Knowing Your Genes with 23andMe

For a price, consumers can tap into their predispositions for certain diseases. Along the way, the startup hopes to change medical research

For the better part of two decades, Linda Avey, the less celebrated founder of startup 23andMe, toiled away in the life sciences industry, pondering how to make the power of its discoveries accessible. Now, thanks to a well-timed partnership and the falling cost of genetic testing (BusinessWeek, 1/14/08), she could be poised to help make DNA a bigger part of the way people manage their health.

Avey's business partner, former health-care industry investment analyst Anne Wojcicki, garnered attention this spring when she married Google (GOOG) co-founder Sergey Brin in a secret Bahamas ceremony. Google invested $3.9 million in 23andMe, which launched a home genetic testing service Nov. 16, and Brin made a $2.6 million loan that the company has since repaid.

Turned off by what she viewed as greed in the pharmaceutical industry, Wojcicki has been casting around since 2005 to become involved in a venture that would affect people's health in a positive way. She previously tried to start a company called Catalytic Health with social entrepreneur David Green that aimed to provide low-cost medical products and drugs to the world's poor.

Avey arrives at the problem of unlocking genetic information to help guide health care from a different perspective. She got hooked on biology at Augustana College in her home state of South Dakota, then spent more than 20 years in sales and business development at biotech companies, including Applied Biosystems Group (ABI), Affymetrix (AFFX), and Perlegen Sciences.

"I got frustrated a lot more information wasn't trickling out to consumers," she says. Avey recalls holiday parties those years where guests would make cocktail chatter with her husband, an executive at Merrill Lynch (MER), then "roll their eyes that they had to talk to this boring science person the rest of the evening." She even tried writing a children's book on genetics in the 1990s.

Revolutionary Research

Few scan the room when they're talking to Avey today. On Nov. 29, the World Economic Forum named 23andMe a winner of its annual "Technology Pioneer" awards, which recognize companies in biotech, health, energy, and computing that develop products with the potential for far-reaching impact on business and society. 23andMe sells a $1,000 home DNA test that requires customers to spit in a vial, then mail it to a lab where it's tested for hundreds of thousands of genetic variations. Consumers use 23andMe's Web site to explore their ancestry and predisposition to diseases.

Eventually, the company hopes to amass enough customers to make it economically feasible to study reactions to drugs that occur in only small percentages of the population. "There's always been this long talked-about area of personalized medicine, and we're never going to get there until we get enough people to study," says Avey. "It's really up in the air when you take a drug whether or not you're going to have an adverse reaction…23and Me just wants to try another way of doing research."

Increased Risks

But making genetic information accessible on the Web raises thorny questions. What are the societal implications of knowing whether we are especially likely to contract diseases? Should doctors play a greater role in disclosing the meaning of people's genes? And will DNA test-kits that cost $1,000 or more for even the most basic data create a "DNA divide" in which only the affluent are privy to information that could help them lead healthier lives?

"Genomics is statistics," says John Halamka, a doctor and chief information officer at Harvard Medical School. If a population's chance of contracting a disease is 1%, and a patient's genetics reveal a 20% higher than average risk of getting it, that's still only a 1.2% chance. "Would you change your lifestyle?" he asks. "Trying to build that into a product or service to communicate what these things actually mean is tough."

Then there's the question of how to break bad news, which could get more important as 23andMe and others scan more of their customers' genetic material. "For many results, as long as you wrap them in really good educational material, it's O.K.," says Halamka, who runs an electronic medical records project at Boston's Beth Israel Deaconess Medical Center that sends patients most lab results via the Web. But for an HIV or cancer diagnosis, "those things need to be communicated orally between patient and doctor."

There's a wide gap between a fatal disease diagnosis and the type of information 23andMe is disclosing, such as whether customers possess genetic variations that increase their risk of diabetes, Crohn's disease, rheumatoid arthritis, and heart disease. Still, Avey admits the company's service "is not for everybody. There's probably going to be a different comfort level people have learning about themselves," she says. For consumers who are curious—and rich—enough to do so, 23andMe could help change the way they relate to their genetic blueprints.

Join a debate about whether health insurers should pay for genetic tests.

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