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On the Comeback Trail

Anne Wojcicki and 23andMe made it through some rough water. Now it's full speed ahead.

SLIDESHOW

Serious Business 
After some earlier setbacks, 23andMe’s service is now FDA-approved. “The reality is that figuring out regulation is hard,” says Wojcicki.

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Work Force
Wojcicki meets with VP of Research Joyce Tung. “I really believe that this is something special that we do,” says Tung.

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Full Circle
In the 23andMe office, artist Olafur Eliasson’s “Polychromatic Attention” measures nearly 75 inches in diameter and consists of 24 partially chromed crystal spheres.

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Like a dude walking into a bar full of his bros, Anne Wojcicki announces her arrival at a magazine-cover photo shoot with a half-ironic, half-genuinely enthusiastic cry of “What up?!” In between shots, she grooves to the beat of A Tribe Called Quest’s “Check the Rhime” and banters with the photographer about online photo-storage software and the relative merits of Hasselblad and Phase One cameras. She is ostentatiously comfortable in the moment.

She occasionally checks her phone—later that evening, she will be flying to Japan for the International Congress of Human Genetics. Her mother, she announces, might be “crashing the trip.” She seems more amused by the potential logistical complications this implies than anything else, punctuating her comments with her signature laugh, a staccato bark that opens a direct window into her personality: forceful and game for anything.

Her aplomb is impressive, especially when you consider the turmoil that Wojcicki, the CEO and co-founder of 23andMe, the first direct-to-consumer genetic testing company, has endured over the last few years. In 2013, Wojcicki was hit with a double whammy of supersize personal and professional drama. That summer, news broke that she and then-husband, Google’s Sergey Brin, had split (their divorce was finalized last year). The second hammer blow dropped in November, when the Food and Drug Administration stunned the entire digital health universe with a letter ordering 23andMe to shut down the core of its business, the sale of genetic test results that informed consumers of their likelihood of contracting diseases like breast cancer or Alzheimer’s.

But here we are, three years later, at a photo shoot in April (her third this week, actually), and circumstances have changed, dramatically. In October, 23andMe raised $115 million in new capital, a sign that investors were happy with a much-improved relationship with the FDA and some new strategic initiatives. Some of the biggest names in pharma—Pfizer, Genentech—are now paying real money to exploit the massive database of genetic information 23andMe has collected from 1.2 million consumers. Her divorce is in the rear-view mirror—indeed, the week before I interviewed her, online tabloids were going crazy over a picture of her eating lunch with her arm draped around the shoulders of Yankees slugger Alex Rodriguez. (“Yeah, we’ve become good friends,” she later acknowledges.)

So when we sit down for an interview in 23andMe’s cafeteria, the first question has to be: Is this a comeback story? Is it good to be Anne Wojcicki again?

Here comes that quick bark of a laugh. Ever since she graduated high school, she says, she’s had fun “riding the waves of life.” Sometimes it gets messy. The FDA letter, she acknowledges, “wasn’t fun.” The divorce, with two small children in the middle, “wasn’t fun.”

“It was hard to focus,” she concedes—though even admitting that much seems grudging. But it’s all ancient history. Today, she and Brin are “very good friends” who live near each other to facilitate co-parenting responsibilities. As for the FDA, which is once again allowing 23andMe to provide (a much more limited) set of test results, she asserts that the new, improved relationship will “drive policy change.” 23andMe’s founding mission—to “revolutionize” health care by giving people access to their genetic information—is unchanged.

Apple’s Steve Jobs was famous for his “reality distortion field.” Wojcicki’s equivalent is what she calls her propensity for “unrealistic optimism,” a sunny side-up predisposition that treats crushing blows as the lightest of speed bumps. Her friends and co-workers agree.

“If you say, ‘Oh, Anne, I don’t know; that seems really hard,’” says VP of Research Joyce Tung, who has been with the company almost since its inception in 2006, “that will just galvanize her. Anne loves a challenge. If you want her to do something, you should just tell her that it is impossible.”

The task that Wojcicki and Linda Avey set for themselves when they co-founded 23andMe a decade ago might not be, strictly speaking, “impossible,” but in a part of the world where grandiose ambitions are as common as iPhones, 23andMe’s goal—“to solve health”—ranks in a class of its own.

23andMe believes that by empowering consumers with access to their genetic information, it can help them make health decisions that will extend their lives. So for $199 you can buy a testing kit from 23andMe and send a sample of your spit back to the company for analysis. Then you modify your lifestyle accordingly. (When Wojcicki’s own test results revealed an elevated risk for breast cancer, she quit drinking alcohol.) 

But that’s just the consumer-facing side of the business. 23andMe also intends to accelerate (and lower the cost of) the process of developing new drugs by leveraging the information contained in the massive database of genetic information generated by the millions of people who have purchased its “personalized genetics reports.” The goal is a kind of virtuous feedback loop. The more people who have their DNA tested, the bigger the database gets and the more likely that drugs can be developed to address the diseases they may have.

It’s an intoxicating dream, but it came crashing down hard to Earth in November 2013. When the FDA sent its letter forbidding sales of test results, it crippled the company. Because you can’t build the database if you can’t get the spit.

The FDA had three basic concerns. The agency was worried that consumers would make rash, medically inappropriate decisions when informed that they were at higher risk for disease. It also wanted to understand exactly how 23andMe was coming up with its risk estimates. And it was flat-out livid that for six months in 2013, 23andMe had simply refused to respond to multiple requests from the FDA for further information, even as it prepared a massive television advertising campaign.

Forbes journalist Matthew Herper called 23andMe’s fumble “the single dumbest regulatory strategy I have seen in 13 years of covering the Food and Drug Administration.” The geneticist Eric Topol, who evangelized the promise of the digital health revolution in his book The Patient Will See You Now, and is a longtime admirer of Wojcicki, called it “unfathomable.” There was a real question, Topol says, whether the company would be able to survive the debacle. In the healthcare industry, you just don’t ignore the FDA. “They learned that the hard way,” Topol tells me.

Wojcicki later conceded to Forbes that “things slipped through the cracks.” The executive responsible for dealing with the FDA soon left the company and was replaced by an entire department devoted to regulatory compliance. Today, while acknowledging that the incident made 23andMe the poster child for conflicts between Silicon Valley’s urge to innovate and Washington’s responsibility to regulate, she downplays the underlying drama. There was no hubris involved, she says. “We thought we were working with them in the right way.” 

Right or wrong, the details of why 23andMe ignored the FDA for a few months are probably less important than the deeper roots of the conflict: the question of whether ordinary people—you and me—can or should be trusted to know what to do with genetic test results provided without the direct mediation of a doctor. Wojcicki has a very different view on this topic than does your traditional medical professional. Understanding why that might be goes a long way toward explaining just what kind of a person Wojcicki is.


According to Topol,
the FDA’s hard line on 23andMe was a manifestation of “deeply engrained medical paternalism” that dates back thousands of years. “The idea is that the doctor needs to be the purveyor of all information,” he says, “especially of this remarkably complicated, sensitive, genomic information.”

But as one might expect of someone raised in Silicon Valley—Wojcicki’s father is a Stanford physics professor, her mother a high school journalism teacher in Palo Alto—she has a more expansive view of the proper relationship between people and information. “I genuinely believe that everyone has the potential to learn the type of science that we are teaching,” she says. “I believe people can understand risk.” These beliefs are part of the core cultural DNA Wojcicki inherited from her family. Wojcicki says her mother, Esther, always told her three daughters: “If you don’t take care of yourself, no one will.”

The advice evidently stuck. One of Wojcicki’s sisters, Susan, is the CEO of YouTube. (Wojcicki met Brin when he and Larry Page were renting the garage of Susan’s Menlo Park home as Google’s first headquarters.) The other sister, Janet, is an anthropologist and epidemiologist at UCSF.

That advice was also more than just a cliche; it was a tragically learned lesson rooted in a family disaster. In 2015, while accepting an award honoring her as a Silicon Valley Visionary, Wojcicki recounted to the audience that her mother’s 15-month-old brother had overdosed on aspirin decades ago. The family took him to several hospitals in sequence, but their concerns were brushed off. He’ll be fine, they were told. But when Wojcicki’s grandmother called the hospital where he was finally accepted for observation the next day to find out how he was doing, she was informed that “he’s in the mortuary.”

A Financial Times article theorized that as a result “mistrust of medics runs deep in Ms. Wojcicki’s family.” Could that be true? Was 23andMe, with all its rhetoric about “democratizing” access to medical information, in part a psychologically predetermined response to her uncle’s death? Not exactly, says Wojcicki, who stresses that she has “massive respect for the medical profession.” 

But you still have to take charge of your own life. “My mother’s takeaway from that,” says Wojcicki, “was that sometimes you have to be superaggressive, and you need to question the advice that you’re getting.” Rosalind Bordo, a friend of Wojcicki’s dating back to middle school, says Wojcicki was voted “most likely to succeed” at Gunn High School in Palo Alto. “Even in high school,” says Bordo, “she just believed things could get done. And she would go full force into doing them.”

After Gunn, Wojcicki played ice hockey at Yale, did a 10-year stint as a Wall Street analyst specializing in health care and now is the CEO of a company valued at more than a billion dollars. That’s a career trajectory that clearly benefits from more than the normal dose of aggression.

And it probably explains both the collision with the FDA—and the comeback. “When the FDA issued their letter, a lot of people pronounced the end for her company,” says Euan Ashley, the chairman of the Biomedical Science Initiative at Stanford, “but she dug in, made a plan and bounced back. She engaged even more with the genetics community, started conversations with the medical community.”

Ashley continues, “Anne brings passion and indefatigable energy for what she believes in. She’s a huge advocate for the consumer, the individual, the patient to take control of their medical journey. We could all learn something from that.”

Since 2005, Wojcicki has made her home in Los Altos, a historically sleepy little town of 30,000 inhabitants just west of Mountain View, where 23andMe’s headquarters is located. (Wojcicki says she rides her bicycle to work and back every day.) 

Upuia Ahkiong, a massage therapist who has a practice in a downtown Los Altos building owned by Wojcicki, says that one of the first adjectives that comes to mind when asked to describe Wojcicki is “bold.” Ahkiong, who worked at Google for 10 years before opening Kua Body, says Wojcicki is a role model who inspired her to make her own leap into the unknown. “It’s all about taking risks and trusting that whatever idea you have,” says Ahkiong, “if you fuel it with passion and commitment, there is potential for amazing things.”

In Los Altos, it’s easy to see how Wojcicki’s defining boldness permeates every part of her life. When she and Brin started raising children in the town, they established a real estate development company to ensure that the downtown district would be as family friendly as possible. Los Altos Community Investments now owns 11 buildings and three businesses in downtown Los Altos, including Bumble, a family-friendly restaurant with on-site babysitting; Area 151, a gaming arcade; and Play!, an indoor space for kids to learn and explore.

“I want Los Altos to be the best town in the United States,” Wojcicki tells me. In an interview with the Los Altos Town Crier, she explained her development strategies as motivated by the long view: She planned, she said, “to live in the town for the next 80 years.”

That’s quite the time frame to use to shape one’s life goals. It will almost certainly be long enough, she hopes, to see the spread of self-driving cars in Los Altos, a development which would allow the city’s parking lots to be transformed into parks—“That would be amazing!” she blurts. Maybe it will even be long enough for 23andMe and its partners to make headway on Parkinson’s disease, a time bomb lurking in her ex-husband’s DNA and consequently one of 23andMe’s top priorities.

It could even be long enough for 23andMe to deliver on its promise to give us the information we need to learn “the best way we can live our lives.”

Which would also be, without doubt, amazing.

 

Originally published in the May issue of Silicon Valley

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