are many more fun facts. Do you have a fun fact about Ann? So we've actually stemmed from before she was appointed. Oh. So I had some research on this. Apparently, you used to ride a motorcycle. I did. Oh, wow. It's true. I dated someone that had a motorcycle. And then we broke up, and I decided to buy my own motorcycle. You're like, how did you buy a motorcycle? Pretty much. And no longer riding them. No, no, no, no. Good. Awesome. All right. Well, we can launch into our health product questions. And a motorcycle is not part of our health. It's not good for your health. It's not an indicator of how she runs. No. All right, Ann, this one's for you. Oh, man. What do you feel is one of the top challenges consumers have with modern health care, and how can 23andMe help? Oh. I think one of the top, I mean, I think the big picture, there's two elements. One of the big picture top challenges in health care is that health care, I think, is not fundamentally focused on your best interest. So, for instance, health care is not necessarily, it's very much focused on reactive. Like, if you come in and you have an illness, or you have a family member who's just in a bad biking accident, and Stanford was amazing, and the trauma, and all that, it's amazing how that can work. But if you come in and you're like, hey, I just, I'm high risk for type 2 diabetes, and I'm overweight, and I have a family history, they kind of are going to send you home. And be like, we'll come back when you're diabetic. So I think one of the hard parts of health care is that it's really hard to prevent. And it's hard to, like, we don't have a lot of information about how to stay healthy. And it's like one of the core elements that we're trying to do here is, like, if I give you this information, I'm trying to help you prevent. Like, if you were high risk for a blood clot, you know, a lot of people, a lot of insurance companies will tell me, like, well, you can just treat a blood clot. And no one's really that excited to just treat their blood clot. Like, I'd rather just not have that blood clot. And so a lot of what we try to do at 23andMe is to give people information about what your risks are. And it's a better proxy in many ways than a family history. And, you know, it's kind of saying, like, okay, here's the deck of cards that you were dealt. What are all the different things that you should think about? And I think about even in, like, the logistic family. It's like, okay, well, we know, you know, my father has atrial fibrillation. My grandmother had macular degeneration. Both of those are things that have high genetic components. So, like, you know, what do we do with, like, all the kids, like, of thinking about that? And my sister and I were talking about it actually the other night. It's like, you know, kids who are high risk for macular degeneration, like, they're going to be more proactive in those organs. So, like, there's a lot that you can start to do then to be proactive about your health. And if you know what your risks are, I think that everyone would much rather use than just necessarily treat it. That's my thought. Great. Any more bottles? Okay, good. Can any of you talk a little bit about the difference between the Ancestry-only product and the Health Ancestry product? Sure. The Ancestry service is obviously awesome. The Ancestry service gives you so much more information to look up. So it covers everything from traits like physical characteristics you might have, certain preferences and reactions to the environment, wellness-related traits like weight and sleep, all the way to disease risks and conditions you might carry genetic risks for that you could pass on to your children. So it covers the whole range of the potential life of DNA. It's one thing people don't realize, too, is a lot of the Ancestry information is related to health. And so people come to us, obviously, and they ask the question all the time, like, wow, what's the difference between you and the other products that just have Ancestry? I'm like, like, a lot. Like, because we have health. And if you know, like, people come to me every so often. They're like, wow, I learned from you that, you know, I'm 50% Ashkenazi Jewish, and everyone in my family has this history of, you know, of cancer. Like, should I get tested for, like, for the health side? I'm like, yeah. Like, there's a lot of populations that are associated with different conditions. So in some ways, like, Ancestry is just part of the story. You need to actually, like, that's part of the reason why we've always said we give people some of that, you know, the entrance just in, like, learn about some of the Ancestry. But understanding how your Ancestry connects to your health is really important. And so it's one of the things that we, like, we realize a lot of people who just first learned about the Ancestry product, then really, like, they got the health information. They're like, wow, like, I had no idea. Especially if there was these kinds of connections. And actually, that's really the case. Certain populations, that information, now that you know that, now there's some other step in the journey you can take from there. So it's just a continuous journey of just stuff like that. Totally. Hey, guys. So we're going to be keeping you guys a little quiet. The giant mic. I'll lean in. Lean in. All right. Shirley, along those lines, what are some of the health reports that you want to see returning to the product and why? Lots. There's so much more we could have. So some of the, I think, major areas of information that we're really excited to bring back. So some of you may have heard we recently got FDA authorization to provide information about how people process certain medications. So we're working on getting those reports, just making sure that we meet all those requirements before we release those. We're excited to get those back in. And then there's a whole bunch of conditions that are very complex. There's lots of factors that influence whether someone develops them, like diabetes and heart disease and all these diseases that affect a lot of people, but they are complex conditions. That's just a huge area that our current product doesn't cover that well, but we are working hard to bring into the product. And then we just got our fifth FDA authorization for colorectal cancer. So we now, in addition to breast and ovarian, we can now report on colorectal, which is a really important milestone for the product. Emily, this one's for you. How does the research that 23andMe does translate to the reports that we provide customers? Oh, that's a great question. You know, there's such an interesting synergy between the research that we do. So for those who aren't as familiar, when people join 23andMe, they're invited to participate in research. It's totally opt-in. And about 80 percent of our customers choose to opt-in and participate. And then we ask them questions through online surveys about diseases they have or their background. And then we use that information for research, so to better understand genetics of disease, but we also use it to inform our product. And now that we've grown so much in size, we have millions of folks that have done the 23andMe test and are participating in research. It's become this really rich resource for helping us create new products and features. And so, for instance, we have a report on genetics and body weight, which is not surprising that how much you weigh is influenced by genetics. It's influenced by other things, too. And so the team was able to use our own data to create essentially the best and most predictive model of genetics and body weight that exists. We have data from hundreds of thousands of customers that helped us create that. And so now when you log in, you actually get a report on genetics and body weight that is fueled from that research of 23andMe consumers. And so this is a direction that the company has really been going in more and more. It's like, how do we use that data to create better products and features so that we can tell people more interesting things about themselves? That's great. And it can help people with their New Year's resolution. Exactly. Shirley, how does 23andMe determine what trait reports we include in the product? So there's a lot of factors we consider. You know, A, just how interesting is it? Do a lot of people want to know about this certain trait? And you'd be surprised, you know, there's so many weird quirks of human behavior. And, you know, so there's a lot of options we have. And so we have to look at both the interests and how relevant it is to how many people, but also how much data we have. So Emily was just talking about this rich resource we have with customers participating and providing survey answers. And so we need to have enough of that kind of data to be able to do the kinds of studies and analyses to really develop predictions around those traits. So if both of those things work out, then it's just a matter of creating a compelling report around it and going through all the work of building that feature. But, you know, those are some of the things that we consider. You know, my, you know, itch response, which I feel like is it's one of those things that perhaps may not get studied in, like, an NIH grant. But customers care. Like, I care. Anyone who's on camping, you're like, why do I keep getting bitten? Yeah. And my friend has, like, nothing, you know. And so genetics are part of that. And I think traits is one of the things that's really fun where everyone in the company has an idea. So there was one weekend where all these airplanes were getting grounded in Arizona. And because of the heat. And so, of course, like, I call our head of marketing at the time. She's like, or who's still here. And she's like, oh, I'm flying to Arizona. Like, I love 130 degree heat. And I was like, what's wrong with you? And she's like, I love it. And I was like, there's only certain people who clearly love that kind of extreme heat. I was like, that's going to be a quick question. So, like, we put it in. And that's the way these things happen is, like, you think of something. I called them the data collection team. I was like, let's add that in as a quick question. And then you can start to see, like, do some people just, like, really love extreme heat? And some people love extreme cold. And that's kind of how a lot of these things start to come up. Like, we can see, like, again, you're never. Cavities. Cavities. Cavities is me because I have no cavities. I was like, well, am I really special? You are. Or am I just, like, a little special? But a lot of it is that, you know, people can relate to traits. And it's fun. And you're right. You're never going to get an NIH grant. So it's kind of very unique to 23andMe is that we can actually do all this research that people can relate to. Like, again, my favorite from last time, the chocolate ice cream versus vanilla ice cream. Like, who would have known that that's a genetic preference? But people can relate to that. And it's really fun. And it's super fun for people in this building to kind of look around and be like, so why are you like that? Yeah. Let's study it, Emily. Yeah, totally. Without a question. Right. So speaking of traits, sometimes the report doesn't match the actual trait that the person shows. So how are these calculated and how can we make the predictions better? Yeah, so our trait reports generally look at a bunch of different genetic factors and then often also things like your sex, potentially your ethnicity or your age, factors that may influence whether someone has a trait or not. But we're still learning a lot about what makes people the way they are. And we only have uncovered a subset of those factors. And so our predictions are based on the best science that we have. But there's so much more to learn. And so we know that traits aren't determined by any one thing often. And so that's why these things aren't 100% predictive. But we try and give those percentages of how many people with a certain genetic profile said that they have this trait. And that gives you a sense of there's some people who say they have this and some people who don't. And depending on your genetics, maybe you're more likely than not to have that. But it's still not 100%. And like genetics and body weight is a good example where genetics are really important. They definitely influence how much you weigh. But if you don't exercise and eat very poorly, then that is also going to have a very big impact on how much you weigh. And so for many of the traits, sometimes we know what those things are. And sometimes they're factors that we don't yet understand that may impact why your hair is straight or wavy, things like that. Anne or Emily, Carrie from Facebook would like to know, health-wise, how do you understand your reports? And what doctor do you see to understand the results? Oh, that's a great question. You know, there's a lot embedded in the health report. And I think maybe we can talk about a couple of the categories. So one of the categories is carrier status. So these are diseases that tend to be somewhat genetically determined. And so we can tell you if you are a carrier for something like cystic fibrosis. If you're a carrier, it doesn't mean that you will develop the disease. But if you have a baby with someone that's also a carrier, then your child could potentially be born with that condition. So for that whole category of reports, that's really relevant to people that are thinking about having kids. I'm a mom. I have two kids myself. And so when I was pregnant, my OB wanted to know if I had been tested for cystic fibrosis. And I was able to say, yes, I have my 23andMe results and share those with my doctor. And then that information was actually put into my chart, and I didn't have to get tested again. So that is kind of relevant in sort of the family planning. That would be in somewhat contrast to the genetic health risks. So these are conditions that are not genetically determined, but where genetics can influence your risk up or down. So, for instance, risk for hereditary thrombophilia. These are the blood clots. And that information, it's quite handy to have that in advance of actually meeting it, but sharing that with your doctor at various points in your care. If you're about to have surgery, if you're getting prescribed the pregnancy pill, birth control pills, those types of things, it's really, really good for your doctor to have that information. So it kind of depends a little bit on which result you're talking about, sort of what the opportune time is. But we want to make all that information available to our customers so they can share it as needed. I think one thing just relevant to the question of what doctors to go to, it's one thing that I think we recognize. A lot of physicians are not trained on genetics, and so it's definitely a gap that we have, and 23andMe has a medical affairs team that is definitely thinking about more and more how can we make sure that we have education programs for physicians. So we do, for instance, have continuing medical education out there, specifically about genetics, about some of the content that we have in reports. And so the main thing I can say is when I go to, for my physician, when I brought them my kid's reports, I printed it out so that they actually had the whole scientific background. Because for a lot of physicians, some of this information is new and what exactly to do it, but we try to make those reports, or Shirley actually tries to make those reports pretty comprehensive. So it's a backgrounder really for a physician as well, especially the technical details if they wanted that. But more and more we'll see 23andMe making sure that we are helping the physician community know what to do with this information. And part of it, there's a whole new world coming that is doctors on demand and telemedicine, and a lot of those physicians are helping people think more and more about prevention, and even the physicians that are within a retail store or the urgent care centers. So there's a new world that is coming that's thinking more and more about the preventative care and where is it in the right place. And it's not always a physician. It could be a health coach, it could be others. So that's part of what the world's really changing, is how to use this information. So I agree, there's times where one thing I'd also say is that it's important for physicians to have it, but it's also important for families to have this information. So people, like I have a friend who had a stroke, who I called as soon as I heard that she had a stroke. I called her doctor and I was like, she's a carrier for Factor V. She is higher risk for clotting, and that does then have a different triage of treatment. So it's helpful for your family also. It's part of the reason why, again, when we think about connections within 23andMe and having the family features, knowing you all take care of each other. And so creating that village where you can, again, my sister and I were sitting there talking about, hey, everyone's genetic information. And how do you help manage all of that, and you all help each other. So it's important for the physicians to know your family, and I think that we create a lot of content so that it's a pretty robust experience and you can know how to follow up. Great. And just to make note for our listeners, that we're not testing for every single variant for each of the diseases. We make clear in the reports which variants we do test for, and there are certainly other non-genetic factors. We're just telling you it's in your DNA. Of course. Great. One last question, and this could be for all of you. What would be the one takeaway that you want our consumers to have after doing 23andMe? You can start. Okay. We can each do one. Okay, we can each do one. The takeaway? I mean, I don't know. Can I do two? All right. One is that I think is really cool, and people forget this all the time. Maybe I'll start with the other one. It's really interesting, I think, what is impactful for one person is different than for another. I think having an open-mindedness when you look at your 23andMe data, you never know what part may be the most interesting for you. I think we have people come in thinking it's going to be something ancestry, and then they find something unexpected in health. But there's always something interesting in there. Then I think the piece that is so cool that I think most people don't realize is that if you look between any two human beings, we're over 99.5% genetically identical, completely identical, over 99%. Because most of our DNA is about how to make an eyeball and build a heart and make us a human and not a bumblebee or a banana or a gorilla. And so it's incredible. I just think that's so remarkable, that 0.5% for all the diversity that we have. It's so incredible to me. So I think that's a good thing, especially in these times, to remember. Mine is a little bit related to what Emily was just saying. It's just kind of saying that you can learn about your genetics. It's not rocket science. Genetics, a lot of people think, is just like the scientific concept that's kind of reserved for people with special training. But genetics is about all of us, and it's about you, and anyone can really learn about this. And that's, I think, part of why this company was started was to really democratize access to this information and just help people see that this information is for everyone. And you never know what you might discover from that. So I think that's super cool. So I was going to say, I think one thing that's really fun that we've seen with customers, especially customers who've been around for a long time, is the state of science is continuously evolving. And so that's one of the really fun things that the research team here does is we're constantly trying to make discoveries. But the NIH gives billions of dollars a year, every year, trying to make more genetic discoveries. And so kind of to your point, we're 99.5% the same, and this 0.5 variability, we're just barely scratching the surface of what that means. And so we keep uncovering. I mean, for me, I tell my kids, it's like Christmas every day in the company. Every day you come in, there's new journals coming up, there's publications. We had something out just about genetics of risk. It's so interesting. One day I'd met all these people who love skydiving out of airplanes. They'd done over 5,000. But I told her, I was like, oh, I have a finance background. I used to short stocks. And she's like, oh, I would never do that. That's so risky. And I was like, what? So risk, it's so interesting. Every single day you're learning something new out there. And it's so cool because also it's about you. That's the thing that's the best. Sometimes you read about, again, I love all the space research and astronomy. But genetics research, it's applicable to all of us, every single person. And to your point, I love it. It's the beauty. Everyone can understand it. You don't need a degree. You don't even need the high school education. Anyone can understand about genetics. It's one of the most important aspects for me in the company is we really believe in people. You don't necessarily have to have a physician overseeing this. You don't need the genetic counselor. You can learn it, and you're going to be on this spectacular journey with us for your entire life. And so it's super fun, and it's super interesting. That's what we have for you. Yay. I really do feel like we should write him a song. You sing. You actually do sing. You do sing. I was going to say, you just sang a song, I remember, at my birthday. The Chromatones. Our acapella group. I love that. Then it's for you. You can sing. Next time we'll sing. Thanks, guys. Thanks, you guys.