SPEAKER_03: There's so much to discover in humanity. And that's where even people don't always realize there's some people who genetically can't get HIV.
SPEAKER_02: Wow. That's mind-blowing. They have a genetic variant and the virus cannot penetrate them.
SPEAKER_03: And that now, there's a drug that's now modeled off that. If we study all of life and the genetics of life and why we have diversity, and that's actually why diversity is such an amazing and powerful part of humanity. It's like, why some people have blue eyes or some people have dark skin, or some people can smell things in a certain way, or some people don't get HIV. Every single one of those variants in our genome is a story of our human survival.
SPEAKER_00: This Week in Startups is brought to you by CLA, Innovation Takes Balance. CLA CPAs, consultants and wealth advisors can help you get from startup to where you want to end up. Get started now at claconnect.com slash tech. House of Macadamias is the next big health trend. Get a free month's supply of macadamia milk with any order at house of macadamias.com slash twist by using code twist20. And dot tech domains has a new program called startups.tech, where you can get your company featured on This Week in Startups. Go to startups.tech slash Jason to find out how.
SPEAKER_04: All right, everybody, welcome back to the program. 23andMe has been sequencing people's genomes for close to two decades now. 14 million people have done this already, probably more at this time. And it used to be something a lot of the quantified self people were obsessed with, you know, Tim Ferriss and all those folks. But now this has become a cultural phenomenon every Black Friday, every Cyber Monday, you see 23andMe tests all over the place. People are taking them, they're talking about it at Thanksgiving and over the holiday break. And these things are evolving, right? The evolution of what 23andMe is offering has expanded greatly. And we're gonna get an update on that from Anne Wojcicki today, and I suspect Anne with AI and this big revolution going on, all this data and some of the new offerings you have, something is happening here and coming together as you get into the second decade of this company, huh? Oh, definitely, definitely.
SPEAKER_03: So many good questions in all of that. I mean, I think that the reason why we started 23andMe was if you can almost look back to when Clinton and team came out and said, you know, the human genome has the potential to revolutionize how we diagnose, treat and prevent all human disease. And the reality is we're getting closer and closer to that. And so as you have data, as you have massive amounts of data that you can actually learn from and understand, and now you have the age of LLM and AI, you're gonna really be able to predict and prevent, which is what I'm most focused on, is like predict and prevent human disease. And I think coming as well as the biotech revolution, where you will be able to use all that data then to really treat and develop novel therapeutics for disease.
SPEAKER_04: What technology has done to the cost of this is a major part of it. It was George Church who did the first one, right? The sequence, the first human genome. Craig Venter.
SPEAKER_03: Craig Venter. Yeah, yeah, yeah, yeah. No, they wouldn't like you. You've said that, yeah.
SPEAKER_04: So I know a bunch of smart Harvard people did this. A lot of smart people.
SPEAKER_03: A lot of smart people were involved in the sequencing of the human genome and George was definitely quite important there too.
SPEAKER_04: If I remember correctly, didn't this cost like well over a billion dollars to do the first one? Billions. Billions, yeah. And so explain to the audience, what happened in technology in just two decades that made it drop so precipitously that now I think you can do this for 99 bucks. Like it's basically cheaper than taking a Southwest flight. It is remarkable when I think on that initiative
SPEAKER_03: as like when you first start, you were just able to look at single data points in your genome and you think about what one of the things that was really revolutionized around that time, sort of the late 90s and early 2000 was the shotgun sequencing and the ability for you to sort of chop up your genome, sequence these little bits and then the computation of like putting that together. So imagine like a really, really complicated puzzle and you've got to put this all together. So that's called these reference genomes and it became, it was a very expensive initial project and as technology, like really largely thanks to Illumina, Illumina drove down the cost of sequencing and it came really from major technology innovations as well as volume and market demand for these services but Illumina has single handedly really been able to develop technologies, chip technology where they were able to put a number of these, you know, the known human variants on a chip and allow people to test themselves and 23andMe actually started when, there's actually another company called Affymetrix but Affymetrix launched something called the 550K and it was the first time you could actually get a whole genome analysis pretty cheaply and Illumina came in hot and heavy and was able to drop down that pricing and they've been able to continue to drop down that pricing and they've actually now really aggressively dropped it for getting your entire human genome and the fact that there are so many of these human genomes that were out there, you could have reference populations that you could make sure that you were building against, you know, it became very accessible for everybody. So people sometimes also get a little confused because we, 23andMe genotypes people, so meaning we look at all of the known variable regions in the genome but you can also now get your whole genome or, you know, you can actually start to look deeper and deeper and as we understand some of these harder to analyze areas, there's reasons for people to come back and actually test themselves again.
SPEAKER_04: Yeah, so this seems to be like a turning point. People when they initially took these tests, it was a novelty, maybe they were really into their ancestry, they wanted to know where they were from and listen, people got a lot of surprises, people found relatives they didn't know they had, all that is just fascinating on a social basis but then the promise was always, hey, we're gonna be able to tell you, you might have a predisposition to this disease later in life, maybe here are some ideas of what you could do knowing that, right? And so when we look at both of those use cases, the first one's obvious, like I wanna know where I came from, it's super fascinating. I'm sure you had some great stories there and people finding, I mean, actually, there's been some really weird stories too, people finding out that like- Oh, there's a lot of weird stories, yeah.
SPEAKER_04: There was some documentary and I don't know if it was 23andMe but I remember seeing this documentary of a doctor who was a fertility doctor who had essentially inseminated people. Our father.
SPEAKER_03: Our father, yeah. Yeah, yeah, yeah, we are prominently featured in that. Yes, I mean, they are. I mean, people learn all kinds of interesting things. Like the thing that's so interesting about your genome and actually just, I should take a step back, the thing that's so interesting about genetics is it is the code for all of life. So like obviously we're most interested in the human genome but the thing that's the, like what captured my fascination with this in the early days was that you have these four base pairs, like an A, C, G and T and different combinations of that can give you a fly or a banana or a tree or you. Yeah, crazy. And it's so interesting, like how is it that like these different combinations? And in some ways, because we live in obviously this technological age, I love that this, I'm like, this is just a code. Like, don't we wanna understand it? It's like the whole code of life. And so it's interesting to think about your ancestry and your family and your connections and your health but it's actually the fundamentals of everything about you as well as everything about our common past. Like we all have a common past of humanity. Like where did we come from? How are we all connected? What are our common ancestors? Like I was pointing to my kids, I'm like, you have a common ancestor with the banana slug. Like you are, like you, you know.
SPEAKER_03: Not just in the fact that you don't wanna wake up in the morning, but like you are. You just wanna stare at your phone and scroll TikTok.
SPEAKER_04: It's not just that kind of slug. Exactly, exactly.
SPEAKER_03: But you know, we share a common foundation. Like all of life has a common history. And so that's what I'm so excited about understanding about and I'm so excited for individuals to be able to learn about themselves and the ancestry part is fascinating like how did we evolve? Like where are you from in the world? And you know, how you could find connections that you never thought about. But then also, well how do you actually live as healthy as possible? Like we all wanna be, I mean frankly I look at like in the last week as you know, you have Churchill and you have Charlie Munger, like I wanna be like them. Isn't that amazing?
SPEAKER_04: 100 years old and 99 and like 11 months old. So essentially they were 200 years old. Yeah. It's incredible.
SPEAKER_03: 100% and I look at that, I was like they were still planning meetings, they were still like, I wanna be that. Like as vibrant and as healthy as possible. So what do I need to do? And if there's risk factors in me, if I have, you know an important risk factor that I need to take medical action on or I need to change my lifestyle, like tell me, tell me and I will be proactive and I'll do that.
SPEAKER_04: What are the things, I wanna get into science fiction so I just put a note about, you ever seen the movie Prometheus by chance? With the alien series? Maybe not, okay. Oh, pop culture wise, what you just described is essentially this guy from Prometheus Wayland who runs this enterprise basically to go find out who the engineers are and it's gonna blow your mind just how great Ridley Scott was at taking what happened with the genome and then putting it into science fiction because he basically goes and tries to find who created the aliens, you know, like the crazy monsters from that and then also, oh wait, they also created the humans, oh, and they were terraforming planets. It's just mind blowing, but it does make us wonder when you start doing the genome and then you start putting in like AI, which seems to be recreating in some ways consciousness, which we'll get to in a minute, but it feels like they're trying to unpack exactly how human cognition works, which is super mind blowing. Like it's almost like we're on the precipice of figuring out something very fundamental in our lifetime. All right, everybody, Steven Estes is a principal at CLA, Clifton Larson Allen, a professional service provider that specializes in CPA, tax consulting and wealth advisory. Welcome to the program, Steven. Thank you for having me. Maybe you talk a little bit about private equity versus venture, you work with both types of companies. We're seeing some startups that maybe venture capital aren't as interested in, but private equity is very interested in. So how do those companies generally operate differently?
SPEAKER_02: To some extent, venture capital and private equity both serve the same primary purpose, right? We're looking to expedite a company's growth, but maybe that's kind of where the similarities can end. You know, VCs are looking to maximize a company's value, right, we're trying to grow that top line revenues, whereas PEs can be a little bit more focused on taking an active role within the company, growing a sustainable and profitable business. I mean, a lot of different PEs out there, some that are just looking to maintain a 20 or 30% stake so that the founders are still, you know, have enough skin in the game and they're actively involved, whereas others want to have control. And you know, all VCs are not created the same either, but I think the most important thing for founders is to not limit their options or considerations to one or the other, right? There's a number of ways to grow a successful business and it's important to consider what each route's gonna look like at the end of the day.
SPEAKER_04: Get started right now at claconnect.com slash tech. Let them know your boy Jake House sent you. Claconnect.com slash tech to get started right now. Do you ever think about that? Like, is there gonna be some fundamental tipping point here where we understand things that we didn't ever think we could understand and what those things might be?
SPEAKER_03: Well, I either my, I mean, I love these conversations. So my father was a particle physicist. And we used to talk about the intersection all the time of physics and biology. Like at some point as you understand subatomic particles and understand prediction, like at what point could you really understand all cellular function and predict outcomes? The thing that I love about science and I always try to get kids to think about is like there's just an endless amount of open questions. And for us to ponder like there is, like where it's all connected in some way. The world of physics and what my dad was studying and the search of mass and neutrinos. And again, we just have this memorial and I was with a couple of friends like talking about the neutrino world and like they're all over but they don't interact with any of ourselves. They don't interact with the earth. Like they don't, like what, but how is that connected? What is the purpose of this?
SPEAKER_04: What is the purpose and why is my dad studying this whole life? What is it doing out there?
SPEAKER_03: Right, but I think that there is going to be a world where at some point you will be able to understand the very basics and the foundations of, you know, how the world, the universe really is working and then how that actually led to all of us. I think that's gonna be far off but I do think that there's a lot of really phenomenal discoveries happening in very basics, whether it's in physics and in chemistry and then I think also that brings in the whole world of our language models and the ability for you to predict things now like protein function and for you to predict, you know, variant resolution. So understanding what a particular mutation is doing. Like that's, you know, that's gonna be, that's gonna be the fascinating world and I think understanding the one thing that I always have a huge appreciation for is just how complex the human body is. And so your ability to predict all those different interactions in your body and exactly how that's turned into you is just like such an exciting and interesting problem.
SPEAKER_04: What have we learned in terms of healthcare? Let's get back to this pursuit of hitting 100 years old or 120. We seem to have, in terms of lifespan in the Western world, the things that kill us seem to be self-inflicted. Diabetes, you know, smoking, opioids, suicide. It's almost like where the limitation now has been, the surplus and the abundance we have in society in the West is kind of like capped us out at whatever it is, 76 or 77 year old average lifespan. But you do see people who have access to healthcare and some of these new technologies and maybe some thoughtfulness really starting to live to 90, 100, but also as Pedia, what is his name? Atia sort of talks about healthspan. And I think that might be the big unlock is that like, hey, 80s and 90s, you could actually be like Charlie Munger and doing Q and A's with, you know, world's smartest people asking you really challenging questions and be witty and be there and not like be a vegetable. So what have we learned from this or what have you learned in the company from the last 17, 18 years, 14, 15 million people doing this that applies most traumatically to healthspan, lifespan and just living a better life? Like what's been accomplished here?
SPEAKER_03: Well, I think the first thing that's really almost the lowest hanging fruit is you have certain genetic variants like BRCA mutation or Lynch syndrome, which are sort of well known. So BRCA mutations can make you high risk for breast cancer and a number of other cancers. Lynch syndrome can make you high risk for early colon cancers and other conditions. What always saddens me is that genetic testing, despite being a 20 year old technology and despite being very affordable is not a universal part of any healthcare system and it really should be. And there's all kinds of really important genetic variants that every single person should know about today.
SPEAKER_03: So for example, all your cancer risks. If you have a BRCA mutation, you should know about it because you can be proactive about doing a mastectomy or about screening for cancer. And if you Lynch syndrome, you should be proactive then about colonoscopies. If you're high risk for something called factor five and that means for blood clotting, you should be proactive about how you are flying and make sure that you're wearing compression stockings or moving around when you're on an airplane. I can go through a whole list of genetic variants that are important for people and their outcomes. And so the easiest thing for right now, when I think about people increasing their health span is about avoiding preventable deaths. And so right now there's a lot of people who have a condition where they could really manage it and they are not getting access to that genetic information through the existing healthcare system. And largely in part because I think it's just, it's not part of the reimbursement system, it's not part of the education system, but through 23andMe and through other groups out there, you have access to it. People should get access to it now. And I think you're gonna be able to prevent a big number of preventable deaths. I think then you do have a lot of conditions like heart disease, obesity, et cetera, that have an environmental component as well, but there are genetics with that. So understanding the genetic components there, I think it will help people be able to also manage that, manage their lifestyle, understand for instance, like with all these GLP-1s now, who is it who actually really should be proactive thinking about that before they end up having any other sort of serious health consequences from obesity? Like how do you actually help use those therapies and get it to people at the right time?
SPEAKER_04: It's super fascinating when I hear you talk about how obvious this is. It reminds me, I don't know if you've ever read about the introduction of the seatbelt and the shoulder belt and like airbags, like we had these things so many years earlier than we actually implemented them. And it's like, we have people driving around in cars and we could easily put an airbag and a shoulder belt in them and save a hundred thousand lives a year, whatever it is. And, oh, by the way, it costs $99 or $199, whatever it costs and we're not doing it as a society. Is there any society out there that's, I don't know, smaller affluent Nordic country that just said, you know what, everybody in the country is gonna have this as a offering for free as part of their universal healthcare. Has anybody made that jump yet? Canada, Norway, I don't know.
SPEAKER_03: I think the closest is actually in the UK. The UK has a couple of initiatives that the UK Biobank and they have a new initiative called the, our future health. And that UK Biobank has half a million people and our future health is 5 million people. And so they talk about returning those results to individuals. The US has an initiative as well to get a million people but they have not returned results yet. I think there's a couple of things. Like I think one, like the healthcare system is not well set up to fund prevention. And I think a lot of physicians are also not trained on how to use genetic information. So if you think about if I find out that you're higher risk or something, how is it, all those costs, for instance, let's say you're high risk for colon cancer and I'm gonna go and do proactive colonoscopies on you. The way the healthcare system works is they're gonna look at what does that cost of preventing versus just treating you once you have the disease. And also because not everyone's gonna develop the disease. So one example in particular was for factor five which is the one that makes you higher risk for blood clots. So any woman who is taking an estrogen based birth control, if you have the factor five mutation, you're higher risk even with a blood clot. So if you ask companies like, well, why don't you pay for people to get tested for factor five and actually screen, they'll say it's just cheaper to treat people once they have a blood clot than it is. Which is true, that's part of the issue with population based healthcare and there's a limited number of dollars. And frankly, I think that's why 23andMe is a believer in both an insured covered world but also a self-paid world. So people should go and get this information on their own proactively. If you are a carrier for factor five, your physician and the medical world then has an obligation to use this information and to integrate it into care. So for instance, if you found out you're for factor five and you take that then into your doctor, you're gonna have a different triage for pregnancy, for taking oral contraceptives, you're gonna have probably a different type of oral contraceptive. So you would then have that triage in. And so 23andMe has always been an advocate of people should have the ability to get their genetic information on their own. It's a self-pay but you can be part of an FSA. Like you can pay for it in different ways. But once you have that medical information, the power is in your hands to decide how you want the healthcare providers to use it or potentially to not use it. But then you have that ability to say, yes, I want, I have a BRCA mutation, I have a factor five, I have familiar hypercholesterolemia, I need now to get into the system and I need to be proactively managed.
SPEAKER_04: Okay, I got a funny story to tell you. House of Macadamia has graciously sponsored the All In Summit and to wow the crowds, they created a special edition salt and vinegar pack of macadamia nuts. And guess what? People went crazy for them. Dozens have been messaging the founder, Brandon, asking him to make the salt and vinegar nuts available on the website. Listen, you've heard me rave about the health benefits of macadamias, but don't take it from me. The most health conscious people in the world are eating them. Dr. Andrew Huberman, I like his pockets, I started listening to it. He mentioned he snacks on macadamias in his GQ profile. And that guy, Brian Johnson, he was on the podcast when he wasn't a health lunatic. He's trying to reverse his aging and he eats macadamias. So all you really need to know, House of Macadamias products are delicious and they support good health. My favorite, dry roasted chocolate dipped macadamias, you know I get my chocolate dipped in there and they also have a dip snack bar. So I put a couple of those in my backpack, I put a couple of them in my little roller so I have a healthy and delicious snack. I make a better decision. Listen, if I had a candy bar, which you know, like sometimes I break down and I buy one of those, not a good choice for me. Now I make a better choice. House of Macadamias, they got a new product, Macadamia milk. Get a free month's supply of macadamia milk with any order at houseofmacadamias.com slash twist. That's a free month's supply of macadamia milk with the code twist20 at houseofmacadamias.com slash twist. It does feel like consumers are now starting to do this. They're starting to look at the healthcare system and say, hey, there's things I can do on my own proactively out of my own pocket that I want to do. And then there's this other thing, you know, whatever I'm covered for. And you know, that does seem to be a really nice trend that's occurring. I noticed this when we were looking at investments in healthcare and we made an investment in a meditation company, Calm, and everybody was like, this will never work. And then millions of people actually signed up because they just wanted to use this as a solution. And it wasn't like the Medicare, the medical system in America is going to pay for people to go do meditation, even though that could have a really great impact on them. It's just a backward system, I guess, where, but if the price comes in, it's weird. Well, I mean, I think about,
SPEAKER_03: like I remember asking people like, look at the end of the day, like why isn't something like Weight Watchers or Calm free for every single American? Yeah. Like if it's such an issue, and it should be, I think that that's part of an issue is like we just don't have incentives that are aligned. The healthcare system is full of really great people who are there to take care of patients and care about individuals. But fundamentally the system pays for services once you're sick. Like if you're not sick, people aren't paying for it. So I have a friend who ran a diabetes prevention center and she's like, oh, I'm reminded every day that that's a cost center, that we only make money treating diabetes, we don't make money preventing it. And so I do think there is a really important role. And I think consumers are actually used to this now. Like they are used to saying like, hey, no one's paying for my yoga. No one's paying for my $45 SoulCycle class. Like you have to take ownership. And I think prevention is something that is largely in the hands of the individual and you have to be proactive. But the thing that has been important for me to realize with 23andMe is that I need to help my customers know when do you go into the physician. So for example, and that's actually part of the reason why we bought a company called Lemonade. That has a physician group and we hired a really impressive physician lead, Nora Bulhassen, who ran genomic medicine at Cedars-Sinai and how we actually are going to deliver genomic medicine to all 14 million customers so that people can get their information. They can self pay, they can get it from us, but that they now have this ability to go and actually get physician advice when they need it. And also recognizing that most clinicians today or most healthcare practitioners are just not trained on genetic information. So if you have something like you want to prevent chronic kidney disease, where do you go for that kind of information? We will become that best source for it. And then they can help guide you to say, okay, you want to be able to take medications that are going to more proactively manage your blood pressure.
SPEAKER_03: Here's actually how you should do it. And then you can kind of go back and forth between a self pay and a covered world.
SPEAKER_04: And there's also blood testing that fits into this because I saw that you now have a subscription model. Yeah. What is it called? It is total health. Total health. Is it exome sequencing or exome sequencing? It is an exome. Good job. Yeah, yeah. Exome. Yeah, you actually say exome. Yeah. Exome is really looking at all of your genes.
SPEAKER_03: So it's kind of going deeper. So it's not the whole genome, which sequences a lot of regions that are less likely to be as clinically relevant. And there's still some cases where a whole genome makes sense. But for, again, we're kind of stepping up more and more into that clinical world, as well as what is financially feasible for most people. And an exome at this point in time will get you a lot more information that will supplement what you get from 23andMe, but it's going to have a deeper clinical sequencing. So we don't, for instance, test for all the BRCA mutations, but we do a very comprehensive scan across your entire genome to see if there's potentially variants that you have that you want to follow up on. But if you came and you told us that, I'm not of Jewish descent, but I have this family history of breast cancer, we would then recommend and say, yes, you should get this exome. And what's interesting, actually, even with total health, I mentioned my father, who had just recently passed away. A lot of, we've talked about doing an exome for a while, but I actually realized this even with my father, who had a heart condition and was being treated at a facility that was amazing. We got great care. I'm obviously very adept at genetic information. I'm a good daughter to have. I'm a good daughter to have.
SPEAKER_04: I'm a good daughter to have doing your back care advocacy.
SPEAKER_03: Exactly, yes, I know. I always have to apologize to physicians. Like, I'm sorry that we're so aggressive. But even still, it wasn't till a week or so before he died that I said, I need to get a whole, I need to get an exome on my father. And even though his clinician is also very adept at genetics, no one had ever asked, but it actually turned out that he had a mutation that was actually the fundamental foundation of a lot of his heart conditions. And if he had known that 10 years prior, he potentially would have had a different outcome. And that to me kind of like honed in why everyone should have something like total health or an exome is that even if you're getting great care, like everyone still just needs to have the fundamental information. And there's a lot of things that, a lot of actions that you can take now to have better healthcare outcomes.
SPEAKER_03: And the information we had 10 years ago has really evolved quite a bit. And what we have to- Just in the last decade. Just in the last decade. Just in the last decade. And that's actually like, that's also, like when I think about LLM, what's so exciting is the ability, and again, the reason why we have a subscription model now is to keep you updated.
SPEAKER_04: Yes. To keep saying is like, okay, next year,
SPEAKER_03: maybe we have discovered something like, hey, we could, and more and more it's getting into that world of lifestyle. And what's super exciting is like the world of like sleep. You know, you mentioned calm, like your stress levels. Like what are those things that most impact you? Like my kids, like I'm a total night owl. Like how does that impact when I don't have enough sleep? Do I, should I be going to bed earlier? Like how do I live my life? And is there coaching that I should do that's gonna better impact my health outcomes? And I look at that example as something like a heart condition. There's a lot of lifestyle factors that really would have influenced for him.
SPEAKER_04: Yeah, see this is where it gets super interesting. It is this blood testing plus lifestyle changes plus quantified self. All of these things have been, and entrepreneurs like yourself or Alex from Calm, or this is coaching company Fountbio that I've been using. Oh yeah. Yeah, kind of interesting. Like, you know, kind of taking what Peter does, which is absurdly expensive. And for the 0.1% of society, maybe saying, hey, can we get that to the next 10%? Kind of like what you did with, you know, 23andMe. It's like how far down, you know, this bell curve of adoption can we get this stuff? But it's all gotta come together. And this is the thing that I find insanely frustrating. I have my weight information. I have my prescriptions. I have my steps, you know, Apple Watch, Calm, meditation, eight sleep, aura. Everybody's got all this different disparate data pools. And I'm just hoping somebody, and you know, maybe it will be 23andMe with, you know, the subscription service can start to put that together and then connect coaching to it. Because if you were to look at the average general practitioner in America, you know, really hardworking people, as we know, overwhelmed in many cases is a very difficult job. The system is, you know, just hard for them to be part of the healthcare machine. Of them, what percent do you think have, what you would describe as a great knowledge of how to use genomics and blood tests to give people great advice, like actionable advice? What percent are, you know, have had the time to be educated enough? It's so hard now.
SPEAKER_03: I mean, I think, I mean, even answering, and I did realize I didn't answer your question on blood. I'm always surprised. Like, when's the last time you did blood?
SPEAKER_04: Titted in the last year, because I'm on this bit of a healthcare without bio, right? And I'm 53 now, this last week was my birthday. Oh, happy birthday. Thanks. And I'm trying to get in the best shape of my life, my adult life, in my 50s. Because I'm like, you know what? After reading about Healthspan and all this stuff, that now's the time, I think, right? Your 50s is the time to super invest in it. So I've been, any test that's available, I'm taking, I'm gonna join your total health thing. Get that 360 going.
SPEAKER_04: We're back with another segment of Pitch It to J-Cap. .Tech domains is giving Twist listeners the chance to show off their startup, right here on This Week in Startups. So go to startups.tech slash Jason to apply. It's only one rule. You need to have one of those amazing .Tech domains to get featured. And this week, I'm gonna tell you all about Fotenix. Fotenix.tech is an ag tech startup focused on reshaping the way we approach farming. Fotenix has AI powered cameras that help farmers address critical challenges like early detection of plant diseases, identifying optimal growth conditions, preventing food waste and smarter resource allocation. All of this data empowers farmers to drive resource efficiency, sustainability and profits. So here's your call to action. If you wanna be featured on This Week in Startups, like we just did for Fotenix, you can go to startups.tech slash Jason and apply today. That's startups.tech slash Jason and fill out the form to apply.
SPEAKER_03: I'm always surprised, like most people don't get regular blood tests. I have Hashimoto's, so I take thyroid pills. And so it means I don't make enough thyroid. So I have to measure it regularly. And with each pregnancy, it dramatically changed. I've had to adjust the dose. So I get blood every six months. And I'm one of those people, like I just, I get the order, but then I check all the other boxes. Like I just want everything. Why not? And well, it's interesting. And it's interesting. So I have also like 20 years of tracking and I can see different things, but things like my hemoglobin A1C, cause we have a family history of diabetes. And I remember my doctor calling me once and she was like, what have you been doing? She was like, your hemoglobin A1C is so high. And I was like, really? And I was like, well, the only thing that's different is like 23andMe, we started stocking this really delicious aloe water. And I was drinking like 10 to 12 a day. And she was like, what? 10 a day? I'm at the break, man. I was pregnant. I was like, they're really good. She's like, you need to, she's like, you need no more aloe water. And it was interesting how much, just like one, obviously, I was able to catch it quickly. Secondly, I could change my diet. When I cut out carbs and I cut out more sugar, I was like, it could drop so much. It was so empowering for me to see how much was actually in my control. And that I could make things, like I could definitely have a high hemoglobin A1C if I want and I could make it low if I want, granted not everyone can do that. But being educated, most people don't even know about the hemoglobin A1C. There's other things that are really important, like LP little A, which is obviously, it's really important for heart disease. There's also therapies that are being developed out there for that now, knowing your cholesterol, like so many important numbers for people to know. And I do think it's, that going to your question then about the physicians, it's really hard for a physician to keep track of everything. It's too much. And those people don't have a continuous relationship with a physician. So one thing I always encourage people to do, like I do keep just a Google spreadsheet of all my blood tests I ever get. Like keeping a sheet yourself so that I can then walk in and I now, like I said, have 20 years of data where I can see how my thyroid has changed and I can track that. I can see my hemoglobin A1C and how that's changed. Like you need that information and it's not on the physician, it's not on the healthcare system to do that. You are going to have to do that. So 23andMe is definitely also thinking about how I pull in all that information from you. How do I pull in your various medical records? How do I pull in your medication history? And then you're wearable. Like how can I help you also track and say like, hey, when you haven't been feeling good and you're anemic and you're not sleeping as well, this is the type of outcome. Those insights are going to be so exciting for you. So when I think of the future for us and data and LLM models, it's going to be about pulling in all of that data, plus your genetics, plus survey information of like, well, how are you feeling? What are you doing? And then really being able to help you manage with all of that information, because people are overwhelmed with all of the different data points coming now and help you know like really what you should do.
SPEAKER_01:
SPEAKER_01:
SPEAKER_04: This is where at some point you'll go to 23andMe and you'll just be talking to some AI, right? And you'll ask it like- Yeah, I mean, it's too much for any one clinician.
SPEAKER_03: Like you realize that like it's overwhelming amounts of data so AI and LLM, like it's so exciting what can happen there because you'll be able to help. You'll be able to keep track of everything that's happening. And then the more and more we'll be able to train models based on all the data that we have with respect to lifestyle which frankly is like, I think a missing piece from the sort of like the traditional healthcare system and the traditional research that's funded. But how do we actually leverage all that environmental lifestyle information and then give that into a score really for you?
SPEAKER_04: I did the pre novo or prenouveau. Mm-hmm, prenouveau. Yeah, yeah, yeah. I did the prenouveau. I did the blood test. It was a blood test for cancer screening. Yeah, Grail. What's the name of that one? Grail. Yeah, so I did that one, knock on wood, no problems. But when I did the prenouveau and I started talking to physicians, I had two different physicians at the time, it was like kind of overlapping. They all gave me the same camera response which is like, well, you could find things in there that could be something or you could find things in there that are nothing and it's gonna give you anxiety. And I'm like, yeah, no, I read that. I did a Google search. Right, right, right. I have that piece, I have that stump speech and I was like, how many of these tests have you actually gone through with your patients and do you do them over time? And just no answer. And listen, we're in the Bay Area. Yeah. People of means having access to this. I'm not price sensitive to paying a doctor for an hour to talk to me. And they don't even, these are great doctors, awesome, love them, but they're not educated on this. And then I saw Vinod was treating and he's like, I think for the 95% of interactions with a doctor, right now, ChatGPT could do a better job than maybe what's already happened. I don't know if I buy that, but it does seem like they're going down, like some decision tree heuristics and opening a book and then repeating it back to you. So this, I think individually led healthcare is gonna ultimately be the solution. I think you believe that as well. Individuals have to take control of this.
SPEAKER_03: Well, I think also, I mean, you talk about Pernuvo and others and I've done it as well. We are definitely on the cutting edge. And so, one of the things that is very true with healthcare is like there's not necessarily guidelines. Like how do you actually use all that information? And I think that healthcare functions a lot based off, what are the guidelines? What's the protocol? How should you do? It's all very evidence-based. So we're in a gray zone, like there's not necessarily great. So I've taken something like Pernuvo to say, I'm gonna do it yearly. And what I'm looking for is not necessarily, okay, like, oh, I have, you have this bump, like my knees are degrading, my spine is this and that. Super depressing, they're like, you're getting old. Exactly, exactly. Well, the thing is- It's all breaking down. I mean, what you wanna do then is like, see, is it changing? Like what in your body has changed? So what I, again, it's kind of when I think about my blood and how I track that, what I'm looking for is the change over time. Like if something has been stable and consistent, that's probably okay. But if I wanna, you're all gonna find nodules.
SPEAKER_03: So you're gonna find nodules, you're gonna find things that look unusual. You're gonna say like, hey, your spine has these kinds of issues. Like for me, like spine information was good. Like you see, I'm like standing straighter now, and you've been just talking about it. Knowing that when I see C4, C5, like I need to just be aware. And I think looking at like the different nodules that I see in my body and then tracking, like it's exciting, because I feel like then I can prevent. Like if something pops up, I don't wanna come when it's already too late and it's causing problems for me, then I can be proactive. And I do think that having a clinician or a clinician that's educated about like, hey, you don't overreact to everything. And I think also that's where genetics is gonna be interesting to say, okay, well, are you higher risk for pancreatic cancer? Are you higher risk for these other conditions? And then what does that increased monitoring look like? So, I think more and more, there will be a world that, again, a smaller community of people are pioneering, which is about really proactive prevention. So you can get all this information, you can be really proactive. And I think that the medical world in the more traditional way is looking to say, okay, well, does that actually improve survival and outcomes?
SPEAKER_04: I'm curious your thoughts on these GLP ones. It seems like every time they do a study, they're like, yeah, we can stop this study because it works. So they do a study on alcoholism. They're like, yep, this helps with that. Wait, diabetes, it just helps with everything. I did it, lost maybe 20 plus pounds on it and had lost. Wow, congrats. Well, yeah, I'm down 40 pounds, but the first 20, which is fasting and going by more keto and doing all that Tim Ferriss kind of stuff. And then the second 20, which were kind of like the hard pounds, just all will go via was epic and it just works like magic. It's pretty amazing. So when you've seen this like revolution, all of a sudden happened, go from people with diabetes to civilians, people who are obese, and then even people who maybe are just having like a sticky kind of final 10 pounds or whatever, this is going to have a dramatic impact. And why did we just figure this out now? It's like one of those interesting things. There was actually,
SPEAKER_03: you know, this is a little bit of a lesson on healthcare for everybody in biotech industry. So when I was a biotech investor back in like 2002, 2003, there was a company called Amelan, which actually sold to Amgen, I believe. But Amelan, I remember the CEO at one point telling me, like they were the ones who were originally pioneering the GLP-1s, which come from the Gila monster, which is fascinating. And it was the first time I remember coming and saying like, wow, the Gila monster is like, has a role in healthcare. I've never heard of that. It's like, you should go and look at it. It's like a lizard. It's fascinating. I'm looking at it right now. G-I-L-A monster.
SPEAKER_04: Yeah, yeah, yeah. It's a literal lizard. Yeah, yeah, yeah, no.
SPEAKER_03: But that's where like people found it, like researching the Gila monster. Like again, going back to my point, like we're all connected, like the variants of like genetics and life, like the secrets are all around us and the solutions are all around us. Like we want to study everything. So again, it was like back, I mean 20 years ago right now, like talking to the CEO and talking about how they were developing the GLP-1s for diabetes, but it was going to be useful in obesity one day. And I always think about that. It was like, okay, it took 20 years and that first drug had side effects and others, and then they kept reformulating it. So like 20 years ago, I remember definitely thinking like, oh, this is going to come and it potentially could be useful in obesity. It sometimes takes that long in biotech. Like biotech is complicated. Like you're dealing with the human body and that's where again, the potential of LLM and predicting side effects, predicting like what's the right kind of drug to design. So like the idea was there 20 years ago.
SPEAKER_04: I just pulled up this thing about, I thought you were talking about like some esoteric biological term when you were like, oh, the gilla monster, and I'm like typing in HI. You're talking about the G-I-L-A monster. It is a venomous lizard. If it bites you, you vomit, it's not fun. And then in the venom, they found that there was some compound that helped you metabolize sugar.
SPEAKER_03: Yeah, hey, isn't it so cool? I'm just telling you. That's bizarre.
SPEAKER_04: I'm going to go get a Komodo dragon and see what that does for me. Maybe I can run a six minute mile if I can get the venom of a Komodo dragon. Those are my favorite. All the crazy things still on the planet. Saltwater crocodiles, which I don't know if you've ever seen one in person. No. Terrifying. Yeah. Like you see this and there were two moments in my life when I thought, wow, this is going to be a horrible but quick death. One was seeing like a 15 foot saltwater crocodile on the beach in Australia. I was far enough away that was no threat, but these things look like, and like, you're like, okay, that's like a tyrannos, might as well be a tyrannosaurus rex or phycelloraptor. You're dead. And the second was in Tahoe biking at a sundown alone, which you should never do. And I come around the trail and there's a mountain lion on the trail. Oh, no way. Wow. Like 10 feet away from me. And I'm just like, well, this is how it ends. Like this mountain lions you think are not like these big creatures. The thing is giant. It looked like a pony. Wow. Just stared at me for five seconds and I just decided I'm not hungry and walked away.
SPEAKER_04: Wow. It was like the longest five seconds of my life. But all this stuff goes back to, yeah, we all came from some comedy. I mean the diversity of humanity. Like it's, you know, there was that article
SPEAKER_03: or there was that book, you know, why elephants don't get cancer. You know, there's, I don't think that was the exact title or why elephants don't get ulcers, but like there's so much to discover in humanity, you know, and that's where like, even people don't always realize like there's some people who genetically can't get HIV.
SPEAKER_02: Wow. That's mind blowing. They have a genetic variant
SPEAKER_03: and the virus cannot penetrate them. And that now, like there's a drug that's now modeled off that. Like if we study, and again, the whole purpose here is like, if we study all of life and the genetics of life and why we have diversity, and that's actually why diversity is such an amazing and powerful part of humanity. It's like why some people have blue eyes or some people have dark skin or some people can smell things in a certain way or some people don't get HIV. Every single one of those variants in our genome is a story of our human survival. And that's why we wanna study it. And it's all good. It's like helps us all understand how we can all be the best that we can be. It's so exciting. And even again, looking at like the Gila monster, like that's so cool. Like we can learn not just from other humans, but from all of life that's out there.
SPEAKER_04: And things that are pretty gnarly, like you would be like, well, there's nothing to learn from venom that's gonna kill you and melt your muscle tissue. It's like, oh no, there might be something actually in there. It's almost like God's pointing, like, hey, check this out. I mean, I'm an atheist. I think.
SPEAKER_03: People don't realize like taxol, like which is a cancer treatment comes from a tree. What? Like trees are also, like there's venomous trees. Like there's like, I don't know if it's called venomous, but there's poisonous trees. Like there's so many cool things that you can learn from the world. And there's a number of products that we all take advantage of that actually came from other animals and other life that's out there. So we can learn a lot that way. And a lot of our products today, we just don't even realize that come from that.
SPEAKER_04: It's kind of like when you start getting towards this stuff, you start to like believe that there is a higher power at work. And listen, I'm an atheist and I kind of like don't waste too much time on it. But it's like, wait a second. Somebody did architect this? Yeah. You start thinking about that, like, oh, helo monster or some of these things. You're like, okay, there must have been an architect. There must be an engineer somewhere in the cloud. I don't know if this is a simulation. Pick your theory. You know what I feel like sometimes,
SPEAKER_03: like remember those books when we were little, like choose your own adventure? Yes. And you get to pick, like, I feel that way sometimes. Like there's like, the clues are all there. We're just trying to pick them up. Working backwards. There is a solution somewhere. But my dad used to say that too. Like when we would talk about these things, he's like, listen, the only thing that is so fast is how complex life is like, it's the chance of it all coming together and working this like, is that the higher order? Like, but it's just so it's, it's so phenomenal. And the fact that there are these pieces and the clues all over. And that's why I just get so excited about all aspects of science is like, it's all these clues coming together.
SPEAKER_04: It really is. And this is where like, the language models in year one, like literally this week was the week where chat GPT 3.5 came out. And you just think about what happened in 12 months, taking pictures of, you know, tumors and people are uploading their prunovo and their blood testing, and they're getting some value from this. Now, obviously don't trust it. The thing hallucinates, it's imperfect, but it could kind of point you to clues. So now the silicon that we made is going to point us to more clues that we were finding through, you know, decade long experimentation and research and people in the field, you know, collecting specimens and bringing it to laboratories. Back to these GLPs, what do you think the impact is going to be? Because they feel like, again, make your own, do your own research audience. But I have to say, this has been life-changing for me. And I was at a poker game and I've been very open about it after about two years I started talking about it because I didn't want to influence anybody to take this stuff. Talk to your doctor. Obviously I'm not a doctor. Don't take your medical advice from a person. From a podgaster or an angel investor. There's better people to give you advice. But now that I look at it, I mean, I was at this dinner and maybe like three of 10 people were on it. I was at this poker game, four of nine people were on it. Like this is really spreading quickly and having a dramatic effect and it seems safe. So it almost feels like a miracle. What's your take on this and where it's going? I think that's what's interesting
SPEAKER_03: and kind of where I brought up, like, you know, the fact that it happened in 2022, like, you know, the early 2000s. So it's been researched for quite a long time and I think that there is a pretty well understanding at least of how people are using it and some of the safety and some of the side effect profiles on it. You know, I think what's inspiring for us and part of the reason why, you know, even at 23andMe we ponder, like, what should we be doing with this and how should our customers interact with it? The fact that you're seeing, you know, such a positive result in the decrease of heart disease or, you know, it was interesting one day there was an article that came out and all the dialysis stocks were down because, you know, the use of GLP-1 is gonna mean less dialysis in the future. And so it's, I mean, again, this is what's so interesting in healthcare. And again, like how, if you can successfully prevent people from having some of these conditions, you will have certain businesses that get hit and go away. But like the reality is with GLP-1s in the short term, the data so far is really supporting that people are having not just weight loss benefits, but broad healthcare benefits. And I think it's too early to say exactly what that true impact is gonna be, but it's certainly like really exciting and interesting to track. And that's actually why I think about it even for 23andMe for people who have risk factors for certain kinds of conditions, how should they be thinking about this and using it?
SPEAKER_04: Well, now you have the doctors. So if you can find these obesity, diabetes traits in the genome, you got lemonade, the doc is that it's called lemonade, the doctor. Yeah, you got lemonade could give actually people a prescription and then and work with them on it. And that really feels to be that to me, it seems like this chasm that just you could fill in and build a bridge across. Yeah. What your predispositions are, what prescription do you need? Right. And that's exactly why we got lemonade with this idea
SPEAKER_03: is that like the biggest bottleneck our customers face is the translation of what to do with the information when they go into the medical world. So us having a team of trained clinicians who know what to do with the information that they have that ability to actually also get you a prescription, we have a pharmacy, we ship out same day that they can do lifestyle, they can do behavior. And if they need a medication, for instance, proactively managing blood pressure so that we can actually be a partner with them
SPEAKER_04: in doing that. It's so interesting to overlay financial systems. So like there's all these systems at work, and then you have the financial system, which is a bunch of lunatic traders trying to make sense of the innovation that entrepreneurs are bringing to market. And then I too was listening to like CNBC at some point, they were talking about Mozempic, etc. And everybody's shorting like TGI Fridays, Frito Lays, Pepsi, and it's like, you know what? Not a crazy thought, because if this became widespread, and the concept of being obese became like, yeah, it kind of like smoking, like we grew up, I think we're the last generation, you and I, Gen Xers will remember, do you remember being on a flight with ashtrays in the smoking section? Or did you miss that?
SPEAKER_03: I don't know, I remember being, yeah, 100%. I remember going on a plane when there was like no security and that you did have, I remember sitting in the smoking section, or sitting right behind the smoking section and saying, like, you know, the smoke is floating over. It's like a cloud. Literally like there's a cloud in the back of the plane
SPEAKER_04: and you're like, this makes no logical sense. Why on earth? And they're like, well, you know, if we don't, then you know, half the country smokes, so we lose half our customers. So it's like, okay, reasonable. But the same way now, if you took one of our children and put them on a plane and people were smoking, they'd be like, what's going on? It burst into tears. Like, this is crazy. It seemed like you're on another planet. And I think that's like maybe where obesity goes. Like the idea that we had this 30 year delusion that like, this is fine, large and in charge, you could be obese and all body types are valid and whatever. Listen, I don't want to be a bully or cruel to anybody, but man, I wish people had bullied me more when I was overweight, please.
SPEAKER_03: There's real health consequences. And I think that the reality is it's going to become a choice for individuals. Like, you know, I think that there's going to be obesity that leads to like real health issues. Like there's some obesity that's not going to have health issues, but it will become more and more in potentially an option where people can look at it really as a condition to be medically managed. And I do think, you know, you talk about the economics of the healthcare system. You know, one of my favorite things to do is always to point out to people is that you can actually buy ETFs in obesity. Like there's ones that are out there and like- That's insane. Isn't that crazy? I always love going to nonprofits and be like, hey, you know, you could actually just like invest in obesity. Like you could go and say, and a lot of the banks put out reports saying like, hey, you know, like here's all the companies that are maximizing obesity. And I remember even in 2006, there was a bunch of drugs going off patents. And I remember asking people like, what's going to save pharma? And they were like, ah, obesity in China. Like that's what's going to save us. Hundreds of millions of people. Hundreds of millions of people. Are following the West down the road to obesity.
SPEAKER_04: Exactly. So the reality is that there's all of these industries
SPEAKER_03: that are set up to support health consequences of obesity. And it is a dramatic shift. If none of those people ended up having, you know, chronic kidney disease, what are those businesses? Like there's definitely gonna be some businesses that go away. And you see this, like occasionally there are big technology shifts in healthcare. And then that changes and that renders certain areas. Like no one does an iron lung anymore. Everyone who was like big in the iron lung business is gone. So like there's gonna be some areas like that. And I think that GOP wants to have that potential to be that disruptive.
SPEAKER_04: That's gonna be extraordinary. So literally like what email did to fax machines. We also are the generation that remembers like a line at the fax machine. It's like, this is amazing. We can get these eight pages to New York or Tokyo and we don't need to put somebody on a plane. And it's like, now you think about it. You're like, really? There was a line for the fax machine. That was...
SPEAKER_04: I tried to explain this to someone. We used to wake up in the middle of the night
SPEAKER_03: to like make a reservation in Europe.
SPEAKER_04: Yes, yeah. You had to, yeah. I was explaining to my daughter cause I was buying tickets to a movie for tonight. And I was like, you know, what we used to do is we would go to the movie theater at noon, look at what was available for the weekend. And you'd pick what you wanted to watch that night. And if you got there at six o'clock, you would pick from whatever tickets were left. And then we had this amazing thing where you had 800 movie phone and you dialed your credit card into the phone and then it didn't work and you had to start over. But it took 10 minutes, but that was 20 less minutes than go to the movie there at noon. So it was a big innovation. So where is this all going if you were to look at
SPEAKER_04: what's happening in terms of chemistry, the genome, finance, consumers taking this all together. If we were to look, you know, cause now you got a little bit of an arc here. This is your career. This is your chosen work. Yeah, yeah. Obviously I suspect this will be the rest of your life's work. I don't see you pivoting out of this cause it's just getting interesting now. It's just getting interesting, yeah. Like 17 years of pain and suffering to get to this point, I think, right. As an entrepreneur. Now you look at the next 17. Okay, so if we just say, hey, this is the halfway mark on your journey. Where do you think this goes in the next 17?
SPEAKER_03: I, so you're right. Like it's super interesting. And I do look at that first 17 years of the company almost as that pain of establishing, you know, a brand, establishing a mechanism to get people their genetic information. So like we've gone through the FDA, we have all we, you know, have done all of the scientific validation work to prove out that the database and the data quality that we have. So that self-report information makes sense, that it works, that we can validate studies. Like all of that has been really well refined over the last 17 years. And we now have over 14 million customers. We have massive amounts of phenotypic data. We have shown that we can do research. We have drug discovery, like we're ready to execute. And frankly, like LLMs becomes transformative because I think about on the consumer side, the ability for us to be the world's best in risk prediction and then also to have to supplement healthcare providers with LLM, you know, chatbots that help coach you and look at all of your environmental information. And the reality is there's just been so many variables. How do you manage all of that? And I think that's where developing the models to really do risk prediction and help think about like, okay, you Jason, like in five years, like you have three different trajectories, pick the path that you wanna be on. Choose your own adventure. And then we'll guide you to choose your own adventure, a hundred percent. So I think that is really exciting. And frankly, like I'm grateful to the, you know, Apple, to Google, the Fitbit world, like everyone who's developing the wearables because that will become an integral part of all of this with your genetics about like, how do you want to manage your life? And like, what are the, and it's one thing I like to emphasize to people is that your health is not something about just like showing up with a doctor once a year, but it's the sum of what you have done every single day. So every day matters. Like you can have a cheat day and you can go and, you know, be hung over and eat badly, but it's about the sum of everything that you have done. So every day does become cumulative in some capacity. So working out, small amounts of exercise, how you eat, all of that adds up. And I think that we'll be able to help really, you know, for people who are interested, have the best outcomes they can. On drug discovery, it's fascinating because if you start with a human genetic insight, you are more than twice as likely to be successful on drug discovery. And drug discovery, it's real. So that's why we started a drug discovery division in 2015, because starting with human genetic data means you're more likely to be successful. So being us, for us, like right now, we do these huge genome-wide association studies. Like we run through all the data, we look at all the genetic variants, we look to see if we can get insights, but understanding all those insights and then understanding what is that drug that you want to make to potentially, you know, modify that genetic variant is a lot of biology and a lot of work. And that's what I think can actually start to become disruptive. Are you gonna actually develop that drug
SPEAKER_04: or are you gonna work in partnership with somebody? People don't realize this. Like if you look at my burn rate,
SPEAKER_03: my burn rate is not from the consumer business. My burn rate is from drug discovery. So 23andMe actually has two programs in the clinic, both from immuno-oncology. And it's really interesting what we were able to do is look at some of the existing, like these immuno-oncology drugs that are on the market today and look in our data set, what other genetic variants cause a similar kind of signature? And so we're looking to see, okay, like, hey, you know, the PDL1, CTLA4, this is what this looks like in the database. How do I actually find something that's similar? So we have two that are, you know, one that's in the clinic, one that should be going in the clinic soon. And then we have a whole drug discovery team dedicated to doing drug discovery. We've had a large partnership with GSK for years. So it's really exciting. And I think that's where like you yourself, like we like to say, you know, manage what you can, like change what you can, manage what you can't. So some things are in your control to change, and some things are not. And for the things that are not, we're gonna take care of that with therapeutics and like being more aggressive with medical intervention. But for the things that are within your control that you can potentially change your lifestyle on, we're gonna help you manage that.
SPEAKER_04: Yeah, so as a business, you've got this, you know, profitable, break even whatever business and you know, for consumers, but then you have this optionality, this hit based business of a drug. And if you can, if you wind up doing 10 of these over the next decade or two, if you hit but one, that could be this explosive revenue stream for you. Yeah. 100%, 100%.
SPEAKER_03: I mean, I think between now and then you have, you know, you have to invest in that therapeutics business. So we definitely, we look at partners, like that's one big opportunity for us. And that's actually where we've been focused is that, you know, us doing all like managing all that burn ourselves is not reasonable. So yeah, I was about to say those are expensive studies.
SPEAKER_04: And also, like, what's the hit rate? I think this is one of the problems in terms of capital formation and placing these bets. Like, what is the hit rate on drugs these days? Like more than half? 90% fail. 90%? I know. It sounds like my job angel investing. It literally is 80, 90% go to zero. Yeah.
SPEAKER_03: Yeah, I mean, biotech is a tough business. And I think, again, going back to sort of that, that I have of the industry is that if it was about, if anyone could actually predict human biology, Pfizer would never fail. Like you could, I mean, you could buy it. Then if I could hire the right people or do the right experiments, like you wouldn't, then like the big companies would fail. They had like Lilly right now. Lilly has so much cash because of GLP ones. The reality is like, there's still always that mystery of biology and we don't understand it. But that's where I do think that there is an incredible promise with AI. And again, it has to be based in data. So again, we are excited about leveraging human genetics, the data set that we have for building DNA language models that are eventually going to translate and have an impact as part of new ways of doing drug discovery. So it's definitely exciting.
SPEAKER_04: What if you just, I mean, imagine if every year you get 10% better at picking, if you just reduce the mortality rate of drugs not working 10% a year, then you'd be sitting here in seven years and you could have doubled it. I mean, that could be just change all of society.
SPEAKER_03: I mean, the problem is it takes so long to develop a drug. You know, it takes 10 years to do it. So you don't know your outcomes. You know, that's my point on the GLP one is like back in 2022, or like, you know, 2000, I was talking about it, but it took 20 years. So it's just, it's a really slow process because you have to, you develop it, you do, you know, preclinical studies, and then you have to do your safety studies in humans. It takes, the whole process takes a long time. People don't realize that 10 years. Mostly because of regulation.
SPEAKER_04: I mean, there's obviously physics and then there's regulation.
SPEAKER_03: It's regulation, but in some ways, you wanna have regulation because you don't wanna try drugs that don't work or that are not safe. So there's probably ways that you could, I mean, again, I would never say regulation is perfect, but there's gonna be ways that you could obviously, you know, evolve over time. And I can imagine that. The preclinical studies are a lot of work. I think it's really gonna be more about, are there ways for you to do biology at higher speed? And you have companies that are starting to look at that. Like, how do I go from a genetic insight to then thinking about like, what is now that right drug to target, to change that kind of pathway?
SPEAKER_04: Are there any countries, I know this sounds crazy, but are there any countries that have kind of lowered the safety regulations and are going much faster? Because I would think there would be some crazy country that would see an opportunity there. But then also, I guess you would have to also have engineer scientists and be somewhat enlightened to be able to even pursuing drug discovery. So we saw this with cloning at some point, I guess the Koreans were maybe jumping the fence a little bit, lowering the regulation, obviously bad things happened. And then in China, somebody was doing something with cloning last year or two years ago. Yeah, with CRISPR. With CRISPR and that got somebody- That got in trouble. Yeah, that's a big no-no. So are there people who've gone rogue?
SPEAKER_03: I mean, look, I think on gene editing and cloning and not as much cloning, but on CRISPR, you know, I think there is a reasonable push for just having discussions around what is the right way to safely do that. And because you're really editing the genome, there's some concerns about, you know, making sure that you are thoughtful, you know, similar to what people have said about COVID and like whether or not it came from a man-made virus. Being thoughtful about the consequences of CRISPR, I think is important. Where do you wind up on that?
SPEAKER_04: You think this was done in a lab, right? It seems like it was kind of coming. Yeah, where do you wind up? You'll put a percentage on it. Yeah.
SPEAKER_03: Look, I think it's a reasonable assumption that, I mean, look, I think that there's debates on both sides, but I think it's not reasonable to say that it came from a lab.
SPEAKER_04: Yeah, I mean, the John Stewart thing, like Wuhan, came from the location, the lab's here, it's in the name.
SPEAKER_03: There's a lot, and when you think even some of the data is people look at the genome, again, I haven't dug into it of great depth, but people who I respect at least have, you know, there's reasonable hypotheses, not saying for sure that's it, but it would be something I rule out.
SPEAKER_04: What do you take from that in terms of, should we be even accelerating our understanding of those things, or should we be pumping the brakes? Like this seems to be- I think that there's,
SPEAKER_03: I was with actually some friends from Stanford. Stanford has actually a pretty interesting CRISPR team. This guy actually grew up with Matthew Tordias, and we were talking about things like the cystic fibrosis approval that just came out from Vertex. There's really interesting opportunities to cure disease. And so I think that I'm all about reasonable risk. You know, like I think that you need to take a reasonable risk because you could potentially really save someone's life. And if you know they're gonna have a really poor quality of life or you know that they are going to die, you should have a reasonable risk with them. So I do think about, like for instance, one of the things right now, and this would be a regulatory push, it's really hard to do a study of one person. So that's called like an IND of one person. And most centers are not set up for it. Like it's these bespoke studies they're called. And that's like part of, there's like a whole movement of like how is it more and more that we can do studies on just one for people who are eager. And there's a lot of regulatory work to get to that. And I think like my main thing on regulatory and thinking about the future, and this does impact a lot of healthcare, is like we're in a world where we can track, we can get daily information. So planet.com takes a picture of earth every day and they know exactly when something like a tree has been cut down, when a boat has moved. Like we need that snapshot of healthcare in this country. So that- And we don't have it, it's so crazy. And we don't have that. So like- Bizarre. You should know side effects. So like right now, have you ever reported a side effect to the FDA? Of course not.
SPEAKER_01:
SPEAKER_04: Yes, but you've had probably a lot. I wouldn't even know where to begin. It's a fact, it's a fact. Oh, good, yeah. Wow, share the number with me offline. I don't wanna, because you know, it can be a busy signal on the facts line. I don't wanna, it's hilarious. But I think like, that's my point is like,
SPEAKER_03: we all have different like great responses, adverse responses to drugs. Like we should absolutely- Totally. Be like having that kind of real time. So when I think about like my main push on regulatory is like drugs should get out there faster, but we should be much more comprehensive in following them regularly. And like part of what I think about also with 23andMe and with the opportunities that are coming with things like 21st Century Cures, is the ability for you to easily get access to all your medical records. So there should be some way to pull all that data in a real time way to be able to track like, okay, how are people taking, like a GLP-1? We want all that information. Yeah, and it's out there. Like who's taking a GLP-1 and what's the side effects?
SPEAKER_01:
SPEAKER_04: Yeah, like why can't I just opt into that? And then if you think about it, we would have solved for the spread of COVID much quicker if we had challenge trials. Now, most people don't know what a challenge trial is, but it's very simple. You introduce COVID into a person who's had a vaccine and so they're taking a massive amount of risk, depending if they're, you know, have high risk factors. But there are young people who would love to, you know, say, you know what, for the sake of the world, I'll do a challenge trial. I'll opt into it. It's illegal in the United States, right? It's completely not allowed. It's unethical, but I guess in Europe, some countries allow it. Yeah, well, they do the flu studies.
SPEAKER_03: Like, well, they'll give you the flu. I feel like COVID got into its own category, but like they will do the flu challenge. I think they've even done some malaria challenges, but I don't know if it's, I don't know enough, I'm out of talking on the chart. I don't know if they do it in the US or if it's other countries. I just noticed some physicians signed a petition saying,
SPEAKER_04: hey, you know, post COVID, we probably should rethink this concept because we let people go fight wars. You know, we've got Navy SEALs who are putting themselves in massive amounts of risk. And a challenge trial is like a small portion of that risk that, you know, a Navy SEAL or a deep sea diver might opt into taking for whatever reason. And, you know, there's things we can think about ethically morally to your point about like healthcare for one, if I have cystic fibrosis and I actually have a family member, it's a very rare thing. It's like, I think 30, 40,000 people in the US have it, but I happen to have a family member who has it. And she's been very lucky because she got into some trials and she's lived in an amazing life. But the lifespan is typically very short. But if you ask one of those people, hey, do you want to take something that could be risky or do you want to be part of this experimentation? The heck yes I do. Yeah, and I think this is where I think maybe some morality.
SPEAKER_03: I think this is where you're right. And I think the patient voice, and again, this to me, and it goes back to a lot of things that we think about is like more and more, I think healthcare will change when the consumer has a bigger voice. But right now, if you think about like even talking about clinical trials and talking about this, you have a regulatory body that makes decisions. How do you have almost a stronger collective voice of the community about what we want? So there are patient advocates and there are patient councils, but I would say the average individual is not terribly involved. And so are there better ways for us to have that kind of advocacy about like, what is it that is important to us? And then I look at things like N of one study, especially for cancer, how do you actually start to have more and more of that? Like, how can you actually, you know, pioneer, if you already know that there's gonna be a bad outcome in area, how can you actually instead then have a N of one study to be able to push the boundaries of science and actually really better understand and like, and also grant the patient wishes?
SPEAKER_04: Yeah, great, great thoughts. All right, listen, and I gotta let you go. You've been so generous with your time. It's awesome to talk to you mind blowing. Listen to you go watch this movie Prometheus. I wanna talk to you about what we'll have a post Prometheus discussion, but it really is I just love science fiction. And it's just like this incredible mind blowing that puts together our whole discussion and a lot of your career, frankly, of these engineers and why are they doing what they're doing? And it's a little dark and crazy, but you'll very much enjoy it. So that's interesting. Everybody go to 23andMe sign up if you haven't done it, join one of the programs, take control of your health care, yada, yada, yada. And I know you're hiring all the time. So I guess you go to the 23andMe career space, you wanna work for somebody brilliant like Ann. Sounds like a good noble mission instead of trying to optimize, no offense to people making money off advertising, but some social network optimizing advertising to make people click 10 basis points more.
SPEAKER_03: I think it's definitely the next big area.
SPEAKER_03: Definitely is being able to really treat what being able to transform health, like understanding the language. Like for me, it's about like, understand the language of life. Just like big picture. Like to me, that is a computational issue. And it's so exciting and it impacts everything around you.
SPEAKER_04: I just, it's so exciting to be alive at this very moment. And you know, it's like, we're such a lucky generation because we get to say it every 10 years or so like, oh, wow, this mobile phone came out can do everything. Wow, so great to be alive right now. Oh, electric cars. Oh, space travel. The internet itself. Like it's just every like seven to 10 years with this great Christmas present under the tree. And it's like, we open it up and it's like, oh my God, the world is going to advance. And people are so negative. People are so caught up in nonsense. And if you just look at entrepreneurship, science, technology, research, you become so optimistic, right? I think it's one of the great things about living in the Bay Area. It's just so many optimistic people. Yeah, it's gonna be super exciting. Okay, and can't wait to see you again. And we'll see you all next time. Great to see you. Thanks for doing it. Have a good time everybody. Bye bye.
