This Week in Startups - Genomes Unlocked: Anne Wojcicki's Vision for 23andMe and the Future of Proactive Healthcare | E1858

Starting point is 00:00:00 There's so much to discover in humanity. Yeah. 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 mind-blown. They have a genetic variant, and the virus cannot penetrate them. And now, like, there's a drug that's now modeled off that.

Starting point is 00:00:17 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. It'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. This weekend startups is brought to you by CLA. Innovation takes balance. CLA's CPAs, consultants, and wealth advisors can help you get from startup to where you want to end up. Get started now at cLA connect.com slash tech.

Starting point is 00:01:02 House of macadamias is the next big health trend. Get a free month supply of macadamia milk with any order at House of macadamias.com slash twist by using code twist 20. And dottech domains has a new program called startups. com, where you can get your company featured on this week in startups. Go to startups.tech slash Jason to find out how. All right, everybody, welcome back to the program. 23 and me has been sequencing people's genomes for close to two decades now.

Starting point is 00:01:35 14 million people have done this already, probably more at this time. And it used to be something a lot of the quantified self people were obsessed with, you know, Tim Ferriss and all those folks. But now this has become a cultural phenomenon every Black Friday, every Cyber Monday. You see 23 and Me tests all over the place. People are taking them. They're talking about it at Thanksgiving and over the holiday break. And these things are evolving, right?

Starting point is 00:02:00 The evolution of what 23 and me is offering has expanded greatly. And we're going to get an update on that from Ann Wichitski today. And I suspect, Anne with AI and this big revolution going on, all this data and some of the new offerings you have, something is happening here and coming together as you get into the second decade of this company, huh? Oh, definitely. Definitely. So many good questions and all of that. I mean, I think that the reason why we started 23 and me was, if you can almost look back to when Clinton and team came out and said, you know, the human genome has the potential to revolutionize how we diagnose, treat, and prevent all human disease. And the realities were getting closer and closer to that. And so as you have data, have you have massive amounts of data that you can. actually learn from and understand, and now you have the age of LLM and AI, you're going to really be able to predict and prevent, which is what I'm most focused on, it's like predict and prevent human disease. And I think coming as well as the biotech revolution, where you will be able

Starting point is 00:03:10 to use all that data then to really treat and develop novel therapeutics for disease. What technology's done to the cost of this is a major part of it. When it was George Church, who did the first one, right? The sequence of the first human genome. Craig Venter. Craig. Yeah, yeah, yeah, yeah. No, they wouldn't like you.

Starting point is 00:03:29 If I said that, yeah. So I know, I know a bunch of smart Harvard people did this. A lot of smart people. A lot of smart people were involved in the sequencing of the human genome. And George was definitely quite important there too. If I remember correctly, didn't this cost like well over a billion dollars to do the first one? Billions.

Starting point is 00:03:45 Yeah, yeah, yeah. Yeah. And so explain to the audience, you know, like what, what happened in technology? in just two decades that made it drop so precipitously that now I think you can do this for 99 bucks. It's basically cheaper than taking a Southwest flight. It is remarkable when I think on that initiative. It's like when you first start, you were just able to look at single data points in your genome. And you think about what one of the things that was really revolutionized around that time sort of the late 90s and early 2000 was the shotgun sequencing and the ability for you to

Starting point is 00:04:19 sort of chop up your genome, sequence these little bits, and then the computation of like putting that together. So imagine like a really, really complicated puzzle and you got to put this all together. So that's called these, you know, reference genomes. And it became, it was a very expensive initial project. And as technology, like really largely thanks to Illumina, Aluminah drove down the cost of sequencing. And it came really from major technology innovations as well as volume and market demand for these services. But Illumina has single-handle-handle-me really been able to develop technologies, chip technology, where they were able to put a number of the known human variants on a chip and allow people to test themselves.

Starting point is 00:05:10 And 23 and me actually started when there's actually another company called Affometrics, but Affametrics launched something called the 550K, and it was the first time you could actually get a whole genome analysis pretty cheaply. And Aluminah came in hot and heavy and was able to drop down that pricing, and they've been able to continue to drop down that pricing, and they've actually now really aggressively dropped it for getting your entire human genome. And the fact that there are so many of these human genomes that were out there, you could have reference populations that you could make sure that you were building against,

Starting point is 00:05:46 you know, it became very accessible for everybody. So people sometimes also get a little confused because we, 23-mead genotypes people, so meaning we look at all of the known variable regions in the genome. But you can also now get your whole genome or, you know, you can actually start to look deeper and deeper. And as we understand some of these harder to analyze areas, there's reasons for people to come back and actually test themselves again. Yeah, so this seems to be like a turning point.

Starting point is 00:06:13 People, when they initially took these tests, it was a novelty. Maybe they were really into their ancestry. They wanted to know where they were from. And listen, people got a lot of surprises. People found relatives they didn't know they had. All that is just fascinating on a social basis. But then the promise was always, hey, we're going to be able to tell you, you might have a predisposition to this disease later in life.

Starting point is 00:06:37 Maybe here are some ideas of what you could do knowing that, right? And so when we look at both of those use cases, the first one's obvious. Like, I want to know where I came from. It's super fascinating. I'm sure you had some great stories there and people finding, I mean, actually, there's been some really weird stories too, people finding out that like. Oh, there's a lot of weird stories. Yeah.

Starting point is 00:06:59 There was some documentary, and I don't know if it was 23 and me, but I remember seeing this documentary of a doctor who was a fertility doctor who had essentially inseminated people. Our father. Yes. Our father. Yeah, yeah, yeah, yeah. We are prominently featured in that.

Starting point is 00:07:15 Yes, I mean, they are. I mean, people learn all kinds of interesting things. Like, the thing that's so interesting about your genome, and actually just, I should take a step back, the thing that's so interesting about genetics is it is the code for all of life. So, like, obviously, we're most interested in the human gene. you know, but my, the thing that's the, like, what captured my, my fascination with this in the early days was that you have these four base pairs, like an AC, G, and T. And different combinations of that can give you a fly or a banana or a tree or, you know, you. And it's so interesting. Like, how is it that? Like these different combinations. Like, and in some ways, like, because we live in, obviously, this technological aid, I love it this. I'm like, this is just a code. Like, don't we want to understand it? It's like the whole code of life. And so it's interesting to think about, you know, your ancestry and your family and your

Starting point is 00:08:14 connections and your health, but it's actually the fundamentals of everything about you, as well as everything about our common past. Like, we all have a common past of humanity. Like, where did we come from? How are we all connected? What are our common ancestors? Like, I was point to my kids, I'm like, you have a common ancestor with the banana slug. Like, you are, like you, you, not just in the fact that you don't want to wake up in the morning, but like, you are. You just want to stare at your phone and scroll TikTok. It's not just that kind of slug. Exactly. Exactly. But, you know, we share a common foundation. Like all of life has a, has a common history. And so that's what I'm so excited about understanding about it. And I'm so

Starting point is 00:09:00 side for individuals to be able to learn about themselves. And the ancestry part is fascinating. Like, how did we evolve? Like, where are you from in the world? And, you know, how you could find connections that you never thought about. But then also, well, how do you actually live as healthy as possible? Like, I all, we all want to be, I mean, frankly, I look at like in the last week, as, you know, you have Churchill and you have Charlie Munger. Like, I want to be like them. Isn't that amazing? A hundred years old and 99. and like 11 months old. So essentially they were 200 years old.

Starting point is 00:09:34 Yeah. Between them, it's incredible. 100%. And I look at that. I was like, they were still planning meetings. They were still like,

Starting point is 00:09:39 I want to be that. Like as vibrant and as healthy as possible. So what do I need to do? And if there's risk factors in me, if I have, you know, an important risk factor that I need to take medical action on or I need to change my lifestyle,

Starting point is 00:09:53 like tell me, tell me. And I will be proactive and I'll do that. What are the things? I want to get into science fiction. So I just put a note. about, you ever see the movie Prometheus by chance with the Alien series? Maybe not.

Starting point is 00:10:05 Okay. Oh, pop culture-wise, what you just described is essentially this guy from Prometheus, Wayland, who runs the, this enterprise, basically, to go find out who the engineers are. And it's going to blow your mind just how great, really Scott was at taking what happened with the genome and then put it into science fiction because he basically goes and tries to find who created the aliens, you know, like the crazy monsters from that. And then also, oh, wait, they also created the humans. Oh, and they were terraforming planets.

Starting point is 00:10:34 It's just mind-blowing. But it does make us wonder, when you start doing the genome, and then you start putting in like AI, which seems to be recreating in some ways consciousness, which we'll get to in a minute, but it feels like they're trying to unpack exactly how human cognition works, which is super mind-blowing. Like, it's almost like we're on the precipice of figuring out something very fundamental in our lifetime. All right, everybody.

Starting point is 00:11:00 Stephen Estes is a principal at CLA, Clifton, Larson Allen. This is a professional service provider that specializes in CPA, tax consulting and wealth advisory. Welcome to the program, Stephen. Thank you for having me. Maybe you can talk a little bit about private equity versus venture. You work with both types of companies. We're seeing some startups that maybe venture capital aren't as interested in, but private equity is very interested in.

Starting point is 00:11:23 So how do those companies generally operate differently? To some extent, venture capital and private equity both serve the same. in primary purpose, right? We're looking to expedite a company's growth, but maybe that's kind of where the similarities can end. VCs are looking to maximize the company's value, right? We're trying to grow that top line revenues, whereas PEs can be a little bit more focused on taking an active role within the company, growing a sustainable and profitable business. I mean, a lot of different PEs out there, some that are just looking to maintain a, you know, 20 or 30 percent stakes so that the founders are still, you know, have enough skin in the game and

Starting point is 00:11:57 they're actively involved, whereas others want to have control. And, you know, all VCs are not created the same either. But I think the most important thing for founders is to not limit their options or considerations to one of the other, right? There's a number of ways to grow a successful business. And it's important to consider what each route's going to look like at the end of the day. Get started right now at CLA connect.com slash tech. Let them know your boy, J.Kalllll sent you.

Starting point is 00:12:19 CLA connect.com slash tech to get started right now. Do you ever think about that? Like, is there going to be some fundamental tipping point here? where we understand things that we didn't ever think we could understand and what those things might be. Well, I, you know, my, I mean, I love these conversations. So my father was a particle physicist. And we used to talk about the intersection all the time of physics and biology.

Starting point is 00:12:48 Like at some point, as you understand subatomic particles and understand prediction, like, at what point could you really understand all cellular function and predict out? comes the thing that I love about science and I always try to get kids to think about is like there's just an endless amount of open questions and for us to ponder like there is like where it's all connected in some way you know the world of physics and what my dad was studying and you know the search of mass and neutrinos and you know again we just had his memorial and I was with a couple friends like talking about the neutrino world and like they're all over but they don't interact with any of ourselves. They don't interact with the earth. Like they don't like like what, but how is that

Starting point is 00:13:31 connected? What is the purpose of this? What is the purpose? And why is my dark matter? What is it doing out there? Yeah. Right. But I think that there is going to be a world where at some point, you will be able to understand the very basics and the foundations of, you know, how how the world, the universe really is working and then how that actually led to all of us. I think that's going to be far off. But I do think that there's a lot of really phenomenal discoveries happening in very basics, whether it's in physics and in chemistry. And then I think also that brings in the whole world of language models and the ability

Starting point is 00:14:13 for you to predict things now like protein function and for you to predict, you know, variant resolution. So understanding what a particular mutation is doing, like that's, you know, that's going to be, that's going to be the fascinating world. And I think understanding the one thing that I always have a huge appreciation for is just how complex the human body is. And so your ability to predict all those different interactions in your body and exactly how that's turned into you is just like such an exciting and interesting problem.

Starting point is 00:14:44 What have we learned in terms of healthcare? Let's get back to this pursuit of hitting 100 years old or 120. We seem to have, in terms of lifespan in the Western world, the things that kill us seem to be self-inflicted, diabetes, you know, smoking, opioid, suicide. It's almost like where the limitation now has been the surplus and the abundance we have in society in the West is kind of like capped us out at whatever it is, 76 or 77 year old average lifespan. But you do see people who have access to health care and some of these new technologies and maybe some thoughtfulness really starting to live to 90. 100, but also as Pedia, what is the name, Atia, sort of talks about health span. And I think that might be the big unlock is that like, hey, 80s and 90s, you could actually

Starting point is 00:15:37 be like Charlie Munger and doing Q&As with, you know, world-smartest people asking you really challenging questions and be witty and be there, not like be a vegetable. So what have we learned from this, or what have you learned in the company from the last 17, 18 years, 14, 15 million people doing this, that applies most dramatically to health span, lifespan, and just living a better life. Like what's, what's been accomplished here? Well, I think the first thing that's really, almost the lowest hanging fruit is you have certain genetic variants like Broca mutation or Lynch syndrome, which are sort of well known. So broca mutations can make you high risk for breast cancer and a number of other cancers.

Starting point is 00:16:20 Lynch syndrome can make you high risk for early colon cancers and other conditions. What always saddens me is that genetic testing, despite being a 20-year-old technology, and despite being very affordable, is not a universal part of any health care system. And it really should be. And there's all kinds of really important genetic variants that every single person should know about today. So for example, all your cancer risks, if you have a BRCA mutation, you should know about it because you can be proactive about doing a mastectomy or about screening for cancer. And if you Lynch syndrome, you should be proactive then about colonoscopies. If you're high risk for something

Starting point is 00:17:11 called factor five, and that means for blood clotting, you should be proactive about how you are flying and make sure that you're wearing compression stockings or moving around when you're on an airplane, I can go through a whole list of genetic variants that are important for people and their outcomes. And so the easiest thing for right now when I think about people increasing their health span is about avoiding preventable deaths. And so right now there's a lot of people who have a condition where they could really manage it and they are not getting access to that genetic information through the existing healthcare system and largely in part because I think it's just it's not part of the reimbursement system. It's not part of the education

Starting point is 00:17:57 system. But through 23 million through other groups out there, you have access to it. People should get access to it now. And I think you're going to be able to prevent a big number of preventable deaths. I think then you do have a lot of conditions like heart disease, obesity, et cetera, that have an environmental component as well. But there are genetics with that. So understanding the genetic components there, I think it will help people be able to also manage that, manage their lifestyle. Understand, for instance, like with all these GLP ones now, who is it who actually really should be proactive thinking about that before they end up having any other sort of serious health consequences from obesity? Like, how do you actually help use those therapies and get it to people at the right time? It's super fascinating when I hear you talk about how obvious this is.

Starting point is 00:18:43 It reminds me, I don't know if you've ever read about like the introduction of the seatbelt, you know, and the shoulder belt and like airbags. Like we had these things so many years earlier than we actually implemented them. And it's like we have people driving around in cars and we can easily put an airbag and a shoulder belt in them and save 100,000 lives a year, whatever it is. And oh, by the way, it costs $99 or $199, whatever it costs. And we're not doing it as a society. any society out there that, you know, I don't know, smaller, affluent, Nordic country that just said,

Starting point is 00:19:19 you know what, everybody in the country is going to have this as a offering for free as part of their universal health care. Has anybody made that jump yet? Canada, Norway, I don't know. I think that the closest is actually in the UK. The UK has a couple initiatives. They've the UK Biobank and they have a new initiative called our future health. And that, you know, UK Biobank has half a million people and our future health is five million people. And so they talk about returning those results to individuals. The U.S. has an initiative as well to get a million people, but they have not returned results yet.

Starting point is 00:19:56 I think there's a couple of things. I think one, like the healthcare system is not well set up to fund prevention. And I think a lot of physicians are also not trained on how to use genetic information. So if you think about if I find out that you're higher risk for something, you know, how is it, you know, all those costs, you know, for instance, let's say you're higher risk for colon cancer and I'm going to go and do proactive colonoscopies on you. You know, the way the health care system works is they're going to look at what does that cost of preventing versus just treating you once you have the disease. And also because not everyone's going to develop the disease. So one example in particular was for factor five, which is the one that makes you higher risk for blood clots. So any woman who is taking, you know, an estrogen-based birth control, if you have the factor five mutation, you're higher risk even with a blood clot.

Starting point is 00:20:59 So if you ask companies, like, well, why don't you pay for people to get tested for factor five and actually screen, they'll say it's just cheaper to treat people. once they have a blood clot, then it is, which is true. You know, like, that's part of the issue with population-based healthcare and, like, there's a limited number of dollars. And frankly, I think that's why 23Me is a believer in both an insured, covered world,

Starting point is 00:21:23 but also a self-paid world. So people should go and get this information on their own proactively. If you are a carrier for Factor 5, your physician in the medical world then has an obligation to use this information and to integrate and into care.

Starting point is 00:21:38 So for instance, if you found out your fur factor five and you take that then into your doctor, you're going to have a different triage for pregnancy, for taking oral contraceptives, you're going to have, you know, probably a different type of oral contraceptive. So you would then have that triage in. And so 23 Me has always been an advocate of people should have the ability to get their genetic information on their own. It's a self-pay, but you can be part of an FSA. Like you can pay for it in different ways.

Starting point is 00:22:05 But once you have that medical information, the power. is in your hands to decide how you want the healthcare providers to use it or potentially to not use it. But then you have that ability to say, yes, I want. I have a Brockett mutation. I have a factor five. I have, you know, familiar hyperclosteremia. I need now to get into the system and I need to be proactively managed. Okay, I got a funny story to tell you. House of Macadamia's graciously sponsored the All-In Summit. And to wow the crowds, they created a special addition, salt and vinegar. pack of macadamia nuts. And guess what? People went crazy for them. Dozens have been messaging the founder Brandon asking him to make the salt and vinegar nuts available on the website. Listen,

Starting point is 00:22:49 you've heard me rave about the health benefits of macadamia's, but don't take it from me. The most health conscious people in the world are eating them. Dr. Andrew Huberman, I like his podcast. I started listening to it. He mentioned he snacks on macadamias in his GQ profile. And that guy, Brian Johnson, he was on the podcast when he wasn't a health lunatic. He's trying to versus aging, and he eats macadamia. So all you really need to know, House of Macadamia's products are delicious and they support good health. My favorite, dry roasted chocolate dip macadamias, you know, I get my chocolate dipped in there, and they also have a dipped snack bar. So I put a couple of those in my backpack. I put a couple of them in my little roller, so I have a healthy

Starting point is 00:23:28 and delicious snack. I make a better decision. Listen, I've ate a candy bar, which, you know, sometimes I break down and I buy one of those. Not a good choice for me. Now I make a better choice. House of Macadamias, they got a new product, macadamia milk. Get a free month's supply of macadamia milk with any order at House of Macadamacadamia's.com slash twist. That's a free month supply of macadamia milk with the code Twist 20 at House of Macadamacadamias. com slash twist. It does feel like consumers are now starting to do this.

Starting point is 00:23:58 They're starting to look at the healthcare system and say, hey, there's things I can do on my own, proactively, out of my own pocket that I want to do. this other thing, you know, whatever I'm covered for. And, you know, that does seem to be a really nice trend that's occurring. I noticed this when we were looking at investments in healthcare and we made an investment in a meditation company calm and everybody was like, this will never work. And then millions of people actually signed up because they just wanted to use this as a solution.

Starting point is 00:24:28 And it wasn't like the Medicare, the medical system in America is going to pay for people to go do meditation, even though that could have a really great impact on them. It's just a backward system, I guess, where if the price comes in, yeah, it's weird. Well, I mean, I think about, like, I remember asking people, like, look, at the end of the day, like, why isn't something like weight watchers or calm free for every single American? Yeah. Like, if it's such an issue, and it should be. And I think that that's part of an issue is like we just don't have incentives that are aligned. You know, the healthcare system is full of really great people who, you know, are there to take care of patients and care about individuals.

Starting point is 00:25:04 but fundamentally the system pays for services once you're sick. Like if you're not sick, people aren't paying for it. So I have a friend who ran a diabetes prevention center, and she's like, oh, I'm reminded every day that that's a cost center, that we only make money treating diabetes. We don't make money preventing it. And so I do think there is a really important role. And I think consumers are actually used to this now.

Starting point is 00:25:31 Like they are used to saying, like, hey, no one's paying for my yield. No one's paying for my $45 sole cycle class. Like you have to take ownership. And I think prevention is something that is largely in the hands of the individual. And you have to be proactive. But the thing that has been important for me to realize with 23 me is that I need to help my customers know when do you go into the physician. So for example, and that's actually part of the reason why we bought a company called Lemonade. Oh, yes.

Starting point is 00:26:01 Yeah, that has a physician group. and we hired a really impressive, you know, physician Lee, Nora Bulhoussin, who ran genomic medicine at Cedar Sinai, and, you know, how we actually are going to deliver genomic medicine to all 14 million customers so that people can get their information. They can self-pay. They can get it from us. But that they now have this ability to go and actually get physician advice when they need it and also recognizing that most clinicians today or most healthcare practitioners are just not trained

Starting point is 00:26:34 on genetic information. So if you have something like you want to prevent chronic kidney disease, where do you go for that kind of information? We will become that best source for it. And then they can help guide you to say, okay, you want to be able to take medications that are going to more proactively manage your blood pressure. Here's actually how you should do it. And then you can kind to go back and forth between a self-pay in a covered world. And there's also blood testing that fits into this, because I saw that you now have a subscription model, yeah. What is it called?

Starting point is 00:27:06 Total health. Total health. Is it an e-exome sequencing or exome? It is an exome. Good job. E-Xom. Yeah, you actually say the e-exam. Ex-em really looking at all of your genes.

Starting point is 00:27:16 So it's kind of going deeper. So it's not the whole genome, which sequences a lot of regions that are left like to be as clinically relevant. And there's still some cases where a whole genome makes sense. But again, we're kind of stepping up more and more into that clinical world as well as what is financially feasible for most people. And an exome at this point in time will get you a lot more information that will supplement what you get from 23 ME, but it's going to have a deeper, you know, clinical sequencing. So we don't, for instance, test for all the Brock mutations, but we do a very comprehensive scan across your entire genome to see if there's potentially

Starting point is 00:27:58 variants that you have that you want to follow up on. But if you came and you told us that, you know, I'm not of Jewish descent, but I have this family history of breast cancer, we would then recommend and say, like, yes, you should get this exome. And what's interesting, actually, even with total health, like part of it, I mentioned my father, who had just recently passed away, a lot of, you know, we've talked about doing an exome for a while, but I actually realized this even with my father, who had a heart condition and was being treated at a facility that was, you know, that's amazing. We got great care.

Starting point is 00:28:34 I'm obviously, like, very adept at genetic information. I'm a good daughter to have. I'm a good daughter to have. Good daughter to have doing your advocacy. Exactly. We were, yes, I know. I always have to apologize to physicians. Like, I'm sorry that we're so aggressive. But even, still, it wasn't until, you know, a week or so before he died that I said, I need to get a whole shot. I need to get an exome on my father. And even though his clinician is also very adept at genetics, no one had ever asked. But it actually turned out that he had a mutation that was actually the fundamental foundation

Starting point is 00:29:15 of a lot of his heart conditions. and if he had known that 10 years prior, he potentially would have had a different outcome. And that to me kind of like honed in why everyone should have something like total health or an exome is that even if you're getting great care, everyone still just needs to have the fundamental information. And there's a lot of things that,

Starting point is 00:29:42 a lot of actions that you can take now to have better health care. outcomes and the information we had 10 years ago has really evolved quite a bit. Just in the last decade. Just in the last decade. And that's actually like that's also like when I think about LLM, what's so exciting is the ability. And again, the reason why we have a subscription model now is to keep you updated. Yes. Like to keep saying it's like, okay, next year, maybe we have discovered something like, hey, we can. And more and more it's getting into that world of lifestyle. And what's super exciting is like the world of like sleep. You know, you mentioned calm. Like

Starting point is 00:30:16 your stress levels. Like, what are those things that most impact you? Like my kids, like, I'm a total night owl. Like, how does that impact when I don't have enough sleep? Do I, should I be going to bed earlier? Like, how do I live my life? And are there, is there coaching that I should do that's going to better impact my health outcomes? And I look at that example, something like a heart condition. There's a lot of lifestyle factors that really would have influenced for him. Yeah. See, this is where it gets super interesting. It is this blood testing plus lifestyle changes, plus quantified self, all of these things have been

Starting point is 00:30:50 at entrepreneurs like yourself, or Alex from Calm, or this is coaching company, found bio that I've been using. Yeah, yeah. Kind of interesting, like, you know, kind of taking what Peter does,

Starting point is 00:31:04 which is absurdly expensive and for the 0.1% of society, maybe saying, hey, can we get that to the next 10%. Kind of like what you did with, you know, 23 of me is like, how far down,

Starting point is 00:31:14 you know, this bell curve of adoption can we get this stuff, but it's all got to come together. And this is a thing that I find insanely frustrating. I have my weight information. I have my prescriptions. I have my steps, you know, Apple Watch, Calm, meditation, eight sleep, aura. Everybody's got all this different disparate data pools.

Starting point is 00:31:37 And I'm just hoping somebody, and, you know, maybe it will be 23 and me with, you know, the subscription service can start to put that together and then, connect coaching to it because if you were to look at the average general practitioner in America, you know, really hardworking people, as we know, overwhelmed in many cases is a very difficult job. The system is, you know, just hard for them to be part of the healthcare machine. Of them, what percent do you think have, what you would describe as a great knowledge of how to use genomics and blood tests to give people great advice, like actually? What percent are, you know, have had the time to be educated enough?

Starting point is 00:32:20 It's so hard now. I mean, I think, I mean, even answering and I did realize I didn't answer your question on blood, I'm always surprised. Like, when's the last time you did blood? Did it in the last year because I'm on this bit of a health care with Fount Bio, right? And I'm, I'm 53 now. This last week was my birthday. Oh, happy birthday.

Starting point is 00:32:39 Thanks. And I'm trying to get in the best shape of my life, my adult life, in my 50s. Because I'm like, you know what? after reading about health span and all this stuff, that now is the time, I think, right? Your 50s is the time to super invest in it. So I've been any test that's available I'm taking, I'm going to join your total health thing.

Starting point is 00:32:55 Okay. Get that 360 going. We're back with another segment of Pitch It to J-Cap. dot tech domains is giving twist listeners the chance to show off their startup right here on this week in startups. So go to startups. So go to startups. Dot Tech slash Jason to apply.

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Starting point is 00:33:54 you can go to startups.com slash jason and apply today. That's startups.com 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, so 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. So 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. Sure. Why not?

Starting point is 00:34:27 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? 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 me, we started

Starting point is 00:34:53 stocking this really delicious aloe water. And I was drinking like 10 to 12 a day. And she was like, what? 10 a day. I was like, they're really good. She's like, you need to. 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.

Starting point is 00:35:14 Secondly, 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 a 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

Starting point is 00:35:54 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. And those people don't have a, you know, continuous relationship with a physician. So 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 hemogloin A1C and how that's changed. Like you need that information.

Starting point is 00:36:29 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 23Me is definitely also thinking about how I pull in all that information from you. How do I pull in your various medical records? How do I pull in your medication history? And then you're wearable. How can I help you also track and say like, hey, you know, when you haven't been feeling good and you're anemic and you're not sleeping as well, like this is the type of outcome.

Starting point is 00:36:56 Like 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 overwork. with all of, you know, the different data points coming now and help you know, like, really what you should do. This is where, you know, at some point, you'll go to 23 and me and you'll just be talking to some AI, right? And you'll ask it like.

Starting point is 00:37:30 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 LLLL, like, it's, 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 healthcare 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?

Starting point is 00:38:05 I did the pre-novo or pre-novo. Prenovo. Yeah, yeah. I did the Pernovo. I did the blood test. There's a blood test for cancer screening. Yeah, Grail. What's the name of that one?

Starting point is 00:38:16 Grail. Yeah. So I did that one, knock on wood, no problems. And, you know, but when I did this pre-novo and I start 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.

Starting point is 00:38:37 And I'm like, yeah, no, I read that. I did a Google search. Right, right. I have that piece, 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.

Starting point is 00:38:52 You know, people of means having access to this. I'm not price sensitive to paying a doctor for an hour to talk to me. And they don't even, these are great doctors. Awesome. Love them. But they're not educated on this. And then I saw Ivano was treating. And he's like, I think, you know, for the 95% of interactions with a doctor,

Starting point is 00:39:11 right now, chat GPT could do a better job than, you know, maybe what's already having. I 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 pro-neuvo and others and I've done it as well.

Starting point is 00:39:37 Like, we are really, we are definitely on the cutting edge. And so, you know, one of the things that is very true with health care is like there's not necessarily guidelines. Like, how do you actually use all that information? And I think that health care 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 per Nouveau to say, I'm going to do it yearly. And I am going, what I'm looking for is not necessarily. really okay, like, oh, I have, you know, you have this bump, like my knees are degrading my spine. Super depressing. You got so many things. You're getting old. Exactly. Exactly. It's all breaking down. I mean, what you want to do then is like, see, is it changing? Like, one of your body has changed.

Starting point is 00:40:24 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 the change over time. Like, if something has been stable and consistent, that's probably a. okay. 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 C4C5, 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

Starting point is 00:41:02 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. And 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 people are pioneering, which is about really proactive, you know, prevention. So you can get

Starting point is 00:41:46 all this information. You can be really proactive. And I think that the medical world and the more traditional way is looking to say, okay, well, does that actually improve survival and outcomes? I'm curious your thoughts on these GLP ones. They have 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.

Starting point is 00:42:11 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 Ferriss kind of stuff. Yeah.

Starting point is 00:42:23 And then the, the second 20, which were kind of like the hard pounds, just all will go V O-Zempec and it just works like magic. I know. 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?

Starting point is 00:42:50 It's like one of those interesting things. There was actually, you know, this is a little bit of a lesson on health care for everybody in biotech industry. So when I was a biotech investor back in like 2002, 2003, there was a company called Amelan, which actually sold to Amgen, I believe. But Amlin, I remember the CEO at one point telling me, they were the ones who were originally pioneering the GOP ones,

Starting point is 00:43:16 which come from the GILA monster, which is fascinating. And it was the first time I remember coming and saying, wow, the Gila monster is like, has a role in health care. What is it? What is it? Milo monster. I've never heard of it. It's 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, yeah. It's a literal lizard. Yeah, 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, the secrets are all around us and the solutions are all around us. Like, we want to study everything. So, um, 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 ChilP-1s for diabetes, but it was going to be useful in obesity one day. And I always think about

Starting point is 00:44:05 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

Starting point is 00:44:40 biological term when you were like, oh, the GILA Munster. And I'm, like, typing in H-I and you're talking about the GILA Munster. It is a venomous lizard. If it bites you, you vomit, it's not fun. And then in the venom. Yeah. They found that there was some compound that helped you metabolize sugar. Yeah.

Starting point is 00:45:03 Isn't it so cool? That's bizarre. I'm going to 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 Komoto 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.

Starting point is 00:45:24 Terrifying. Yeah. Like you see this and there were two moments in my life when I thought, wow, this is going to be a horrible, but quick death. 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 tyrannus. Might as well be a Tyrannosaurus Rex or a Fluseloropter. You're dead.

Starting point is 00:45:49 and the second was in Tahoe biking at sundown alone which you should never do and I come around the trail and there's a mountain line 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. It 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 in my life. But all this stuff goes back to, yeah, we all came from some common. The diversity of humanity. Like it's, you know, there was that 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

Starting point is 00:46:32 title or why elephants don't get ulcers. But like, there's so much to discover in humanity. Yeah. And that's where like even people don't always realize, like there's some people who genetically can't get HIV. Wow. They have a genetic variant and the virus cannot penetrate them. And now, like, there's a drug that's now modeled off that.

Starting point is 00:46:54 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 a powerful part of humanity.

Starting point is 00:47:07 It'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. 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

Starting point is 00:47:43 pretty gnarly. Like, you would be like, well, there's nothing to learn from venom that's going to kill you and melt your, you know, muscle tissue. It's like, oh, no, 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, like, 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, 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

Starting point is 00:48:18 other life that's out there. So 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 like believe that there is a higher power at work. And listen, I'm an atheist and I kind of like don't waste too much time on it. But it's like, wait a second, somebody did architect this? You start thinking about that. that, you know, Helo 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,

Starting point is 00:48:54 choose your own adventure? Yes. 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, there is a solution somewhere. But my dad used to say that to you, like, when we would talk about these things, he's like, listen, the only thing that is so fast 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 is like it's all these clues coming together it really is and this is where like the language models in year one

Starting point is 00:49:39 like literally this week was the week where chat chp t 3.3. 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 pro novo and their blood testing. And they're getting some value from this. Now, obviously, don't trust it. The thing hallucinates.

Starting point is 00:49:57 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. Back to these GLPs, what do you think the impact is going to be?

Starting point is 00:50:19 Because they feel like, make your own, do your own research audience, but 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.

Starting point is 00:50:31 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,

Starting point is 00:50:40 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 dinner and maybe like three of 10 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 it almost feels like a miracle. What is your take on this and where it's going? I think that's interesting and kind of where I brought up like, you know, the fact that it happened in 2022, like, or you know, the early 2000s. Yes. 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

Starting point is 00:51:17 are using it and some of the safety and some of the side effect profiles on it. You know, I think what's inspiring for us and part of the reason why, you know, even at 23 Me, we ponder like, what should we be doing with us and how should our customers interact with it, the fact that you're seeing, you know, such a positive result in the decrease of heart disease or, you know, it was interesting one day, there was an article that came out and all the dialysis stocks were down because, you know, the use of GLP1 is going to mean less dialysis in the future. And so it's, I mean, again, this is what's so interesting in health care and again, like how if you can successfully prevent people from having some of these conditions,

Starting point is 00:52:03 you will have certain businesses that get hit and go away. But like the reality is with GLP1's in the short term. the data so far is really supporting that people are having not just weight loss benefits, but broad health care 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 23Me, for people who have risk factors for certain kinds of conditions,

Starting point is 00:52:36 how should they be thinking about this and using it? Well, now you have the doctors. So if you can find these obesity, diabetes traits in the genome, you got lemonade the doc. It's called lemonade the doctor. You got lemonade could give actually people a prescription and then 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?

Starting point is 00:53:03 What prescription do you need? Right. And that's exactly why we got lemonade with this idea is that like the biggest bottleneck our customer. space is the translation of what to do with the information when they go into the medical world. So 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 the 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

Starting point is 00:53:37 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. And then I, too, was listening to, like, CNBC at some point. And they were talking about Ozempic, et cetera. And everybody's shorting, like, TGI Fridays, 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, kind of like smoking. Like we grew up.

Starting point is 00:54:16 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? Oh, no, I remember being, yeah,

Starting point is 00:54:26 100%. I remember, I remember going on a plane when there was like no security and that you did have, like, I remember sitting in the smoking section or sitting right behind the smoking section and saying like, you know, the smoke is floating over.

Starting point is 00:54:39 It's like a cloud. Literally like 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, you know, if we don't, then, you know, half the country smokes. So we lose half our customers. So they don't get reasonable.

Starting point is 00:54:52 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.

Starting point is 00:55:16 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. What are my friends? You should have told me. There'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,

Starting point is 00:55:34 real health issues. Like, there's some obesity that's not. not going to have health issues, but it will become more and more in punishing 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 health care 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. Like there's ones that are out there. And like, that's insane. Isn't that crazy? I always love going to to nonprofits, I'd be like, hey, you know, you could actually just like invest in obesity.

Starting point is 00:56:10 Like, you could go and say, and a lot of the banks put out report saying like, hey, you know, like here's all the companies that are maximizing obesity. And I remember even in 2006, there was a bunch of drugs going off patents. I remember asking people, like, what's going to save pharma? And they're like, ah, obesity in China. Like, that's what's going to save us. Yeah, hundreds of millions of people. Hundreds of millions of people are following the West down the road to obesity.

Starting point is 00:56:35 Exactly. 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 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 renders certain, you know, areas. Like, No one does an iron lung anymore. Everyone who was big in the iron lung business is gone. So, like, there's going to be some areas like that.

Starting point is 00:57:13 And I think the JLP wants have that potential to be that disruptive. That's going to be extraordinary. It's literally like what email did to fax machines. Like, 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 put somebody on a plane. And it's like, now you think about it.

Starting point is 00:57:34 You're like, really? there was a line for the facts machine I tried to explain this to something We need to wake up in the middle of the night to like make a reservation in Europe Yes, yeah, you had to yeah I was explaining to my daughter because I was buying tickets to a movie for tonight

Starting point is 00:57:50 and I was like, you know, 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'd pick what you wanted to watch that night and if you got there at 6 o'clock, you would pick from whatever tickets were left And then we had this amazing thing where you had an 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.

Starting point is 00:58:12 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. or 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 rest of your life's work.

Starting point is 00:58:40 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. Now 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 right.

Starting point is 00:58:59 Like, it's super interesting. And I do look at that first 17 years of the company, almost as 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 all, we, you know, 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,

Starting point is 00:59:27 that we can validate studies. Like all 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. Like 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 health care 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

Starting point is 01:00:05 been so many variables. How do you manage all of that? And 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, like, I'm grateful to the, you know, Apple to Google, the Fitbit world, like everyone who's developing the wearables, because that will become an integral part of all of this with your genetics about like, how do you want to manage your life? And like, what are like, and it's one thing I like to emphasize to people is that your health is not

Starting point is 01:00:47 something about just like showing up with the doctor once a year, but it's the sum of what you have done every single day. So every day matters. Like you can have a cheat day and you can go and be hung over 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, you know, 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.

Starting point is 01:01:28 Oh, wow, I didn't know that. It's really, 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 being us, for us, like 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

Starting point is 01:02:02 start to become disrupting. Are you going to actually develop that drug? Or are you going to work in partnership with somebody? People don't realize this. Like if you look up, if you look at my burn rate, my burn rate is not from the consumer business. My burn rate is from drug discovery. So 23 Me actually has two programs in the clinic, both from immunolology. And it's really interesting. What we were able to do is look at some of the existing like these immunolology 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 PDL1, CTLA4, this is what this looks like in the database. How do I actually find something that's similar? So we have two that are, you know,

Starting point is 01:02:45 one that's in the clinic, one that is, 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. But 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,

Starting point is 01:03:25 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 revenue stream for you. Yeah. 100%. I mean, I think between now and then you have, you know, you have to invest in that therapeutics business.

Starting point is 01:03:51 So we definitely, we look at partners. Like, that's one, a big opportunity for us. And 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, 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?

Starting point is 01:04:14 Like, more than half fail or? Well, 90% fail. 90%. I know. It sounds like my job, angel investing. It literally is 80, 90% go to zero. Yeah. Yeah.

Starting point is 01:04:23 I mean, it's a top business. And I think, again, going back to sort of that that awe I have of the industry is that 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 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, like, Lily right now. Lily has so much cash because of GLP ones. Like, like, the reality is like there's still always that mystery of biology. and we don't understand it.

Starting point is 01:04:55 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 have it be an impact as part of new ways of doing drug discovery. So it's definitely exciting. What if you just, I mean, imagine if every year you get 10% better at picking,

Starting point is 01:05:23 you know, if you just reduce the mortality rate of drugs not working 10% a year. Yeah. And 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.

Starting point is 01:05:49 But it took 20 years. So it's just, it's a really slow process because, you know, 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. People don't miss. Mostly because of regulation. I mean, there's obviously physics.

Starting point is 01:06:06 You know, people. Yeah. It's regulation. But in some ways, like, 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 and I can imagine that. The preclinical studies are a lot of work. I think it's really going to be

Starting point is 01:06:28 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

Starting point is 01:07:02 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. And then in China, somebody was doing something

Starting point is 01:07:17 with cloning last year or two years ago. Yeah, with CRISPR. With CRISPR and that got somebody I got in trouble. Yeah, that's a big no-no. So are there people who've gone roads? I mean, look, I think on gene editing and cloning and not as much cloning, but on CRISPR, you know, I think there's a, there is a reasonable push for just having discussions around

Starting point is 01:07:40 what is the right way to safely do that. And 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 manmade 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.

Starting point is 01:08:05 Yeah. Where do you wind up? You put a percentage on it. Yeah. Look, I think it's a reasonable assumption that, I mean, look, I think that 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, to the name. There's a lot.

Starting point is 01:08:28 I mean, I think even some of the data as people look at the genome. Again, I haven't dug into it of great, but of great, you know, depth. But people who I respect at least have, you know, there's reasonable hypotheses, not saying for sure that's it. But there's, it would be something I rule out. What do you take from that in terms of should we be, even accelerating our understanding of those things, or should we be pumping the brakes? Like, this seems to be.

Starting point is 01:08:58 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

Starting point is 01:09:28 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. So 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 I-N-D of one person. and most centers are not set up for it.

Starting point is 01:09:51 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 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 is like we're in a world where we can track, we can get daily information. So planet.com takes a picture of,

Starting point is 01:10:19 earth every day and they know exactly when a tree has been cut down, when a boat has moved. Like, we need that snapshot of health care in this country. We don't have it. It's so crazy. We don't have that. So, like, you should know side effects. So, like, right now, have you ever reported a side effect to the FDA? Of course not.

Starting point is 01:10:40 Yes, but you had probably a lot. I wouldn't even know where to begin. It's a fax. It's a fax. Oh, good. Yeah. Wow. Share the number with me offline.

Starting point is 01:10:47 I don't want to, because, you know, it can be a busy signal on. I'm a fax line. I don't want to. Totally. But I think that's my point. That's my point is 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,

Starting point is 01:11:10 but we should be much more comprehensive in following them regularly. And like part of what I think about also with 23 and me and with the opportunities that are coming, 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 GLP1? We want all that information. Yeah, and it's out there. And what's the side of us? Yeah, like, why can 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

Starting point is 01:11:47 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. I'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,

Starting point is 01:12:26 but I don't know if it's, I don't know enough. I'm out of talking about it, I don't know if they do it in the U.S. or if it's other countries. I just know some physicians signed, a petition saying, hey, you know, post-COVID, we probably should rethink this concept because we let people go fight wars. You 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,

Starting point is 01:13:04 30, 40,000 people in the U.S. have it. But I happen to have a family member who has it. And she's been very lucky because she got into some trials and she's lived in an amazing life. But black lifespan is typically very short, but if you asked one of those people, hey, do you want to take something that could be risky or do you want to be part of the expectation? The heck, yes, I do. And I think this is where I think maybe some morality. I think this is where you're right. And I think the patient voice.

Starting point is 01:13:29 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 health care 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 councils, 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?

Starting point is 01:14:04 And then I look at things like N of one study, 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 area, how can you actually instead then have a end of one study to be able to push the boundaries of science and actually really better understand and also grant the patient wishes. Yeah. Great, great thoughts.

Starting point is 01:14:28 All right, listen, Ann, I got to let you go. You've been Joe 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. We'll have a post-promotheas discussion, but it really is. I just love science fiction.

Starting point is 01:14:42 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? And it's a little dark and crazy, but you'll very much enjoy it. So that's interesting. I love it. Everybody go to 23 and Me, sign up if you haven't done it. Join one of the programs. Take control of your health care, yada, yada, yada. And I know you're hiring all the time.

Starting point is 01:15:06 So I guess you go to the 23 and Me careers page. You want to work for somebody brilliant like Ann? Yeah, sounds like a good noble mission instead of trying to optimize, no offense to people making money of advertising, but some social network optimizing advertising to make people click 10 basis points more. I think it's definitely the next big area. The next big area definitely is being able to really train. Well, being able to transform health. Like understanding the language. Like for me, it's about like understand the language of life.

Starting point is 01:15:36 Just like big picture. Like to me, that is a computational issue. And it's so exciting. And it impacts everything around you. 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 and do everything. Wow, it's so great to be alive right now.

Starting point is 01:15:54 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. And 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.

Starting point is 01:16:09 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. It's just so many optimistic people. Yeah, it's going to be super exciting. Okay, Ann, can't wait to see you again.

Starting point is 01:16:22 And we'll see you next time. Great to see you. Thanks for doing it. See you next time, everybody. Bye-bye.

This Week in Startups - Genomes Unlocked: Anne Wojcicki's Vision for 23andMe and the Future of Proactive Healthcare | E1858

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