"The consumer does not have a real voice in healthcare＂ ｜ Anne Wojcicki ｜ Google Zeitgeist

So Anne, let's start with you and 23andMe. You have collected the genomes of over a million people from what I understand. We have. What is your goal? I assume it's just sitting with Larry of all these ideas about world domination that I should joke with, but with DNA it's probably not appropriate. But we can get into world domination. So the idea with 23andMe when we started the company, and it was interesting actually hearing Sean and talking about some of it. So my background was Wall Street, and part of what I learned on Wall Street was just sort of how much the healthcare system as is today is not actually aligned with what we as individuals and as consumers want. And I can have tons of different examples, like pharmacogenetics is one of those things where we all can, I don't know if people know the Benadryl example, how some people actually take Benadryl and they get hyper, and some people take Benadryl and they get sleepy. And if you're giving your child Benadryl on an airplane, it's really better if you know that earlier, ahead of time. And so the idea with 23andMe was really to actually start to reconcile the fact that the consumer does not actually have a real voice in healthcare. That there's this layer above you where all kinds of decisions are being made about you and you don't actually have a voice. And when I started to see the genome being fully sequenced in 2000, I realized that there was gonna be an opportunity for us to get access to our own genome. And how exciting to see this mysterious code within us that we're actually gonna get access to, and we're gonna see in our lifetime how we actually get to understand what it means. And so 23andMe started with this idea that you should actually get access to it. And between the time that it was first sequenced and between the time that 23andMe started, we didn't find anyone else moving in that direction. And so it was kind of started as this rebellion that one, the consumer should be entitled to their own genome. They should have the ability to get access to it. And that two, we can actually start to reconcile some of these differences with the fact that the consumer does not have a real voice in healthcare if we actually can almost crowdsource health information. And that us coming together, that we can actually start to understand things like prevention. Like it'd be great to actually treat a disease with effective medications, but how much better is it to just prevent cancer than never to have it? And that 23andMe is a company that can actually specifically represent the voice of the consumer because we can all start to actually impact that research together. So Jamie, have you taken the test? I did, I was one of the first consumers. I loved it, I learned a lot. I found out that I'm 0.01% Yakut, which I had to Google. It's a group in Siberia. So I don't know whether they have Jews there, but maybe we've mixed at some point in the past. Does that maybe explain your ultra-marathoning or something like that? Yeah, I think so. And how much I like the cold. Right, right. But you've written about how we're really almost at an evolutionary turning point. Why do you, what do you mean? Is that kind of over-exaggerating things? I don't think so. Our species for four billion years has evolved by one set of rules, which is random mutation and natural selection. And now we are turning a corner in our evolutionary process. It will unfold over centuries and millennia. But basically, we're moving from that to guided mutation and guided selection. And the implications of that are enormous. And in 1865, Jules Verne wrote a story about landing on the moon. And it was a plausible idea. None of the science existed. But when President Kennedy in 1962 spoke about landing on the moon, it wasn't that this is some crazy idea, quote-unquote moonshot. It was we knew the technology existed. We had to perfect it. We had to evolve it. And then seven years later, as we talked about earlier in this session, Apollo 11 landed on the moon. That's where we are now. We have all of these tools to fundamentally transform our species. And they already exist. And we don't need to invent some kind of magical gazorning plot or thing that we can't even imagine. We just need to improve these tools. And we're already using them. The work that Anne, the work that others are doing is laying a foundation. And it will lead to a fundamental change in our species, which will accelerate over time. Anne, what are you seeing people do with their results? I mean, there's been talk of women having preventative double mastectomies. Are you seeing a real impact in terms of people's lives being able to take control of their own decisions? I see two things that are very clear. So one, one of the most interesting things actually is this ancestry side, is that people, as much as we're regulated on health, what I find really interesting is how much the ancestry element changed people. And we had one woman who was, you know, in a great marketing position, a big Silicon Valley company. And she called me and she was adopted. And she called me and she's like, I've actually decided to quit my job, but I'm moving to the Arctic Circle. And I found that I'm part of the reindeer people. And I'm living there now. And she checked back in two years later and she's like, I've never been happier. But because of the 23andMe results, and she's, again, was looking for this sense of identity, that she was so happy. And I find that ancestry actually really moves people immensely. And they actually have this sense of connection that they didn't necessarily have before. The second thing is that I think the health information almost any data point, whether it's a cystic fibrosis result or your caffeine metabolism, in some ways people opening up to the fact that there's something black and white within you, meaning your genetic code, that is actually predisposing you to illness and predisposing you to why you are the way you are wakes people up. And so one of the things I find fascinating is how much the health information that we all get is, you know, don't smoke, eat better, lose weight, is so generic that it's not meaningful. But when you get something in black and white, it suddenly becomes this aha moment for people who are like, oh my God, I should exercise. And that's part of what we're actually thinking about a lot next is actually then how do we actually connect people to this whole world of where people really do wanna, you know, help people be motivated and execute on what they're actually thinking about doing. And Jamie, talking about what's next, Sean Parker was just talking about cancer. And the invention of the CRISPR technology has been something that's been talked about a lot in terms of having a potentially revolutionary impact on cancer. Could you explain why? Sure, well, let me just give a little bit of background of why I think that all of this suite of technologies is going to be revolutionary. And then I'll get to CRISPR because it's not just about treating disease, but treating disease is the entry drug. So that the more that we understand about how the genome works and the pathways for various diseases, we have a lot of new opportunities to treat them. What Sean called cell therapy or gene therapy is one of the most specific ones. We take cells that are mutated with cancer or whatever out of the body and you fix them and then you reintroduce them to the body. And so people are very, very excited about that. But there's a lot of technology that's even more mature than some of this gene editing and gene therapy that is in common use today that will lead to this transformation. One is just simple, now it's simple, IVF. And IVF coupled with pre-implantation genetic selection, which is embryo screening, paired with the type of deep understanding of genomes and the cost of genome sequencing is decreasing far, far faster than Moore's law. And so now if you're sequencing, if you're doing IVF, you fertilize the eggs, you sequence cells from those pre-implanted embryos and the more you understand, the more you can make informed decisions about which of those fertilized eggs will get implanted in the mother. So you talk about CRISPR, the next phase beyond that will be using CRISPR, which is precision gene editing in just a simple way. It's kind of like a Microsoft Word. You find a letter that you don't want, you just put your cursor there, you can cut it out, you can turn off a gene, turn on a gene and or add something else. And that's gonna give a huge and extremely powerful new tool. So embryo selection will be in the near term and then embryo selection paired with using precision gene editing to make small changes because right now the things that we understand, our genome is extremely complex. Most genes do lots of many different things. Maybe sometimes some are good and some are bad. And there's about 10,000 single gene mutation diseases, Mendelian diseases. So in the near term, we're gonna wanna fix those things. In the medium term, these same capabilities will open up a whole set of other possibilities for selecting and creating traits that may be desirable. So along the way come the regulators. And as technology gets into other industries, the regulators are certainly scrutinizing various startups. Anne, you had a brush with the FDA that I think actually impressed a lot of people. We impressed in all kinds of ways. But your test was held back for a year and a half and then you reintroduced it. What was that process like? Do you understand that level of scrutiny and where do you think this is heading? I mean, obviously we heard about Theranos and it seems that as technology gets more into healthcare, could we see even more regulation? As much as most diagnostics in this country are not regulated by the FDA. They're regulated by Medicare. So when you go to a lab core request and you actually draw blood, that's not regulated by the FDA. And there's all kinds of things. Like I think a lot of the CRISPR, these initial embryos that are being developed with CRISPR are actually not regulated by the FDA. They're regulated as the practice of medicine. And so it's really, you can get regulated for in some ways all kinds of different reasons. The hot button issue for 23andMe without a doubt is the fact that we're direct to consumer. And I think that part of the challenge as well is that a lot of physicians themselves and medical systems don't know how to integrate genetic information into the clinic. And even things like, I'm surprised always at the number of births in this country where people are not screened for basic things like cystic fibrosis. And the number of women I know who have a family history of breast cancer and they never then in fact go and get a test for the BRCA variant for breast cancer. Jamie, when we spoke yesterday, you talked about your sense of a growing need for a kind of a global conversation among regulators and geneticists, people all around the world. The US is by no means the leader in this field because there's a certain fear that genetics could become almost like GMOs and have a little bit of a bad rap. Yeah, so it's not just the geneticists and it's not just the regulators because those are two groups who actually know each other pretty well. It's people, it's regular people. What we're talking about is the radical transformation not just of how we do healthcare and when we talk about precision medicine or personalized medicine, what this means is that over time, everybody's genome sequence is going to be the foundation of their health record. And so there's one thing on a very basic level, people need to have access to that and understand it. But as we move on relatively quickly, I mean, we know very, very little about the genome now. It will be far more complex even than what we understand now but over time, we're going to know more and more and more and we're going to be empowered to do all types of different things. And the way I kind of summarize what this means is if you had a time machine and went 1,000 years into the past and took a baby and brought that baby back to today, replace them with a family, that kid would be just a normal kid. Go 1,000 years into the future, bring that baby back and that kid would be a genetic Superman, resistant to all kinds of diseases, live longer, healthier, have all kinds of capabilities. And so what we're talking about is potentially a pretty fundamental transformation of our species and it's so, it's far more important than just for scientists or just for regulators or just for government. Everybody who is part of this species needs to be part of this conversation and we saw with the GMO debate, what happened in the 1970s when scientists were developing this, these technologies, they said this is so amazing because we're going to save hundreds of millions of people and they didn't have that kind of engaging dialogue and now it's whatever, 40 years later and pretty much most of the scientists in the world say that GMOs are fine. I mean, there are issues but they aren't about consuming GMOs and yet people have this gut feeling that there's something wrong and if people were uncomfortable with genetically modified crops, imagine how people are going to feel about genetically modified humans and the first genetically modified humans, state-sponsored genetically modified humans in a very minimal way will be born in the UK later this year as a result of mitochondrial transfer which was approved for clinical trial last year by the British Parliament and we talked earlier about Ebola and we had 20, 30 years, we could have invested in understanding Ebola and actually helping the countries in Africa and it took a crisis here and we had this mad response that was completely irrational. So now is the time we have a relatively short window to invest in a species-wide dialogue on the future of human genetic engineering that really needs to bring everybody in including the people from faith communities, from all types of backgrounds because we can be open, we can inform people, we can have a dialogue that won't be possible in the future once ideas and positions harden. We are unfortunately almost out of time. I want to end by just asking the two of you what your goals are for the next two or three years in terms of genetics and you're at a million now in terms of people. Over a million, yeah. Over a million, where do you hope to be in the next stretch? I think one of the more exciting things that's come up, so Obama last year announced actually something called the Precision Medicine Initiative which is a federal initiative. Recently we just launched an initiative with the governor of Nevada where Nevada actually wants to go and genotype and bring together medical records for the entire state of Nevada. And so it's the first, and the great thing about that initiative, like PMI, Obama's initiative is going to take years and years to roll out. This one, we actually enrolled 5,000 people in 24 hours. They expanded it to 10,000 people and they got 10,000 people in 36 hours. So there's just this massive demand where people want to participate. So what I actually see that I'm super excited about is one, there is sort of a rising where people actually want to be in control of themselves. And I think that's where you do see this next generation that's so used to having Uber and Instacart and Airbnb and like everything at their, and Google, everything at their fingertips. And then you go to your doctor and it's like, like here's your little pen and paper, and like, oh, you put the numbers in wrong. So like that is gonna change. Like that has to change. So I do think there's gonna be radical transformation and the fact that we enrolled so many people into this Nevada initiative so quickly, I think shows that there's this massive interest. And I think then you bring together that data. We have a therapeutics initiative where we are actually now trying to use all this data to develop therapies. And it's proved out to be so incredibly fruitful to actually see when you start with a human instead of a mouse, what it actually turns into and the insights you can have. And so I'm really hoping that 23andMe becomes just a platform for really radical transformation in the sense that it wakes everyone up to saying, you should take control of your own health information and we can actually also really try to transform the drug development process and actually make it much more efficient than it is today. Yeah, as I mentioned a moment ago, my big mission in life is to launch a species-wide dialogue on the future of human genetic engineering. Because as Anne said, these technologies promise to do incredible good, to really help our species live longer, live healthier, eliminate these terrible diseases that nobody wants. And yet there are real potential dangers. People talk about, and it's real, about the diversity of the species. Diversity is our greatest protection. There are real equity issues. There are just values issues. And we really, we have to bring people together. But to get from here to there is going to require a massive level of understanding, of engagement, and of mutual respect. And that's, it's very, very difficult. And that's why people, organizations like Google, conferences like this, my goal is just to engage people because everybody here, as I mentioned before, is part of this species. And what's going to happen to our species is part of your future and your children, your grandchildren. And this process isn't just for experts. It's not just for government. It's for all of us. Please join me in thanking Yan and Jamie for a fascinating conversation.