Anne Wojcicki, co-founder and CEO of 23andMe, discusses the founding story of the company and the need for a healthcare system that focuses on keeping people healthy. She explains how 23andMe aims to empower individuals by giving them access to their genetic information and crowdsourcing health data. Wojcicki believes that personalized information and a shift in societal attitudes towards individual responsibility for health are necessary for a more effective healthcare system. She also highlights the importance of genetics and social networking in driving the company's mission.

- The speaker discusses the importance of genetics and environment in determining health risks.
- The company faced slow sales initially but focused on educating the population about the value of genetic information.
- The speaker emphasizes the importance of hiring the right people and maintaining humility within the company.
- Regulation in the industry has pros and cons, but the speaker believes it is not overwhelming and requires effective communication.

- The speaker has a lot of respect for those who keep us safe and believes it is important to explain how their startup works using data.
- They emphasize the importance of persistence and sticking with a vision for success, even in the face of challenges.
- The speaker's company has played a significant role in changing the perception of genetic testing and empowering individuals to take control of their health.
- The company's future goals include making discoveries about prevention and forming partnerships to help people make behavior changes for better health.
- The speaker believes that there is a lot of variability in how individuals respond to different factors like food and exercise.
- The company is conducting intervention studies to determine the impact of genetics on weight loss and lowering the risk of certain conditions.
- The speaker aims to provide personalized recommendations for individuals to improve their health within the next decade.

- Anne Wojcicki, co-founder and CEO of 23andMe, discusses the founding story of the company and the need for a healthcare system that focuses on keeping people healthy. She explains how 23andMe aims to empower individuals by giving them access to their genetic information and crowdsourcing health data. Wojcicki believes that personalized information and a shift in societal attitudes towards individual responsibility for health are necessary for a more effective healthcare system. She also highlights the importance of genetics and social networking in driving the company's mission.
- The company faced slow sales initially but focused on educating the population about the value of genetic information.
- The speaker emphasizes the importance of hiring the right people and maintaining humility within the company.
- Regulation in the industry has pros and cons, but the speaker believes it is not overwhelming and requires effective communication.
- The speaker has a lot of respect for those who keep us safe and believes it is important to explain how their startup works using data.
- They emphasize the importance of persistence and sticking with a vision for success, even in the face of challenges.
- The speaker's company has played a significant role in changing the perception of genetic testing and empowering individuals to take control of their health.
- The company's future goals include making discoveries about prevention and forming partnerships to help people make behavior changes for better health.
- The speaker believes that there is a lot of variability in how individuals respond to different factors like food and exercise.
- The company is conducting intervention studies to determine the impact of genetics on weight loss and lowering the risk of certain conditions.
- The speaker aims to provide personalized recommendations for individuals to improve their health within the next decade.

Anne Wojcicki  - https://twitter.com/annewoj23 - is the CEO and co-founder, 23andMe - https://www.23andme.com/

Anne co-founded 23andMe after a decade spent in healthcare investing. 23andMe's mission is to empower consumers with access to their own genetic information, and create a simple way for people to participate in research. 23andMe currently has more than 5 million customers worldwide, and has created the largest crowd-sourced platform for genetic research.  More than 80 percent of 23andMe customers participate in a research program that has generated nearly 100 published genetic studies to date. 

Access podcast and transcript versions of this interview here:
http://www.ycombinator.com/future/anne/

Today we're here with Anne Lajiski, co-founder and CEO of 23andMe.

We always like to start with how you came up with the idea and sort of the founding story of the company.

I always thought I'd end up being an academic.

I got very, my parents, I went to a job fair right out of college.

And I got this job offer to go on Wall Street.

And it's 1 thing I always tell young people, like you never really know what's gonna come your way.

So I very randomly got this job on Wall Street.

I had no idea what it was, but I kind of figured, like I actually only took the interview because they gave me free frequent flyer miles.

I won the flight, I won the frequent flyer miles.

You had to fly there, but you got to keep the frequent flyer miles.

So I was on Wall Street for 10 years, and I loved it.

Like, for me, it was because it wasn't just about, like, trading and making money and doing these things, but it was like I gotta learn about companies.

And the 1 thing that is amazing on Wall Street is that you get to go deep on certain companies when you're really interested in them, and then really broad, knowing a whole sector.

So I got to know small cap biotechs and pharma companies and hospital systems and insurance companies.

And I got to have a really broad landscape of healthcare.

And in the beginning I had this eternal optimism, like healthcare's gonna totally change, there's antibodies, there's all this new, there's technology, there's all these new discoveries coming.

And then when the bubble burst in 2000, a lot of innovation dried up, and I started to see more what healthcare really is.

And at the end of the day, healthcare is an amazing business that really effectively monetizes illness.

And I used to always say, if I successfully get you to never be diabetic, no 1 makes money.

But if you do become diabetic, There's all kinds of ways I can make money.

And at the end of the day, when I think about what I care about, what's in the best interest of me, I'd rather just never be diabetic.

And there's no 1 in the system today that really thinks about how to keep me healthy.

So after 10 years of investing, I felt like I really understood the system, and I also understood that you had all these people with the right intentions who really care, but the ship's just pointing in the wrong direction.

And that no one's actually focused on keeping people healthy, and that I wanted to have a company that was frankly somewhat rebellious, and was going to inspire people to try to really be healthier.

And I felt like it was, again, it had sort of that a little bit of a Robin Hood kind of mentality in the beginning of, you know, we have to, you can't change the system from within.

So we gotta do something more radical from outside.

1 of my favorite Charlie Munger quotes is, incentives are a superpower, and I always believe this, and I think this is the clear problem you just identified.

So How do you think about how you design a system or a company that is incented to keep people healthy?

Well, I realize the main thing in healthcare is that you don't actually ever have a voice.

Like you don't, because you're not the payer in healthcare, like you the individual, you don't actually make decisions.

It's your insurance company, your doctor, the pharmacy benefit manager.

There's all kinds of people in the back who actually make decisions.

And I think there's all this data now about, you go in for surgery and there's doctors coming into the surgery that you've never even met.

So for me, what was transformative, like what we did to change the incentives, is to put you in the power seat.

Because I feel like you make retail decisions that are in your best interest because you're actually the 1 paying the bill.

So for us, what we decided to do that wasn't frankly seen as disruptive is we are direct-to-consumer.

I remember when you launched, doctors or healthcare professionals in general were saying, patients, this is irresponsible, you need a medical professional to do this.

I remember 1 quote that really stuck with me, something like, we can't have people making their own healthcare decisions, they don't know how to interpret the data.

There was all kinds of interesting, it was like a whole, there's all kinds of interesting things because people would publish stuff on Facebook and then doctors say like, do you have the right?

And we'd remind people, yeah, it's their own information.

So there's always been, I'd say, a tension a little bit with the medical system.

And the medical system, historically, there's tests like the pregnancy test.

The pregnancy test, when it came out, was seen as radical.

Like, how could women ever possibly learn at home that they're pregnant?

And if you look at the literature of that era, we look at that today and we'd say it's crazy.

So 1 of my favorite papers is there's this JAMA paper, the Journal of American Medical Association from 1969, I think, where they asked doctors, would you tell your patients that they have cancer if they had a cancer diagnosis?

So I always put that in context of like, it helps people understand, like, physicians were trained in such a way, and so I don't blame the system or the individuals.

It's just that like, that was the culture, that was thought of like, what was actually in your best interest.

And I think what we do is as we empower consumers, we are showing that people actually can be, like people wanna be in charge of their health, they want the information, and they actually wanna be in control.

I always like the sort of model of thinking about the world 50 or 100 years from now and looking back, what would we think was just totally ridiculous?

I think healthcare is a type, because healthcare is like really, as much as it's science and it's data driven, it's also not.

Like part of what people don't necessarily always understand is that the practice of medicine is an art.

The reason why you can go to 5 different physicians and get 5 different ways of treating cancer is because there's the practice of medicine.

And 1 of the things that we're specifically trying to change is exactly that, is exactly to say that we're trying to get data so that it's no longer a question of like, hey, Sam, what's the best in your best interest, that there's actually data to say exactly what you should be doing.

How do you think the medical system, the healthcare system overall, will eventually get to a place where we don't have this misalignment of incentives you talked about.

And we have data and we have people in control of their own healthcare.

Like, if you could wave a magic wand and say, I'm gonna fix the healthcare system, what needs to happen?

I think the reality is what needs to happen is never going to happen, which is like you have a universal payment system.

The reality is who cares about keeping you healthy today?

Because you could be overweight and you could eat poorly and you can never exercise, and you won't see the consequences of that for the next, let's say, 20 years.

So the reality is like, who's going to benefit from that?

And it's you personally, and it's like, you know, somebody who's willing to invest in you in the long run.

And I think for a single-payer health care system or a country, they care about actually trying to keep you healthy for as long as possible.

I think second, people, we don't want, We saw that communism doesn't support the system that we all want.

People have to be willing to spend money and they have to step up.

And I think the same way you see people stepping up with yoga and vitamins and weight loss studies and all kinds of different alternative cares, people at some point have to step and say, your health is also your responsibility.

And I think the more that we can give people personalized information about themselves, the more that they are going to be willing to execute on taking care of themselves.

Speaking of that, you could have started so many different companies in the healthcare space.

How did you decide this was not an obvious choice at the time?

So for me there's a couple things that were happening.

And so in some ways, it was my first and it was my last.

Like right in when I started investing, there was the race of getting the cost of the genome down.

And I started looking at those investments again and realizing that you're going to be able to buy, essentially, a scan of your entire genome pretty inexpensively.

And so that was the first nugget of, OK, wow, you can actually start to get huge amounts of genetic information.

And second was seeing this world of social networking.

That social networking was happening and you don't actually need the old guard to get things to happen.

So it gave me this idea that, wow, if I just empowered everyone with their genetic information and I crowdsourced all this information, if I had the world's health information, what could I do?

And people were like, well, you could cure, you could save, you could know a lot.

So the idea really was, well, we should do that.

We should, instead of relying on Stanford or Harvard or Pfizer to go and solve a disease or how to be healthy, we the people, we can do it.

So in some ways, having grown up in this Google environment and knowing the social networking world that was coming up, it was piecing those things together that was like combine the technology in science with the platform that is really emerging.

I've noticed that many of the most transformative companies come because the founder sees an intersection of 2 pretty different but really important trends a few years before everybody else does.

It's like the fact that crowdsourcing works is still amazing to me.

Well, it's also, I think, when a founder really wants something personally.

To me, it was like the whole beauty for me of genes, of genetics is like you have gene by environment.

And I always love like people debating, but is it your genes or is it your environment?

The whole beauty of it is that it's both.

So like you might be genetically high risk for diabetes, but there's your environment.

So very few genetic ailments are 100% deterministic, meaning 100% likelihood that you're going to get it.

So that means there's an environmental component where you can potentially do something.

So let's go figure out what you can do, and then tell people.

What was the reaction when you first announced that you were going to do this?

I mean, I read the news, what was it like inside the building?

I think there was, you know, it's always like, startups are so fun, you know, because you get a bunch of people who really, are really passionate, and I think people were excited, and people knew that there would be controversy, and in some ways, I think we attract, we attract people who have all experienced the healthcare system in their own way and realize it has its limitations.

And so there's people who are excited about 23andMe because of the mission, and they're looking to contribute in some way to helping change the system.

So there was enthusiasm, and we had videos.

We were also, we were super excited to launch and we thought there was gonna be this big coming, like everyone, and we had tons, like we had spit parties, we had the cover of the style.

I know, we had the cover of the style section, we had the spit party in the building.

But I have to say, we sold a lot the first day.

And we were probably selling 20 to, you know, 15 to 25 kits a day.

And how did you, how do you as a leader, keep momentum in the building when, you know, you have this great lunch, Everyone, the first day is always awesome.

And then you have what we call the trough of sorrow.

And I think it's important to not let people be totally, you know, to not be hoping for immediate success and then to be overly distracted by the trough of sorrow.

And I think that that actually happens not just in launches, but every time you come up with a product, you have no idea how well it's going to go.

I remember when my sister first launched AdSense.

And I feel like for us in that trough of sorrow, we recognize more.

What do we need to do to get to this point?

And I think as a leader, for me, 1 of the most important things is not to wallow on today, but to wallow on like, okay, in 2 years, this is what it's gonna look like, and these are the steps I need to do to get there.

People love a vision, and people love a plan.

You just need to outline, like this is where we're going.

So when we saw that sales were slow, we're like, people don't understand genetics.

Some basic market research could have told us that.

But like people don't know why they want their genetics.

Now we actually need to educate the population about why would you want your genetic information.

In the early days, you gave me a conference invite and I took it.

Well, any talk, because part of it is constant feedback.

So again, for the people who want to be entrepreneurs, you're constantly learning, constantly getting the feedback.

When I look at my inventory of all my talks, it's like there's like 500 of them because each 1 was slightly different.

So I remember specifically getting the feedback.

People question, is there a value proposition in what you're doing?

Over 50% of my customers get a medically meaningful result.

And then I started shifting the conversation.

So part of it was getting real-time feedback, and part of it was helping us define what is it that we have to do to show the value.

And it was clear people need to understand genetics.

They need to know what is the medical utility of this.

And then also people need to know that they're not the only 1, like that's not weird.

And, you know, and part of it also is medical acceptance.

So we did a ton, it's 1 thing I always advise science companies, is you can't speak, like I can't just tell you, like, oh, we're great.

So what you need to do is you need to publish.

So I can make all kinds of claims, but here's my data to actually support it.

Can you talk about the best decisions you made in the early days?

People always ask about the worst, which we can talk about if you want.

But I'm curious if you look back, things like that, where you learn, I need to interact with the scientific community in this way.

Are there a few decisions you made that, looking back, have been critical to success?

I think the first 2 hires, the 2 founding scientists, were just like, Brian and Serge were amazing.

And so in some ways, hiring the right, for me, it was such a critical part of the company.

It was the scientific integrity of what we were going to do.

And it set a bar of the talent that we are going to hire going forward.

So I think in some ways, having the right people.

We've noticed that it is almost impossible to start.

You can make a lot of mistakes as a company, but if you screw up the first 5, 7 hires,

it's almost impossible to get through that.

When I look at the first 15 people, a number of them are still here.

And the others who have left, we're still very close to.

We found them through a friend of a friend of a friend, and they had a similar idea, and so it was a good, it worked as a partnership, But it's hard.

I mean, I would say hiring is 1 of the hardest things.

And I think 1 of the things that we've tried really hard here in the company is there's a lot of smart people who have humility, and there's a lot of smart people who like want to tell you how smart they are.

And I think it's really important to have people who are constantly open to feedback and constantly open to, you know, constructive criticism and learning about other areas.

And I think that's actually 1 of the things that did make us successful, or allow us to grow and attract other people, because it's a group of people who are really eager to learn from others and to keep learning.

I've noticed in my own, looking back on my own career, the big hiring mistakes that I've made are people who are really smart, but just awful to work

because they want to tell you how smart they are.

And the framework that I finally figured out is, you have to look at the net output that a person has on the organization as a whole.

And even if they do a lot themselves, if they make everybody else miserable.

I think it's 1 of the things, hiring is always really hard.

And I think especially in leadership roles, if you have the wrong person.

I just recently watched 1 of the old documentaries about Steve Jobs and Bill Gates and Jobs talking about how disastrous it was when Scully came.

I'd kind of forgotten about some of these stories.

And I realized, I was like, yeah, if you hire the wrong senior leadership,

What's it like being in a regulated industry?

I think 1 thing that a lot of people say when they think about, they want to do this really ambitious startup, like genetic testing, but they are afraid because it's regulated.

So I think regulation, in some ways there's pros and cons.

In some ways when you're regulated, it means that there's rules.

Like there's guidelines and you can figure out exactly what that means.

So in some ways there's more of a path about actually how you have to execute.

It definitely also means that it's more expensive.

And you don't always agree with all those rules.

And when we went from an unregulated company to a regulated company, there was definitely a pretty major transition for us.

Because we were used to, you know, you hire smart people.

They like to question and they like to argue.

And so we would question all the time, like, ah, well, why would you need, like, why do you need that test or why do you need this study?

And 1 of the things I think in a regulated environment, again, it's like the DMV.

So I'd like to encourage people, it's not so overwhelming to be regulated.

That said, it requires a lot of communication.

And in some ways, it requires a communication style that's not prevalent in Silicon Valley.

And I think we always said, we thought we were communicating.

I look at some of my old communication, and I'm like, oh, wow, that's embarrassing now.

The way we thought we were communicating appropriately and how it really wasn't.

So there's a style, and there's a form, and there's ways, there's actually a path, and there's a rule.

I think the regulatory world can do a better job of helping outline.

And 1 thing I do appreciate from now having been regulated for a number of years is that there is a bigger picture that they see.

So people who work at the FDA or people who work in government, it's a public servant job.

Like at the FDA, they care about public safety.

There are so many companies trying to dupe the consumer.

And their job, they are there to keep us safe.

So I have a lot of respect for what they do.

And the onus is on us as this startup and the new company.

All these people wanting to do things in a new way.

The onus is on us a little bit to explain how we're doing it, how that works.

And the way they speak, just like I mentioned about scientists, is they speak in data.

Like, you can't just say, oh, no, no, no.

And you have to show with data in lots of ways.

So in that capacity, I don't really mind.

You know some of the people we worked with there, you know, have been there for, you know, 20 years and were amazing and they have a depth, a breadth of knowledge that I'm never going to have.

And so learning, there's input to genuinely take.

As you look back from the day you signed, your vision on the day you signed the incorporation paperwork to now, how much has this all played out like you thought it would?

So I have this picture of the day we signed.

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Anne Wojcicki : How to Build the Future