CEO Series: 23andMe’s Anne Wojcicki on Scientific Breakthroughs and Public Trust
Anne Wojcicki, CEO of 23andMe, spent a decade in healthcare and biotechnology before launching the DNA testing and analysis company in 2006. Her goal was twofold: to help individuals learn more about their own genetics, enabling them to pursue more personalized medical care, and to create a database of genetic information for commercial and academic researchers to promote broader improvements to the healthcare system. She speaks with HBR’s Editor-in-Chief Adi Ignatius about tackling challenges in an emerging industry.
ALISON BEARD: Welcome to the HBR IdeaCast from Harvard Business Review. I’m Alison Beard.
It’s hard enough to run a company. But when you add cutting edge science, rapidly developing technology, a complicated healthcare system, and shifting public opinion about an industry, it’s even more difficult.
Today’s guest is navigating all of that. For the third episode of our special IdeaCast series with current and former CEOs, we’ll hear from Anne Wojcicki, CEO DNA analysis startup of 23 and Me. Before founding the company in 2006, she studied biology at Yale and spent a decade in healthcare and biotech.
And she started 23andMe with the goal of giving consumers more insight and access to their own genetic information – to both create paths to more personalized medicine, and to build an anonymized database for commercial and academic use.
Wojcicki spoke to HBR editor in chief Adi Ignatius during our recent virtual conference, HBR Live: Leaders Who Make a Difference. Here’s their conversation.
ADI IGNATIUS: To start off, I’d love to hear you do, it’s sort of a version of an article that you wrote for Harvard Business Review, but really how you developed the business. Usually, the Silicon Valley approach is to move quickly and exploit the gray areas. And find customers, worry about regulation later. But you had fundamental issues with regulators from the start, or almost the start. Talk a little bit about how you had to pivot to handle that, to grow.
ANNE WOJCICKI: Well. So, the company came out of a background that I had, which was on investing in healthcare companies. I spent a decade on buy-side investing in companies, and I got to really understand the healthcare system. And so much of what went into the thought process of 23andMe, was around this belief that the healthcare system can’t change from within. And I believe that pretty strongly, even today, that the $4 trillion that goes into healthcare, the spectacular fragmentation just enables inefficiencies, and that people are not genuinely driven to have change.
So when we started the company, the number one guiding philosophy for us, was about how is it that we are going to create a platform that’s genuinely in the best interest of customers, and is entirely outside of the system?
We always knew there would be controversy. In some ways, that was part of the plan. And a lot of my inspiration was groups like the HIV activists, who really drove significant change in the ’80s and ’90s. And so, we always knew that there was going to be change. So our philosophy wasn’t about running fast and breaking things, and it was a real mission-driven company. It was like, “We really want to put the consumer at the forefront of healthcare.”
And, Francis Collins came out and outlined a whole vision in 2003 that said, the human genome has the potential to revolutionize how we’re going to predict, prevent and treat all human disease. And, it’s 20 years since that first genome came out, and it’s kind of a sad state. It’s an amazing technology, and very few people still have access to it. And it’s really fully integrated, into healthcare. So again, our philosophy was, “We’re going to put the consumer at this at the forefront. We are going to bring forward genetic-based care. And, there will absolutely be bumps along the way, and you’ll have to manage those.”
And I think one thing, it’s actually been fun chatting with more mature companies out there. When we launched, we actually worked with Kessler, who’s now in the administration. And others, to talk about whether or not we needed to be regulated. And the consensus was that we were not a medical device, and we actually then went and even spent time with von Eschenbach and said, “Are we a medical device?” And it was a very hands-off, “We are not going to regulate you.” And when the administration changed, with Obama, it was suddenly very clear. “Now we are going to regulate you.”
So it’s, one thing that became really clear is that, regulation is quite dynamic. And just because we, again, we started in a way that we believed was not going to be regulated. And then obviously, it became clear that we had to, and that’s part of also being in a more controversial area, is that you have to be adaptable to what the latest perspective is on regulation.
ADI IGNATIUS: So let’s talk about adaptability. There were moments in your early years where you were able to do some things, but not able to do some other things. How do you keep the team focused? How do you keep, I guess, mission and purpose consistent when you are forced to adapt, and the business model is shifting?
ANNE WOJCICKI: Well the thing that’s interesting is, the vision, the long-term vision of the company never changed. And when you look actually even at the Series A documents that we had, versus the SPAC documents that we have now. The concept of this flywheel, the idea that you’re putting consumers front and center, that you’re giving them opportunities to learn about themselves, to opt into research and to participate in this massive crowdsourced research community, and that, there’s a lot you can do. You will make insights that will go back to the consumer. You’ll make insights that potentially lead to papers. You’ll have insights that also eventually lead to drug discovery.
And so, the model has actually never changed. I’d say, the short-term priorities definitely are dynamic, but the long-term didn’t change. And so, it’s easy from a retention perspective and how we’ve motivated the people in the company, it’s always been about getting people to focus on the long-term and the vision.
I’d say one other thing that’s really inspiring for people is, we do have direct access to our customers. And customer stories are amazing. And I can’t, like when you are doing something, and people write in and they say, “I found my child because of you,” or, “I found my parents,” or, “I feel like you’ve filled in a different, a new piece of me.” Or, “I got information about myself, and I prevented being diabetic,” or, “I prevented having breast cancer.” It’s a real, feel good kind of experience. And I think that everyone at 23andMe feels like the work we do is really meaningful. And so, that really helped keep people through the bumps.
ADI IGNATIUS: Yeah. So I get that, and I get that the technology is valuable and it’s fun. I did 23andMe, and it was fun to figure out who I was, and where I came from. But the fact is that, there is a big, I know a lot of people who say, “You’re crazy, to give that information away.” I mean, there is a big trust gap, between the public and tech companies generally, and I think in this field specifically. So obviously, you have plenty of case studies of people who are quite happy and have no issues, but how do you manage the trust issue? It doesn’t just go away, because…
ANNE WOJCICKI: Well, a hundred percent. I think the thing that’s – the issue that I have, and actually a bunch of privacy experts had actually sat me down in those early days, and explained again. And privacy is not all of trust, but that privacy really is about choice. And I think the issue, when you think about what happened with Cambridge Analytica and with aspects of Google and Facebook and Twitter, all of these out there, is you’re not necessarily clear about, what are the choices that you’ve made?
So I would argue there’s not necessarily great transparency about, what are the ways that that data is going to be used. And I think one thing that 23andMe has done from the outset is, we’ve always said that choice and transparency have to be really obvious to people. So for instance, we don’t opt anyone in automatically, to research. Over 80% of our customers elect to opt into research. So they actually actively have to click that box, and we make it really clear when you’re answering a survey, we make it really clear that you are answering questions and you are either opted in or opted out of research.
So when we did our large collaboration with GSK, we actually emailed all of our customers with a link to say, if you no longer want to participate, here’s how you can participate. So I would actually say it’s more of a media story, that likes to push on… Again, the privacy worries are very real, and the trust issues are absolutely real, but I think the way that you solve it is actually with the transparency. So I’m really quite proud of our brand, because I think we have a brand that’s absolutely associated with research.
ADI IGNATIUS: So, you may be right that it’s a media scare story. But I know one of the concerns that seems like a real concern is that, yes, there are these guarantees of privacy, but what happens in the future? Will it become easier in the future somehow, to link this private anonymized data to an actual identity? And, I mean, there’s no real way to guarantee against that. Is there?
ANNE WOJCICKI: To guarantee consent or to guarantee privacy?
ADI IGNATIUS: To guarantee privacy as, the way that this anonymized data maybe can be used and broken down?
ANNE WOJCICKI: I think that the same way, no website can promise you that your credit card is safe. No one can, absolutely. But I think that you need to make sure that the risk versus the reward benefit is there. And I think the thing with 23andMe is, it’s absolutely a choice. People don’t have to do it. So people have the ability to learn about themselves, and they can not participate in research. Someone could do 23andMe, get all their information and then download it and close the account. Which is totally fine, too. So I think it’s… There’s no way to a hundred percent guarantee that this is full safe. Anyone who tells you that is just lying. So I think we’ve taken, we’ve done a lot.
The way I think we manage it is one, again, with the transparency and choice, but also with really being incredibly vigilant on the data security side. And, from a structural component of keeping all of your identifiable information in a separate database from your genetic information, to all kinds of various partnerships we do to make sure that we’re vigilant on data security. So, it’s a top priority for us. I think we’re still a relatively young company, and have a mighty security team for those reasons.
ADI IGNATIUS: I know that you’ve been trying to look at COVID-19 and, and see if you can contribute to the knowledge, and looking for genetic predispositions. Have you found anything to talk about, or is it too soon?
ANNE WOJCICKI: We have. I have to say, it’s quite remarkable. And again, this to me speaks to some of the other things that you talked about, just in terms of choice and privacy and how people manage it.
What we find is that people actually really want to participate in research, and they’re just almost never given the opportunity to do it. So with COVID, obviously as a national, global crisis, we put out a survey to our customers and we got over a million people, relatively quickly, to take the survey. And 60,000 or so have COVID. And we were able to, we were early on publishing about the O blood type being associated, there’s publications that have come out now that we’ve contributed to.
There’s some other interesting findings that again, are still pretty early. So, we keep putting information out there either in the form of a blog post, or a publication, or contributing data to other groups that are publishing. But it’s remarkable to me, how quickly we could put together the survey, put it out to our customers, get over a million people to take that survey. Having tens of thousands of people who said that they had COVID, and actually find meaningful results, from that.
ADI IGNATIUS: So I know last year was… Well, last year was tough for everybody, and for a lot of companies. For you, as I understand it, demand for the product was down, you had to lay off staff. As a manager, what have you learned from the 23andMe journey, so far?
ANNE WOJCICKI: Wow. Look, I think the most important thing running a company, and frankly, when I think back on the layoffs and this year, you can almost never predict what’s going to happen. And so, the most important thing you can do is about how are you going to respond? And, you can’t prevent failure. You can’t prevent… In some ways, there’s a lot of factors that are just out of your control. And what’s key for me, is making sure that we have… I have phenomenal people around me, a phenomenal team, and a process to be able to make decisions quickly and an adaptable enough culture so that when there are dramatic changes, like last year, that we can react to it. So I always emphasize people, not to fear failure, but just to really make sure they’re continuously learning. And use all the information that we’ve learned, to make better decisions going forward.
ADI IGNATIUS: You mentioned that 23andMe will be riding the SPAC wave, and going public. I guess that was announced a couple months ago. Are you still feeling optimistic about that path, to a listing?
ANNE WOJCICKI: I think so. Yeah. I feel super lucky, because we had Richard Scheller has a SPAC… Sorry, not Richard Scheller, Richard Branson. Richard Scheller wishes he had a SPAC. Richard Scheller is our, was our Head of Therapeutics.
But Richard Branson, with Virgin, was an early investor in 23andMe, a phenomenal person, and somebody who really defines almost, “How do you think big?” And clearly thinks big, has a huge vision, and also knows how to manage ups and downs. And, he has had experience in healthcare. And I just, I love, because as a kid, I remember just loving Virgin Airlines and the cleverness of the brand. And there’s so much aligned with what he has done in the travel sector, and even with healthcare. And the ability to have a vision, stick with it, it’s long-term and, all around brand and consumer and doing something that’s right, by the person.
So I think the SPAC process as well, is I think it’s here to stay. And I think it’s a phenomenal process. When I think back again, on my investment days, where it was just all about the S-1 and the IPOs, I think SPACs are here to stay. And I think frankly, it has some significant advantages, which is why we chose that path.
ADI IGNATIUS: So I’m going to slip in some audience questions. So here’s a question from Magdalena, and it’s really about your competitive landscape. Asking, “How is 23andMe different from Ancestry or other competitors? How do you make the case, for 23andMe?
ANNE WOJCICKI: It’s pretty different, and largely because, 23andMe focuses on the re contact-ability and the engagement of the customer. So when you think of Ancestry, is very much about the ancestry experience in getting you onto their tree. And what 23andMe has really done since day one is about, “How is it that I’m engaging you with your whole genome, holistically? Whether the ancestry side, the health side, relationships to your family, relationships to other parts of the world? And I want to keep you coming back.” And it’s that engagement, that is a huge differentiator.
So Ancestry, we saw a lot of overlap in the Ancestry world. And it’s an area that we, 23andMe, scientifically really pioneered. This idea of autosomal ancestry. So, the way that you can look at all of your chromosomes and understand where they are. It’s an area that we really pioneered. And even, the DNA relatives, the ability for you to compare your own genome to others out there and find family members.
And so, we also look at ourselves as scientific leaders, where we keep innovating. And we keep innovating because we have an incredibly unique dataset, so we can get insights from there, and we keep giving it back to customers. When I think about other large genetic databases that are out there, the number one thing that they’re missing, is really that engagement. COVID-19 was a good example, when we could put something out to people and very quickly have them fill out surveys and answer questions. And, I don’t see other companies or other academic groups that have that ability, to so rapidly be able to engage people.
ADI IGNATIUS: Here’s another audience question. “The tech industry has not traditionally been a particularly welcoming place for women. Do you think that’s changing and are you trying to find ways to change that?”
ANNE WOJCICKI: I’m definitely in, I have a little bit of a unique perspective here, because I have my sister who also happens to be, obviously a female, and a tech CEO. And so, I’ve actually always had… And I think about other people, who were mentors like Sheryl Sandberg and others. I’ve been really lucky to be in a world where, I’ve had phenomenal women around me. And other people, like Diane von Furstenberg, and Arianna Huffington. These are all people who’ve reached out and been supportive. So I actually feel like, first and foremost, there’s absolutely a problem. You just look at the numbers. The numbers speak for themselves, and there’s an issue.
So, what can I do? My job is to make sure that I use my time effectively. And one of the things I can do with my time, is to mentor.
And I’m really happy at the number of people… I never want employees to leave 23andMe, but if they do, I want them to be successful. And I look at, one of my former VP of Business Development is now a CEO of a biotech company. And one of my other product people started Modern Fertility. And, I have a number of employees who have left and have that confidence in themselves, and done something important and significant. So I think that one of the most important things for anyone who’s in a position of responsibility, it’s your job to make sure that you are pulling up people who are interested in pushing themselves further, and bringing up a diverse world. So it’s absolutely, it’s a priority for me.
ADI IGNATIUS: So, let’s look forward. What are you seeing, that I’ll see at some point? What’s next, in terms of genetic research? Both in terms of something you could productize, or just in terms of medical treatment?
ANNE WOJCICKI: Well, I think the vision that Francis Collins outlined in 2003-ish, of using the human genome to really predict, prevent, and treat all human disease. Is real. Like, that’s absolutely a vision I think that is going to come to fruition one day, and it’s just a matter of when. And what has been fascinating to me, in this last year, is the fact that COVID-19 accelerated the entire virtual care world. And so, virtual care is no longer seen as weird, it’s seen as wonderful. And, I think the world’s not going back. So it’s absolutely a moment now, where everything is changing, and we have this opportunity to really move forward this vision of helping everyone prevent, predict, and treat all human disease that has a genetic foundation.
And I think one thing that’s obvious in some ways, in other sectors. Like when you sign up for Apple news, it’s personalized for you. Or if you sign up for Netflix, it’s personalized for you. And I think one of the key things that genetics is going to be able to do for people, is to personalize their healthcare. Like, everyone has a different hand that’s been dealt to them, and so how do you take advantage of that and actually use that to have the best care possible and and the best prevention possible?
So I think there is, I think the combination of the virtual care world, which is exploding. As well as the vision that, genetic medicine really is going to have a huge impact on all aspects of your health care.
ADI IGNATIUS: As you look at the healthcare system, let’s say in the US, because that’s where you are. People seem to be very proud of our system, but it doesn’t really hold up all that well, against systems in other countries. When you look at that, do you think there are a couple of doable fixes that we could do to make our healthcare system as good as it could be?
ANNE WOJCICKI: I am probably the worst person to ever pontificate on that one, because I would say absolutely, no. My decade of investing in healthcare made me realize that $4 trillion, is a lot of money, and no one’s giving it up easily. So, there’s a lot of reasons why you can make money on diabetes. You can make money on readmissions. You can make money in every way, as soon as you’re sick. And I… Listen, there’s all kinds of games… It’s like taxes, there’s all kinds of games you can play to follow the code, to lead to a slightly better outcome. But hands down, I just don’t want to be in the system. I’d rather just be healthy at a hundred.
So, no. I do not think that there are any financial – Tell me who makes money, if I’m healthy at a hundred, and I will go in that path. And right now the closest thing I can find to that is Kaiser Permanente. And beyond that, I just, I don’t see healthcare has the opportunity to change.
ADI IGNATIUS: So I think you were the right person to ask. That’s actually a very unexpected and interesting answer. So, I think we’re out of time, but Anne, I want to thank you for joining us. And thanks for giving us the final word, and I wish you luck with the SPAC.
ANNE WOJCICKI: Well, hopefully I will end on a positive note that there is, I do see a beautiful vision coming from a direct to consumer world that, the more people are actually empowered with their purse and they can make choices, you’re going to get better care.
ALISON BEARD: That was Anne Wojcicki, CEO of 23 and Me, an online company that offers DNA genetic testing and analysis. She recently spoke to Harvard business review editor in chief at the virtual conference: HBR Live: Leaders Who Make a Difference
This episode was produced by Mary Dooe, we get technical help from Rob Eckhardt, Adam Buchholz is our audio product manager. Thanks for listening to the HBR IdeaCast. I’m Alison Beard.