Stop Disease 5 Years Early: AI + DNA Playbook With 23andMe's Founder Anne Wojcicki

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genetic information and use that to modify and prevent disease this is ann she built 23 and me a genetic testing company that provides ancestry breakdowns and health predisposition insights more than 14 million people have used its dna test helping build one of the world's largest genetic data sets then it all collapsed her board resigned and she lost her company 2024 was a brutal year for you with bankruptcy and having to buy out your company did you ever have thoughts of giving up i thought about it a lot because everything is pointing in the direction that things are not going well but after winning a court-approved auction she bought the company back and turned it into a non-profit now she's working to combine dna data sets with ai to help people catch disease before they feel it what can ai plus dna do now what a doctor couldn't do five years ago you can pull in your medical record link all this then with your genetics and understand where you could potentially intervene today and change the outcome from all the data that you're seeing what do you think of the diseases that have the best chance of being cured or treated in a different way in the next five years i think a couple things one my audience really loves using ai for everything what can ai plus dna do now what a doctor couldn't do five years ago i love that and um i feel like we're really getting to the point where everything that we set out to do back in 2006 is can can start to happen and that really revolves around preventing disease and i think the fundamental issue in the health care system is that when you go to the doctor today they're compensated to treat disease like almost no aspect of health care rewards you and makes money on disease prevention and so it's really going to fall in the hands of you the consumer like you the individual are going to have to leverage all these different you know ways you know all these different means that are now in your in your power to start to understand what your health risks are and then to help start to manage that more and more and so 23 and me started with this idea is that the most fundamental layer of your health is your genetics so for example if you want to be healthy and you're worried about your all your cholesterol numbers and let's say you um you just have very high numbers and you have a genetic risk factor called familial hypoglycemia and that's me is it really yes okay so you're a prime example of this like no matter what you do with your diet you doesn't affect anything you have to take a statin and so it's that type of thing is like you you find out that you have something you have high cholesterol numbers but but there's a limit to how much the environment can be modified to impact that yeah so you have to go on a therapy and there's the aspects of for instance in cancer like if you have hereditary colon cancer hereditary breast cancer you need more proactive screening you know environment definitely makes a difference there but you have to be proactive with the medical world and so for me your genetics was always this core layer where you have to understand genetically do you have a significant risk factor where are you on the spectrum for heart disease for cancer risk for you know other things that could be passed down to your children like understanding all of that is really step one what's amazing today is that you can pull in all this other information your wearable information your zip code has your air quality and your water quality um you can pull in your medical record and you can link all this then with your genetics and really understand are there are there signs are there things happening where you could potentially intervene today either with a medical world or with your lifestyle and change the outcome so for instance even like with my mom types of things i look at like we're genetically higher risk for type 2 diabetes people in the family had type 2 diabetes my mom knew that she was pre-diabetic and she was like oh my god i'm gonna die i'm gonna die i'm gonna die i'm gonna die you know i put on a cgm on her and suddenly she's like oh my god like i can now change my behaviors so it was a combination of her genetics her medical records her blood values and then using a new tool like a cgm or again you can be able to use aura rings other things as well to then actually change your behavior so that's going to be the magic of ai is combining all of that together and your genetics is going to be what powers the customization of all this other information coming in and knowing where do you need to be proactive with your lifestyle and where do you need to be proactive medically how do you know how much genetics are actually contributing because if you look at cancer stats it says on average it's 70 to 90 percent environmental for coronary diseases same 79 how do you know that for you specifically it's mostly genetics or it's mostly environment so you can control and take out there's two types of reports what we call monogenic risk and that's where you can get the information that you need to get like familiar hypocalistremia one variant that says you are much higher risk based on this one variant and so in some ways those general numbers are not meaningful to you as an individual they're meaningful to a population but not meaningful to you so you have one monogenic variant and it puts you really high risk for heart disease or sudden cardiac death or high cholesterol that impacts you that range is no longer relevant you have another area called polygenic risk scores and polygenic risk is looking at hundreds or thousands of genetic variants that add up into a score and it puts you almost on like a bell curve like where are you on that curve like i can look at my type 2 diabetes risk and i'm like fit i'm healthy i work out a lot but genetically i'm still higher risk and so for that reason that's part of why i can say okay i'm higher risk but there's actually been a lot of data that shows if you manage your environment if i manage what i eat i'm regularly get my hemoglobin a1c test i use you know a continuous glucose monitor i stay fit and healthy i can reduce that risk so i have a genetic risk factor but i can reduce it now when it comes to cholesterol since we touched it and it's a huge problem for me because i'm 36 i don't want to go on statins and every doctor almost every doctor is like 10 of doctors are like we can wait yeah till you have like a third kid because it affects pregnancies and we haven't studied statins and pregnancies etc but is there any study that shows where because you mentioned different people react differently to different drugs correct yeah and ideally i'd love to do some testing before yeah statins is there any research around that that shows that some people don't have to take statins or wouldn't react to that or i think that's just me hoping this is where the few this is the future of personalized medicine you should have a physician who has a very comprehensive genetics background and i think that's where you're going to be able to have ai training to say based on all the literature with genetics let's no longer look at you just as an average as like a one-size-fits-all of like here's what we do on a population level with you know with you know treating high cholesterol that we should actually now understand specifically based on your genetics based also on pharmacogenetics because there's interactions of your genetics and statins so what's the right one for you and what's the best way for us to reduce that what are the best prompts that people can put into their ai today to make this kind of personalized health assistant that is a great question you know i think it's still pretty early days um i have to say the areas i've been coaching people the most is around blood values cancer information anybody who gets a genetic test in cancer or even just basic things of like helping understand um lifestyle information with a hereditary factor like APOE based on your age based on you know all your metrics of you know your weight how you are living your life like you know asking it for prompts you know ask me 10 questions about my lifestyle and um and including it for something like APOE what are the things that you can do that can make a difference APOE can you APOE is about um is the genetic risk factor for Alzheimer's and so that's one area where we get a lot of questions from our customers about like well what can i do what can i do for that and that's where when you go to a traditional doctor it's going to be worse at finding out okay here's your lifestyle information what are the things you can do but there is a lot of research out there that's happening and more and more you're finding there's all these you know groups coming together to run their own studies about what is it that we can do what's having an impact now you have 14 million people participating in your research and you said your goal is to get 100 million people what does this unlock we see the potential with ai right now and your listeners definitely are early adopters here so ai came because all the big tech companies had data, like they had tons and tons of data, they could invest in training models, like it came because there was a world of billions of people who contributed data. So in many ways, you need to do something similar with respect to healthcare information. And 23andMe, I think as impressive as it is that we have 14 million, and it's the largest genetic data set that's out there. It's only 14 million. And your DNA is fascinating to me, because it's a digital code. Every form of life has an A, C, G, and T. And so you just have different combinations, different variations, different, you know, ways it's organized. And you could be you, you could be a frog, you could be a banana. I find it amazing that you get this kind of genetic, like this variability in the world. So what you need to really understand the code, of life is more data, and you're going to need to train models, not on words, but you're going to need to train models on DNA. And so that's where I look at is like, we're at 14 million today, I point to 100 million is sort of the next milestone. But the reality is, you're going to need data sets that are massive. So you need more than that. It doesn't, 14 million doesn't really represent a significant group of people to. Well, it does. So what we found, I mean, what we found is the publication that we had at NeurIPS actually showed that at over a million people. You start to really get the benefits of training models with AI. And so you get nonlinear improvements with risk prediction, that for us sort of valid validated that more and more data, because we get this question from people all the time, like, why do you need more data? You have enough data. It's funny, because we get that a lot from the biotech world. It's like, that's enough data. Why do you need any? Yeah, for me, it also looks like like 14 million. Maybe that's, this is where you see differences. And that's what's been interesting with our background is like, the tech world is recognizes, you always want more data. And the biotech world sometimes like, that's enough. Like, you don't necessarily need more. And I think now you're having this convergence where people recognize like, to really be able to take advantage of AI, you need to build these extraordinary data sets based on human data. What do you think it's going to unlock? Like, for example, we can't really treat cancer now on genetic level. Do you think at 100 million, we're going to see some? What I'm most focused on, if I think about like, what do I want? And again, this is like 23andMe is very focused on sort of like a single area. Yeah. Which is focused on prediction. And so disease prediction, because we all know, it's tough. Like, if I look at my sister, Susan, it was tough having a late stage cancer diagnosis, what you really want to know is, are you at risk, and then find it at those earliest stages. And that is what I think is exciting is being able to identify something really early. And then also understand the basic biology. Why are you getting something like we don't understand, like we know that bodies are constant. Yeah, we're constantly getting, you know, you're always under assault. So you always have like little micro cancers. And so why is it that sometimes they take off and sometimes they don't? Yeah, it will be fascinating when you have this DNA, even now with 14 million, when people start adding their whoop information or the lifestyle and then connecting and seeing correlation between lifestyle and genes. That's the most important. I mean, that's what we don't really know, like lifestyle. And people have to recognize that the challenge that you have with AI and health, is that you have to run experiments, you have an intervention. And maybe it's that we eliminate microplastics from water, or you have a new drug that you think is going to prevent heart attacks. But then you have to run the clinical trial to see, do you get that outcome, you have to wait for people to get heart attacks, you have to wait for people to not develop cancer. So it's just hard to run models in the same type of way. And so that's why we're always trying to come up with like, you know, other types of biology experiments to, you know, mimic what we think is potentially, you know, a biomarker for it. And the more data, the better. The more data, the better. This is where we're just getting into those early days of, you know, on AI, and all the environmental information. You know, you see this very clearly things like, you know, people who live near a golf course, and people who live near farms, the pesticides. So you can see from a population level, you have increases in diseases like Parkinson's. We barely understand the impact of all this environmental damage. I think we're just scratching the surface of what all the environmental impacts are, and it hasn't been that well studied. It's hard. It's a hard area to study. What are you seeing from your data? Are there like top three environmental factors that could affect your potential risk? I mean, pesticides is one of the biggest. So don't eat non-organic? Is that something that's practical? I think it's, I mean, I actually don't, I mean, in some ways the debate around organic and non-organic is controversial. And I haven't, again, I'm not an expert in that area. I mean, I definitely would say like, don't. Don't live near a farm? Living near, and again, I think that's where there's all the occupational hazard issues, you know, people who are, who don't have a choice, who are spraying pesticides. Yeah. But, you know, it's very clear that pesticides have health impacts. And so you look at all of that data. I think air quality is huge. People having filters in their house is important. Like California had all the fires. There's this guy that we fund, Charlie Swanton in the UK, who has done a fair amount of work on air pollution and the inflammatory effects in your lungs and in your body. So I think air quality makes a huge difference. And I think people, it a hundred percent makes sense to have high quality filters in your house. And it makes sense to have filters around. I do think water quality, like all of these things really matter for people. And you can test for it. I mean, that's where like, or you can, the government is constantly testing for it and you can pull up, it's all publicly available. So you can look at these water quality sites. You can see, and that's, you know, the issue is like, not everyone has the choice about where they live, but knowing whether or not you're living near one of these sites makes a difference. I mean, the other thing that's like just abundantly clear is the impact of exercise. And, um, you know, like I would have ridden my bike to your house, but then I saw how high up on the hill you are. People do bike here. And I almost always bike. Um, but you were, you're sort of next level. Um, but I do think about that a lot. Like I'm always trying to exercise like, and even with my kids and other, like, I try to be like, let's do burpees now. Let's do, um, let's do squats. Like little things make a big difference. Um, we have a trampoline at the house. We're always bouncing. All these things make a big difference. And again, I going back to genetic side, if you know that you have a significant genetic risk in one way or another, then it can help direct. Where do you want to put your focus? Knowing that you're higher risk for Alzheimer's or Parkinson's, um, there's a lot of data about exercise and quality of your food and what you can do with that. And like we had, um, somebody named Rob, um, Lustig coming yesterday, who's a professor at UCSF talking all about, um, you know, APOE, so Alzheimer's risk and, um, ultra processed foods. Oh my God. And it's one thing, like I complained to my kid's school, you know, they had a parent, I always complain. Well, they had a parent event and I, and they were serving hot dogs. And I, I was like, you know, like it's like plastic plastic plastic. No, I don't know if it was in plastic, but it's like the one food. I was like, it's the one food society agrees on is really unhealthy for you. Like, shouldn't we be doing more to train kids? Yeah. Isn't it proven that processed meat causes like it's a cancerogenic. Correct. And like ultra processed foods are just like the one area you really want to try to avoid to the question that you had is like, what are the top three biggest areas? And I think that's where there's so much data. Like again, healthcare is, is in human biology as a lever of complexity that we just like barely scratched the surface on. Like, it's just, it will be humbling for the whole world, like understanding the complexity there. So using AI to help really understand that, I think will, will be potentially transformative. After what happened with Susan and, uh, with her diagnosis, have you changed anything in your lifestyle and your kids' lifestyle? I mean, like, I think that the number one thing that happened after Susan was diagnosed, um, and I think a lot of her friends at this is they sort of reevaluated what's most important to me. I've been reading this book recently, um, by Eddie Egger, um, called the choice, a Holocaust survivor who actually lived to 98. I think there's a big question for people in life about, are you doing the right thing? I think there's a big question for people in life about, are you doing what's happy, what makes you happy and that you personally find rewarding and meaningful. What I found impacted us, me the most after Susan was less on lifestyle of like, okay, am I exercising enough? Am I getting enough checkups? But more, are you living the life that you actually want? I think there's a number of her friends who changed jobs, made pretty dramatic decisions of like, I, like I wasn't, and you have one life and you have, um, there's a number of things that you can control, but ultimately you also just have, like you, you always have lightning and you have no idea what's going to strike. You should enjoy every day. And it's kind of the things that Susan said. It's like being, um, meaningful. And again, that's right. I do really love this book, the choice of, you know, this ability to choose every single day, um, to be happy and to appreciate the things around you. And I think that was overwhelmingly the number one. Um, and I think that was overwhelmingly the number one, um, thing. And I think it's an interesting component is like, we live right now in a time period where it's like, everything's moving so fast. Like even this morning I was doing it like a new cloud training and, and it was different than like two weeks ago. oh yeah it's different every day it's different every day and i have it's like things are moving so quickly and it is exciting it's an exciting time because we're rebuilding the entire world but it's also one of those things to for people to check in and say like are you doing something that brings you true meaning yeah and you know it's one of the things that was really clear with susan is you know when she died and she was saying like you know if you're all left behind like do things that are meaningful with your life and i think that's something that um that resonates the most with me ukg is the workforce operating platform with unified hr payroll and workforce management built to solve the unique challenges of frontline work powered by people first ai and decades of labor data ukg turns workforce intelligence into real-time decisions around staffing pay compliance and productivity enabling every worker to confidently take action as work happens because when work works everything works learn more at ukg.com work ukg hr pay and workforce management this episode is brought to you by google chrome you think you know a browser but gemini and chrome that's new it can help you with practically anything on the web like restoring a vintage motorcycle from a 50-page restoration block or finally break down that long article you've had open for weeks gemini and chrome is here for it ready to make anything online make sense there's no place like chrome check responses set up required compatibility and availability varies eighteen plus one hundred percent but were you able to identify any of the issues that you had with hr or any of the challenges that you had with hr or any of the challenges that you had with hr or any of the challenges that you had with hr or any of the challenges that you had with hr or to what to why that happened to her or it's still no i mean we all think about i will never know and i think so even with ai advances i think that there's it there's always going to be a combination of factors so clearly we're running right now the 23 me lung cancer study i'm super interested to understand genetics like do we have like there's no polygenic risk score for lung cancer right now like we don't understand why so many women don't have polygenic risk scores we don't understand why we don't have polygenic risk scores we don't understand why so many women don't have polygenic risk scores so many women who were never smokers are getting lung cancer so is there a risk factor like i would love to understand that and is there some kind of susceptibility like are some people more susceptible to pollution people have reached out to me now who have lung cancer who were triathletes and runners is there something then about increased exposure to air quality like you just have no idea i think the thing that is not well studied is stress people having chronic stress and high cortisol level and just never being able to have a down time i can hypothesize all i want about all these things that impacted susan but i i can say no like without a doubt like she had a high stress job i don't think we'll ever know but i know that prospectively like the 23 me lung cancer community is looking specifically at like can i identify genetic risk factors that made people at risk for lung cancer i would love to as we get more and more into ai and multimodal data and i can look at um environmental factors like zip codes of where people are getting diagnosed um environmental information how often are they exercising and we 23 me links up now with apple health kit and we pull in we have about half a million customers who are consented in giving us their wearable data so their watch data or or ring data and then we can pull in medical records and so we have a number we have you know 50 plus thousand people who are consenting and giving us medical records and then we have all the self-report data so pulling all that together um and i'm eager to look at stress data that or a ring is starting to put like yeah can we actually start to understand what are some of those factors it's a complex problem it is um but i think the next five years can be transformative with how we can understand environment and your risk factors and your life stress is also this funny thing i feel like i'm stressed all the time but then you look at my whoop it's pretty calm like nothing's happening well there's good stress and there's bad stress maybe and there's also like can you turn it off in some way and i do think like knowing you and seeing you with like your kids and your dog like you seem to enjoy them yeah i love that it's just a lot sometimes it's a lot yeah but but but just because it's stressful in the moment is like oh my god i have to go and volunteer and like do this and like it's a lot but then i do think there's good stress and there's bad stress um and i think they've quantified in some ways and looking at even like it's it's hard to fully understand stress um and i think aura has a feature now on stress um and i think it's just it's those early days like no one's measuring your cortisol yet of like can you actually measure chronically continuous um but i think we're getting towards that like there's some of these devices it was device for continuous cortisol yeah there's some that are coming out and i think that's where it's not going to be everyone in the population who suddenly wants to measure everything but at least for a couple weeks like with a glucose monitor at least you can figure out what affects you right and i think i love doing it like when i'm doing talks or other things or just even like like we've had all the graduations which has been a lot like measuring for a period of time yeah um will be interesting for people to understand like what are those behaviors from all the data that you're seeing what do you think of the diseases that have the best chance of being cured or treated in a different way in the next five years i think a lot of people think about what's the best way to be cured or treated in the next five years and i think it's really important to think about what's the best way to be cured or treated in the next five years and i think it's really important to think about what's the best way to be cured in the next five years and i think it's really important to think about what's the best way to be cured in the next five years and i think it's really important to think about what's the best way to be cured in the next five years and i think it's really important to think about what's the best way to be cured in the next five years and i think it's really important to think about what's the best way to be cured in the next five years and i think it's really important to think about what's the best way to be cured in the next five years and i think it's really important to think can we in five years just if you're predisposed to breast cancer just modify the gene this is outside of my area um but if you look at jennifer daudna and people in the crisper field and there's a number of experts in this and um i sat at a conference recently with one of them and he was just like you know so passionate like every disease is genetic and we should be able to like we're at the beginning of a crisper era where you should be able to figure out like cystic fibrosis or you should be able to figure out like cystic fibrosis or you should be able to figure out like cystic fibrosis or you should be able to figure out like cystic fibrosis or you should be able to figure out like cystic fibrosis or you should be able to figure out like cystic fibrosis or you should be able to figure or you with familiar hypercholesterolemia or BRCA variant, like there should be a world where that's coming, where you can fix that. We're not there yet. But baby KJ is a pretty amazing story. Yeah, it's the first sign of the future. I remember when there was the first IVF children, and it was like it was so extraordinary, and now it's so common. Yeah. So I think the next 20 years will be extraordinary in that way. Hopefully sooner as well. I was just talking to an economics professor from Stanford yesterday, and he said in the next two or three years, we're going to see something dramatic. It's going to happen because of AI that's going to change our lives. I'm always more hesitant in health care. Like I'm a little bit always of the Debbie Downer, because like you still have to do human clinical trials. You still have the FDA. There's going to be issues like it's not going to be perfect the first time. So I always try to set expectations. Biotech's not the transformative industry that's going to change in the next five years. I think that there's all kinds. Of things that are happening in the early stage of discovery. But you have to then translate out that those those discoveries in those insights actually lead to drug discovery. When I was in my investing days, there was all these technologies on like high throughput chemistry and all these high throughput ways of doing biology that were important techniques. But, you know, fundamentally, 90 percent of drugs all fail, and it was 500 million to develop. A drug back when I started, and now it's like four billion dollars to develop a drug. So maybe it's like two billion. We're not getting better, is my key point. And so the only thing, the reason why 23andMe got in drug discovery is because one of the only areas that was seen to improve the outcome and the likelihood of success was starting with the human genetic insight. And so we know that starting with human genetic insight means that your drug is more likely to succeed. We don't yet know on AI how much that's going to help it. So I'm super optimistic and I love that there's all this money going to the space, but I'm always like cautious to the broad population to not overset expectations that you're going to have a radical change in the next five years. Yeah, just eat whatever you want. I think the radical change that you can have in the next five years is risk prediction. I think 100% you should be able to predict who's most likely to have breast cancer, colon cancer, heart disease, like 100%. And then you should allocate. You should allocate resources based on that. What do you think are the top three things that everyone should do after listening to this conversation in regards to their health? Because when I was at Susan's foundation launch, I was like, okay, I need to do this pre-nouveau scan. Yeah, yeah. I have done my 23andMe, then I'm going to connect all of that with AI and see what it tells me. Do you think it's a decent plan? I think that the most important thing, 23andMe has three different products. We have a product called Total Health. Total Health is your exome. So it's a deeper level of sequencing and it's blood. Everyone from a medical perspective should go and get that. It's the gold standard what people want to be able to go and get. So it's better than spitting? It's two products. So the DNA is still spitting. Yeah, okay. But at some point you want to get your blood. You want to be able to understand your blood as well. And so pre-nouveau is super interesting and I'm an investor in it. I do it every year. There's still like a world of people all assessing like exactly what do you do with this information. And I recognize there's people who are anxious. They're anxious because you'll find all kinds of things. And so it's for people who want to embrace like I can handle it. If you go and you tell me you have like a strange lump in your uterus, you're not going to freak out and that you're okay to follow up because you'll find a lot of things. And some of them, like I know lots of people who found brain tumors and heart issues and aneurysms, like the stories are astounding, but you also have stories of people saying, oh, they found something and it was nothing and I had this whole workup. So that's where pre-nouveau, I think, is doing a lot of work to understand exactly how you want to do an MRI. I do annual chest CTs. So a low dose chest CT is minimal radiation. I'm in a category that's genetically higher risk now because Susan had it and I do that. And there's amazing AI work here where and this is part of what the Susan Wojcicki Foundation was also part of and helping to support is can you use your my chest CT to give me a five year prediction? So when do I build to identify right? So when do I want to get when do I need to get another scan similar to a colonoscopy when you go and they say like you need to come back in two years. You need to get back in 10 years. So it's going to be a similar kind of experience there. The other thing that's important for people to recognize is like health can be really stressful and triggering for some people. You know, so some people we get Brian Johnson who like obviously loves testing everything and I'm so grateful to him because he tests all kinds of things that I do. Not. Want to test he's testing all of it. I get other people like I dinner with someone last night who's like I don't like getting blood. And so there's a an element of choice and respect for people like people should all have and there's people who are going to be Pioneers helping to sort of Pioneer. What is this revolution? And like what are we all learning together? And so for those people like you're doing blood twice a year, you're doing your genetics. You're doing prenuvo. You're doing like as many scans as you can. You're like putting all that data together the stuff that's really validated for people is like. Having a baseline genetics making sure that you're doing the core blood tests and that you're doing all of the preventative screens that makes sense for you. It all comes down to discipline as well because your AI can tell you anything but then right you have to go and execute and yes getting those annual checkups to see how you're progressing or what's changing. And this is where I do think like aura and all these, you know, your Apple watch are amazing at predicting changes and even, you know, we had a friend. Who just had a health issue and it was amazing how Apple the Apple watch, you know triggers and says like, oh, you know, you were unstable the day before and so having those and that's what I love looking at is the patterns of like, oh, I you've really been sleeping worse. Like what like what happened and like I stopped wearing the aura ring when Susan was sick. I was like, I don't need you to go and tell me. Yeah, but like having the trends over time and and watching things like I'm 52 now like understanding how. You know, my body is changing and what do I need to do and like am I sleeping better? It's actually nice to have data and to understand that and and I was really clear. I was like, okay, I'm going to start going to bed earlier and I can see a difference like when I'm in bed reading on my phone versus I turn off social media and I just go straight to sleep and I read a paper book. Like I see the difference in quality. Yeah, and so like that's where data has helped me totally quick pause my team and I are celebrating one year of the Silicon Valley girl podcast. The channel has existed for a while. But a year ago, I made a decision to focus on amazing conversations with people who are building our future with AI and for a whole year. We work to bring you the biggest founders and builders in AI so you can keep up in this era and get inspired. If you love what we're doing, please subscribe and hit the notification bell. It's what helps us bring you the biggest minds of our lifetime. Thank you so much for being here. I want to focus in this conversation as well on your mindset as a founder because a lot of your bets I think all of your bets because you're doing 23 and me. I want to talk about downtown Los Altos. You're doing Susan's Foundation. They're all long long-term bets. How does your mind function in the world where every day there's something shiny something fancy and all of your bets are like 10 plus years. You know, it's interesting because when when I was driving up here and I was talking to some of the bankers about this SpaceX IPO, I knew Elon because of Sergei and I remember in like the very earliest days when he was starting Tesla and he would stay with us and he would he was so consistent talking about his vision of like Tesla and the space world and the potential. I have to say like it's complete kudos of like when you think of like long-term vision the world and I look at all around us. I like everything that's happened today to make significant changes in the world. You have to. Have a long-term vision and you have to be so consistent and maniacal about doing that and you have to also love what you do and that's where I like I look at again. I talk ad nauseum about like how much I love genetics and but I do again. It just occurred to me thinking this morning is like people who love what they do. You have a long-term vision and you're consistent with it and it never feels like work and and every single day builds on the previous days and So I look at 23 and me every single day. I walk into the office and I'm fascinated by the research that we can do like what motivates me every day is this idea of when I'm helping people like I always wanted to be a doctor but I feel like now it like I help more people because I help connect on identity. I help connect on family connections like reuniting all these people and we save lives like I give people valuable information about themselves. And then the. Research is like I mean for me. It's Megan my dad who love neutrinos like and he loves space and all that like I was like you like looking up in the sky and I like looking inner I like find that there's an entire universe in every cell. We understand nothing about it like even I was with somebody talking about like the beauty of the mitochondria and like that you have this like power engine and how it works like we understand so little and that's what I love like every day. It's like little tiny bricks coming together to build this foundation of knowledge and it's so interesting and again that's what like I always advise kids like whatever you do like make it so every day you have like that spark of joy where you're like oh that was so cool what was fun is like when we first moved into Los Altos it was a pretty sleepy town and there wasn't much like there wasn't much going on at night there wasn't much for the kids to do. It's like I always advise kids like whatever you do like make it so every day you have like that spark of joy where you're like oh that was so cool what was fun is like when we first moved into Los Altos it was a pretty sleepy town and there wasn't much like there wasn't much going on at night there wasn't much for the kids to do. And you know I have to say it's like it's been such a pleasure because like you can buy buildings I bought buildings and and then I could bring in you know really extraordinary owners who love what they do so like Linden Tree. It's an amazing bookstore you know bookstores and this is where I was like I have a pleasure I can like help get a building I can renovate can make it nice and then you know create an environment and an economic environment where it can support a children's bookstore we started State Street Market so that we could have the best thank you so much so my whole idea there is like I want to go somewhere where I can bring the whole family and everyone's happy and in the earliest days I remember I would go out we had 17 people in the family and like one you call a restaurant a restaurant you're like I need a reservation for 17 and everyone's like no and they hang up so now it like it's easy to go everyone's happy no one's fighting and it's like a child throws spaghetti like it's not a big deal and so I wanted something that was truly multi-generational. And I think it's also, I think society, it's important you have multi-generation. It's important that young people are exposed to older generations and that people in the midlife, you have support for your kids and, you know, that you can support your parents, that, you know, your kids are supported. Like, I just think multi-generation is so, it's so valuable for how everyone grows. UKG is the workforce operating platform with unified HR, payroll, and workforce management, built to solve the unique challenges of frontline work. Powered by people-first AI and decades of labor data, UKG turns workforce intelligence into real-time decisions around staffing, pay, compliance, and productivity, enabling every worker to confidently take action as work happens. Because when work works, everything works. Learn more at ukg.com slash work. UKG, HR, pay, and workforce management. This episode is brought to you by Palmolive. Family time isn't just the big moments. It's weeknight dinners. Sitting around the table, everyone talking all at once. So when the plates are empty and the sink is full, use Palmolive Ultra. Palmolive's most powerful formula removes up to 99.9% of grease, leaving your dishes sparkling clean. And the new convenient pump makes cleaning even easier, so you can spend less time tackling dishes and more time together. Shop now at palmolive.com. I think that's your Slavic genes playing out. Yeah, yeah. Because, you know, I was raised by my grandparents. Everyone lived together and it was like a small apartment, but my grandparents would come over, we'll sleep on the floor, but they will help raise me. In the U.S., I don't see that. Parents are very lonely. They move to another town, sometimes another country. And so you're just raising a kid in a completely different environment. And the sense of community is getting lost, especially in big cities. Well, that's why I wanted, because I think so many people come. So many people are in Los Altos and they are immigrants. They don't have family around. And so my whole thought process was like, well, how can we use downtown Los Altos as a community? And it's also really fun to get kids excited about the different businesses. So I love, you know, like when we did the arcade, I would ask my kids, I was like, OK, make a business plan for each machine. Nice. Like, you know, tell me what machine you want. My son the other day, like, wanted some machine, it was like $200,000. I was like, OK, well, like, just do the math on that one. Like, when do you get an ROI on that kind of machine? Great task. But it's good. Like, I want more and more for kids also to be able to learn. I think also learning about business and having lots of small business owners is great because you want-- I want kids to be able to, like, understand that they can create as well. Like, you have an idea. Like, my daughter wants, you know, a clothing store or something like-- or like, I always think about, like, should 23andMe create a retail store? Like, be able to walk in-- Like an experience, yeah. An experience. I think it would be so fun. So I'm always-- I'm always thinking about that. I'm always thinking about what else can I create. Thank you so much for downtown. Yeah. And all the things that you were doing-- so 2024 was a brutal year for you with bankruptcy and having to buy out your company. Did you ever have thoughts of giving up? Like, this is not something I want to do. I just want to live a happy life. I thought about it a lot. Like, do I-- because it became-- you know, there's moments where I'm like, is this a sign from God that, like, I should give up? Because, like, everything is pointing in the direction that things are not going well. You know, there's-- I called a friend who had also started a company and given it up and had walked away. And he-- he was like, look, I think about it every single day of my life. He's like, I just always regret it. He's like, I just-- I wish I hadn't. And in some ways, it's-- I felt like I had a responsibility. Like, one, I love 23andMe. So there was a selfish component of, like, I just love it. The second thing is, like, I felt a real moral responsibility to my customers, all 14 million, and my employees. And the responsibility that I felt was that I promised them that 23andMe was going to be a company, a mission-driven company, focused on helping people access, understand, and benefit from the human genome. I really believe strongly that you want the company that owns that genetic information should be a neutral party. And I believe strongly that you want the company that owns that genetic information should be a neutral party. Meaning that they should be supporting research all around the world, but it should not be owned by a single pharma company. It should not be owned by a single entity. And I thought about, like, my sister, like, my deceased sister, her genetic information's in 23andMe. I don't want that owned by a single company. I want every single researcher in the world who's doing lung cancer work to have access to be able to make a difference. And, like, this is a community that came together to make a difference. And I felt this huge moral responsibility that I should do whatever I could to make sure that we were true to that mission. And I feel really lucky. I feel really, really lucky that I got it. And I'm not a person that was like, oh, I really wanted to just, like, hang out and, like, sit at the pool all day. I would love slightly more work-life balance. And I would, like, I am trying to take, like, have, again, now I have an amazing, I have 175 people at the company. I have an amazing man. I have an amazing management team. So I have more of that time to do things like this and to, you know, volunteer at my kid's school and things like that. But, you know, it's kind of all the things that we talked about at the very beginning is that you want to do something in your life every single day that brings meaning. Yeah. And if I thought of, again, anything that I learned from Susan was, like, contributing on a daily basis and feeling like you're having an impact on the world is the most important thing. And it was a really, really hard year. And there's definitely things I would have changed. But I love what I do. What's your key learning from that year? There's a dark side. And then there's, like, the positive side. I think the dark side was I was really surprised that how many people backed away from helping me. I was really surprised in bankruptcy at, you know, the friends who showed up. And so I think it kind of came to me as a bit as, like, you know, you do live, we're in Silicon Valley. It's a very competitive, aggressive environment. And I. I have always, like, I operate in a way where I feel like I try to always be honorable and I try to be genuine and ethical. I think that was, like, one of the hardest things for me is, like, wow, like, I might be playing in the wrong community and in a community of people that are not necessarily there to support. I think on the positive side, the thing that impressed me the most was, you know, my customers and my employees who rose to the challenge. I couldn't do it without them. And they were there. They stuck with it. And they also, like, they embody the mission and they care and they feel this responsibility and that passion. And they feel this responsibility and that passion. And there's really good people in the world. You have to just make sure that you spend the time with them and align yourself. Like, I feel really, really good every single day that I feel like I'm doing things that make a difference. Like, I'm doing things that make a difference with 23andMe. Like, I feel really good every single day that I feel like I'm doing things that make a difference with 23andMe. I love what I do with Los Altos. I love what I do with Susan Wojcicki Foundation. And I work with extraordinary people. Having a community that supports you and supports the mission and you can trust them is a really special thing. was like oh shit you know you're right like i i should get on this and you know they kind of torture you going through a donor a sperm donor process where you have to like like do all these therapy meetings did you pick a scientist or something or someone with a phd yeah no i wanted i wanted to find somebody who was gonna characteristics that would be that would match in well and um and i i listen i like it was it was one of those things like i was really um i went into it i would get you have to go through all this therapy and everyone told me you're never gonna get pregnant you're never gonna get pregnant you're never gonna get pregnant and so you had to do all these therapy sessions doing it i was like i get it you guys like i'm old and my numbers are bad um but i'm just gonna try it because if you don't try you never know you never know but i didn't even do a pregnancy test because i was like ah there's no reason like first attempt it worked no the first i actually got pregnant the first time and then i miscarried but i was like holy cow like the machine works um and and then a couple months later i got pregnant and i just every and i i was almost in denial like even at eight months i was still like riding my bike around and i was like ah like i think i'm pregnant so it was an easy pregnancy yeah i'm so lucky i mean i'm so so lucky and i feel for all the people who've had like tough reproductive journeys and all this and i do think on all these areas like um stress again going back to stress and that impact like the fact that i really went into it like okay like i i don't think i'm going to get pregnant and i have to just be okay that like i have two really amazing children like i always tell people like walking having a mentality where you know failure is the likely outcome um but but you're trying still yeah and it helps it doesn't put much stress on what you're doing again it was um a whole journey of like okay well like now i'm having i'm doing this on my own and i had um you know one of my best friends at the late like my labor was a party because i had i was like i was like a communal we're like all gonna raise this baby and um and it was so fun family is the best and um i spend a lot of time with family i um dedicate a huge amount of my energy to the family and you know part of it is like you have to invest like good relationships come with investment but i am really lucky to you know have three kids that are all you know so far pretty nice to me me i was raising her like the early days uh when you were 45 yeah all good is it easier than the first because the big kids help oh okay i'm a big believer like people having an age gap is really fun because you're just so much more relaxed and also you're more secure with your job you know what you're doing it's your third kid you're just secure with everything and the big kids come in to help they like you can go out to dinner and they watch them and you're just like you know that they're likely to survive like you know that they're likely to survive like you're not you're not so incompetent that um that you'll do like you're just and you're comfortable with school and like clothes and i mean it's amazing like my daughter doesn't have to buy anything because like we just like we have you saved all of it okay good we saved like not only like some people come to the house and they're like why your house is like a playground i'm like i'm i'm like the accumulating it's like it's like a funnel like all the kids stuff from like all 10 like it's all come down to us and so we have like tons and tons amazing of of items from the last 20 years do you have any hard rules when it comes to being a working mom like i'm home by six i don't work on weekends there's no difference like before i had kids i was like a machine like i was like always working i remember i would sleep and like my blackberry was like next to my head like it was it was like my companion i mean now i'm very clear like i go to bed when the kids go to bed i try to almost never do a dinner and in those early days with the kids like and early on like my kids came on a lot of my trips i try i'm not good with boundaries like i remember my son at the european society of human genetics and i told him i was like take a notepad and go and interview how it was he i was like seven and i gave him a little notepad and he was walking around to all the booths and i was like just interview people and ask them questions and then come back in an hour that's great experience it was great but he came back and i remember he was like i've learned genetics is very important good but i i i try to almost always do dinner um i think the other thing is don't like you have to show up like i have to like i try to volunteer pretty regularly with the kids um the older kids are are cute they'll say like oh you don't have to drive me so and so and where but they actually really want you to um and so showing up is meaningful and you have to then really prioritize what do you do at work and i think for me also as a leader i try to make sure that trickles down to everybody and be really full of people at dinner time and um at like seeing their children's performances or somebody's moving their child into college like having true work-life balance and respecting people is important and i think as a leader of a company if we want to change society you have to honor and respect that people also have to support their families totally and so like if if the world is saying like oh there's you know fertility crisis you have to have more children okay have more but then you have to be work-friendly and so you can't have both you can't be like oh it's a 996 world six weeks off after having produced it's like it's not feasible yeah so i had um i mean that was the thing i had 23 me does hire a lot of women and so like i regularly had like i would like be breastfeeding with my child and like in meetings and like doing different things like everyone it just became very normal my primary rule is again to be super friendly um family friendly as a company to make sure that i sort of root loosely prioritize what's actually important and to be home at a reasonable time makes sense i wanted to ask you about being married to sergey i don't know if you want to answer it but it's just um i wonder if two very ambitious people who have their companies can coexist in a marriage with kids what would be your lord well our example said no yeah and so um i think it definitely can what helps survive help you know what's interesting like i remember talking to um jane the ceo of citibank who and i have to say give kudos to citigroup that she when her kids were little she took off i can't remember if she stopped working or if she went part-time for a while but like she recognized at some point like i'm i'm taking on more responsibility now i need more of that time and then went back and obviously went on to be incredibly successful i think in a relationship it's always it's always a push and pull and in the early days my kids wanted me all the time and it was hard like my kids like really wanted me around all the time and they wanted to be at my house all the time they're older now and you know like frankly like my kids are like really clear they're like um you're not helping us with math homework that is and or like if they're 3d printing stuff they're like you know there's some things mom that you're good at and there's some things we go to him for you know i think it's you you kind of step in and out so i think that's the beauty of a relationship that works well is that you can support like it's pistons it's piston engine and you're just you know responsive at different times but it is that recognition like it's hard like who's going to cook who cleans i mean like the amount who gets to travel because there's only one person who can travel no at a time 100 i mean in the early days for me because my kids wanted to be with me all the time they were like traveling with me and i remember i have this like image of us like going at the train and i was like i'm going to the train i'm in dc and i'm like carrying car seats and like the kids and i was like and you have a meeting to prep oh 100 and i remember the i mean the stuff that we did it was like it was so crazy even i remember after the fda warning letter and you know being at the white house and i was like can i bring my kids and how old were they like then small enough to spill m m's all over the floor it was hard it's like definitely it's it's i read like respect like for all working parents recognizing it's hard and if you have two people who have like high pressure jobs um and that's the reality for a lot of people in silicon valley because you won't survive here otherwise i know you can't survive well i think this is where you need community comes back to yeah 100 i look at like there was one day where um my youngest again i had meetings i had something to do and i was just like calling my neighbors i'm like so what's your daughter doing right now you want my daughter too um and they were so great i was like what's your daughter doing right now you want my daughter too um and they were so great they're like 100 bring her over like wool you know and she had the time of her life she was so happy so leveraging the community is the only way you can survive you have to support each other yeah and i think that's where like the pandemic did open the world of like okay we can have um you know people who are remote people like lots of people at 23 moved home you know moved away to be near family who could help with kids like completely understand like all of that is um you know what's your daughter doing right now you know what's your daughter doing right now you know what's your daughter doing right now you know what's your daughter doing is is key like it's hard like you have to have support tough but somehow we're making it work uh yeah yeah with the dog on your lap uh yeah yeah yeah with the dog on your lap uh yeah yeah yeah with the dog on your lap yeah that's how right yeah that's how right yeah that's how right all right one last question can you finish all right one last question can you finish all right one last question can you finish this sentence for this sentence for this sentence for everyone who's watching the smartest thing everyone who's watching the smartest thing everyone who's watching the smartest thing you can do for your body in 2026 you can do for your body in 2026 you can do for your body in 2026 is one everyone should get genetic testing is one everyone should get genetic testing is one everyone should get genetic testing hands down like everyone should know what hands down like everyone should know what hands down like everyone should know what their genetic risk is their genetic risk is their genetic risk is second exercise every day just like second exercise every day just like second exercise every day just like right now every day right now every day right now every day a hundred like but small things and i a hundred like but small things and i a hundred like but small things and i think people shouldn't get overwhelmed think people shouldn't get overwhelmed think people shouldn't get overwhelmed do 50 squats a day broken up into five do 50 squats a day broken up into five segments. Like, do 10-- we're going to do-- we're going to do squats after this. Like, because we've been sitting for an hour. like just something small the way to build the habit is like you just do something small every day and then i'd say like cut out soda oh even probiotic what do you have with you in general like i i was thinking about like understanding what your core risks are and then exercise makes a huge difference in your life yeah and so like the more you can just integrated into your life like take the stairs instead of the elevator you know do some jumping jacks like if your kids are playing you play move around get a walking like a standing desk things like that like it makes a huge difference like walk the dog um but like all of that makes a big difference and then on food like my kids are really good we have a garden but i try to make them like have a salad have cucumbers like my kids are very good at eating cucumbers with salt but like just something like i avoid sugar like i and as soon as i cut it out it's like i never want it again so like i just never um have like soda like sugar sugar water is just like one of the worst yeah things for you i always have my vegetables love it thank you so much and it looks like what you are doing has come together in this day and age with ai yeah it looks like you've been preparing for this i mean i think that the i mean going back to sort of where we started i i do feel like you know 23andme in many ways has just been very early we set out like i look at my deck my fundraising deck from 2013 it was like you know we're not a genetic testing company like we're not just you know an ancestry company like we're a big data company and that goal has always been like fundamentally if you can understand the human genome we can all benefit and so that's why that the mission has always been you know help people access understand and benefit from it we're set up like everything about how we set up our research infrastructure and how we consent people and we give people choice and transparency and we've created this community it's like 14 million people 90 have opted into research we collect tons of information on we ask our customers questions like you know do you have dogs or you do have allergies and we can do extraordinary research like people have no idea how many insights we have across everything from like fun phenotypes like you know handedness are you left-handed right-handed eye color medication response you know pet allergies cancer risk like all of it it's it's extraordinary and suddenly now with ai it needs data sets and you know the number one thing for us blocking you know 23 me again we have the nurips paper on doing risk prediction like what we need next is just like we have capital we're capital constrained and i'm resource constrained but those are all things that we'll fix in time and so but the world is suddenly primed like the technology's there we have the data that's there and i have customers who are hungry to say like let's go and we want to be healthier we want to prevent disease and like the world is 100 moved into that that space now and that's amazing that you never gave up yeah we're stubborn yeah thank you so much thank you so much so inspiring ukg is the workforce operating platform with unified hr payroll and workforce management built to solve the unique challenges of frontline work powered by people first ai and decades of labor data ukg turns the world around you workforce intelligence into real-time decisions around staffing pay compliance and productivity enabling every worker to confidently take action as work happens because when work works everything works learn more at ukg.com slash work ukg hr pay and workforce management mr monopoly here miss me monopoly is back at mcdonald's with millions of prizes a 2027 cheap charity a carnival cruise vacation you gift cards from door dash and best buy peel then play in the mcdonald's app get your bag no purchase necessary 50 us and dch 18 plus see play at mcd.com for rules and play at mcd.com slash amoe for info and playing without purchase by mail by november 2nd chance card game ends november 8th game ends november 22nd 2026 see rules for prize details monopoly is a registered trademark of hasbro thank you