23andMe's next stage? Using DNA data to help you make better health choices

The direct to consumer genetic test company 23andMe has been lending out its data to develop drugs, a process that could take years to produce something viable. In the meantime, founder Ann Wojcicki is hoping to turn her 13-year old company into a personal health guru for the masses.

At a press breakfast held last week, Wojcicki was notably not center stage. Instead, she sat comfortably on a cushioned pink chair off to the side of a panel of three women poised behind microphones who were teed-up to talk about how the direct-to-consumer test had meaningfully impacted their lives.

One woman had discovered she had genetic predisposition to breast and ovarian cancer and as a result underwent a double mastectomy and removal of her fallopian tubes and ovaries. A second woman discovered that she was genetically prone to abnormal blood clots, the kind that can lead to a blockage of an artery in the lungs. Doctors for both women had their results affirmed by medical diagnostic labs, which offer a wider range of gene variant tests than 23andMe does. A third woman, who was already diagnosed with Parkinson's Disease, contributed her genetic data to 23andMe's research pool in hopes that it could be used to develop preventative therapeutics.

These anecdotes serve to paint 23andMe as a crucial component of people's health journey-not just a spotter of silly facts about your genetic data. In a world where insurers are reluctant to pay for medical services that aren't absolutely necessary, 23andMe asserts it can give people agency to discover more about how their bodies work when doctors won't.

Since 2015, 23andMe has been in the process of developing drugs to help people manage the diseases they have a likelihood of contracting later on. Back then, the company hired Richard Scheller, a former Genentech executive, as the chief science officer to head up its drug discovery efforts (he has since left this role but still sits on the board). In the past three years, it has built a team of 100 people in San Francisco that has identified roughly 12 compounds worth investigating. The company has had several relationships with pharmaceutical companies, but a 2018 partnership with GSK has drawn the most attention. It is an exclusive deal for four years to develop drugs based on the 23andMe's vast collection of data.

Wojcicki said the relationship with GSK is crucial to helping her company scale and eventually become a drug purveyor all its own. "One day, I can absolutely imagine us distributing," she said.

When the news first broke about 23andMe's partnership with GSK, some people were upset that the company was planning to profit off of health information customers forked over for the fun of learning whether their fear of public speaking was hereditary or not. Also, as journalist Stephen Dubner points out in an episode of Freakonomics, people pay $100-$200 for 23andMe to analyze their spit; if the company is going to profit off of that data through pharmaceutical deals, shouldn't it be paying its consumers?

While the company is investing in using its vast store of data to develop drugs as a long-term plan, in the near future, it's hoping to do more to shape people's day-to-day health choices. Wojcicki sees this insight as being more valuable to consumers than cutting them a check for their data.

"A lot of these diseases like Parkinson's and Alzheimers, I think you're going to be able to shift the outcome by treating earlier," Wojcicki said. While 23andMe can't give medical advice, it can link people to information about how to lead a healthier life. The company also already has a network of social communities around genetic traits and gene mutations it can leverage to disseminate information or even foster discussion. In the future, this set of services will fit under what she calls "23andMe prevention": tools that will help people understand their genetic predisposition to disease and use that information to inform healthier life choices. For now, she has no specifics on what sort of products the company will offer to usher in this next chapter of the business.

However, Wojcicki believes with certainty that eventually all humans will be sequenced at birth. As the healthcare system shifts toward prevention and away from waiting to see if you develop a disease, it's likely that doctors will look to genetic code as way to hinder future illness. Some doctors are already doing this kind of testing.

Less clear is what role 23andMe will play in this future. One of the company's early advantages seemed to stem from a healthcare environment where physicians didn't see the utility of genetic testing except in instances where it was clear there might be a genetic link (for example, if a patient's immediate family member had previously gotten a cancer diagnosis). Wojcicki has many times told the story of how she couldn't get her ex-husband Sergey Brin's doctor to test him to see if he was genetically at risk for Parkinson's ( he was). If a consumer wanted to know more about what information might be lurking in their genes and their doctor wouldn't approve a test, 23andMe provided an alternative.

As more doctors turn to genetic testing (and more insurers cover it), they're likely to recommend medical diagnostic labs over direct-to-consumer tests. After all, 23andMe has only 13 tests for health predispositions. It also only reports on some of the most common gene variants linked to the diseases it tests for as opposed to the full spectrum of variants-a handful compared to thousands.

Still, 23andMe continues to grow its number of tests on offer, thanks in part to all the data it has accrued. This year, the company launched a test for the genetic likelihood of Type 2 diabetes. Still, it's unclear if 23andMe's roster of tests will ever rival that of medical labs like Ambry Genetics, Myriad Labs, or Invitae.

Perhaps that's not the point. Maybe 23andMe's real role, before it starts rolling out drugs based on the genetic material of millions, is in getting people to unwittingly care about their health through playing up the fun aspects of their tests-like whether they inherited that cleft chin. This has the potential to screen people that otherwise might not do so.

"A test that finds out cancer and heart disease is not necessarily something that people are rushing out to do," Wojcicki said. "The fun side has definitely inspired people."