 We have been focusing on reading DNA for the last 40-50 years. We've entered an era of reading and writing DNA, you know, if you like, in the last 5-7 years. And we're now transitioning into an era that we call the social genome era, where many aspects of our life are going to be influenced by our own genetic and also other types of bio-data, whether it's microbiome, immune, phenotypical data, etc. So as these different data affect different parts of our day-to-day life, not just wellness and health and medicines, but also nutrition and exposure to different components in the environment, etc. You know, it's a very different world, and we will have some of the same questions that we're having today on the digital revolution, if you like, or out of the digital revolution. We're going to have the same in the bio-revolution. So we are entering the era of the social genome. Boom! What's up everyone? Welcome to Simulation. I'm your host, Alan Sacian. We are in the beautiful Cambridge, Massachusetts. We are going to be talking about the era of the social genome. We have Rodrigo Martinez joining us on the show. Hello. Hey, Alan. How are you? Good to see you. Thank you so much for coming on. It's actually round two from ArcFusion that we did about a year ago. Rodrigo is the chief marketing and design officer at Veritas Genetics, where they do whole genome sequencing for under $1,000. And he's been doing that for three years. Prior to that, he spent six years as a life sciences chief strategist at IDEO. And with Juan Enriquez, he co-founded Harvard Business School's Life Sciences Project Interim Bioeconomy. So let's jump into this, the era of the social genome. Teach us about what this is and why it's so important. Yeah. Imagine we're in the early 90s or even late 80s. There are a bunch of offices and government projects that have really big computers. And some of us have our little Commodore 64, and you had your little Radio Shack computer, and some of us are in the edge trying to figure out what to do with these little things called computers. And there's no way that back then we can imagine things like Facebook and Google and Amazon Prime and election hacking and trolling and bullying and all of the opportunities and risks that we have today throughout our life out of the digital revolution. So that dimension, think about 20, 30 years, is sort of where we are in the bio world. We have been focusing on reading DNA for the last 40, 50 years. We've entered an era of reading and writing DNA, if you like, in the last five, seven years. And we're now transitioning into an era that we call the social genome era where many aspects of our life are going to be influenced by our own genetic and also other types of bio data, whether it's microbiome, immune, phenotypical data, et cetera. So as these different data affect different parts of our day-to-day life, not just wellness and health and medicines but also nutrition and exposure to different components in the environment, et cetera, it's a very different world. And we will have some of the same questions that we're having today on the digital revolution, if you like, or out of the digital revolution. We're going to have the same in the bio revolution. So we are entering the era of the social genome. This is a really good way of explaining it. And you guys did this in the blog article that you posted that we see with computational capacity going from the mainframes to the desktop computers in our homes to the smartphones in our pockets and that with the whole genome it used to cost egregious billions of dollars over spans of over a decade to sequence a whole genome. Now it's down to less than a thousand dollars. And the insights that we can gain from the genome to live a healthier and more fulfilling life. And there's so many of these insights. So this is kind of like you're explaining. It's this revolutionary time for biotechnology to come in and start augmenting almost every single aspect of our existence. I want to hear from you what exactly this is doing because sometimes people don't necessarily know how does this even happen? Do we take a sample of my saliva and submit it into Veritas genetics? Is this how we do it? Yeah, correct. So we have basically a service both for consumers and for physicians and clinics and also for researchers. So consumers go to our website and veritasgenetics.com and they order a kit. They have to read some important documentation and get the proper signatures. They have to give their consent, etc. Because we're HIPAA compliant. So there are serious and also GDPR compliant, which is a standard in Europe that we also support here for all our customers. And then we send a kit to your home. It's a very simple kit. You spit on a little tube, send it back to us and we sequence that DNA in our top facilities that have all the acronyms that you can imagine. Slea, CAP, all of the acronyms to the highest standards. After we sequence, we then interpret those results and then you have a report that you can look online. It's a web-based report. You can also print it, but there's no point in printing it really. You want to be able to access it on your phone, on your computer. And it basically details some things that are in red, meaning these things are very important. You need to talk to your doctor about immediately. These could have significant life-threatening consequences. There's a section in yellow. These are things, risks that you might have given your genetic map and things that you need to know about. You need to talk to your doctor about. Things that you could adjust in your lifestyle to reduce some of those risks, etc. And then there's a whole series of things that we think are fine to know, if you like. It's a bit more of infotainment, you know, all the traits and some ancestry, etc. But our focus is mostly on things that are important for your health and that are actionable. And when we sit down together in the future, I want to really get into the science of how to actually take a saliva and turn that into over six billion characters, A, T, Cs and Gs. Correct. And we can do that at a later time. But what I want to hear now is, when I get this digital report, how do you know what is critical red? How do you know what I need to act on right away? Correct. Is there specific locations in the sequence that I have some sort of a mutation that I need to go and take action on? Exactly. So we all have, you know, while we're more than 99.5 or 7 or 8% identical in our genomes, right? And you write 6.4 billion base pairs of letters. We all have different variants. So somewhere between 2 and 5 million variants. Right? And those variants mean there's changes in letters along our genome. We know from some different public databases what some of those variants mean. Right? If you have an A instead of a T in this particular gene, we might know that that may increase your risk of a particular condition or a particular cancer or something like this. Or it might mean that you are a carrier, for example, of cystic fibrosis. It doesn't mean that you have the condition, but you could pass it on to your children. Right? So we know some of those things. Now, the key here is that we have, if not the best clinical team, we have one of the best clinical teams in the world. Right? So we have an incredibly experienced team that most actually the largest segment of our team, if you like, we have over 50 people doing interpretation from computer sciences, MDs, engineers, doctors, geneticists, genetic counselors. So the interpretation of the result is really the key here. Right? Sequencing is quickly becoming a commodity. Right? You can sequence DNA in different machines in different countries. Right? And you can get good quality data. The key here is who interprets that information so that you know it's done at a high quality. Okay. And then to be able to then act on some of the changes. Thank goodness we are now exploring the genetic engineering technologies that can take a mutation like a cystic fibrosis and be able to potentially change that so that we don't pass it down to our children. So there's different things. Look, let's be very clear. We are still in step two out of 100 of understanding and exploring everything in our genome. We are early on, right? But given that, there is already a lot of very useful information. And I'm happy to give you an example if you like on my genome. Yes, please. For example, so I have a risk associated with a condition called pulmonary fibrosis. It does not mean that I'm going to die tomorrow from it, but certain lifestyle aspects could trigger as I grow older to create these fibroids in my lungs. So I stay away from construction sites, places where there are small particles either from stone, metal, wood, by inhaling them, that could eventually trigger that condition in me. So I've adjust my lifestyle in a way that is relatively easy, and that will probably have an effect on me not getting these fibroids in my lungs or at least delaying it, right? Yes. And that's the type of thing where it's actionable, right? Now, there are other things, for example, I carry three conditions that are not life-threatening. And when my wife and I decided to have a baby, a baby Julia who's now six months old, we also noticed, she also knows in her genome that she does not carry those, so therefore we don't need to worry about that. And it's just good to know, right? That is more of a good to know. We can read some literature about it. You can prepare yourself. Now, there are some conditions where we know the risk of getting something like Alzheimer's, right? If you have an E4 variant in your ApoE gene, you know that your chances of getting Alzheimer's are much, much, much higher than the general population after a certain age. And my dad died of Alzheimer's, so this is sort of very personal to me. So I wanted to know if I had that variant. One, because I wanted to prepare myself better. Now, I do not have that variant, which doesn't mean that I won't necessarily get the condition. I can get it for other reasons that it's not genetic, right? But I'm less likely to get it. But at least I've informed myself more about the latest literature, the latest studies, the latest clinical trials, et cetera. So even when you find out something in your genome that has to do with a terrible condition for which there is no treatment, that doesn't mean you can't do anything about it. You can inform yourself. You can find out who was doing the research, who were doing the clinical trials, right? And you think about it for your kid. If, unfortunately, you know, or by genetic chance, one of my two daughters had a condition that was genetically triggered, even if there was no cure, I would go and make sure that I know everybody doing the science at the edge of that field, because I would want to be the first in line eventually to be there ready for a clinical trial or a treatment or something like this. And then what would it look like then to describe the difference between a whole genome sequence at Veritas versus what a 23andMe does, a nebula genomics, what would be the big difference? Yeah, that's a great question. So there's two main different technologies, genotyping and sequencing. So what 23andMe does and Ancestry DNA is genotyping, which is they look at a very small percentage of your genome, right? So in the case of 23andMe, they will look at something like less than half of 1% of your whole genome, right? And the technology allows you to ask questions for what you already have the answers for. So you're basically asking, is there an A here or an S? No, okay, I know already what that means. Is there a T here? Yes, I know what that means. So you're basically asking questions for which you already have the answers to. You cannot go and ask additional questions, right? It's a one-time transaction and you have those answers and that's it. And that also because of this technology, you have very limited actual medical, useful information, right? So the example is BRCA1 and BRCA2 genes, BRCA1 and BRCA2, which are well known for increasing. If you have a mutation that is pathogenic in either of those two genes, you have a higher chance of getting breast cancer, for example. Using the 23andMe test, they only look at three out of thousands of variants, which means the result that you're getting is very limited because it's actually only useful for less than 1% of the general population. If you want to look at your risk for breast cancer in your BRCA1 or BRCA2 genes, you need to sequence completely the genes and you only do that when you do whole genome sequencing. So that's the difference. Genotyping, small amount of DNA, limited information that comes out of that and you're asking questions for which you know the answers to. Now, sequencing, you literally sequence almost all for technical reasons. Let's just thank you. Sequence all your genome, right? 6.4 billion base pairs. And for some of those findings, we have answers and some we don't because we're still discovering, right? But not only can we give you more complete and actionable and medically relevant insights, but we can also go back 6 months later and say, Alan, you sequenced your genome 6 months ago and now there's some new research happening that identified 10 more genes associated with a condition that you're interested in. Let's say, schizophrenia. Do you want us to go and look and see what do we find in your genome? Sure. You don't need to spit again. Your genome is already digitized. It's basically a file and we can just go search it and give you back that insight. Basically, it's a resource for your life that you can go back and extract value from. And that's the difference between sequencing and genotyping. And look, I think part of this evolution into the era of the social genome is it makes no sense to do any more genotyping tests. The only reason this was done, it was because it was easier to do it and it was cheaper. But as the cost of sequencing your whole genome drops down and drops down and drops down to a couple of hundred dollars, it makes no sense to do genotyping because you're missing a huge amount of information. And this takes us all the way to how this is being done now a million times. A million genomes are already on the path to be sequenced by 2021. Yeah, so look, talking about the future is always difficult, right? We have an idea of how fast we're scaling and I'll give you an example. Last November, we decided to offer a thousand genomes to the first thousand customers that would come to our website for $199. And we thought we would do that for 48 hours, either 48 hours or a thousand genomes, whatever comes first. And we sold out in less than six hours. And we spend $358 on marketing. Which is basically nothing, right? So the demand is there. You know, this year we'll probably finish between 15 and 17,000 genomes. Next year we're somewhere between 8 and 10 times that. So, you know, we are collectively on a path to have sequenced a million people in 2021, 2022. That is the idea, right? And partly because as soon as we have a really, really good standardized set of genomes sequenced, we can now deploy machine learning tools to start to do research and identify new relationships between genes, phenotypical data and conditions. Which you can do with just a few genomes, right? That is where precision medicine really comes to exist or to realize. Once we're able to identify relationships between genetic traits and, you know, genetic characteristics, phenotypical characteristics across a large set of standardized genomes. Yes, yes. So the data enables the insights that we would really like with precision medicine. Yeah, there is no precision medicine. First of all, without you sequencing your genome. Because in order to affect you, right, you need to know what are your genetic characteristics and other things in order to provide a precision treatment, a precise treatment, right? And also in order for us to identify all of these new insights, we need large scale standardized genomes. And I say standardized because for the most part over the last 20 years, the people that have been doing, you know, sequencing DNA, including genomes, you know, it's a scientist that has 2,000 rick together in his own spreadsheet. Then there's another scientist that she applied for a grant and put them in a different database. Like they're all distributed in different standards from Excel to your own hotch podge, you know, duct tape system. We need to standardize them. And we also have obviously a data strategy for that. Yeah, yeah. To be able to actually get these key insights, I want you to speak on some of these today assisting aspects that a whole genome sequence can actually do for you. So you gave us some of the red, yellow, and what was that last color? The green? We just call it gray. It's just gray. Like it's noteworthy. It's fine to know. Fine to knows. Because this dives into everything from the current nutrition choices that we make to our health and life insurance, to diseases and enhancements, to eating, matching. There's so many interesting things. The marketplace for research is so cool. Like you said, with the big amount of data, we can actually open up the machine learning algorithms to find new relationships. So you should start exploring this area with us. Excite people about the social genome. Yeah, I mean, I'll give you an example of not only the breath, but also the speed at which this is happening. So yesterday, we had a discussion with George Church, Jason Kelly, and Carl Schmitter and myself around synthetic biology, genetic engineering, opportunities and risks. And one of the things that George mentioned is, look, there may be some people interested in using genetic engineering, not just to address diseases, et cetera, but to introduce additional diversity among human population. We understand the importance of diversity from the biological perspective, evolutionary perspective, and also other aspects. Right? So just think about that for a second. Not only are we going to be able to start addressing, over time, certain conditions. First, it will be monogenic, you know, conditions, eventually some more complicated, but also the ability to introduce genetic engineering to the human population has also to do with things like diversity. Right? And that's yesterday. Today, you and I are talking about this, right? After this, I'm going to go to this event where we're talking at Harvard Medical School with another group of people around preventive genomics. How do we scale having people sequence their genome to prevent the onset of conditions? Right? And we know that this is already being introduced in the clinical setting. For example, the Mayo Clinic, we have a collaboration with them in their executive health program. They offer our product. So if you come and do your checkup, your annual checkup to check everything, they will also sequence your genome if you want and also use that information to prevent certain things from coming along. Right? Now, in the afternoon, we'll have a panel today talking about the social genome, digital health and genetic engineering to address very specific things. And today is announced in the paper, online, as you may have seen, there's a new genetic engineering therapeutic company that is going to be Stardverth Therapeutics that was just announced today addressing cardiovascular. Right? So the number of things that are happening around our understanding of our genome, together with other bio data and how to actually offer a product or a service to people is starting to expand. Right? And so where does this go in the next 5, 10, 15, 20 years? Health insurance programs that take that into account. We know already that different insurance companies are looking into the space to be able to better understand your particular risks. Right? So health and life insurance. You bet somebody is already introducing, we already do it in certain communities, for example, in some traditional Jewish communities, sort of a bit of Mitch matchmaking depending on certain genetic characteristics. Right? So a more broadly genetic influenced tender world. Sure. Where do I get a service if one of my kids has a particular condition or even if it's, I mean, the pregnancy process or embryo, who's going to offer the different services to be able to address and genetically engineer out, if you like, a particular condition. It's coming. So 5 years, that doesn't matter. 5, 10, 15, of course, some of this is going to take some time. But we're entering that space, right? So everything from the hardcore science and reading and editing and reading your genome to start to edit and to offer different products and services is this dynamic that we're entering, right? And it's similar to, again, to the digital revolution, right? There was very little you could do in the late 80s with your little radio shack, you know, computer or your Commodore 168. There were very few little things. We didn't have any of all of the things that we did today across our life, right? So that's sort of a good analog to see where we are moving towards. There's obviously legal issues, political issues, you know, ethical, more on all of those, and they're very important and we should, you know, talk about them as well. So then what does it look like for someone that has a concern about their data and privacy? You know, you listed that you're a GDPR compliant, so teach us about this. Yeah, so, I mean, privacy is obviously a very important topic, not just for us, but for many players in the industry. And by the way, which is not different from other industries, right? There were times where people would say, I would never do online banking because what if somebody hacks my account and I lose all my money, right? I mean, those were real concerns. And today, a certain number of banks get hacked around the world every once in a while. But we all do, you know, I mean, not only online banking and Venmo and PayPal, I mean, it's like you can't imagine your life today without, you know, digital transactions and money, period, right? So it's not unique to health. So what we do is, of all the possible standards that we can take, we take the highest standards, both in terms of our labs, how we treat the data, how it's encrypted, how it's stored, all of that, we apply the highest standards, right? But this is more of an important topic, not just for Veritas, but for any other player, right? Why? Because understandably, many of our consumers group together a concern that is, oh, well, Facebook is, you know, selling this data and 23andMe did a deal with a pharma company, then all of this is out of my control. It's a very understandable fear, right? So what we need to do is we need to just continue building a trusting, you know, a trust relationship with our consumers, with the members of the Veritas family that not only are we taking the highest standards, the service that we're providing to them is focused on what they need and how they need, right? And evolving our services to respond to very specific needs while still in the back, you know, in the back end, taking all the technical precautions and encryption, et cetera, et cetera, et cetera, right? So, you know, will there be some hacking in this space at some point? Of course, like there is no, we've seen that every time we have a new sort of technology that allows for some people to abuse this, of course. We're trying to do the best we can to avoid that and not be, you know, those affected. But I think this is, you know, this is, we need to have these conversations. And there's also, let me point this out, I was having a conversation with a friend and he said, look, I'm concerned that my genome is stored even though you encrypted. And I said, look, why are you concerned? He's like, well, because it's my health data and I want it to be secure. And I said, okay, are you concerned that your last lab work and your last x-rays that you did at your hospital are still being sent around via fax? He's like, well, no, and actually that's a good point. We've already assumed that when it goes into the healthcare system, it's okay, it's fine, it's good enough. Even though we know it's completely hackable and even though we know it happens every once in a while, okay? So we need to take a stand, you know, we need to take a much better stand than what is the method right now or if you like the level of security in the traditional healthcare system. Now, the other question is, well, I'm concerned because my health insurance, I want to know that I'm not as healthy as I am and therefore they're going to, you know, increase my premiums. Okay, let's take that as an example. Let's say that you have Blue Cross, Minnesota and they are Allen, somebody there is going to try to look at your health and see if you are less healthy than you said you are and increase your premiums. Let's just assume for a minute, right? The easiest thing is to have a 21-year-old working there, look at your Facebook page and measure your waist size. That will give them a much clearer indication of when are you likely to have something like a cardiovascular issue than anything else right now. And if they want to go a little bit further, they can go into your Instagram and look at what you eat, right? Now, that's one case. Another case is there is a bioinformatician at this Blue Cross Blue Shield looking through your genome, identifying the variants, being able to distill what are the risks and how much likely are you that not, which of those two is more likely, right? That's one. The health insurance companies and life insurance companies and many of them have already approached us because they're working to find ways to develop new products that take into account your genomic and other bio data to be able to give you a product that better positions you in a risk curve as opposed to your mid-thirties, you know, white male of the zip code that doesn't smoke, which is very much like... So I think we're going to see an explosion of products and services. Some of them will be more real than others. Some of them will try to abuse it, sure. But I think we're going to see many more products and services based on not just our personal DNA but also other bio data. Okay, and then the current state of the technology seems to be that we take what is the saliva samples and we sequence that and then we store it and then we gain access to it and then do we get to be able to control any of the data flows themselves out to researchers? Do we get that permission? Yeah, sure, so there's different ways to do this. One, for example, everyone that sequences their genome with us, we ask them if they would like to participate in research. More than 80% of people say yes that doesn't mean that we then give your genome to a researcher at all. But if there is a particular researcher working on a, let's say doing a cardiovascular study and they want to ask a specific question about 5000 genomes, do they have this variant and also this variant they could search we could give them access to that search including your genome but they don't get the data they might just get the answer and say oh yes, actually among 5000 people this variant also exists when this other variant is present, right? So that's the type of research we're talking about it's not like we hand over your genome or anybody's genome to anyone so that's an important point. Now, there are other platforms that are emerging like Luna or Nebula and others that are encrypt gen that are trying to figure out a model where if you upload some of your genetic information then can you control bits of it to be able to serve a particular research effort and in some cases can you get remunerated for that? Could you get somehow paid in tokens or in some form, some currency for that? And I think we'll see more of those emerging I think they're still trying to figure out exactly what the model is but we're excited that they're doing that and look, we thought about this from the beginning, the reason we didn't start a marketplace is because as a startup you've got to focus but that doesn't mean we're not going to develop a marketplace like that in the future. And then why would I not just be comfortable with what is it, the personal genome project that enables me to just upload all of my sequence right up on the internet for anyone to be able to access? So the personal genome project is an effort that started at Harvard Medical School over more than 10 years ago, actually several of the people that founded that project are part of the Veritas team so that project the goal was to be completely transparent and public with your information and many people do that, many people upload everything, not just the genome but also other data into the personal genome project and open it up for research of any form. And we're talking thousands and thousands, so many people are very comfortable about that and they don't see really any risk or the risks that there are there they don't worry about it, so yeah that is definitely another avenue for people to participate in research. And the only risks that could happen was something like that would be that a health insurance provider could look at that and then discriminate against you or that potentially you could maybe have some sort of a malevolent attack against you that's specific to your genome. Is this the things to be concerned about? That's what people are concerned about. So right now in the U.S. we have what is called the GINA which is basically a non-discrimination piece of legislation that does not allow a health insurance company to discriminate against you something that you have in your genome. Now this does not apply to life insurance companies. So I had recently a conversation with my life insurance company and I said hey I was sick 10 years ago and they were concerned that one of my organs would still be damaged from that sickness 10 years ago and I said no I don't I talked to my doctor and I'm perfectly fine and they said well we're still going to have to ask you to pay a little more in your premium and I said okay so you're considering a risk possibility. I said okay how about I tell you that I also I do not have an E4 risk for Alzheimer's I do not have a mutation in my BRCA1 and BRCA2 for breast cancer because if you're going to consider things risks to charge me more I want you to consider my risk profile to charge me less. We can't do anything with your DNA yet etc etc etc Right now they're basically hands off but they're actually are figuring out and I know this from different conversations that we have with them trying to figure out not necessarily a product that says oh let me look at your genome but imagine for example that life insurance B says Alan here's your policy here's your premium by the way if you sequence your genome and you meet with your doctor reviewing those results we don't need to see the information we actually don't want any of that information but if you demonstrate to us that you've sequenced it and you talk with your doctor about it we'll give you a discount. Why because now you're more likely to know your doctor is more likely to know one of the risks or several of the risks that need to be addressed which means that you probably might be a healthier individual than otherwise so I think we're going to start to see which means we saw it already in the driving right if you put this little thing this little gadget in your car and you drive well we'll give you a little discount basically lowering your risk profile I think we're going to see something similar with whole genome sequencing. Yeah there's so much to still dive into I'm really excited to get to dive deeper into the nuance of the science I'd love to hear some more of the thinking around how to open notebook science and open source the data and just decrease malevolent actors and increase the spiritual unity so that we can have precision medicine be at its fullest more easily there's still so much to talk about and it's really exciting to hear about Veritas bringing the cost down to whole genome sequencing down to under a thousand dollars you had the two hundred dollar special and it's looking like hopefully in the future we'll be able to get more and more people sequenced even potentially a million by 2021 is very exciting yeah we think the cost we think our price whole genome sequencing is probably going to be somewhere around $500 by the end of this year 2019 and next year it'll be $200 or less and therefore that changes the whole space that changes our ability to have more people sequenced we also participate in research projects we're now in a collaboration with the genomes to people project around the Franca what is called the Franca fund and I invite everybody to research this where we're also donating for X number of people that sequence their genome we're donating some genomes for underrepresented minorities which is a huge important aspect of research happening we need more minorities to participate and so we can obviously understand some of the genetic characteristics of many of these minorities Hispanics included as myself what a great model potentially even like a buy one donate one model this could be so interesting yeah huge thank you for tuning in everyone Rigo thank you so much for coming on to the show we greatly appreciate it welcome to the era of the social genome that's right that's right it's coming it's here we're really excited everyone check out the links below to Veritas also check out Rodrigo's links below and go and have more conversations with your friends your family or coworkers on social media about the era of the social genome start talking about this more and what it's going to be like go get sequenced ourselves and support the artists entrepreneurs and organizations around the world that you believe in support simulation our links are below so you can continue doing cool things like coming to Cambridge interviews and go and build the future everyone manifest your dreams into the world huge thank you for tuning in and we will see you soon peace