Medical Genetics | Medical Genetics for students

Posted: December 29, 2014 at 11:45 am

You can purchase 14 gallons of organic milk or 396 lollipops. You can give her 33 rides on the Ferris wheel at the state fair, or you can get him a couple of violin lessons. You could put the money in a savings account, you could buy her her very own LeapFrog LeapPad Explorer digital learning tablet, or you could buy enough pizzas to feed all of her friends on the block. So many options, so many choices.

I took that money and got my daughters genes tested, ordering up an analysis of the composition of her very small self and its odds of living a long and healthy life. And in so doing, I in some small way tied her fate to the success of the company doing the analysis, a genetic-testing startup called 23andMe in Mountain View, California.

Last May, Angelina Jolie revealed in a New York Times op-ed that she had chosen to have a double mastectomy after testing positive for a likely lethal BRCA1 mutation. Her generous manifesto spoke to the value of knowledge and the ability to act upon it. That morning, emails, texts, and calls came pouring in for Anne Wojcicki, founder and CEO of 23andMe. Did you see this? Did you see this? Do you test for that? Yes, she had seen it. Yes, her company might test for it (Jolies exact mutation was not disclosed)it tests hundreds of possible risk associations, including the three most common BRCA1 and 2 mutations. Angelina Jolie talking about a technical subject and saying, I did this, you can do this is a great thing for us, says Wojcicki. She did something to prevent disease, and thats exactly what we want people thinking about.

Wojcicki has been thinking deeply about this for years. A former Wall Streeter with a degree in biology, she has parlayed a personal interest in wellness into a thriving, potentially groundbreaking business. Since founding 23andMe in 2006with the backing of an impressive list of investors including her husband, Sergey Brin, and the company he then ran, Googleshe has been working toward two goals: bringing the power of genetic testing to everyday consumers so they can better manage their own health care, and using the aggregated data from those tests to help doctors, scientists, hospitals, and researchers discover new cures for diseases that emanate from troublesome genetic mutations. (Wojcicki and Brin announced their separation in August. A 23andMe spokesperson says, He remains committed to the company.) It has not been a business for the faint of heartthe three other similarly positioned startups in the field have changed coursebut Wojcicki has deep pockets, having raised more than $126 million since 23andMes inception, with Yuri Milner, the Russian billionaire whos invested in Facebook, Twitter, and Airbnb, joining as a backer last December.

Wojcicki is connected to the fabric of Silicon Valley, which has served her well. But her goals are global. Were not just looking to get a venture-capital return, Wojcicki says. We set out with this company to revolutionize health care. On the same December day when she closed a $59 million round of financing, she dropped the price of 23andMes genetic testing from $299 to $99. While prices like that may not make taking control of ones health a universal, democratic reality, they accelerate our societys move in that direction. The end result could be a wholesale shift in the way we treat illness, a move away from our current diagnostic model to one based on prevention. Thats why, if Wojcicki gets it right, 23andMe could help change the health care industry as we know it. At $99, we are opening the doors of access, she says. Genetics is part of an entire path for how youre going to live a healthier life.

As 23andMe scales, its business model will shift. Right now it gets most of its revenue from the $99 that people like me pay in return for test-tube kits and the results we get back after we send off our spit-filled tubes. The long game here is not to make money selling kits, although the kits are essential to get the base level data, says Patrick Chung, a 23andMe board member and partner at the venture-capital firm NEA. Once you have the data, [the company] does actually become the Google of personalized health care. Genetic data on a massive scale is likely to be an extremely valuable commodity to pharmaceutical companies, hospitals, and even governments. This is where the real growth potential is.

But first Wojcicki needs spit. Her goal is to sign up a million customers by the end of 2013. Eventually, she says, I want 25 million people. Once you get 25 million people, theres just a huge power of what types of discoveries you can make. Big data is going to make us all healthier. What kind of diet should certain people be on? Are there things people are doing that make them really high-risk for cancer? Theres a whole group of people who are 100-plus and have no disease. Why? As of September, 23andMe had 400,000 genotyped customers. Its betting on quite an impressive fourth quarter.

I had never really considered getting genetic testing before taking on this story assignment. (And getting the testing was not a mandatemy editors just wanted me to write about the process of considering it.) But my 5-year-old daughter, whom my husband and I adopted as a baby from Ethiopia, had started asking questions about her birth family that we couldnt answer. Did we think they looked like her? Were her siblings fast like her? Where had her grandparents come from? With kindergarten fast approaching and with emotionally loaded projects such as constructing a family tree looming on the horizon, I thought maybe I could erase at least a few of the question marks. The same saliva that allows 23andMe to find genetic mutations that increase or decrease your odds of getting a disease also reveals a lot of data about your genealogical roots.

I went back and forth for a few days before deciding to get her tested. Theres something scary about asking for cold, hard, computer-driven data about someone you love. Did I really want to know? What would I do with the information? Would I change as a parent if I found out she was at risk for something scary, and would that change be helpful or harmful to her?

Wojcicki believes its a parents duty to arm herself with her childrens genetic blueprint, that the power of knowledge outweighs its burden. Shes already put that pragmatism to work for her family. In 2008, her husband took a 23andMe test that revealed he possesses a genetic mutation called LRRK2, which gives him a sharply increased risk30% to 75%, compared to 1% for the general populationof contracting Parkinsons. His mother possessed the same gene and was diagnosed at the age of 47. It also meant there was a 50% chance their two young children would inherit his mutation. Id rather have Sergey be proactive, says Wojcicki, when I meet with her in August. Hes drinking coffee and exercising all the time [two behaviors thought to reduce a persons risk for Parkinsons]. Id rather we give a lot of money to Michael J. Fox than be surprised at 50 when [Sergey] is diagnosed and say, Well, shit, I wish I couldve done things. And as for my kids, theyre going to die of something. My eyes widen at her frankness, and she starts laughing. Its just the reality. Everyones going to die and everyones going to get sick at some point. But I do believe that there are choices you can make in life that will make you as healthy as possible.

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Medical Genetics | Medical Genetics for students

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