Page last updated at 11:56 GMT, Thursday, 20 November 2008

Valley Girls: Linda Avey and Anne Wojcicki

By Maggie Shiels
Technology Reporter, BBC News, Silicon Valley

23andme co founders Linda Avey and Anne Wojcickil
Both women say genetics helps us understand what makes us unique

With just over a year under their belt the women behind 23andMe are already notching up awards for their personal genome service.

In October the service, started by Linda Avey and Anne Wojcicki, was named 2008's Invention of the Year by Time.

It is a tribute for a business that is among a handful pioneering a novel approach to healthcare and personal health issues.

"We want to empower people with information and it's really amazing to have a product that really impacts every single person on the planet," said Ms Avey.

"The reason we started this company is that we really dramatically wanted to change healthcare," said Ms Wojcicki.

"Everyone is going to have some kind of disease or illness or event that is going to happen in their family and we feel very strongly that if you know that ahead of time you will be able to take actions to impact that and have a better life."

Ms Wojcicki understands this only too well. Her husband Sergey Brin, the co-founder of Google, discovered as a result of a gene test that he is predisposed to Parkinson's disease, a degenerative disorder of the central nervous system.

"In Sergey's case it has been really empowering for him. He exercises more, he doesn't drink caffeine. It impacts me because I am pregnant and I know that our child is at a higher risk for that too but there are things that you can do," said Ms Wojcicki, who worked for 10 years in healthcare investment.

Pandora's box

But is ignorance bliss or knowledge empowering?

23 chromosomes sign
Humans have 23 pairs chromosomes and bananas have 11

"I think it is absolutely crazy in this day and age that I have to go through a trial and error method to see if my child is allergic to an antibiotic or peanuts. I should just know," said Ms Wojcicki.

"So, by getting the genetic information early in life, I am going to be able to create a better atmosphere and healthcare outcome for my child."

Personal gene testing is not new but before now has been beyond most with a full scan said to cost at least $350,000 (236,000).

23andMe said it was "democratising" the process by offering genetic test kits for $399 (269). Rivals such as deCODEme and Navigenics offer tests from $1,000 to $2,500.

All you do is spit into a tube, mail it in and a month later get your results via a web account. The information on more than 90 markers includes details about ancestry as well as what current research suggests are predilections to certain diseases and other genetic traits.

monkey with 24 pairs of chromosomes
Man's nearest relative has an extra set of chromosomes

Personal gene tests have been criticised by medical experts who worry about the quality of the analyses and whether such information could hurt consumers.

But 23andMe emphasise education is at the heart of everything it does and customers are offered counselling and advice on what their results indicate. They can also specify if they do not want information on any specific disease.

"This isn't for everyone and if you are not comfortable with it, you shouldn't do it," said Ms Avey.

Dark ages

Both women predict that in the next 10 years or so, their service will help personalise medicine and ultimately provide a much more tailored healthcare system.

They hope it means an end to a situation in which a drug that can cure one person can injure another.

A slide used for testing DNA
DNA tests can reveal predisposition to a wide range of diseases

"Our approach to medicine is very 19th Century. We are still in the dark ages," said Ms Wojcicki. "We really need to get to the molecular level so that we are no longer groping about in the dark."

Already the US Food and Drug Administration (FDA) has declared it wants to work with companies such as 23andMe to track adverse drug reactions.

The other added advantage to knowing your genetic information, argue both women, is that people may look after themselves better.

"This is something that will put the onus on the individual. It could be used in a way that will help people down a path of wellness," said Ms Avey.

"They will own their own healthcare and say I have to take care of myself and can't fall into the arms of the waiting medical community to try and fix me," she said.

The Scripps Translational Science Institute is joining forces with Navigenics, Affymetrix and Microsoft to conduct a 20-year study to see whether knowledge about certain genomic details motivates individuals to make lifestyle changes or seek medical care.

Discrimination

While the FDA is warming to personal gene services, an ongoing hurdle for the company is that of a sceptical public concerned as to how companies will use genomic information to discriminate or refuse health coverage.

Protection is provided under the US Genetic Information Non-discrimination Act but that may well change if, as 23and Me envision, genetic testing becomes the norm from birth.

"As a society we are going to have to come together and say how do we figure out how to tackle this in a positive way that empowers the individual," said Ms Wojcicki.

"We hope that as the model moves more towards prevention rather than just treating illnesses companies will actually look more favourably upon you having your genetic data.

"And if you are following a specific plan to help you avoid disease, that's really a great outcome for the insurance providers," she added.

Diversity debate

23andMe has grabbed headlines through endorsements from Oprah Winfrey and Ivanka Trump. More controversially the company held a "spit party" during New York fashion week earlier in the year where volunteers spit into a test tube.

Both women admit this might seem gimmicky, but they hope it will help spark a national conversation.

"We actually keep spit tests in our house," confessed Ms Wojcicki.

"But it's these little things that get people talking about genetics. Things like why some people can curl their tongue, why some people excel at swimming or maths.

"It's the long tail of human diversity," she said.

Oprah Winfrey
Oprah Winfrey has endorsed the company

It was not just a love of genetics that brought these two women together but a chance to change people's lives.

"I really like people and I really like sick people," said Ms Wojcicki.

"It's a really acute moment in someone's life and you want to help them. I have always been interested in health care and doing something that is dramatic."

Ms Avey is similarly motivated and was inspired to do good by her parents.

"I grew up in South Dakota where my dad was a Lutheran minister and my mom was a nurse," she said.

"Between them the worked at a micro scale and helped people in their own community and that's what is so great about the web that we can do it in a much bigger way where we are not limited by our geography."

Ms Wojcicki's inspiration comes from her husband, her father, who is a particle physicist and a mother, a journalism professor.

"My husband is incredibly driven to change the world and has stayed true to that. You don't focus on the money.

"I was always raised to be cheap and it's a joke in this company because I found an office space that didn't have any windows but was really cheap but people vetoed me on that.

"So, I just don't require that much money to survive and I was taught that you focus on doing something that is good and contributes to society."

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