23andMe: How the DNA Pioneer Took On the FDA and Redefined Health Tech

Contents

Anne Wojcicki: Lizzo dressed up like 23andMe for Halloween. And we had Eddie Murphy come to Saturday Night Live and, like, talk about 23andMe. Like, we’re in crossword puzzles and jokes. Everyone suddenly was exploding with stories about 23andMe.

And then, in 2019, kit sales started to flatline. It was really a question of like, “Well, what happened?” 

Roelof Botha: Welcome to Crucible Moments, a podcast about the critical crossroads and inflection points that shaped some of the world’s most remarkable companies. I’m your host, Roelof Botha.

When Anne Wojcicki launched 23andMe in 2006, the company revolutionized the healthcare industry by becoming the first to offer individuals direct, affordable access to the information contained in their genome—information to help people understand their ancestry, but also their genetic predisposition to different health outcomes.

But as with any company that shakes up an industry—especially the medical establishment—there comes enormous risk and no guarantee of survival. 

In today’s episode, we’ll hear how 23andMe confronted a regulator with the power to shut down the company, took a leap into the high-risk, high-reward territory of drug development, and transformed its consumer business after booming sales suddenly flatlined. 

Anne Wojcicki: My name is Anne Wojcicki and I am the cofounder and CEO of 23andMe.

Why Anne started 23andMe and the company's "Why Now"

So many things played into me wanting to start 23andMe. First and foremost, I had spent about 10 years investing in healthcare companies. And over time I started to realize that healthcare was this massive system that was really wildly optimized to monetize you. And I also realized how much the patient doesn’t have a voice in their own healthcare. 

And so, 23andMe really kind of came from this idea is, like, how do I bring people together where the whole purpose of that community is about what we, the community, actually all see as our interests—not necessarily what is that interest of the bottom line of, you know, a drug discovery company, or a healthcare company or an insurance company. But like, what’s reflective, truly, of people’s needs and interests. 

And frankly, that is about how do you actually stay healthy as long as possible, or then crowdsource solutions if you actually have an illness and you wanna have a better outcome. 

Roelof Botha: Just a few years before Anne founded 23andMe, the field of genetics experienced a paradigm shift: scientists successfully sequenced 92% of the human genome, which, amongst other insights, gave society a greater understanding of genetic contributions to numerous diseases. 

Anne Wojcicki: I feel really lucky that I was kind of in the right place, right time of knowing the healthcare sector, knowing the tech world, and then, also seeing the human genome and the cost decline that you were actually gonna be able to get access to your own genetic data at a relatively affordable price. 

So, the mission of 23andMe is to help people access, understand and benefit from the human genome. 23andMe was groundbreaking in a number of ways right when we launched. First off, like, people had never had access to their genomes before. You had one-off stories of people spending, you know, a million dollars, prohibitive sums, to get access. And what 23andMe is, we really democratize that access. 

So, I think the second thing is that we were, you know, absolutely interested in providing lots of information back to individuals about, you know, things that the medical community would otherwise not return, like Alzheimer’s risk, because there’s not necessarily a treatment for that. And a lot of that was actually driven by my ex-husband Sergey, who, at the time, there was a discovery about Parkinson’s and he wanted to know whether or not he had that risk factor. And nobody would test him. And I think it’s one thing that the medical world sometimes overlooks. You know, people do wanna plan their lives and they can make other decisions outside necessarily just a clinical medical one, that there’s lifestyle choices. And so, that was one of the tests that 23andMe put on our chip, you know, testing actually for that Parkinson’s mutation. And we were able to show obviously that that Sergey did in fact have that variant and was a carrier for it. 

And then, I think the third thing that we did that was like, really controversial and groundbreaking was the idea that we were actually creating this incredible database of consented individuals who were helping us make the product better.

Meaning that, as more and more people signed up, we were able to create Relative Finder, meaning that you were able to consent to say, “Yes, I wanna see if I’m related to anybody.” Or, you wanted to look at your ancestry composition and you wanted to see what parts of the world your DNA came from.

So, we were able to actually pioneer a lot of really innovative tools to help you not just, you know, get access to your DNA, but then, to also explore it and get meaning from it.

Finding the market for genetic testing

Roelof Botha: Any company that pioneers a truly innovative product faces a harrowing question early on: Will there even be a market for it? Finding that product-market fit was 23andMe’s first test.

Anne Wojcicki: We had an incredible launch. We were the New York Times cover story. We were the cover of WIRED. We had this crazy launch party during fashion week. We had all these celebs, and it was, again, kind of unintentional, but like, it ended up getting so much press. And again, because it was sort of controversial. Like, it was like the world of sci-fi was coming real. Like, suddenly you could look at this code inside of you.

Roelof Botha: I was one of the earliest adopters, and took my 23andMe test in 2007.

I’ve always wondered what’s wrong with me ‘cause I’d often sneeze once as soon as I stepped outside the building into bright sunlight. And I never understood why that was the case until I did 23andMe and I got the results back.

And it turns out there’s a genetic trait called photic sneeze response where certain people have this genetic trait that they step into the sunlight and have one sneeze. 

The novelty of this kind of discovery, along with more profound health and family insights, helped drive an early surge in sales.

Anne Wojcicki: The first price point was $1,000 and we sold like, a thousand kits our first day. And then, the volume trickled down to, like, 15 to 20 kits a day. And for those of you who are math majors, that’s not a lot of money. 

And it became kind of that question, it was like, “Well, what are we, like, how are we gonna get people to think that they need their genome?” Ultimately, we decided one day that we were just gonna cut the price to $99 and see what happens.

My engineering team called me at seven in the morning and they’re like, “Anne, we’ve sold over a thousand kits. Like, what should we do?” And I was like, “I don’t know, like, let it rip.” I think that was my exact words, like, “Let it rip.” And you know, to make a long story short, we sold 17-18,000 kits by the end of the day. And that was actually frankly all of our inventory.

I realized like, there’s demand. Suddenly, being able to get almost 20,000 people in a day to spit was, like, amazing because, you know, previously, there hadn’t really been like, big studies over 10,000 people hadn’t happened. We raised our series C, kind of, off that data and it gave us that hope and that inspiration that we knew there is really this potential for it.

A challenge from regulators

Roelof Botha: The company had finally found the kind of product-market fit where customers were lining up to spit in tubes. But with 23andMe exploding in popularity, it wasn’t long before the medical establishment started to turn on the company.

You’ll often see this in science that new ideas are often discounted initially. You know, people forget that Galileo was ridiculed for his notion that the universe didn’t revolve around the Earth. And that was certainly the case in the early days of 23andMe, where many of the established medical profession heavily discounted the company’s importance. It was really discredited in the early days.

Anne Wojcicki: For years, there were medical meetings that did not want us to attend really solely based on the fact that we were a direct-to-consumer company. 

I had one dinner, I was describing what we were gonna do, and this individual actually stood up and he left. And he said, you know, “23andMe is gonna cause so much destruction in people’s lives because women are gonna be abandoned everywhere because of the non-paternity rates.”

The thing that I realized is that there was a lot of general fear about genetics and information and a lot of fear about what consumers or patients, in this point, will do without physician supervision. But, that was unsubstantiated with data. The fact that we were circumventing the medical world really just hit a nerve.

Roelof Botha: And when you circumvent the medical world, regulators start noticing.

Anne Wojcicki: 23andMe had a history with regulatory agencies. In our earliest days, our first warning letter came from the Department of Health of California. And that actually forced us to move from working with Illumina for processing labs over to LabCorp. And we were able to resolve that one pretty quickly.

Roelof Botha: Despite the medical community’s concerns and the occasional regulatory warning letter, 23andMe forged ahead sending out testing kits. But then, in November 2013, it received something more ominous than a warning: The FDA ordered 23andMe to shut down all of its health testing services.

Anne Wojcicki: So, when I got that letter in November, it was a real shock. And then I think the bigger shock was that it became public a matter of days later.

When I got the FDA warning letter, I was actually at a offsite with the leadership team of 23andMe. And I got a text message from my assistant at the time who said, “You got a package that was couriered to you from the FDA and they want me to sign it.” And I actually said to her, “Don’t sign it.” And then, she said, “I already did.”

It was brought over to me and I opened it and I read it to everybody. And my take was like, you know, we’ve had a long history of issues, like, we can solve this too. You know, I did not read it as being that bad. And, on Monday, the letter became public. And that’s actually when David Kessler called me.

Roelof Botha: The Former FDA commissioner. 

Anne Wojcicki: And said, “Anne, I know you. And I know that you don’t think that letter is so serious, and I’m telling you now it is, and you have to stop.” And so, suddenly, I had the world to grapple with. 

Roelof Botha: All companies face obstacles, but when a government regulatory agency, like the FDA, orders you to stop selling your product—that’s a true crucible moment. As a condition for selling their health product, the FDA demanded that 23andMe go through the process of getting FDA-approved, an ordeal that could take years. How should the company proceed? All of the options looked daunting.

Richard Scheller: No one had ever done anything like 23andMe was trying to do. There really was no genetic consumer product at the time. So, when they received the warning letter, frankly I was a, I was a little worried. I was not sure how 23andMe was actually going to deal with this, or frankly, whether they could deal with it. 

My name is Richard Scheller and I was Head of Therapeutics at 23andMe from 2015 to 2019.

23andMe had no experience with interacting with a regulatory agency, all of the hoops that they would have to jump through in order to get a report approved. And I wasn’t sure that 23andMe was gonna come out of that and actually be a successful company.

To fold, to fight or to comply?

Anne Wojcicki: Okay, so option one was to fold. After we got the letter, there was no shortage of people who came to me and said, you know, “Anne, like, most companies fold at this stage,” and in my mind, I kind of made note of those people and I was like, “Okay, never work with these people again.” I was like, of course we’re not gonna fold.

Option two in my mind was like, well, we can fight this, like we should fight. There was no shortage of our customers who wrote in to say, “This is outrage. How dare they try to impede my access to my own data?” And that kind of rallied me up. 

And then, the third option was just to totally comply. And there was one very influential regulatory leader who I met with, and she said to me, “Anne, what do you wanna do? Do you wanna sell this company in the next couple years? Because if you wanna sell this company, you can just like, package this up, ship it out and be done. But if you really wanna do the things that you’re setting out to do, the way you’re going to get there is you put your head down and you do the work.” And she’s like, “It’s gonna be slow and painful and it’s gonna take you years. And are you really up for it?” And, honestly, I think back now, and I’m like, I knew she said the word ‘years’, but I didn’t know exactly how many years.

So I chose option three. I chose the last option because I said like, 23andMe is a mission-driven company that is set out to really have an impact on healthcare.

Gathering the right team for the new job ahead

Roelof Botha: Making the choice to comply with the FDA’s demands was one thing. Now, 23andMe had to figure out how to actually follow through, something Anne admits her staff simply was not yet equipped to do. 

Anne Wojcicki: To be honest, we did not have the right kind of team. Like, I had a team that was very mission driven and very capable, but lacked regulatory experience about exactly how we should be pursuing a regulatory strategy. And our warning letter did come out of surprise. 

My main priority was finding somebody who was gonna lead us through an FDA regulatory process. So, hiring Kathy Hibbs was a huge accomplishment for us. 

Roelof Botha: In April 2014, Kathy Hibbs brought her more than two decades of legal expertise in clinical and medical settings to 23andMe, joining as the company’s Chief Legal and Regulatory Officer.

Anne Wojcicki: It really was a major transition to go from being an unregulated company to a regulated company. And the engineering, the software, like, everything about it was just an incredible amount of work. 

We were in such a hole. And in some ways, the regulatory team that we brought in after the warning letter almost felt like, you know, we are being set up to fail. 

Richard Scheller: Oh, it’s a huge process dealing with the regulatory agency. They asked 23andMe to show that the reports that they provide back to consumers are accurate. And I won’t go into the details, but suffice it to say that this was quite a technical challenge and hurdle.

And then, in addition to that, the FDA wanted to be sure that a consumer could understand the report. So, the FDA asked 23andMe to provide the report to a group of people, and then, for the folks to take a test and to show that they could answer the questions in a way that demonstrated that they understand the report. So, that was a very big lift.

Roelof Botha: It took two years of meticulous testing, proving methodologies and providing data. But 23andMe relaunched an FDA-approved version of their health testing kits to the market in 2015.

Anne Wojcicki: The day we got our FDA authorization, our Head of Legal and Regulatory, she laughed. She’s like, “It’s the only time, I think, anyone in the regulatory team has gotten a standing ovation.” Like, it was really, it was really exciting. 

Roelof Botha: The company was sort of under the hammer and Anne completely turned that into an enormous competitive advantage for the company where they can now truly be the only company to offer these tests.

The work they put in, incrementally earning the FDA’s stamp of approval over time, didn’t just change the way regulatory agencies saw their product, it changed minds with the medical establishment and beyond. 

Anne Wojcicki: I think that the biggest lesson from the crucible moment was, you know, like, the world does change. And the way it changes is not, like, the regulators see an aha moment and they change. It’s like, small steps over time. 

I remind people at 23andMe that when we started the company, gay marriage was illegal. The world does change and it changes because of the effort of people who are persistent and continue to chip away at, sort of, the arguments with data and with activism.

Roelof Botha: With the company’s health product blessed by the FDA, 23andMe was no longer the pariah of the medical world. 

But something else happened in 2014 and 2015 while they were buttoning things up on the regulatory side: Sales of their ancestry product were accelerating, opening the door to a bold new direction for the company.

Anne Wojcicki: So, the business really actually did quite well during that time frame. Like, we hit a level of scale. And we had so much genetic data that we could actually start doing really interesting research. But we started getting that scale of like, well over a hundred thousand people, close to a million. And we were, you know, sort of the largest consent-to genetic database in the world. 

Roelof Botha: The database was finally big enough for Anne to follow through on one of her original ambitions for the company.

The pivot to therapeutics

Anne Wojcicki: I was always really excited about this potential of using human genetic data for drug discovery. Drugs that had a genomic foundation were two to three times more likely to be successful than ones that did not have a genetic foundation. 

From my days as a Wall Street analyst, I realized in the biotech space, you often have just animal data. You don’t have large data sets. It’s hard to recruit people. You do all this expensive work to set up a study and then take it down. 

Roelof Botha: Anne realized that her library of data could be of extraordinary value to companies developing therapeutics. 

Anne Wojcicki: So, we, we started doing partnerships with pharma and frankly, we kind of realized that there just wasn’t a lot of expertise in-house at a lot of pharma companies about genomics, about how to translate from drugs to therapies. And it was an expertise that, more and more, 23andMe was building in-house.

So, we realized that if we really wanted to harness the power of what 23andMe had to offer, we should do it ourselves and lead by example.

Roelof Botha: 23andMe had arrived at its next crucible moment: Instead of partnering with outside firms, should the company build out its own therapeutics division from scratch? 

Richard Scheller: Starting a therapeutics division is a big, bold, risky endeavor. Making medicines is a very long and difficult process. And, in fact, most attempts to make medicines fail. It was not necessarily the case that this was a slam dunk.It was many years ago that I met Anne. We heard about 23andMe at Genentech very early on, right when the company was founded.

Roelof Botha: While at Genentech, Richard oversaw that company’s investment in 23andMe’s initial seed funding. 

Richard Scheller: Because I was an executive committee member of Genentech, when I retired, it was required that the companies put out a press release. 

Anne Wojcicki: When I saw that he retired, I called him.

Richard Scheller: I think it might have even been a couple hours after the press release came out, Anne phoned me. And I didn’t think that it was just a coincidence, if you will, that she was phoning to say hello. And I said, “Why don’t you come over?” 

Anne Wojcicki: I went to go see him and we chatted briefly. And, Richard Scheller is known to be very lovingly skeptical of everything. Richard was very forthright about the risks and, you know, the cash burn.

Richard Scheller: So, one of the first things that I did was to put together a strategic plan, which included a number of people that we might hire, how much it would cost to build out a laboratory, how long it would take to potentially come up with a medicine that would move into clinical testing, how long the clinical testing would take, how much that would cost. And really educating, not only Anne, but the rest of the leadership team at 23andMe on what drug discovery actually is, how long it takes, how expensive it is. But what might come out at the end is a medicine that could really help people.

Anne Wojcicki: And I said to him, I said, “Yes, I spent a decade investing in biotech. I’m well aware of the failures. But it’s a irresistible opportunity to be able to leverage novel human genetic data that’s never otherwise been seen before in this kind of scale to say that, potentially, we could really transform drug discovery.”

Richard Scheller: The thing that impressed me about Anne most was her vision and her enthusiasm and her, just, unrelenting belief that genomics will help with human health.

Roelof Botha: Even though there was a glint in Anne’s eye of building a therapeutics business many years prior, it really took somebody of Richard’s experience and skillset to help galvanize and get that off the ground.

Richard Scheller: Well, so my first day at 23andMe was quite amusing. I came in and somebody said, “Well, you can use this desk.” And I looked and it was a desk in a sea of people. And at Genentech, I had an office that was mine. I had a conference room that was mine. I had a library that was mine. 

The closest they had to a laboratory was the kitchen where lunch was served.So, you know, we needed to build a biochemical molecular biology drug discovery lab from scratch. We had nothing. 

So, we proceeded to hire a few more very talented people. And then, eventually moved into laboratory space. We bought a lot of used equipment actually. We would participate in auctions where a company had perhaps shut down and they were selling all of their equipment. So, we would bid online to buy centrifuges and, you know, all the kinds of millions of dollars of laboratory equipment that you need in order to do experiments.

It was extremely daunting, but I had in the back of my mind that, look, biotech companies were founded and they did start, and they did succeed. So that it wasn’t impossible. One just had to, you know, do it.

Anne Wojcicki: I think some of the biggest challenges we’ve had with therapeutics is, frankly, is almost the perception of the company as a direct-to-consumer ancestry company. Pharma, biotech, CEOs will sometimes ask me like, “You do drug discovery?”

I’m like, “Yes, we do drug discovery.” “And like, with labs?” I’m like, “With real labs.” And like, “Real labs, like a pipette?” And I’m like, “With pipettes, like real, like we have, like, real, like. We know how to make antibodies, we know how to run, you know, assays. Like we have, like, a real working biotech.” And they’re surprised because we’re known for our direct-to-consumer genetic testing.

Richard Scheller: So, we decided to work on a very specific therapeutic modality, and that is to make antibody therapeutics, which was somewhat more straightforward to build from scratch, so it allowed us to more quickly move forward in making therapeutics.

And there were a number of breakthroughs as we began to look at the data. We saw that there were associations of particular genes with disease that suggested that those genes encoded molecules that could be important drug targets. And that was the question that we had when we started, “Would that be the case?” And we found a number of drug targets that we thought were worth pursuing.

Anne Wojcicki: It’s kind of remarkable today because now, I have a therapeutics team that is incredibly dedicated and it’s really hard painstaking work to develop a drug. And they’re sticking to it. 

I have an extensive collaboration with GSK. We have over 50 programs that have been identified. And I think now we actually have this really amazing opportunity of working more and more with pharma and biotech partners as we have proven out just how productive this database can be.

Richard Scheller: Soon after I arrived, the folks in the consumer group asked me, “How big does the database need to be for therapeutics?” And the answer is, “Well, you know, the bigger the better.” So, you know, I just said, “10 million.” 

We’re somewhere around 12 to 14 million people in the database now, which makes the 23andMe genetic database, by far, the largest in the world. Also, the growth of the database was more than I ever dreamed that we’d be able to accomplish.

To build a therapeutics division from scratch takes fortitude, but the main thing that it takes is an idea and a belief that you’re going to do something different that’s gonna make a difference in patients’ lives. And if you get out of bed thinking that every day, anything is possible.

Reigniting growth amid privacy concerns and tapering sales

Anne Wojcicki: In 2018, we saw an incredible inflection point where kit sales really took off and our brand awareness hit an all time high. Whether it was, like, Lizzo dressed up like 23andMe at Halloween. We had Eddie Murphy come to Saturday Night Live and like, talk about 23andMe. Like, we’re in crossword puzzles and jokes. Suddenly, everyone was exploding with stories about 23andMe. 

And then, in 2019, it started to flatline. It was really a question of like, “What happened?” And we did see that there was definitely more of a concern around privacy. So Cambridge Analytica was a big one, Golden State Killer was a big one, where suddenly we needed to address the fact that people were just wanting to know what was gonna happen with their data. 

Roelof Botha: Amid changing tides of consumer sentiment, 23andMe was also facing increasing competition.

Anne Wojcicki: So after the FDA warning letter, we made the decision to continue selling the ancestry product, but not selling the health product. You know, what was actually interesting for us is we sold pretty well. 

So, it was definitely an interesting time because we put most of our effort into health, but suddenly ancestry was taking off. And I would actually argue one of the mistakes we made at the company, it was like, we were not marketing heavily in that timeframe, and that’s when our competitor Ancestry.com really did take off. 

Roelof Botha: As sales tapered off in 2019, 23andMe faced another crucible moment: Had they saturated their market? How could they reignite growth?

Anne Wojcicki: It became a question of readjusting our spend, readjusting our marketing budgets. How are we going to keep growing but in a way that’s going to make sense?

From a product perspective, it became really then about making sure that people understood, well, how is 23andMe using the data? Talking very clearly and frequently about the principles that we operate on, which is really choice and transparency. 

Roelof Botha: Part of readjusting meant laying off 100 people, or roughly 14% of their workforce. It also meant completely reenvisioning what a direct-to-consumer healthcare company could offer users.

Yet another pivot, this time to telehealth

Anne Wojcicki: In the earliest days of 23andMe, we were so consumed with just like, fighting basic survival of, “Is it safe for you to get your genetic information? Are you gonna be able to understand it?”

And more and more, we started to realize that we had that luxury of like, 10-plus years of data, and I realized, like, we have this opportunity to actually do an even better job of keeping people ongoing, up-to-date with their genetic information. That was a moment when we said, like, “We need to pivot.” 

And that became kind of that next phase for the company, is really making sure that we are not just providing information, but we’re gonna actually become part of the full stack of helping make sure that people now also know what to do with it by having a subscription product. 

Roelof Botha: Offering ongoing telehealth services through a digital subscription would require medical professionals who could work directly with 23andMe customers. But at, the time, consulting with medical professionals anywhere but in-person, in their offices, was uncommon. 

Anne Wojcicki: We had actually this offsite in 2019 where I thought about telemedicine and I was like, I just, I don’t think we can do it.

Roelof Botha: But then, like so many other aspects of our lives, everything changed in March of 2020.

Anne Wojcicki: Suddenly, with the pandemic, telemedicine became, like, accepted in a matter of weeks. So, that opened up doors for us to say, we actually have this opportunity to offer telemedicine to our customers, to offer online pharmacy. 

Roelof Botha: But building out a telehealth platform and an online pharmacy from the ground up would require an enormous amount of time and resources. So, the company decided it might make more sense to take a different approach. 

Anne Wojcicki: We had this opportunity to acquire Lemonaid and that gave us the ability to have clinicians who can work with patients in all 50 states, as well as a pharmacy.

And having a pharmacy was really key for me because I look at the opportunities with pharmacogenomics, meaning like, how is that I can look at all of your medications and know which medication has a genetic component and can I get you the right medication based on your genome, and suddenly, we had that opportunity.

Roelof Botha: 23andMe’s acquisition of Lemonaid Health closed in November 2021. 

Lessons learned from 23andMe's crucible moments

Anne Wojcicki: I’d say today, we’re still kind of in that process of harmonizing everything and bringing everything together. We have put more and more of the right people in place to really lead the evolution of the company. 

I look at crucible moments as opportunities to pivot and explore a new path. Like, it forces you to look at the world in a different way. And I think when something like, your sales go flat, or you have a regulatory intervention or competition comes in some way, you have an opportunity to innovate. That’s the exciting moments. 

When it’s just up and to the right, anyone can sail that kind of ship. But it’s a crucible moment when it’s hard and you do need to galvanize people to get that right kind of creativity.

They’re just scary for people because when you walk in and you’re like, “Hey, guess what, we’re gonna do it in a different way,” it makes people uncomfortable, but that’s part of leadership. You have to lead and make people realize that the evolution is gonna be better than where they are today.

Looking at the path forward of 23andMe, I feel like we have this opportunity now to be really, sort of, the world’s only leader of genomic-based medicine. And how is it that people can get affordable access to advisors on the latest in genomic medicine and how to execute on it and what to do.

How do you have not just, like, very generic, “Hey, like eat this, exercise, sleep,” but, you know, being able to help people understand, well, when should you get a colonoscopy? When should you get a mammogram? You know, some people really, it’s toxic for them to eat fava beans. So, I feel like we have this opportunity to really give personalized prevention. 

The biggest gap in my mind in healthcare is this idea of like, how do I keep you well? And your doctor today is not terribly interested in that engagement of keeping you well. And so, we believe that there’s this incredible opportunity, based on your genome, of helping you, you know, stay healthy as long as possible, or if you have conditions, how do you better manage that? 

Roelof Botha: In one of the strongest affirmations of Anne’s vision for her company, on June 1st 2023, 23andMe sent out an email blast with news of 23ME-00610, a new, first of its kind investigational cancer drug. An antibody that they believe has the potential to treat patients with advanced cancers.

Richard Scheller: This is our first molecule to move into phase two of testing. In phase one, we demonstrate that the molecule is safe and tolerable, and in phase two, we test whether the molecule actually works and helps patients and we’re just in the process of that.

Now, if it’s shown to help people with cancer, it will be a tremendous breakthrough. But we still have a very long way to go in order to prove that.

Roelof Botha: But 23andMe is used to long roads. One of the benefits of spending so much time on a problem is that you’re able to look back and recognize progress.

Anne Wojcicki: We do these surveys of clinicians, like physicians, over 90% of physicians say that they understand how genetics will make their clinical outcomes better.

And I do always still think back on like those earliest days in the company when I would go on stage and I would say, “A consumer should have the right to access their own genome.” And there was overwhelming, like, demand. And the medical world was like, “Oh my God, well, I don’t know.” And I do think about the team at 23andMe that did just endure, like, in continuously proving out that this information is accurate, it’s safe and it’s meaningful. And we slowly, like, won over the world.

So, it’s been, like, such a massive transformation of acceptance. I don’t know, it’s just like, it’s amazing to me.

Roelof Botha: Anne, who’s always seen her company as pushing boundaries, continues to see that as a crucial part of 23andMe’s DNA.

Anne Wojcicki: I don’t worry too much about 23andMe becoming too traditional because we’re so far from it. I remember at one point, some big company leaders telling me like, “A lot of leaders who have a brand don’t wanna take a risk,” but why else have a brand if you don’t wanna take a risk and move the world forward? And I feel lucky, like, I have millions of customers and I have a brand.

And as you get bigger, it gets harder to do things. I think it’s important to make sure that you’re always pushing. And frankly, like, that’s my job to constantly inspire and to make sure that I have other leaders who have that vision and that they are inspiring.

Roelof Botha: And one more medical term for good measure. 

Anne Wojcicki: And I do think it becomes contagious. 

Roelof Botha: This has been Crucible Moments, a podcast from Sequoia Capital. 

Join us next time, as Jensen Huang shares how NVIDIA survived near bankruptcies, revolutionized computing with the release of their GPU, and persevered to become stewards of the AI revolution.