CEOSeries: 23andMe's Anne Wojcicki on Scientific Breakthroughs and Public Trust | HBR IdeaCast

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1:09Welcome to the HBR IdeaCast from Harvard Business Review. I'm Alison Beard.

1:21it's hard enough to run a company but when you add cutting-edge science rapidly developing technology a complicated health care system and shifting public opinion about an emerging industry it's even more difficult today's guest is navigating all of that for the third episode of our special idea cast series with current and former ceos we'll hear from ann wajiski CEO of DNA analysis startup 23andMe. Before founding the company in 2006, she studied biology at Yale and spent a decade in healthcare and biotech. And she started 23andMe with the goal of giving consumers more insight on and access to their own genetic information, to both create paths to more personalized medicine and to build an anonymized database for commercial and academic use.

2:06Wojcicki spoke to HBR Editor-in-Chief Adi Ignatius during our recent virtual conference, HBR Live Leaders Who Make a Difference. Here's their conversation.

2:24So it's great to have you here. I, you know, to start off, I'd love to, to hear you do, it's sort of a version of an article that you wrote for Harvard Business Review, but really how you develop the business. I mean, usually the Silicon Valley approach is to move quickly and exploit the gray areas and find customers, worry about regulation later. But you had fundamental issues with regulators from the start or almost the start. Talk a little bit about how you had to pivot to handle that, to grow. Well, so the company came out of a background that I had, which was on investing in healthcare companies.

2:59I spent a decade on buy side, investing in companies, and I got to really understand the healthcare system. And so much of what went into the thought process of 23andMe was around this belief that the healthcare system can't change from within. And I believe that pretty strongly even today, that the$4 trillion that goes into healthcare, the spectacular fragmentation just enables inefficiencies and that people are not genuinely driven to have change. So when we started the company, the number one guiding philosophy for us was about how is it that we are going to create a platform that's genuinely in the best interest of customers and is entirely outside of the system.

3:49We always knew there would be controversy, like in some ways that was part of the plan. And a lot of my inspiration was groups like the HIV activists who really drove significant change in the 80s and 90s. And so we always knew that there was going to be change. So our philosophy wasn't about, you know, running fast and breaking things. And it was a real mission driven company. It was like, we really want to put the consumer at the forefront of health care. and Francis Collins came out and outlined a whole vision in 2003 that said the human genome has the potential to treat you know to revolutionize how we're going to predict prevent and treat all human disease and it's 20 years since that first genome came out and it's kind of a sad state you know it's an amazing technology and very few people still have access to it and it's like really not fully integrated into healthcare.

4:43So our, our, again, our philosophy was like, we're going to put the consumer at the, at the forefront. We are going to bring forward genetic-based care and there will absolutely be bumps along the way and you'll have to manage those. And I think one thing it's actually. Hey, Chicago class it up with Crocs, you know, back to school is coming in fast. So why wait to find your new fave footwear, Step into a local croc store and step into your new look. Try it. Style it. Make it yours. Because the right pair doesn't just show up. It shows off. First day fits, handled. Walk out ready for whatever's next.

5:25Visit your nearest croc store today. Low energy? Unfocused? Foggy? You might be dehydrated. Gatorade Zero Powders have been scientifically designed to help improve hydration balance in the body. With a clinically proven electrolyte blend and no artificial colors or flavors. Great tasting hydration, no matter where you're going. Shop now online or at retailers nationwide. Gatorade, hydrates better than water. Is it in you? Symptoms noted are signs of mild to moderate dehydration. Consult a healthcare professional if symptoms persist. It's been fun chatting with more mature companies out there. When we launched, we actually worked with Kessler, who's now in the administration, and others to talk about whether or not we needed to be regulated.

6:09And the consensus was that we were not a medical device. And we actually then went and even spent time with von Eschenbach and said, you know, are we a medical device? And it was a very hands off, we are not going to regulate you. And when the administration changed in, you know, with Obama, it was suddenly very clear, now we are going to regulate you. So it's one thing that became really clear is that regulation is quite dynamic. And just because we, again, we started in a way that we believed was not going to be regulated, and then obviously became clear that we had to. And, you know, that's part of also being sort of in a more controversial areas that you have to be adaptable to what the latest perspective is on regulation.

6:54So let's talk about adaptability. So, you know, there were moments in your early years where you were able to do some things, but not able to do some other things. How do you keep the team focused? How do you keep, I guess, mission and purpose consistent when you are sort of forced to adapt and the business model is shifting? Well, the thing that's interesting is the vision, the long-term vision of the company never changed. And when you look actually even at the Series A documents that we had versus the SPAC documents that we have now, the concept of this flywheel, the idea that you're putting consumers front and center, that you're giving them opportunities to learn about themselves, to opt into research, and to participate in this massive crowdsource research community.

7:41And that there's a lot you can do, you will make insights that will go back to the consumer, you'll make insights that potentially lead to papers, you'll have insights that also potentially lead to drug discovery. And so the model has actually never changed. You know, I'd say the short term priorities definitely are dynamic, but the long-term didn't change. And so it's easy from a retention perspective and how we've motivated people in the company. It's always been about getting people to focus on the long-term and the vision. You know, I'd say one other thing that's really inspiring for people is we do have direct access to our customers and customer stories are amazing.

8:20And I can't, like when you are doing something and people write in and they say, you, you know, you found, I found my child because of you, or I found my parents, or I feel like you, you filled in a different, a new piece of me, or I got information about myself and I prevented being diabetic or I prevented having breast cancer. Like it's a real feel good kind of experience. And I think that everyone at 23andMe feels like the work we do is really meaningful. And so that really helped keep people through the, um, the bumps. Yeah. So I get that. And I get that, you know, the technology is valuable and it's fun.

8:58You know, I did 23andMe and it was fun to break, you know, figure out who I was and where I came from. But the fact is that, you know, there is a big, I know a lot of people who say, are you crazy to, you know, give that information away? I mean, there is a big trust gap between the public and tech companies generally. And I think in this field specifically. so obviously you have plenty of case studies of people who are quite happy and have no issues but how do you how do you manage the trust issue it doesn't just it doesn't just go away it because well I 100 % I think the thing that's the issue that I have and actually a bunch of privacy experts it actually sat me down in those early days and explained again and privacy is not all of trust but that privacy really is about choice and I think the issue when you think about what happened with Cambridge Analytica and with, you know, aspects of Google and Facebook and Twitter, like all of these out there, is you're not necessarily clear about what are the choices that you've made.

9:54So I would argue there's not necessarily great transparency. Hey, Chicago, class it up with Crocs. You know, back to school is coming in fast. So why wait to find your new fave footwear? Step into a local Crocs store and step into your new look. Try it. Style it. Make it yours. Because the right pair doesn't just show up. It shows off. First day fits, handled. Walk out ready for whatever's next. Visit your nearest croc store today. Low energy, unfocused, foggy. You might be dehydrated. Gatorade Zero powders have been scientifically designed to help improve hydration balance in the body. With a clinically proven electrolyte blend and no artificial colors or flavors.

10:44Great tasting hydration no matter where you're going. Shop now online or at retailers nationwide. Gatorade hydrates better than water. Is it in you? Symptoms noted are signs of mild to moderate dehydration. Consult a healthcare professional if symptoms persist. What are the ways that that data is going to be used? And I think one thing that 23andMe has done from the outset is we've always said that choice and transparency have to be really obvious to people. So for instance, we don't opt anyone in automatically to research. Over 80 % of our customers elect to opt into research. So they actually actively have to click that box.

11:20And we make it really clear when you're answering a survey, we make it really clear that you are answering questions and you are either opted in or opted out of research. So when we did our large partnership, our large collaboration with GSK, we actually emailed all of our customers with the link to say, if you no longer want to participate, here's how you can participate. So I would actually say it's more of a media story that likes to push on, you know, again, the privacy worries are very real. And the trust issues are absolutely real. But I think the way that you solve it is actually with the transparency.

11:56So I'm really quite proud of our brand, because I think we have a brand that's absolutely associated with research. So you may be right that it's a media sort of scare story, but I know one of the concerns that seems like a real concern is that, yes, I mean, there are these guarantees of privacy, but what happens in the future? Will it become easier in the future somehow to link this private anonymized data to an actual identity? And there's no real way to guarantee against that, is there? To guarantee consent or to guarantee privacy? privacy to guarantee you know privacy as as you know are the way that this anonymized data maybe can be used and broken i think the same way no website can promise you that your credit card is safe you know no one can absolutely but i think that you need to make sure that you that the risk versus the reward benefit is there and i think the thing with 23andMe is it's absolutely a choice people don't have to do it.

12:58So people have the ability to learn about themselves and they can not participate in research. Someone could do 23andMe, get all their information and then download it and close the account, which is totally fine too. So I think there's no way to 100 % guarantee that this is full safe. Anyone who tells you that is just lying. So I think we've taken, we've done a lot. The way I think we manage it is one, again, with the transparency and choice, but also with really being incredibly vigilant on the data security side. And from a structural component of, you know, keeping all of your identifiable information in a separate database from your genetic information to, you know, all kinds of various partnerships we do to make sure that we're vigilant on data security.

13:50So it's a top priority for us. I mean, I think we're still a relatively young company and have a mighty security team for those reasons. I know that you've been trying to look at COVID-19 and see if you can contribute to the knowledge and looking for genetic predisposition or anything. Have you found anything to talk about or is it too soon? And we have, you know, it's, I have to say, it's quite remarkable. And again, this to me speaks to some of the other things that you talked about, just in terms of choice and privacy and how people manage it. What we find is that people actually really want to participate in research, and they're just almost never given the opportunity to do it.

14:32So with COVID, obviously, as a national global crisis, we put out a survey to our customers, and we got over a million people relatively quickly to take this survey and 60 ,000 or so have COVID. And we were able to, you know, we were early on publishing about the O blood type being associated. There's publications that have come out now that we've contributed to. There's some other interesting findings that again, that are. Hey, Chicago, class it up with Crocs. You know, back to school is coming in fast. So why wait to find your new Fave footwear? Step into a local Crocs store and step into your new look.

15:12Try it. Style it. Make it yours. Because the right pair doesn't just show up. It shows off. First day fits, handled. Walk out ready for whatever's next. Visit your nearest Croc store today. Low energy? Unfocused? Foggy? You might be dehydrated. Gatorade Zero powders have been scientifically designed to help improve hydration balance in the body. with a clinically proven electrolyte blend and no artificial colors or flavors. Great tasting hydration no matter where you're going. Shop now online or at retailers nationwide. Gatorade hydrates better than water. Is it in you? Symptoms noted are signs of mild to moderate dehydration.

15:55Consult a healthcare professional if symptoms persist. Still pretty early. So we keep putting information out there either in the form of a blog post or a publication or contributing data to other groups that are publishing. But it's remarkable to me how quickly we could put together the survey, put it out to our customers, get over a million people to take that survey, you know, having tens of thousands of people who said that they had COVID and actually find meaningful results from that. So I know last year was, well, last year was tough for everybody and for a lot of companies. For you, as I understand it, demand for the product was down.

16:33You had to lay off staff. You know, as a manager, what have you learned from the journey, the 23andMe journey so far? Well, I mean, look, I think the most important thing running a company, and frankly, when I think back on the layoffs and this year, you can almost never predict what's going to happen. and so the most important thing you can do is about how are you going to respond and you can't prevent failure you can't prevent um you know you can't in some ways there's there's a lot of um factors that are just out of your control and what's key for me is making sure that we have um i have phenomenal people around me a phenomenal team and a process to be able to make decisions quickly and an adaptable enough culture so that when there are dramatic changes like last year, that we can react to it.

17:29So I always emphasize people not to fear failure, but just to really make sure they're continuously learning and use all the information that we've learned to make better decisions going forward. You mentioned that 23andMe will be riding the SPAC wave and going public. I guess that was announced a couple months ago. Are you still feeling optimistic about that path to a listing? I think so. Yeah. I mean, I feel super lucky because we had Richard Scheller has a SPAC. Sorry, not Richard Scheller, Richard Branson. Richard Scheller wishes he had a SPAC. Richard Scheller was our head of therapeutics.

18:08But Richard Branson with Virgin was an early investor in 23andMe, a phenomenal person and somebody who really defines almost how do you think big and clearly thinks big, has a huge vision and also knows how to manage ups and downs. And he has had experience in healthcare. And I just, I love, as a kid, I remember just loving Virgin Airlines and the cleverness of the brand. And there's so much aligned with what he has done in the travel sector and even with health care and the ability to have a vision, stick with it. It's long term and all around brand and consumer and doing something that's right by the person.

18:56So I think the SPAC process as well is I think it's here to stay. And I think it's a phenomenal process. And I think back again on my investment days where it was just all about the S1 and the IPOs, I think SPACs are here to stay. And I think it's frankly, it has some some significant advantages, which is why we chose that path. So I'm going to slip in some some audience questions. So here's a question from Magdalena, and it's really about your competitive landscape asking, how is 23andMe different from Ancestry or other competitors? How do you how do you make the case for 23andMe? It's pretty different in largely because 23andMe focuses on the recontact ability and the engagement of the customer.

19:42So when you think of ancestry is very much about the ancestry experience and getting you onto their tree. And what 23andMe has really done since day one is about how is it that I'm engaging you with your whole genome holistically, whether the answer. Hey, Chicago, class it up with Crocs. You know back to school is coming in fast. So why wait to find your new fave footwear? Step into a local croc store and step into your new look. Try it. Style it. Make it yours. Because the right pair doesn't just show up. It shows off. First day fits. Handled. Walk out ready for whatever's next. Visit your nearest croc store today.

20:28Low energy? Unfocused? Foggy? you might be dehydrated. Gatorade Zero powders have been scientifically designed to help improve hydration balance in the body with a clinically proven electrolyte blend and no artificial colors or flavors. Great tasting hydration no matter where you're going. Shop now online or at retailers nationwide. Gatorade hydrates better than water. Is it in you? Symptoms noted are signs of mild to moderate dehydration. Consult a healthcare professional if symptoms persist. The ancestry side, the health side, relationships to your family, relationships to other parts of the world.

21:03And I want to keep you coming back. And it's that engagement that is a huge differentiator. So ancestry, we saw a lot of overlap in the ancestry world. And, you know, it's an area that we, 23andMe, scientifically really pioneered this idea of autosomal ancestry. So the way that it can look at all of your chromosomes and understand where they are. It's an area that we really pioneered. And even the DNA relatives, the ability for you to compare your own genome to others out there and find family members. And so we also look at ourselves as as scientific leaders, like where we keep innovating and we keep innovating because we have an incredibly unique data set.

21:43So we can get insights from there and we keep giving it back to customers. When I think about other large genetic databases that are out there, the number one thing that they're missing is is really that engagement. You know, it's COVID-19 was a good example when we could put something out to people and very quickly have them fill out surveys and answer questions. And very, I don't see other companies or other academic groups that have that ability to so rapidly be able to engage people. Here's another audience question. The tech industry has not traditionally been a particularly welcoming place for women.

22:21Do you think that's changing? And, you know, are you are you trying to find ways to change that? I'm definitely in a I'm I have a little bit of a unique perspective here because I have my sister who also happens to be obviously female and a tech CEO. And so I've actually always had and I think about other people who are mentors like Sheryl Sandberg and others like I've been really lucky to be in a world where I've had phenomenal women around me and other people like Diane von Furstenberg and Arianna Huffington. These are all people who've reached out and been supportive. So I actually feel like like first and foremost, there's absolutely a problem.

23:01Like you just look at the numbers, like the numbers speak for themselves and there's an issue. So what can I do? My job is to make sure that I use my time effectively. And one of the things I can do with my time is to mentor. And I'm really happy at the number of people. I never want employees to leave 23andMe, but if they do, I want them to be successful. And I look at, you know, one of my former VP of business development is now a CEO of a biotech company. And one of my other product people started, you know, Modern Fertility. And I have a number of employees who have left and had that confidence in themselves and done something important and significant.

23:43So I think that one of the most important things for anyone who's in a position of responsibility, it's your job to make sure that you are pulling up, you know, people who are interested in pushing themselves further and bringing up a diverse world. So it's absolutely, it's a priority for me. So let's look forward. I mean, what are you seeing that I'll see at some point? You know, what's next in terms of genetic research, both in terms of something you could productize or just in terms of medical treatment? Well, I think the vision that Francis Collins outlined in 2003 ish of using the human genome to really predict, prevent and treat all human disease is real.

24:29Like that's absolutely a vision, I think, that is going to come to fruition one day. And it's just a matter of when. And what has been fascinating to me in this last year is the fact that COVID-19 accelerated all the entire virtual care world. And so virtual care is no longer seen as weird. It's seen as wonderful. And I think the world's not going back. So it's absolutely a moment now. Hey, it's Kelly Rowland. You may not know this, but I have eczema, so I get how it can steal your time. But why let eczema take over when you can talk to your doctor about ebglis? Ebglis Lubrikizumab LBKZ, a 250 milligram per two milliliter injection, is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema.

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25:58Breathe in. Now let it all out with Lincoln Rejuvenate, A multi-sensory feature available in the 2027 Navigator SUV. Experience a gentle massage, expansive visuals, and digital sense to help you relax in the driver's seat. It's your time for a reset. Visit Lincoln.com to learn more. Lincoln Rejuvenate does not operate unless the vehicle is in park. When the vehicle is off or if any door is open, do not use the feature in a closed garage or in other enclosed areas. See owner's manual for important operating instructions. where everything is changing we have this opportunity to you know really move forward this vision of helping everyone you know prevent predict and treat all human disease that has a genetic foundation so you know and i think one thing that's that's obvious in some ways in other sectors like when you sign up for apple news it's personalized for you or if you sign up for netflix that's personalized for you.

26:55And I think one of the key things that genetics is going to be able to do for people is to personalize their healthcare. Like everyone has a different hand that's been dealt to them. And so how do you take advantage of that and actually use that to have the best care possible and, you know, and the best prevention possible? So I think there is, I think the combination of the virtual care world, which is exploding, as well as the vision that, you know, genetic medicine really is going to have a huge impact on all aspects of your healthcare. As you look at the healthcare system, let's say in the US, because that's where you are, you know, people seem to be very proud of our system, but it doesn't really hold up all that well against systems in other countries.

27:44You know, when you look at that, do you think there are a couple of doable fixes that we could do to make our healthcare system as good as it could be? I am probably the worst person to ever pontificate on that one because I would say absolutely no. My decade of investing in healthcare made me realize that$4 trillion is a lot of money and no one's giving it up easily. So there's a lot of reasons why you can make money on diabetes, You can make money on readmissions. You can make money in every way as soon as you're sick. And I, there's, listen, there's all kinds of games. It's like taxes. There's all kinds of games you can play to follow the code to lead to a slightly better outcome.