Anne Wojcicki had planned to meet me at an Afghan restaurant in Sunnyvale, Silicon Valley, where you can usually depend on good weather.
But the day arrives stormily. The chief executive of one of the world’s leading — and most contentious — consumer genetic testing companies is reluctant to drag her seven-month-old daughter through the driving rain to our lunch spot.
After a flurry of calls, we meet at 23andMe, where the sterile canteen is enlivened by colourful old sofas from employees’ apartments.
Through a large porthole window, we can see the playroom. Amid tutti-frutti-coloured toys, a member of staff is watching Wojcicki’s baby, the latest member of Silicon Valley’s “first family”: Wojcicki’s ex-husband, with whom she has two older children, is the Google co-founder Sergey Brin; her sister Susan is chief executive of YouTube. The Wojcicki sisters are both comfortable putting their motherhood in the public eye, when many female leaders still feel required to hide them. This is the first baby I’ve met at an interview in a decade as a reporter.
There was a time when Wojcicki was arguably eclipsed by others in her family; no longer. Her company is at the heart of some of the fiercest contemporary debates over data and science. 23andMe sells kits allowing people to send off samples of their spit for genetic analysis, either to discover more about their ancestry ($99), or their ancestry and their future health ($199). It has already sold kits to more than 10m customers worldwide, so Wojcicki sits on a potential gold mine: the largest genetic research database in the world.
But for all her certainty about the value of genetic testing, the 46-year-old faces a battle for consumers’ hearts and minds.
For some, the idea of a 23andMe test is unsettling. Could we lose control of profoundly personal data, or unearth unwelcome family secrets? The company seems to be reaching a crunch point: sales growth of the spit kits, which identify genetic variants, are slowing. Days after we meet, the company announces it is laying off 100 employees.
Wojcicki is adamant that 23andMe’s genetic data will lead to the development of life-changing medicines. “I can see the future. I can see we’re on the right side of history. This is the way the world is going. This is what’s going to happen.” But she does concede that “predicting timing is impossible”.
Predicting anything certainly does seem impossible these days. When I met Wojcicki, coronavirus was yet to lead to lockdown in the US. Then, it looked as if the most immediate threats to westerners’ health were inherited diseases. Customers turn to 23andMe to learn their risk of suffering from cancer and Alzheimer’s. Now, like our ancestors, we live in fear of an infectious disease hiding not in our genes, but on our hands.
We separate to pick up our lunch. I return from the buffet carrying a small bowl of soup and a plate of chicken teriyaki and egg-fried rice; Wojcicki has the chicken too, but has forgone the rice for extra vegetables and a salad scattered with mushrooms. There will be no dessert and no booze. Wojcicki does not drink, after discovering that she has a slightly higher genetic risk of breast cancer; alcohol is a contributing factor.
23andMe bridges the worlds of technology and science. It has inevitably been hit by the Big Tech backlash. Wojcicki readily concedes there is an issue. “People are just nervous about data. I think there’s a moment where people want to pause and say, ‘I want to understand how my data is being used.’ ”
This is all the more pressing as Big Tech companies such as Google, Amazon and Apple redouble their efforts to transform healthcare with data, devices, miniature sensors and computing power. Google was recently criticised for a data-sharing agreement with Ascension, a network of more than 150 US hospitals, which patients only learnt about via the front page of The Wall Street Journal.
“The biggest challenge that’s going to come is consent,” Wojcicki says. “Depending on what they want to do, the consent process is not necessarily something that is part of how a lot of those companies have operated.”
Wojcicki, who worked in her twenties as a healthcare investment analyst, also suggests that the healthcare industry gets a free pass when it comes to privacy: once a patient signs a consent form at the doctor’s, they have no idea how their data is used.
“I think in some ways tech is so under scrutiny, I’m less worried about them,” she declares. “But people are not scrutinising the healthcare industry.” Recent privacy laws in the EU and California provide many exemptions for healthcare providers, she adds.
Wojcicki is a born-again believer in regulation. She has spoken in the past about how, back in 2013, 23andMe “pissed off” the FDA by selling its kits, which the regulator designated diagnosis devices, without approval. It took two years of negotiations to get them back on the market.
Now, she says that there should be an organisation to govern the explosion of data. “Why isolate healthcare data?” she asks. “Is my healthcare data actually more sensitive than my search data? . . . I think you could probably argue that everything that’s in my medical record I have searched on at some point.”
My soup is warming and spicy, perfect for a wet day, although I have no idea what is in it.
I tell Wojcicki that I bought a 23andMe kit a year and a half ago — but it is still sitting in my cupboard. Some people worry about learning they have a propensity for a devastating disease. I’m anxious about uncovering more information about myself than I want to be known. I could submit my spit so 23andMe can tell me whether I’m likely to get breast cancer, but eventually, after new research, my DNA could divulge that I am likely to be a violent criminal, or classify my children by their potential intelligence.
Surprisingly, Wojcicki plays down the value of genetic information. “So much of who we are is down to our environment and its interaction with genes,” she explains. “If you have a propensity for criminal behaviour, which I think is a very unlikely situation here, then there’s obviously a huge environmental component.”
223 N Mathilda Ave, Sunnyvale, CA 94086
2 x chicken teriyaki
2 x bok choy
1 x salad with mushrooms and egg
2 x small spicy soup
2 x water
The science of genetics has a long history of abuse by eugenicists, obsessed with the idea of breeding out “inferior” intelligence or ensuring racial “purity”. As new Crispr technology opens up a world where embryos might be edited, genetic data needs to be handled more carefully than ever. 23andMe has never suggested it could detect intelligence in people’s genes.
However, companies such as GenePlaza allow users to upload their genetic data and claim to show how comparatively intelligent they are. Meanwhile, members of the alt-right in the US have shared their 23andMe results on social media and boasted about their white European ancestry.
Wojcicki does not seem interested in the food, taking small bites between my questions. Pulling my now cooling chicken teriyaki towards me, I enjoy the crunch of the lightly cooked bok choy.
23andMe is making its first major moves in a new sector: drug development. At the start of 2020, it licensed its first potential treatment, an antibody to treat inflammatory diseases, to a Spanish dermatology company; and as part of its $300m partnership with UK drugmaker GlaxoSmithKline, signed in 2018, it expects to have selected its first drug target and launched a clinical trial by the end of the year.
Wojcicki points out that 23andMe has information that no one else does. Nine years ago, it ran a study in partnership with large Bay Area biotech company Genentech on people who have a genetic variation that makes them more likely to get Alzheimer’s — but who have not developed the degenerative disease.
“Previously it would’ve been almost impossible to find these patients because you wouldn’t necessarily know [they had the gene],” she says.
That study came to nothing. But the information held by 23andMe can in theory guide scientists where to look for targets for drugs — and hopefully make the costly and laborious process more productive.
Genes have proved good guides for rare diseases, often caused by one mistake in the genome, but biology is so complex that, for many conditions, improving our genetic understanding may be simply the first step. Or it could just be a contributing factor, as with infectious diseases such as Covid-19, where scientists are exploring how genetic variants may influence how hard the virus hits.
23andMe launched a study this week, hoping to persuade hundreds of thousands of people to participate in online surveys about their coronavirus symptoms — or lack of them — so that it can discover if there are any patterns with their genes.
If the company ends up marketing 23andMe drugs, how will it price them? US politicians and patients have condemned pharmaceutical companies for high drug prices. Participants in 23andMe would surely feel aggrieved if the company uses their data — which customers have paid to have genotyped — to create unaffordable drugs.
Wojcicki agrees that “reasonable” pricing is even more important for 23andMe than for other drugmakers. “We think a lot about what is the right way? What are those right promises? Because ultimately people want a cure, but they don’t want to be surprised,” she observes.
“What makes me sad for the pharma industry is that it’s filled with really good people, and in some ways there’s been some really egregious behaviour by a smaller group of people that sets an awful tone for everyone.”
As Wojcicki finishes her meal, she becomes more animated. I ask if her experience of Wall Street makes her want to go public.
“I don’t think there’s any glory in being public before your time. I absolutely agree that being public at the right time is a necessity and it forces you to have the right kind of transparency and financial controls in place,” she says. “Again, almost everything in life revolves back to children to me, but, like, my company is also my child and it’s not ready.”
At this point, employees have cleared the canteen and some of their children have come out to play. Not distracted by the din, Wojcicki describes the salad as “delicious” and the chicken as “delicious”. She barely touched her soup.
Wojcicki studied biology at university and, imagining that she might become a doctor, regularly volunteered at hospitals. “I was one of the few people who’d walk in and take a deep breath, like, ‘I just love it here,’ ” she says. But she also had the sense that the medical profession did not want to empower patients; historically, she points out, doctors worried about whether women should be allowed to use pregnancy tests at home.
“The medical community fundamentally doesn’t trust you. And, like, that’s fascinating that I can trust you with guns but I can’t trust you to treat yourself,” she says.
When a customer receives their 23andMe results, Wojcicki believes there is a moment when “people are triggered and you have an opportunity to potentially jump in and try to change behaviour”.
I’m not sure most people have Wojcicki’s willpower. It is tough to persuade many patients to take their pills, let alone exercise and eat well.
Our time is up, but Wojcicki has hit her stride. When 23andMe was barred by the FDA from returning health reports to consumers, it focused instead on helping people map their family trees. I wonder why we are so fascinated to learn our genetic origins.
Wojcicki believes it is about “a sense of purpose and connection” in a world where people move around so much.
I ask if 23andMe would launch a dating app. George Church, an eminent geneticist, is starting a service that aims to match people so they can avoid having children with serious genetic diseases.
“I love George . . . ” Wojcicki hesitates for the first time. “I wouldn’t invest in all his ideas. I mean, I think it would definitely be interesting to look at the genetics of attraction in relationships that have been sustained. But I don’t think there’s anything there yet.”
Many 23andMe customers have found secret siblings or even children through the site; others have learnt that their biological parents were not who they thought they were. Wojcicki has her own experience of this — she found a cousin, a son that her uncle did not know about — but she paints it as a welcome broadening of the family.
“We always wanted cousins and now we’re like, ‘Wow, shit, we have a cousin and he has kids,’ and it’s been great. He comes on vacation,” she says.
Last year, Wojcicki’s mother Esther published a book titled How to Raise Successful People (as well as Anne and Susan, there is a third sister, Janet, a professor of paediatrics at the University of California, San Francisco). I ask if she believes her own and her siblings’ success is more down to nature or nurture?
“Everything in life is a combination of the two,” she says. “So clearly my parents are smart and capable, but I think it’s the broader community that we grew up in . . . that was amazing,” she says. Her father was a Stanford physics professor, so they lived on the serene university campus, and her mother still teaches journalism at the prestigious Palo Alto High School.
The more we discover about genetics, the more we realise what a complex dance is played between our heredity and environment. A couple of years ago, the 23andMe kits were a popular Christmas present. Now, like much else borne on a wave of Silicon Valley optimism, testing for fun looks a little naive.
Wojcicki wears her power lightly, but it is she, not a government or a scientific institution, who has at her fingertips a treasure trove of our genetic history.
Hannah Kuchler is the FT’s US pharma and biotech correspondent
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