Genomes Unlocked: Anne Wojcicki's Vision for 23andMe and the Future of Proactive Healthcare | E1858

33:42All of this data empowers farmers to drive resource efficiency, sustainability, and profits. So here's your call to action. if you want to be featured on this week in startups, like we just did for Photonics, you can go to startups.tech slash Jason and apply today. That's startups.tech slash Jason and fill out the form to apply. I'm always surprised like most people don't get regular blood tests. I have Hashimoto's. So I take, I take thyroid pills. And so it means I don't make enough thyroid. So I have to measure it regularly. And with each pregnancy, it dramatically changed. and I've had to adjust the dose.

34:18So I get blood every six months. And I'm one of those people, like I just, I get the order, but then I check all the other boxes. Like I just want everything. Why not? Well, it's interesting. And it's interesting. So I have also like 20 years of tracking in and I can see different things. But things like my hemoglobin A1C, you know, because we have a family history of diabetes. And I remember my doctor calling me once and she was like, what have you been doing? And she's like, your hemoglobin A1C is so high. and I was like really and I was like well the only thing that's different is like my like 23 and me we started stocking this really delicious aloe water and I was drinking like 10 to 12 a day and she was like 10 a day I was pregnant I was like they're really good she's like you need to she's like you need no more aloe water and it was interesting how much like just like one obviously like I was able to catch it quickly.

35:14Secondly, I could change my diet. You know, when I cut out carbs and I like cut out more sugar, I was like, it could drop so much. Like it was so empowering for me to see how much was actually in my control. And that I could like, I could make things like I could definitely have a high hemoglobin A1C if I want. And I could make it low if I want. Granted, not everyone can do that. But being educated, like not people, most people don't even know about the hemoglobin a1c there's other things that are really important like you know lp little a which is obviously like it's really important for heart disease there's also therapies that are being developed out there for that now knowing your cholesterol like so many important numbers for people to know and i do think it's that going to your question then about the physicians it's really hard for a physician to keep track of everything it's too much those people don't have have a, you know, continuous relationship with a physician.

36:09So one thing I always encourage people to do, like I do keep just a Google spreadsheet of all my blood tests I ever get, like keeping a sheet yourself so that I can then walk in. And I now, like I said, have 20 years of data where I can see how my thyroid has changed. And I can track that I can see my hemoglobin A1C and how that's changed. Like you need that information. And it's not on the physician. It's not on the healthcare system to do that. You are going to have to do that. So 23andMe is definitely also thinking about how I pull in all that information from you. How do I pull in your various medical records?

36:43How do I pull in your medication history? And then you're wearable. How can I help you also track and say, hey, when you haven't been feeling good and you're anemic and you're not sleeping as well, this is the type of outcome. Those insights are going to be so exciting for you. So when I think of like the future for us and data and LLM models, it's going to be about like pulling in all of that data, plus your genetics, plus survey information of like, well, how are you feeling? What are you doing? Like, and then really being able to help you manage with all of that information, because people are overwhelmed with all of, you know, the different data points coming now, and help you know, like, really what you should do.

37:23So this is where, you know, at some point you'll go to 23andMe and you'll just be talking to some AI, right? And you'll ask it like... Yeah, I mean, it's too much for any one clinician. Like you realize that like it's overwhelming amounts of data. So AI and LL, like it's so exciting what can happen there because you'll be able to help. You'll be able to keep track of everything that's happening. And then the more and more we'll be able to train models based on all the data that we have with respect to lifestyle, which frankly is like i think a missing piece from the sort of like the traditional health care system and the traditional research that's funded but how do we actually leverage all that environmental lifestyle information and then give that into a score really for you i did the pre novo or prenuvo yeah i did the prenovo i did the blood test there's a blood test for cancer screening yeah i just tell what's the name of that one grail yeah so i did that one uh knock on wood no problems and uh you know but when i when i did this pre-novo and i started talking to physicians i had two different physicians at the time was like kind of overlapping they all gave me the same camp response which is like well you know you could find things in there that could be something or you could find things in there that are nothing and it's going to give you anxiety and i'm like yeah no i i read that i did a google search right right you know i i i have that piece that i have that stump speech and i was like how many of these tests have you actually gone through with your patients and do you do them over time and just no answer and listen we're in the bay area yeah you know people of means have having access to this i'm not price sensitive to paying a doctor for an hour to talk to me um and they don't even these are great doctors awesome love them but they're not educated on this and then i saw vano was treating and he's like i think you know for the 95 percent of interactions with a doctor right now chat gpt could do a better job than, you know, maybe what's already happening.

39:16I don't know if I buy that, but it does seem like they're going down like some decision tree heuristics and opening a book and then repeating it back to you. So this, I think individually led healthcare is going to ultimately be the solution. I think you believe that as well. Individuals have to take control of this. Well, I think also, I mean, you talk about ProNuvo and others and I've done it as well. Like, we are really, we are definitely on the cutting edge. And so, you know, one of the things that is very true with healthcare is like, there's not necessarily guidelines, like, how do you actually use all that information?

39:49And I think that healthcare functions a lot based off, you know, what are the guidelines? What's the protocol? How should you do? It's all very evidence-based. So we're in a gray zone, like there's not necessarily great. So I've taken something like Prenuvo to say, I'm going to do it yearly. Me too. And I am going, what I'm looking for is not necessarily, okay, like, oh, I have, you know, you have this bump, like my knees are degrading, my spine. Super depressing. You're getting old. Exactly, exactly. It's all breaking down. I mean, what you want to do then is like, see, is it, is it changing?

40:23Like what in your body has changed? So what I, again, it's kind of when I think about my blood and how I track that, what I'm looking for is, is the change over time. like if something has been stable and consistent that's probably okay um but if i want to you know you're all going to find nodules so you're going to find nodules you're going to find things that look unusual you're going to say like hey your spine has these kind of issues like the for me like spine information was good like you see i'm like standing straighter now even just talking about it yeah knowing that my c4 c5 like i need to just be aware you know and i think looking at like the different nodules that I see in my body and then tracking, like it's exciting because I feel like then I can prevent, like if something pops up, I don't want to come when it's already too late and it's causing problems for me, then I can be proactive.

41:14And I do think that having a clinician or a clinician that's educated about like, Hey, you don't overreact to everything. And I think also that's where genetics is going to be interesting to say, okay, well, are you higher risk for pancreatic cancer? Are you higher risk for these other conditions? And then what does that increased monitoring look like? So, you know, I think more and more, there will be a world that again, a smaller community of people are pioneering, which is about really proactive, you know, prevention. So you can get all this information, you can be really proactive. And I think that the medical world in the more traditional way is looking to say, okay, well, does that actually improve survival and outcomes?

41:55i'm curious your thoughts on these glp ones um they have it seems like every time they do a study they're like yeah we can stop this study because it works so yeah they do a study on alcoholism they're like yep this helps with that wait diabetes it just helps with everything i did it uh lost maybe 20 plus pounds on it and had lost wow congrats well yeah i'm down 40 pounds but the first 20 was just fasting and going more keto and doing all that tim ferris kind of stuff and then the the second 20 which were kind of like the hard pounds just all will go via ozempic and it just works like magic um it's pretty amazing so when you've seen this like revolution all of a sudden happen go from people with diabetes to civilians people who are obese and then even people who maybe are just having like a sticky kind of final 10 pounds or whatever this is going to have a dramatic impact and why did why did we just figure this out now it's like one of those interesting things.

42:52There was actually, you know, this is a little bit of a lesson on healthcare for everybody and biotech industry. So when I was a biotech investor, back in like 2002, 2003, there was a company called Amelin, which actually sold to Amgen, I believe. But Amelin, I remember the CEO at one point telling me like, they were the ones who were originally pioneering the GLP ones, which come from the Gila monster, which is fascinating. And it was the first time I remember coming and saying like wow the gila monster is like has a role in healthcare monster i've never heard like a um it's worth like you should go and look at it it's like a lizard it's fascinating i'm looking at it right now g-i-l-a monster yeah yeah yeah it's a literal lizard yeah yeah yeah but that's where like people found it like researching the gila monster like again going back to my point like we're all connected like the variants of like genetics and life like Like the secrets are all around us and the solutions are all around us.

43:50Like we want to study everything. So again, it was like back, I mean, 20 years ago or now, like talking to the CEO and talking about how they were developing the GLP-1s for diabetes, but it was going to be useful in obesity one day. And I always think about that. It was like, okay, it took 20 years and that first drug had side effects and others, and then they kept reformulating it. So like 20 years ago, I remember definitely thinking like, oh, this is going to come and it potentially could be useful in obesity it sometimes takes that long in biotech like biotech is complicated like you're dealing with the human body and that's where again the potential of llm and predicting side effects predicting like what's the right kind of drug to design so like the idea was there 20 years ago i just pulled up this thing about i thought you were talking about like some esoteric biological term when you were like oh the gillemunster and i'm like typing in hi and you're talking about the gila monster it is a venomous uh lizard if it bites you you vomit it's not fun it's and then in the venom yeah they found that there was some uh some compound yeah that helped you metabolize sugar yeah hey isn't it so cool i'm just telling you bizarre i mean i'm gonna go get a komodo dragon and see what that does for me maybe i can run a six minute mile if i can get the venom of a komodo dragon those are my favorite of all the crazy things still on the planet saltwater crocodiles which i don't know if you've ever seen one in person no terrifying yeah like you see this and there are two moments in my life when i thought wow this is going to be a horrible but quick death uh one was seeing like a 15 foot saltwater crocodile on the beach in australia i was far enough away that was no threat but these things look like and like you're like okay that's like a tyrannous might as well be a tyrannosaurus rex or phylliselloropter you're dead and the second was in tahoe biking at uh sundown alone which you should never do and i come around the trail and there's a mountain lion on the trail oh no way wow like 10 feet away from me and i'm just like well that this is how it ends like this mountain lines you think are not like these big creatures this thing is giant it's like it looked like a pony wow just stared at me for five seconds and it just decided i'm not hungry and walked away wow it's like the longest five seconds of my life but all this stuff goes back to yeah we all came from some common humanity like it's you know there was that um article or there was that book you know why elephants don't get cancer you know there's i don't think that was the exact title or why elephants don't get ulcers um but like there's so much to discover in humanity you know and that's where like even people don't always realize like there's some people who genetically can't get hiv wow that's just they have a genetic variant and the virus cannot penetrate them and that now like there's a drug that's now modeled off that like if we study And again, the whole purpose here is like, if we study all of life and the genetics of life and why we have diversity, and that's actually why diversity is such an amazing and powerful part of humanity.

47:07It's like why some people have blue eyes or some people have dark skin or some people can smell things in a certain way or some people don't get HIV. Every single one of those variants in our genome is a story of our human survival. survival and that's why we want to study it and it's all good it's like helps us all understand how we can all be the best that we can be it's so it's so exciting and even again looking at like the gila monster like that's so cool like we can learn not just from other humans but from all of life that's out there and things that are pretty gnarly like you would be like well there's nothing to learn from venom that's gonna kill you and melt your you know muscle tissue it's like oh know there might be something actually in there it's almost like god's pointing like hey check this out i mean i'm an atheist i think people don't realize like taxol like which is a cancer treatment comes from a tree what like trees incredible trees are also like there's venomous trees like there's like or i don't know it's called venomous but there's poisonous trees like yeah there's so many cool things that you can learn from the world and and there's a number of products that we all take advantage of that actually came from you know other animals and other life that's out there.

48:20So we can learn a lot that way. And a lot of our products today, we just don't even realize that come from that. It's kind of like when you start getting towards this stuff, you start to believe that there is a higher power at work. And listen, I'm an atheist, and I kind of don't waste too much time on it. But it's like, wait a second, somebody did architect this? Yeah. You start thinking about that, you know, Gila monster or some of these things, you're like, okay, there must have been an architect. There must be an engineer somewhere in the cloud. I don't know if this is a simulation. You know what I feel like sometimes, like remember those books when we were little, like choose your own adventure?

48:55Yes. And you get to pick, like, I feel that way sometimes. Like there's like the clues are all there. We're just trying to pick them up. And like there is a solution somewhere. But my dad used to say that too, like when we would talk about these things, he's like, listen, the only thing that is so fascinating is how complex life is. Like it's the chance of it all... coming together and working this like is that the higher order like but it's just so it's it's so phenomenal and the fact that there are these pieces and the clues all over and that's why i just get so excited about all aspects of science it's like it's all these clues coming together it really is and this is where like the language models in year one like literally this week was the week where chat gpt 3.5 came out and you just think about what happened in 12 months people are taking pictures of you know tumors and people are uploading their prunovo and their blood testing and they're getting some value from this now obviously don't trust it the thing hallucinates it's imperfect but it could kind of point you to clues so now the silicon that we made is going to point us to more clues that we were finding through you know decade-long experimentation and research and people in the field you know collecting specimens and bringing it to laboratories is back to that these glps what do you think the impact is going to be because they feel like yeah make your own do your own research audience but it's uh i have to say this has been life-changing for me and i was at a poker game and i was i've been very open about it after about two years i started talking about because i didn't want to influence anybody to take this stuff talk to your doctor obviously i'm not a doctor don't take your don't take your medical advice from a podcaster or an angel investor there's better people to give you advice but now that i look at it i mean i was at this uh dinner and maybe like three of ten people were on it i was at this poker game four of nine people were on it like this is really spreading quickly and having a dramatic effect and it seems safe so yeah it almost feels like a miracle but what's your take on this and where it's going interesting and kind of where i brought up like you know the fact that it happened in 2022 or the early 2000s.

51:10Yes. So it's been research for quite a long time. And I think that there is a pretty well understanding, at least of how people are using it and some of the safety and some of the side effect profiles on it. I think what's inspiring for us and part of the reason why, even at 23andMe, we ponder like, what should we be doing with this and how should our customers interact with it? The fact that you're seeing such a positive result in the decrease of heart disease. Or it was interesting one day, there was an article that came out and all the dialysis stocks were down because the use of GLP-1 is going to mean less dialysis in the future.

51:53And so it's, I mean, again, this is what's so interesting in healthcare. And again, like how, if you can successfully prevent people from having some of these conditions, you will have certain businesses that get hit and go away. But like the reality is with GLP-1s in the short term, the data so far is really supporting that people are having not just weight loss benefits, but broad healthcare benefits. And I think it's too early to say exactly what that true impact is going to be, but it's certainly like really exciting and interesting to track. And that's actually why I think about it, even for 23andMe, for people who have risk factors for certain kinds of conditions, how should they be thinking about this and using it?

52:40Well, now you have the doctors. So if you can find these obesity, diabetes traits in the genome, you got lemonade, the doc, is that it's called lemonade? Yep. You got lemonade could give actually people a prescription and work with them on it. And that really feels to be that to me seems like this chasm that just you could fill in and build a bridge across. Yeah. what your predispositions are, what prescription do you need? Right. And that's exactly why we got lemonade with this idea is that like, the biggest bottleneck our customers face is the translation of what to do with the information when they go into the medical world.

53:15So us having a team of trained clinicians who know what to do with the information, that they have that ability to actually also get your prescription, we have a pharmacy, we ship out same day, that they can do lifestyle, they can do, you know, behavior, and if they need a medication, for instance, proactively managing blood pressure, that we can actually be a partner with them in doing that. It's so interesting to overlay financial systems. So like there's all these systems at work and then you have the financial system, which is a bunch of lunatic traders trying to make sense of the innovation that entrepreneurs are bringing to market.

53:52And then I too was listening to like CNBC at some point and they we're talking about ozempic etc and everybody's shorting like tgi fridays or you know frito-lays pepsi and it's like you know what not a crazy thought because if this became widespread and the concept of being obese became like yeah it kind of like smoking like we grew up i think we're the last generation you and i gen xers who remember do you remember being on a flight with ashtrays in the smoking section? Or did you miss that? I don't know. I remember being... Yeah, 100%. I remember... Well, listen. I remember going on a plane when there was no security and that you did have...

54:32I remember sitting in the smoking section or sitting behind the smoking section and saying, the smoke is floating over the cloud. Literally, there's a cloud in the back of the plane and you're like, this makes no logical sense. Why on earth? And they're like, well, if we don't, then half the country smokes, so we lose half our customers so they're kind of reasonable but the same way now if you took one of our children and put them on a plane and people were smoking they'd be like what's going on it burst into tears they were like this is crazy it would seem like you're on another planet and i think that's like maybe where obesity goes like the idea that we had this 30-year delusion that like this is fine large and in charge you could be obese and all body types are valid and whatever Listen, I don't want to be a bully or cruel to anybody, but man, I wish people had bullied me more when I was overweight, please.

55:24There's real health consequences. And I think that the reality is it's going to become a choice for individuals. Like, you know, I think that there's going to be obesity that, you know, leads to like real health issues. Like there's some obesity that's not going to have health issues, but it will become more and more in potentially an option where people can look at it really as a, you know, condition to be. medically managed. And I do think, you know, you talk about the economics of the healthcare system. You know, one of my favorite things to do is always to point out to people is that you can actually buy ETFs in obesity.

56:01Like there's ones that are out there. And like, isn't that crazy? I always love going to nonprofits. I'd be like, Hey, you know, you could actually just like invest in obesity. Like you could go and say, And a lot of the banks put out reports saying like, hey, here's all the companies that are maximizing obesity. And I remember even in 2006, there was a bunch of drugs going off patents. And I remember asking people like, what's going to save pharma? And they're like, obesity in China. Like, that's what's going to save us. Hundreds of millions of people are following the West down the road to obesity.

56:36Exactly. So the reality is that there's all of these industries that are set up to support health consequences of obesity. And it is a dramatic shift. If none of those people ended up having, you know, chronic kidney disease, what are those businesses? Like there's definitely going to be some businesses that go away. And you see this, like occasionally there are big technology shifts in healthcare. And then that changes and that re-renders certain, you know, areas. like no one does an iron lung anymore everyone who was like big in the iron lung business is gone so like there's going to be some areas like that and i think the glp ones have that potential to be that disruptive that's going to be extraordinary so literally like what email did to fax machines like i we also are the generation that remembers like a line at the fax machine it's like this is amazing we can get these eight pages to new york or tokyo and we don't need to get put somebody on a plane and it's like now you think about it you're like really there was a line for the fax machine i tried to explain this to somebody up in the middle of the night to like make a reservation and in europe yes yeah you you had to yeah do that i was explaining to my daughter because i was buying tickets to a movie for tonight and i was like you know we what we used to do is we would go to the movie theater at noon look at what was available for the weekend and you you'd pick what you wanted to watch that night And if you got there at six o 'clock, you would pick from whatever tickets were left.

58:04And then we had this amazing thing where you had 800 movie phone and you dialed your credit card into the phone and then it didn't work and you had to start over. But it took 10 minutes, but that was 20 less minutes than go to the movie there at noon. So it was a big innovation. So where is this all going? if you were to look at what's happening in terms of chemistry the genome finance consumers taking this all together if we were to look you know because now you got a little bit of an arc here this is your career this is your chosen work yeah obviously i suspect this will be the less the rest of your life's work i don't see you pivoting out of this because it's just getting interesting now it's just getting interesting yeah yeah like 17 years of pain and suffering to get to this point I think, right, as an entrepreneur.

58:50Now you look at the next 17. Okay, so if we just say, hey, this is the halfway mark on your journey, where do you think this goes in the next 17? I so you're, you're right, like, it's, it's super interesting. And I do look at that first 17 years of the company almost is that pain of establishing, you know, a brand, establishing a mechanism to get people their genetic information. So like, we've gone through the FDA. We have done all of the scientific validation work to prove out that the database and the data quality that we have, so that self-report information makes sense, that it works, that we can validate studies.

59:29All of that has been really well refined over the last 17 years. And we now have over 14 million customers. We have massive amounts of phenotypic data. We have shown that we can do research. We have drug discovery. We're ready to execute. And frankly, like LLMs becomes transformative because I think about on the consumer side, the ability for us to be the world's best in risk prediction, and then also to have to supplement healthcare providers with LLM, you know, chatbots that help coach you and look at all of your environmental information. And the reality is there's just been so many variables.

1:00:07How do you manage all of that? And I I think that's where developing the models to really do risk prediction and help think about like, okay, you Jason, like in five years, like, you have three different trajectories, pick the path that you want to be on. Choose your own adventure. And then we'll guide you to choose your own adventure, 100%. So I think that is really exciting. And frankly, I'm grateful to Apple, to Google, the Fitbit world, everyone who's developing the wearables, because that will become an integral part of all of this with your genetics about how do you want to manage your life?

1:00:44And it's one thing I like to also emphasize to people is that your health is not something about just showing up at the doctor once a year, but it's the sum of what you have done every single day. So every day matters. You can have a cheat day and you can go and be hungover and eat badly, but it's about the sum of everything that you have done. So every day does become cumulative in some capacity. So working out, small amounts of exercise, how you eat, all of that adds up. And I think that we'll be able to help really, for people who are interested, have the best outcomes they can. On drug discovery, it's fascinating because if you start with a human genetic insight, you are more than twice as likely to be successful on drug discovery.

1:01:28Oh, wow. I didn't know that. So that's why we started a drug discovery division in 2015, because starting with human genetic data means you're more likely to be successful. So for us, right now, we do these huge genome-wide association studies. Like we run through all the data, we look at all the genetic variants, we look to see if we can get insights. But understanding all those insights and then understanding what is that drug that you want to make to potentially, you know, modify that genetic variant is a lot of biology and a lot of work. And that's what I think can actually start to become disruptive.

1:02:03Are you going to actually develop that drug or are you going to work in partnership with somebody? People don't realize this. If you look at my burn rate, my burn rate is not from the consumer business. My burn rate is from drug discovery. So 23andMe actually has two programs in the clinic, both from immuno-oncology. And it's really interesting. What we were able to do is look at some of the existing, like these immuno-oncology drugs that are on the market today and look in our data set, what other genetic variants cause a similar kind of signature. And so we're looking to see, okay, like, hey, you know, the PD-L1, CTLA-4, this is what this looks like in the database.

1:02:40How do I actually find something that's similar? So we have two that are, you know, one that's in the clinic, one that should be going in the clinic soon. And then we have a whole drug discovery team dedicated to doing drug discovery. We've had a large partnership with GSK for years. So it's really exciting. And I think that's where like you yourself, like we like to say, you know, manage what you can, like change what you can manage what you can't. So some things are in your control to change and some things are not. And for the things that are not, we're going to take care of that with therapeutics and like being more aggressive with medical intervention.

1:03:16But for the things that are within your control that you can potentially change your lifestyle on, we're going to help you manage that. yeah so as a business you've got this you know profitable break even whatever business and you know for consumers but then you have this optionality this hit based business of a drug and if you can if you wind up doing 10 of these over the next decade or two if you hit but one that could be this explosive uh revenue stream for you yeah 100 100 i mean i think between now and then you have you know you have to invest in that therapeutics business so we definitely we look at partners, like that's one, a big opportunity for us.

1:03:55And that's actually where we've been focused is that, you know, us doing all like managing all that burn ourselves is not reasonable. So yeah, I was about to say, those are, yeah, those are expensive studies. Yeah. And also, like, what's the hit rate? I think this is one of the problems in terms of capital formation and placing these bets. Like, what is the hit rate on drugs these days? Like, more than half, 90 % fail 90%. I know it sounds like my job angel investing. It literally is 80 90 % go to zero yeah yeah i mean it's biotech's a tough business and i think again going back to sort of that that i have of the industry is that if if it was about you know if anyone could actually predict human biology you know pfizer would never fail like you could i mean you could buy it then if like if it was if i could hire the right people or do the right experiments like you wouldn't then like the big companies wouldn't fail they had like lily right now lily has so much cash because of GLP-1s.

1:04:50The reality is there's still always that mystery of biology and we don't understand it. But that's where I do think that there is an incredible promise with AI. And again, it has to be based in data. So again, we are excited about leveraging human genetics, the data set that we have for building DNA language models that are eventually going to translate and be an impact as part of new ways of doing drug discovery. So it's definitely exciting. what what if you just i mean imagine if every year you get 10 better at picking you know if you just reduce the mortality rate of drugs not working 10 a year yeah you could be sitting here in seven years and you could have doubled it i mean that could be just change all of society i mean the problem is it takes so long to develop a drug you know it takes 10 years to do so you don't know your outcomes you know that's my point on the glp1 is like back in 2022 or like you know 2000, I was talking about it, but it took 20 years.

1:05:50So it's just, it's a really slow process because you have to, you develop it, you do, you know, preclinical studies, and then you have to do your safety studies in humans. It takes the whole process takes a long time. Um, people don't mostly because of regulation. Um, I mean, there's obviously physics and then there's regulation. Yeah, there's it's regulation, but in some ways like you, you want to have regulation because you don't want to try drugs that don't work or that are not safe. So there's probably ways that you could, I mean, again, I would never say regulation is perfect, but there's going to be ways that you could obviously, you know, evolve over time.

1:06:23And I can imagine that. The preclinical studies are a lot of work. I think it's really going to be more about, are there ways for you to do biology at higher speed? And you have companies that are starting to look at that, like, how do I go from a genetic insight to then thinking about like, what is now that right drug to target to change that kind of pathway are there any countries i know this sounds crazy but are there any countries that have kind of lowered the safety regulations and are going much faster because i would think there would be some crazy country that would see an opportunity there but then also i guess you would have to also have engineer scientists and be somewhat enlightened to be able to even pursuing drug discovery so like we saw this with cloning at some point i guess the koreans were maybe jumping the fence a little bit lowering the regulation obviously bad things happened or and then in china somebody was doing something with cloning last year two years ago yeah with crisper and that got somebody i got in trouble yeah that's a big no-no so other people have gone rose um i mean look i think on gene editing and cloning and not as much cloning but on crisper um you know i think there's a there is a reasonable push for just having discussions around what is the right way to safely do that.

1:07:42And because you're really editing the genome, there's some concerns about, you know, making sure that you are thoughtful, you know, similar to what people have said about COVID and like whether or not it came from a man-made virus. Being thoughtful about the consequences of CRISPR, I think is important. Where do you wind up on that? You think this was done in a lab, right? It seems like everybody's kind of coming. Yeah. Where do you wind up? You put a percentage on it. Yeah. um look i think it's a reasonable assumption that um i mean look i think that there's there's there's debates on both sides but i think it's not unreasonable to say that it came from a lab yeah i mean the john stewart thing like wuhan came from this location the labs here there's a lot i mean you think even some of the data as people look at the genome again i haven't dug into it of great but of great um you know depth but people who i respect at least have you know there's there's reasonable hypotheses not saying for sure that's it but there's it's it would be something i rule out what do you take from that in terms of should we be even uh accelerating our understanding of those things or should we be pumping the brakes like Like this seems to be...

1:08:58I think that there's... I was with actually some friends from Stanford. Stanford has actually a pretty interesting CRISPR team. This guy actually grew up with, Matthew Porteus. And we were talking about things like the cystic fibrosis approval that just came out from Vertex. There's really interesting opportunities to cure disease. And so I think that I'm all about reasonable risk. You know, like, I think that you need to take a reasonable risk, because you could potentially really save someone's life. Yeah. And if you know, they're going to have a really poor quality of life, or you know that they are going to die, you should have a reasonable risk with them.

1:09:36So I do think about like, for instance, one of the things right now, and this would be a regulatory push. It's really hard to do a study of one person. So that's called like an IND of one person. And most centers are not set up for it. But like, it's these bespoke studies, they're called. And that's like part of, there's like a whole movement of like, how is it more and more that we can do studies on just one for people who are eager? And there's a lot of regulatory work to get to that. And I think like my main thing on regulatory and thinking about the future, and this does impact a lot of healthcare, it's like, we're in a world where we can track, we can get daily information.

1:10:17so planet.com takes a picture of earth every day and they know exactly when something like a tree has been cut down when a boat has moved like we need that snapshot of health care in this country so we don't have it it's so crazy we don't have that so like bizarre you should know side effects so like right now have have you ever reported a side effect to the fda of course not yes but you've had probably a lot i wouldn't even know where to begin it's a fast It's a fast. Oh, good. Yeah. Wow. Share the number with me offline. I don't want to, because, you know, it can be a busy signal on the fax line.

1:10:50I don't want to. Totally. It's hilarious. But I think that's my point. It's like, we all have different, like, great responses, adverse responses to drugs. Like, we should absolutely be like having that kind of real time. So when I think about, like, my main push on regulatory is like, drugs should get out there faster, but we should be much more comprehensive in following them regularly. And like part of what I think about also with 23andMe and with the opportunities that are coming with things like 21st century cures is the ability for you to easily get access to all your medical records. So there should be some way to pull all that data in a real time way to be able to track like, okay, how are people taking like a GOP-1?

1:11:33We want all that information. Like who's taking a GOP-1 and what's the side effects? Yeah, like, why can't I just opt into that? And then if you think about it, we would have solved for the spread of COVID much quicker if we had challenge trials. Now, most people don't know what a challenge trial is, but it's very simple. You introduce COVID into a person who's had a vaccine, and so they're taking a massive amount of risk, depending if they're, you know, have high risk factors. but there are young people who would love to, you know, say, you know what, for the sake of the world, I'll do a challenge trial.

1:12:09I'll opt into it. It's illegal in the United States, right? It's completely not allowed. It's unethical. But I guess in Europe, some countries allow it. Yeah. Well, they do the flu studies. Like, well, they'll give you the flu. I feel like COVID got into its own category, but like they will do the flu challenge. I think they've even done some malaria challenges. But I don't know if it's I don't know enough. I'm out of talking in the chart. I don't know if they do it in the US or if it's other countries. I just noticed some physicians signed a petition saying, hey, you know, post-COVID, we probably should rethink this concept because we let people go fight wars.

1:12:42You know, we got Navy SEALs who are putting themselves in massive amounts of risk. And a challenge trial is like a small portion of that risk that, you know, a Navy SEAL or a deep sea diver might opt into taking for whatever reason. And, you know, there's things we can think about ethically, morally, to your point about like, healthcare for one if i have cystic fibrosis and i actually have a family member this is a very rare thing it's like i think 30 40 000 people yeah in the u.s have it but i happen to have a family member who has it uh and um she's been very lucky because she got into some trials and she's lived an amazing life but the lifespan is typically very short but if you ask one of those people hey do you want to take something that could be risky or do you want to be part of this experimentation the heck yes i do yeah and i think this is where i think maybe some morality a lot i think this is So you're right.

1:13:28And I think the patient voice, and again, this to me, again, it goes back to a lot of things that we think about is like more and more, I think healthcare will change when the consumer has a bigger voice. But right now, if you think about like even talking about clinical trials and talking about this, you have a regulatory body that makes decisions. How do you have almost a stronger collective voice of the community about what we want? So there are patient advocates and there are patient counsels, but I would say the average individual is not terribly involved. And so are there better ways for us to have that kind of advocacy about like, what is it that is important to us?

1:14:04And then I look at things like end of one studies, especially for cancer. How do you actually start to have more and more of that? Like, how can you actually, you know, pioneer if you already know that there's going to be a bad outcome in the area? how can you actually instead then have a n of one study to be able to push the boundaries of science and actually really better understand and like and also grant the patient wishes yeah great great thoughts all right listen and i gotta let you go you've been so generous with your time it's awesome to talk to you mind-blowing listen to you go watch this movie prometheus i want to talk to you they'll have what we'll have a post prometheus discussion but it really is i just love science fiction and it's just like this incredible mind-blowing that puts together our whole discussion and a lot of your career, frankly, of these engineers and why are they doing what they're doing?

1:14:51And it's a little dark and crazy, but you'll very much enjoy it. So that's interesting. I love it. Everybody go to 23andMe, sign up if you haven't done it, join one of the programs, take control of your healthcare, yada, yada, yada. And I know you're hiring all the time. So I guess you go to the 23andMe careers page, you want to work for somebody brilliant like Anne? Yeah, sounds like a good noble mission instead of trying to optimize, no offense to people making money off advertising, but some social network optimizing advertising to make people click 10 basis points more. The next big area definitely is being able to really train.

1:15:28Well, being able to transform health, like understanding the language. Like for me, it's about like, understand the language of life, just like big picture. Like to me, that is a computational issue. And it's so exciting and it impacts everything around you. So I just, it's so exciting to be alive at this very moment. And you know, it's like, we're such a lucky generation because we get to say it every 10 years or so, like, oh, wow, this mobile phone came out, can do everything. Wow. So great to be alive right now. Oh, electric cars. Oh, space travel. Oh, the internet itself. Like, it's just every like seven to 10 years, we have this great Christmas present under the tree.

1:16:02And it's like, we open it up and it's like, oh my God, the world is going to advance. And people are so negative. People are so caught up in nonsense. And if you just look at entrepreneurship, science, technology, research, you become so optimistic, right? I think it's one of the great things about living in the Bay Area is just so many optimistic people. Yeah, it's going to be super exciting. Okay, and can't wait to see you again. And we'll see you all next time. Great to see you. Thanks for doing it. See you next time, everybody. Bye-bye.