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Talking Biotech is a weekly podcast that uncovers the stories, ideas and research of people at the frontier of biology and engineering.
Each episode explores how science and technology will transform agriculture, protect the environment, and feed 10 billion people by 2050.
Interviews are led by Dr. Kevin Folta, a professor of molecular biology and genomics.
Talking Biotech Podcast 409
Dr. Alicia Zhou, Chief Science Officer
Color
Host: Dr. Kevin Folta
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Kevin Folta: [00:00:00] Hi everybody. And welcome to this week's talking biotech podcast by Colabra and check out Colabra's product line. I really am grateful that they sponsored this podcast. Now, in a few weeks, I'd like to try something different. I used to always answer your questions and I would do that occasionally on the podcast, but use Twitter and other means to gather those questions.
But this time I want to do something a little bit different. If you could record it on your phone or any of a microphone somewhere on your laptop and record your question and send it to me, introduce yourself if you like, and I'll be happy to answer those. And if I can't answer it, I'll find an expert to answer it on line live.
Thank you. Or at least recorded from a live person. So that's the plan. We'll put this online sometime in September, but send your questions, whether they're about new technologies and plants or animals in how we communicate about those events in plants or animals or microbes, whatever [00:01:00] new products, new technologies, or even.
Um, areas of how we prepare ourselves for future careers in these areas. I'm happy to give you my two cents. And if I don't know the answer, I'll find somebody that does. So send your questions, record them on your tablet or whatever, and send them to me at. Kevin folta at gmail. com. That's very easy to remember.
So K V I N F O L T A at gmail. com.
Today's guest is here to talk to us about innovative futures in medicine, many facets powered by biotechnology. Now, whether we're talking about new ways to detect the diseases years before clinical presentation or precision medicine that will inform treatments color, the company color has an impressive presence in prevention, detection, And especially access to the newest technology, innovative home based approaches and diagnostics.
They're [00:02:00] changing the patient physician dynamic, making it less invasive, more personal, more precise, and probably a model of broader things to come today. I'm speaking with Dr. Alicia Joe. She's the chief science officer at color. Welcome to the podcast. Dr. Zhou. Thanks for having me. Yeah, this is really cool because I've become acquainted with color some time ago, actually, by hearing about the cancer screening services.
Can you tell me more about this, um, especially the new partnership with the American Cancer Society?
Alicia Zhou: Yeah, absolutely. We're very excited to be working with the American Cancer Society. And so what color is doing is we're really taking a. focus and putting it on prevention when it comes to cancer. I think what's really interesting here is to know that, you know, one in two men and one in three women are going to be affected by cancer in their lifetime.
And when it comes to cancer survival, what we know is that the earlier you're able to detect it, the more likely you're going to have better survival outcomes. [00:03:00] Also, that also translates to um, better sort of morbidity and mortality for those patients, less costs for everybody involved, and of course there's the physical and emotional toll for the patients themselves.
And so these are all things that we think a lot about. And I think, think when we think about cancer. treatment and prevention, a lot of times are focused on the treatment side. How can we come up with a new drug or pharmaceutical that can treat cancers? And oftentimes when we look at these, um, groundbreaking therapies, they might be extending your survival or your lifetime by a matter of months, if not years, a few years.
Um, and yeah, on the prevention side, what we know is that if we can get people into earlier screenings, guideline recommended regular screenings, we can just get ahead of all of this entirely by detecting cancer at an earlier stage. It's much more treatable and you're going to have much better outcomes.
And so that's really what the focus is on. It's not rocket science. It means that all we're trying to figure out Make sure that people who [00:04:00] should be getting their mammograms are going to get their mammograms. You know, every individual when they turn 45, their average risk should be screening for colorectal cancer and there's a couple different ways you could do that.
You can use a colonoscopy, you can use a FIT test, which is just an at home stool based test. So it's really just about taking the basic guidelines that ACS has done a great job of publishing and then making sure that every individual who needs access to cancer screening is getting it where they need
Kevin Folta: it.
Okay. So I want to make sure I'm getting this right. So when I originally came in contact with color, I thought this may have been like a home test kit or something that you would maybe screen for specific alleles, or are you looking for specific biomarkers maybe in the blood? Or give me an idea of the, how the screening works.
Alicia Zhou: Yeah, that's a great question. So there's actually a couple of different components. There's five different cancer areas that we're looking at here. So we're looking at breast cancer, cervical cancer, prostate cancer, lung cancer, and colorectal cancer. And what we're doing in our partnership with American Cancer [00:05:00] Society is we're just taking the risk adjusted screening guidelines that are that they publish, that they use their evidence based committees to publish.
And we're just helping folks get up to date on that. Now, in some cases, that means that we can take advantage of at home testing. So, for example, I mentioned FIT testing. FIT testing is part of the ACS guidelines for colorectal cancer screening. And you can do it at home. It's a stool based sample that you can take at home.
One of the innovations that color is bringing here is that we've recently developed a HPV test that can be done at home based off of urine. And HPV is the primary cause of cervical cancer. And in fact, what we know is that we could probably eliminate cervical cancer in the American population. If we can get ahead of knowing who has.
high risk strains of HPV and getting those people screened earlier. Um, so this is an example of, you don't have to go into your primary care provider to necessarily get a pap smear. Instead, you can consider getting HPV tests. [00:06:00] We also do PSA screening for prostate cancer with a at home blood test. So these are all the components that we're putting together.
In addition, we know that there are certain people in the population who are at increased risk for cancer. These are people who potentially have a very striking family history. Maybe their parents had cancer, maybe their uncles and aunts have had cancer, or their siblings. These individuals oftentimes have some kind of genetic predisposition for cancer.
So in addition to the standard average risk screening recommendations, color also makes available a genetic test. And these are tests for genes that we know increase your risk for cancer. A great example of this is BRCA1. BRCA1 is a gene that if you have a mutation in it, your lifetime risk as a woman of having breast cancer is very, very high on 70 to 80% in your lifetime.
Your risk of ovarian cancer is also 40 to 50%. In fact, very famously Angelina Jolie had a [00:07:00] mutation in the BRCA1 gene and she wrote about it in the New York Times about why she decided to have surgery in order to get ahead of her family's cancer risk. So that genetic test is also a part of the offering, but it's available.
Then the whole package is available. to all individuals, whether you're average risk or high risk. And what happens then is we'll help you determine what are the right guidelines for you based off of your family history, based off of your situation, and make sure that you get in for those.
Kevin Folta: Okay. But that's an important part of this because if you are taking this cluster of tests that are genetic tests as well as other tests and you're getting results back as a consumer, we don't interpret risk very well and we're very uncomfortable with interpreting it.
So how much does color kind of hold my hand through understanding what the results really mean?
Alicia Zhou: Yeah, that's a great question. We really try to make that part as easy as possible. So there's a couple of things that we do here. One is that we have healthcare providers that are here to help you and answer your questions.
[00:08:00] So as you're getting your results back, you're not getting them in this vacuum of trying to understand the reports by yourself. But you have these care navigators, physicians, and in the case of genetics, you have genetic counselors, who are available to you to have that conversation. One of the things that we've always thought about is That moment when you get an abnormal test result is probably the most important moment for you to take action, and it's probably the moment in which you're feeling the most paralyzed into inaction.
So how can we make sure that we really support you through that specific? moment. So as you're getting a result back, the question is, what do I do next? And one of the things that we've always thought about, even in our roots, where we started, which was germline genetic testing, it's one thing to tell somebody that they have a BRCA1 mutation.
If that person just puts that lab result into a drawer and does nothing about it, then it's almost as if you didn't tell them, right? They haven't actually changed anything in their life, but if you can get them to get now proactive about their cancer screening, making sure that they talk to their healthcare [00:09:00] provider, they get in.
to earlier mammograms, potentially breast MRIs. They discuss what it is to get prophylactic surgery done, and they make an informed decision about what they should be doing. Now you've made a difference in this person's life and their potential health outcomes. So the way we really think about it is. If you get an abnormal screening test result, you need to now do that next step, which is to schedule yourself for potentially a conversation with a health care provider.
Maybe if you have a positive fit test, you should go get a diagnostic colonoscopy. Um, these are things that we will help. make sure happen. And so one of the things that we've done in the last year is that we've built out a care advocacy team whose job really is just to make sure you get from point A to point B.
So they do things like figuring out your schedule, figuring out where your insurance coverage is, helping to call imaging centers or healthcare providers offices to schedule you in for that next appointment. And then once they schedule you, they'll call you back and say, Hey, Did you actually go and get that [00:10:00] colonoscopy that I scheduled for you?
If not, can I help you reschedule it? Because ultimately that's the type of little pieces of friction that we can take away that actually gets people to do the right thing.
Kevin Folta: Yeah. And that's such a barrier, right? These, I did it today. I had a doctor order a test on May 28th who told me, this is what I want you to get.
And I haven't heard from the. Place. That's supposed to call me. So I just thought today, maybe I better call them. And they said, Oh, we called you on June 7th. You never answered the call or whatever. And so here I'm two, two months past when I should have gotten the test. But I guess the, the interesting thing for me about this is I, so color the, the test kit that you're talking about, or the suite of tests, this is available over the counter.
Isn't it like a Walgreens?
Alicia Zhou: Well, it's not actually available over the counter. It's actually done through physician order, but, but we do make it really easy for you. So we actually have, um, healthcare providers who are here to talk to you, have a conversation with you, and then order it for you, and then it actually just shows up at your house.
Um, now for some, people, they might [00:11:00] think, you know, they really embrace this sort of digital first way of thinking about the world and they like the idea of things showing up their house. These are probably people who love amazon are doing all their banking online. But then of course when we talk about cancer prevention screening, a lot of these screenings are more tailored to older populations and some of these folks might find it better or more comfortable to actually do in person services.
So the way we think about it is if you'd rather have the in person encounter rather than having this sort of remote, um, at home testing, um, we can also make that possible. So the idea is just, um, the way we talk about it with American Cancer Society and what they always say is the. Best screen is one that is completed.
Um, and so that's all we're trying to do. We're trying to figure out what do you need? What is recommended for you? How do we get to, um, to do it? And so for some folks, that means we're going to help you get an appointment for other folks. We're going to send you an at home test kit.
Kevin Folta: Okay. So this is something a prescriber, a physician prescribes, but our, um, our [00:12:00] physicians.
really that I'm bored with it because I've never had a physician do this for me. They've just ordered the, you know, traditional colonoscopy or traditional, you know, calcium score, whatever.
Alicia Zhou: Yeah. It's really interesting because the guidelines have said for a while that you can do these other types of test modalities.
And in fact, even these days you might go into a provider and they might even tell you that that's the case. I think what has really happened is that over the last Three years, and I can't believe it's been three years since 2020, but I think that we've all realized that we can interact with healthcare in a different way, right?
Because during the COVID pandemic, we all had to sort of reorganize the way we accessed everything in our lives. We didn't want to do in person for a lot of things. We were afraid of social not being too close to people. And so wanting to do social distancing, you certainly didn't want to put yourself in a hospital at the same time as a bunch of.
patients with covid symptoms were going there. And so all of a sudden we thought about different ways to [00:13:00] access our health care. And in fact, we got used to doing things like going to a drive through test site to get a covid test or going to drive through vaccination site to get our vaccines instead of scheduling.
that care with our primary care provider. I think what we learned from that, and I think as a health care industry, what we have to embrace from that is that your average individual, your average health care consumer has a different expectation now for how health care should be given to them. It shouldn't be about me taking my body in to the health care system.
Can we make the health care system some come to the patient. This is a revolution we've seen in every other industry, right? I never go to the bank anymore because I do all of my deposits through my mobile app. I buy most of my stuff on Amazon. Instacart has made it so I don't even have to go to the grocery store.
You know, why can't we take those same principles and apply for health care? I really think that's the opportunity we're talking about here.
Kevin Folta: No, I absolutely love it. And I agree with you in terms of the delivery. But the flip side of [00:14:00] this too, is that it's much more personalized and that you're getting a suite of tests, not necessarily going into a general practitioner who maybe has a line out the door of patients that they'll see that day where it's very easy to miss a problem that you're not complaining about or that you don't anticipate like a genetic issue.
You know, that could be You know, lurking in the genes, you know, until, until it's too late. So this, this seems to me that this should be, uh, you know, and I'm, I'm not just advocating for color, you know, for this, this brand of medicine seems like something that I should do before I even show up at the doctor's office.
Alicia Zhou: Exactly. And I think that's the thing about it is that it's not trying to replace the doctor, it's actually trying to make that interaction with the doctor more efficient and hopefully higher value. So that you're right, your, your average primary care provider really only has 15 minutes with each patient.
And that patient often has to do like a two hour rigmarole to do that 15 minute [00:15:00] consultation, right? You have to show up to be on time, you're in the weight room, then you see a nurse ahead of time and then finally the doctor comes and that doctor Most of your primary care provider doctors really wants to deliver the best care that they can deliver, but now they're burdened with going through your health history questionnaire and having more of sort of that rote memorization of let's just make sure we, we check all the boxes.
One way we can think about this is can we get those boxes checked for you ahead of time? So now you're in that 15 minute consultation and instead of talking about when's the last time you got a mammogram, You're saying, Hey, I noticed you got your mammogram. You know, these are your results. Let's talk about that.
Do you have any concerns about your breast health? That's a better use of those 15 minutes than having the conversation of when was your last mammogram.
Kevin Folta: And you've been doing this for a while already. I mean, the company's eight years old. So, so what has been the biggest success in terms of impacts of, A detection of a certain kind of cancer.
You know, this
Alicia Zhou: is really interesting. So, um, when we [00:16:00] first started thinking about improving access to cancer screening, um, one of the great things about working, uh, at color is that you feel the patient impact almost immediately. So we actually had a patient, um, we have patients right into us quite often.
Um, but I still remember one of the earliest stories of this, and this was eight years ago when, when we first launched back in 2015. We had a patient write in and say that, um, they took one of our genetic tests, they were found to have a mutation in BRCA1, so they went into their healthcare provider, and for, because they were a BRCA1 carrier, they were asked to complete, um, more a higher risk screening, specifically looking for ovarian cancer.
Ovarian cancer is not a cancer that you typically screen for, actually, because it's relatively rare unless you have a genetic mutation and there's not a very good screening test for it. Um, so because of the fact that she was a BRCA1 carrier, she got screened. And they did find early stage ovarian cancer [00:17:00] in her ovaries.
They were able to surgically remove her ovaries and they were able to catch it early enough that it hadn't spread to the rest of her body. And she actually wrote it and said, I really think that because of this, you know, it changed my entire health outcome because as I mentioned, ovarian cancer is not one that you would normally screen for.
So she otherwise wouldn't have caught it until it was. late enough stage that she had other types of symptoms. This is the type of, I remember at the time we didn't even have that many customers, you know, maybe a couple hundred at the time, and I remember thinking like, if this is the best that we do is to have had this impact on this one patient, it's good enough, because all of a sudden you realize the immediacy of impact that you have on, on patients.
Kevin Folta: And that's really a beautiful story where we're talking with Dr. Alicia Joe. She's a chief science officer of color. This is collaborates talking biotech podcast, and we'll be back in just a moment. And now we're back on collaborates talking biotech podcast. We're speaking with Dr. Alicia Joe. She's the chief science officer of color.
And I, the thing that I really [00:18:00] just appreciate about this so much is just the idea of where personalized medicine is going with. This kind of testing. And right now you've, you've mentioned, you know, your screening for a couple of key, what we look like the major cancers, but what's the next steps for this kind of preventative cancer screening?
Alicia Zhou: Yeah, that's a great question. I think there's been a huge promise of precision medicine that we've talked about for a long time. And then that's really only been a very narrow application to date. What I mean by that is that when we think about precision medicine, typically the use case we think about is in cancer therapy itself.
So you've been diagnosed with cancer. Um, now we're going to subtype your tumor and understand its characteristics based on its molecular signature. We're going to now recommend a specific therapy, a specific drug that you should take. This has been a great advance in oncology. We've seen immuno oncology come up.
We've seen precision medicines like [00:19:00] PARP inhibitors become widely adopted. Um, and we've definitely seen better outcomes for these patients. I do believe that if we can understand people's hereditary risk for disease, which is the risk that we carry around with us from the day that we're born. There is a way for us to have more tailored approaches to prevention and to therapy.
At the end of the day, our biology actually really dictates the way that we interact with any number of interventions in the healthcare system. Um, medicine is one of those, right? So we know, for example, that different people have different, um, Uh, sort of activity levels in their liver enzymes, um, and that means that they respond to drugs differently.
Um, and that might mean you need a higher dose or a lower dose than somebody else. It might mean that you need a different, um, medicine altogether than somebody else. Um, and this whole area is called pharmacogenetics. Um, so this is an area of understanding what, uh, your genetics are for your liver function enzymes.
And then based off of that, um, potentially [00:20:00] modifying the dose or the type of medicine that you're prescribed. So I think that's an area that we're going to see a lot of, um, great advancements in in the coming years. And then in general, for both cancer and for cardiovascular disease, we do know there are some...
relatively prevalent genetic conditions, and in the field of genomics, when we say it's prevalent, we mean it's in 1% of the population, so still not that, not that prevalent, but, but not super rare. So these types of conditions, we know there are some in cancer, like I mentioned BRCA1 and 2. There are some in cardiovascular disease, like familial hypercholesterolemia, which means you're born with high cholesterol.
These are all things that if we know that from, um, from day one, we should be treating differently. We should be screening differently. And I do think there's a huge opportunity for that.
Kevin Folta: And I, and I love all this. I think this is so cool and it's such great application of the technology, but the hard nut to crack for me seems to be.
That there's got to be a huge portion of the population. And I'm guessing 50 to [00:21:00] 70% who say, I just don't want to know, because if I know, like, you know, to me, it would be empowering. You tell me that I have alleles for whatever I'm more or less likely to either engage in things that will exacerbate the risk or potentially take more avoidant.
Um, preventative steps if I could, but most people don't feel that way. I think I'm a weirdo. Um, well, how, how do you deal with that psychological barrier of getting people to, to take a test that they maybe don't want to know the results?
Alicia Zhou: Yeah, this is a really interesting question and certainly something we've talked, we've thought about in the genetic space a lot.
I think there's probably two things I would think about. One is that I think we have to start making sure that the narrative around genetics is not this Gattaca narrative of like 100% of your entire health is determined by your genomics, because that's just not true. There are some parts of your biology that are very linked to your genetics.
And then there's a vast majority of your health [00:22:00] that has to do with your environmental risk factors, your exposures, your lifestyle. And these are all things that are modifiable and changeable. And I think it is important for us as the genomics and genetics community, as a research community, to make sure that we're not, um, perpetuating this myth that a hundred percent of your, um, health outcomes are determined by your genetics.
So I think that's one. I think the other piece of this, and it's what you mentioned, which is how do you deal with understanding risk or knowing something about your own risk? Um, and I think here I would say. It's important to inform people of risk when there's something actionable that they can do, when they can get ahead of that risk, when they can change something that changes their risk.
I think it can be, it can feel very disempowering if you're told, you know, you have this risk and there's nothing we can do about it. And I do think there's a whole categories of disease states that that's true for. An example is Parkinson's or Alzheimer's disease where we have some understanding about the genetics.
We don't [00:23:00] really know how that can change your outcome. And I think then in that case, it's a very personal choice if you want to know if you have a genetic predisposition for one of those diseases, but there's no treatment outcome that changes based off that knowledge. And so I can imagine a lot of folks
Kevin Folta: don't want to know that.
So it's, it's a great example. Like I know people who have tested for the APOE variants for Alzheimer's disease, who, every time he can't find his keys, he's like, Oh, it's kicking in already. And I think it does cause some undue stress, but I think you really have hit the nail on the head that if you can give people information about things, they can control and then.
Don't bother with the things they can't unless they want to know. I mean, I still would like to know, even if I can't control it. Um, you know, just, I don't know, uh, it, that seems like a really good defining point for how you would separate out the different kinds of results.
Alicia Zhou: Yeah, absolutely. And I think, you know, on the genetics and genomics community, we actually have this framework that is made by [00:24:00] this professional society called ClinGen.
These are experts, clinical geneticists. from um, across the world who are experts in various areas. They come together and they have um, a framework that they built called the Actionability Framework. And that Actionability Framework actually classifies what we know about hereditary genetics and um, how sure are we about the linkage between the genetics and the disease phenotype.
And then of course, um, how actionable is that. that result. So that's actually one of the things that has happened in the last, you know, 10, 15 years that really has brought the field forward. I think the other thing, if we're, if we're willing to dream out a little bit, let's, let's, uh, let's project out and say, okay, in a world in which, um, personalized medicine is adopted by every individual.
And now we have the ability to look at your germline genomics, your whole genome and really change the way that we can potentially get ahead of disease. My version of that world doesn't actually [00:25:00] have a provider sitting down with the patient and saying, you know, Hey, bad news. You have a mutation in these three genes and that means you're probably never going to live past age blah, blah, blah, blah, like, you know, let's just break down all of the, all of the, those things.
I think the world in which we really integrate genomics. It's just saying, Hey, you had genomics assessed, um, early in your life, you know, at the standard age that's recommended. And ideally, maybe it's something that's recommended for everyone to get done. Maybe even at birth is something that just get integrated into your health record.
And then we just say, Hey, based off of what we know about you, you should start your mammograms, um, at 30 instead of at 40. And it's not even a conversation about what is the genetic reason for that. It's just simply, Hi, I'm your healthcare provider. This is your personalized screening recommendation. Here are the things that you should be doing.
We've changed and tailored this guide and this action plan based off of what we know, including your genetics. And then in that world, you never actually have a conversation about like, Oh, it happens that you have this weird [00:26:00] snip and that makes us think that maybe we should treat you differently.
Kevin Folta: Yeah.
See, I just, I just can't imagine. Why this isn't the standard because physician physicians aren't happy with the way healthcare works. Patients aren't happy with the way it works. Everybody thinks it sucks. The, um, for me it seems like we should just break the whole thing down and let's start with this kind of approach.
Give everybody a prescription based upon their genetic needs and what their genetic predictions may be. And then use that as a starting point because now everybody has, uh, It's a tangible handle on at least what they may anticipate and the things they can control. And then their physician is in the know just by pulling up that record.
And it's only going to get better as time goes on. And so, and I guess, so maybe I'm just kind of. You know, rambling a bit here, but, um, you know, you mentioned you do these tests and that you provide all this guidance. How does your company make money?[00:27:00]
Alicia Zhou: Yeah, it's really interesting. So when we first started back in 2015, we were very hyper focused on making sure that folks get access to the right healthcare where they need it, when they need it. And we started out in the germline genetic testing space. Um, we focused on BRCA one and two, and that was a very sort of, Uh, mission driven reason for that, which was that our co founder and CEO, Atman Leraki, he himself is a BRCA2 carrier and he only learned that he was a BRCA2 carrier because his mother had survived two breast cancers before she was ever tested.
Um, and so she already, she had had breast cancer twice and after the second time she was asked to get a genetic test and she found she was a BRCA2 carrier. So as a first degree family member of someone who has a genetic mutation, um, you're supposed to get tested. And that's why Ottman got tested. Even in that framework, where he had a 50% chance of carrying a BRCA2 mutation, he still found it really hard to navigate the healthcare system to get that [00:28:00] test.
It was, even though there was like a 50% chance, a 1 in 2 chance that he was going to have this risk, still it was hard to navigate. And that's sort of why we focused on BRCA1 and 2 when we first started. What was really interesting, though, is that Ultimately, the mission of the company has always been around access, making sure that people get access to the types of text tests and technology that they need to improve their health.
And we had this really interesting opportunity in 2020, which is that we have a clear testing lab. which is certified to do high complexity testing. We run, um, germline genomics in that lab. Um, March 2020 came along and we were all hit with this very strange moment in history where the COVID 19 pandemic started and there was a shortage of testing.
Um, in the United States, there was that moment where we weren't quite sure what was the right assay. There was the WHO assay there was a primer misdesign problem, and all of a sudden we were stuck in this [00:29:00] position where most of the U. S. had no access to testing. And we realized, you know what? We have a high complexity CLIA testing lab, um, and we have the ability to sequence human genes, so we certainly can run a basic, uh, you know, molecular test for a viral, uh, gene.
Um, so we decided to, to, to jump in, and we started doing COVID testing, actually kind of, uh, as a whim. We thought we were only going to do it for four to six weeks, um, and of course hindsight is 20 20, and I don't even, I think back, and I think that was such a naive thing to believe, um, but, but we. We started doing COVID testing and, uh, and over the course of 2020 to 2021, 22, um, at the height of the pandemic, we were doing 75% of San Francisco's public health testing.
So we're running all the large public, uh, public health testing infrastructure for the city of San Francisco. We learned how to pop up tents. Uh, we learned how to get PPE. We learned how to get swabs when there were no swabs. And, [00:30:00] um, and I. I learned what was the weight limit for the pier in San Francisco for the number of cars that could be on it at one time.
Um, and, uh, and, and it was really still this focus on access that made us go in that direction. Um, but we've expanded as a result, a lot of our test services and a lot of even the healthcare services that we provide because of the COVID pandemic.
Kevin Folta: And I, I love this, um, cause it brings up an interesting question.
Is the focus we say focuses on access is the, are you identifying barriers to access and saying, okay, this is where we're going to design our next assay to break this wall. Or is it really technological driven where you're saying we have this really cool technology that maybe we could apply to this other population.
Yeah,
Alicia Zhou: it's really the former, I would say. I think we're very focused on where is the friction or the barrier of access and what can we do to change that. And what that means is sometimes the thing that's necessary is a sort of lab, wet lab advance [00:31:00] that needs to be done. So for example, we realized that there was a low uptake of Pap smears, especially in the, racial minority community, you were having a lot of people not go in for their standard pap smears.
We knew that you could use an HPV test to do cervical cancer screening, and we did a bunch of research and realized that in Europe, they've already started using urine based testing as a way to detect HPV, and that this is a way to do cervical cancer screening that doesn't require to get an invasive pap smear.
And we were like, okay, well that's something that seems very feasible, something that we can do. And that's something that we worked on for COVID. One of the major things we realized was it was just a volume problem, right? Nobody could get enough COVID tests. Um, on to the market in a timely fashion that would get you a test result in less than 24 hours.
And really during COVID, a result that took more than 24 hours to get to you was not a useful result because now you will have exposed people for multiple [00:32:00] days before you realize that you should have been quarantining. Um, so there it was really, it wasn't about a huge technology advance in that it's not hard to run an assay.
for, you know, get a couple of primers for the viral RNA and you just amplify. Um, but what was hard was figuring how to do that at a super high scale. You know, how do you run tens of thousands of tests a day? And then there was an interesting innovation around automation and the use of, um, uh, robotics in our lab to make that happen.
Um, and then sometimes, for example, with the COVID vaccine, there was a huge technology advance, which was. mRNA vaccines as a technology. Right. Um, but then the next thing was how do we get that into the arms of as many people as you can. And there, the innovation was simply boots on the ground, you know, door to door, bringing, uh, the vaccine into the community, popping up tents, working with faith based organizations and community centers and trying to get every last person who needed a vaccine access to that vaccine.
There's definitely [00:33:00] no technology there. It was simply just saying the hard part of this problem is getting people to have the convenience factor of, you know, I don't have to go anywhere to get my vaccine, so let's just bring it to them. Um, and so for us, I think Anytime we see a problem, um, we're willing to tackle it.
Sometimes there's a really interesting technology solution to it. And sometimes it really is just kind of a manual solution to it. Um, but that's really what drives us.
Kevin Folta: And I guess this is the curve ball then. And I understand, you know, you're in San Francisco, you can access a population. Pretty easily.
But one of the biggest crises that is emerging is the lack of critical care and maybe even testing and testing for oddball diseases in rural communities. And how do you tackle something where people are not so concentrated and still give them access?
Alicia Zhou: Yeah, that's a great question. I mean, I think there's a couple of different things to think about here.
One is, um, you know, how do you just bring the technology to the people where they are? And especially when you're talking [00:34:00] about things like testing and vaccines, it comes down to things like understanding how to do like a mobile test site. You know, how do you get cold chain to happen in a van instead of in a building?
You know, these kinds of things. How do you get health care providers on site, for example? Um. Then there's a whole nother, um, sort of topic area that's worth talking about, which is the potential hesitancy within the community to adopt that technology in the first place. And there, I think we have to be very thoughtful about making sure that you're never feeling like you are parachuting out of the sky and bringing something.
into the community, you have to be partnering with local community leaders and you're going to get much better adoption if you have somebody from the local community, somebody who is a community leader in that community, um, partnering with you. And so when we were doing COVID vaccinations, um, you know, it became a bit of a controversial topic as, as we went, um, and we realized that when we were trying to [00:35:00] help some of the more rural communities.
Um, some of the minority communities, the non English speaking communities in, um, in California, the most important thing was to partner with, um, a community health leader. Sometimes this was a faith based leader, like, um, somebody who was a priest or was a leader in the church. Sometimes it was a community center leader, um, and then you It was never us saying, Hey, you should consider getting vaccinated for COVID.
It was this person that was bringing that message. Um, and then the other thing that was super important was that all of our staff, you wanted to make sure that they, um, were culturally competent and that they were language competent to the community that they were dealing with. Um, so that you're not coming in and not being able to communicate with.
with your patient. You need that trust. And so you have to really invest in those kinds of things. It's, uh, it's not as glamorous as building a really great app, but, um, but it's incredibly
Kevin Folta: important. Well, you're, you're talking about human psychology and trust is such an important element of [00:36:00] any kind of application we have these days.
And especially in the medical area, when you start talking about genetic testing and vaccines, the concern about privacy, the concern about You know, getting a microchip put into you. I mean, even the crazy stuff that people say you have to be able to anticipate and even mitigate those concerns. And, and I totally appreciate that.
And that's, if you're ever looking for somebody to help you with those, I learned the hard way. I mean, I'm a molecular biologist by training, but I have really taken an interest in the last few years in communication strategies around trust. building. And, and that's just the way we got to do everything. I guess the other leg of this might be, uh, you are a co PI on the all of us NIH genomics initiative.
And can you talk about that a little bit and how important this kind of data is? Oh
Alicia Zhou: yeah, totally. So, I mean, this is such an interesting area to be in the genetics and genomics space, but I think also whenever you're on the cutting edge of technology, you have [00:37:00] to be aware of sort of who you might leave behind.
And what I mean by that is. whenever you're thinking about new technology, what often happens is that you have an early adopter community who gets early access to the technology because they're braver, because they have more resources, they can afford it. Um, and then you have the really curious minded folks who are just interested in new things.
But if you want to make genomics, a integrated part of precision medicine for everyone, then you really do need to make sure that all of the data that we're collecting, all of the innovations that were, uh, and, and sort of new explorations that we're making based off of this data that it's done in a more equitable way.
And what's hard about this is that all of the genomics research that has been done to date, the majority has been done on mostly European populations. Some of the largest databases that we have available to us, um, publicly available to us are the UK biobank, which was done in the NHS in England. And, um, there are a bunch of [00:38:00] large biobanks that are done in, uh, in Northern European countries, um, from Finland, from Iceland, these areas.
Um, there's a real dearth of data, um, in non European populations. As a result then, We're learning a lot about the genetics of European individuals. We're learning a lot about things like I mentioned pharmacogenetics, where we know that certain people might need more or less of a certain medicine, but that leaves us with a big blind spot about how these types of interactions occur in non European populations.
So the aim of the all of us research program is really to help change that by recruiting 1 million participants across the United States. to have their data in a large publicly accessible database. Whole genome sequencing is done on each participant sample and their EHR data is integrated in. And one of the lofty goals of the all of us research program is to recruit its participants to have 75% of those [00:39:00] individuals be from individuals that have been otherwise.
underrepresented in biomedical research. So we're talking here about racial and ethnic minorities. We're also talking about things like socioeconomic status and education status, and we're talking about age diversity and rural versus urban diversity. Um, these are all things that we're thinking about when we think about, um, Underrepresented by medical research.
Once we have this large database available, it will change them. These pharmaceutical companies who might be using that data to develop new drugs or healthcare providers who are using that data to manage care. It will be more equitable. So it's a huge undertaking, but I'm very excited to be working on it.
Kevin Folta: Yeah, that's, that's really awesome. How does it compare to the existing biobank, like the UK biobank in terms of size?
Alicia Zhou: Yeah, so the UK Biobank, um, I think right now is in the hundreds of thousands of samples. And they started out having SNP arrays on everybody, then they moved to exomes. Um, and with, [00:40:00] uh, with the All of Us research program, the goal is to have one million participants.
Um, and to have whole genomes on everyone. Um, and then there's also the lofty goal of following these people longitudinally for at least 10 years, so that we actually get their health records over time rather than just a snapshot in time. Um, so that's the goal of the, of the program. Um, and it's definitely been an interesting undertaking because at the end of the day, it's one thing to say you want to do it, and it's another thing to actually get it done.
The difference between, uh, the U. S. and the U. K., there's just, A lot more, uh, people, uh, to spread over a much larger amount of space in the U. S. And then, of course, we don't have a national health system like the, the U. K. does. So, you know, UK Biobank was able to recruit out of the NHS because everybody was in the single health system.
Here in the U. S., we don't, we don't have that privilege. Um, so that means that we have to be recruiting kind of boots on the ground, um, in a very grassroots way for this program.
Kevin Folta: Yeah. And you also have a lot more, I think you have a lot more skepticism in [00:41:00] this country, both around many minority groups, which feel that, you know, something like this could be invasive and potentially, you know, why do they want my information, but also increasingly the same with more, um, rural folks feeling the, uh, feeling that this is an invasion of privacy, that kind of thing.
So are you kind of biasing this data set to the, those who are willing?
Alicia Zhou: Yeah, it's a great question. We're, we're definitely trying to fight that type of bias. And what that means then is we have to get really, um, creative with our recruitment. So of course, every participant who is a part of the program must have full informed consent for their participation because of course their data is going to be in this program.
And every participant also has the right to change their mind and withdraw their consent. Um, so what. In order to do this really well and to get the level of diversity we're looking for, that means that we're have a lot of different recruitment strategies. We have, you know, the regional medical centers that are recruiting.
So these are some of the standard [00:42:00] academic medical centers, um, in some of the major metropolis areas that are recruiting for us. But then we also have, um, a, a bus, the all of us research program, It actually drives around the country and kind of, um, it's, you know, it's a big tour bus and you can see all of us were on the side and it drives around the country.
We work with FQHCs, we work with the BAs and then we have a direct volunteer arm of the program, meaning it's fully digital recruitment. You might see a billboard or you might hear an ad on TV or see an ad online and you just sign up yourself through our online flow. Um, so basically what we're trying to do is just, Make every possible type of recruitment available, um, to try to really get that
Kevin Folta: diversity.
That's really an interesting part of this is how do you, how do you get that? And it sounds like you guys have thought through this very well. I guess I have other questions, maybe more about the business itself. Cause you were there right at the beginning where just a few, few employees and how are things really [00:43:00] different between When you have a handful of employees versus a lot of employees in terms of how you organize the business and think about new missions to take on.
Alicia Zhou: Yeah, this is a great question. You know, I have the real privilege of having started at color. Um, when it was a smaller company, we were a series a company when I first started and I came straight out of academic science into color. So, um, I had wrapped up my postdoc at UCSF. Um, and I was a person who was.
planning to become an academic. I come from a family of academics. Um, I didn't even know there was a different kind of career path that was available. Um, and so when I chose to leave academic science to join a small company, I think I was probably the most surprised of everyone because I didn't expect that for myself.
Um, but I think what I also realized when I joined color was that all of a sudden there was a Different sort of degree of freedom, um, when it comes to working in a industry environment, also working in [00:44:00] a startup environment compared to an academia. Um, so this was something I had to sort of grapple with right away, which is an academia.
I always describe academia as kind of like an Ikea where like the arrow only goes in one direction. So like you start, you get your bachelor's degree and then from there you're supposed to get your master's or your PhD. After your PhD, get your postdoc and then you go and get your K 99. And then you get your R01s, and you know, junior faculty, senior faculty.
It's like a one way IKEA. You're always supposed to be going in one direction. Um, and when you leave academia, all of a sudden there's this huge sort of aperture of choice that opens for you. Um, and that was actually paralyzing for me when I first left academia, which is to understand like, what do I do now?
There's not like the clear demarcated arrow saying this is what you should be doing next. Um, and so I, uh, I, I had to really sort of struggle with and then grapple with and overcome my fear of making a bad choice. Um, and, uh, and then at [00:45:00] Color, you know, we've grown from this small Series A company into all the way to Series E, a much larger company eight years later.
Um, and I've learned all sorts of things that I probably would have never learned in academia in terms of people management, building a team, coming up with, Um, a business plan. Um, how do you get a bunch of people to row in the same direction? Um, and this, these are all things that I've, uh, I've had the privilege of learning here at color that I had no idea I was going to have to learn when I came
Kevin Folta: here.
That's really interesting. And when do you think that that. Flipped because I used to hear horror stories of you go in the industry and you're going to be working in photosynthesis this week and next week you'll be working on a seed quality, you know, because, and, and that if you want real freedom, go to academia.
But I really see that, especially with the changes in states like Florida, where now, you know, we have post tenure review, you know, which, which means that. Tenured faculty that could take on extra jobs and take on riskier projects. Now we got to kind of rein it in a touch and make sure we're still pumping out the [00:46:00] pubs and, and it hasn't really flipped where if you want to, if you want to do have freedom and choice and opportunity.
Go to industry.
Alicia Zhou: You know, it's a great question. I think what it comes down to is that, um, having a academic science background and having a degree in molecular biology or, um, whatever advanced degree that you have is a good stepping point into a number of professions now. And I think the difference is that certainly when I was coming up as a grad student, it was kind of Uh, not talked about that you could potentially leave, um, leave academia.
And if you were going to leave academia, it was most likely to join a large pharma company like Genentech, Novartis, um, these kinds of places that had at least come up with this concept of a industry postdoc, for example. Um, but you know, coming out of your PhD, you didn't really think there were many more options.
Startups are such an interesting injection of sort of chaos into that [00:47:00] system. because all of a sudden now you have all of this extra choice. I think that it's, it's a couple of things. Um, one thing that I thought a lot about when I first started at color, um, when I did have the opportunity to grow a team and to build a team, um, I thought a lot about how can I help to sort of evangelize to the rest of my team members at Color, the value of somebody coming out of academia, because what was really interesting is that people would look at resumes from academic scientists who had completed a PhD program in a postdoc, and they would say, oh, this person doesn't have any job experience.
And I would say, well, yes, they don't have any industry job experience, but if you've... finished a PhD, you've published this number of papers, you know how to overcome adversity, you've definitely run into dead ends, you know how to project manage and timeline manage, you're probably a good writer and a good communicator.
You know, all of these skills that we attribute to job experience in air quotes, we should also be giving credit [00:48:00] to academic scientists that are coming out of these pretty, uh, you know, intense gauntlets that are PhD programs. And of course, you still have to interview and you want to make sure that you have the right candidate with the right culture fit.
Um, but one of the things that I really pride myself on is sort of helping people in the startup Environment and industry environment recognize the value of academic scientists and similarly I think I do a lot in terms of helping academic scientists taking their first step out of academia to be to understand sort of that Huge change in scope, uh, in terms of what you could do, the roles that you could take and how do you deal with, um, all of that sort of stochasticity that you weren't used to before, um, and still show up and do your job.
So I, I really actually love being in this in this spot where I kind of have my foot in
Kevin Folta: both worlds. Well, help me, um, help some other people here. I, I work with, uh, lots of graduate students, undergraduate students, lots of students who have aspirations of moving into industry in, in the end. And. I always have, [00:49:00] I always tell them, we, you've got a lot of great people who are graduating from this place.
You got a lot of great graduates out there from a lot of schools. So how do you raise your brand so that when you're on the market, you're more, um, uh, more, uh, attractive to an employer and especially coming from academia into, uh, in the industry. And I always hit them really hard with let's Publish some stuff online on science websites.
Let's publish some articles. Let's do some speaking. Let's, you know, join me on the podcast. And these are the kinds of things that I really push. And 50% of the students, or I'd say more, I'd say 80% never take advantage. Well, almost a hundred percent never take advantage of it. I get one now and then, and how, how important is that to someone in industry who sees someone coming out of an academic environment who is obviously interested in outreach.
but also interested in showcasing their communication skills, their, their writing skills.
Alicia Zhou: Yeah. No, you hit the nail on the head and you said it earlier, um, which is that you think that scientific [00:50:00] communication is super important. It's, it's super important. I think these days when we talk about, you know, PhD programs, I know that now we have more people doing things like data science and, um, big data type, um, you know, computational biology type courses.
Now you're seeing a lot of grad students take those. Um, in addition, I think that every PhD. Program should include scientific communication because what it comes down to is that you could be the smartest person in the room and know the most about a certain topic, but if you are unable to teach somebody else what you know or convince somebody else that your idea is a good idea, you know, it really is kind of a tree falls in the forest.
No one, no one can hear it. And so I think it comes down to not only having the know how to have the technical expertise to do something. But it's how do you communicate that to somebody who is not a technical expert? Because when you're in industry, the best way to get things done is to work cross functionally.
So the person you're trying to convince is [00:51:00] not a fellow scientist. The person you're trying to convince is a business person, a product manager, an engineer. Um, you really are trying to make your case and if you can't articulate. the value of what you know, then you're kind of unable to sort of extract the value out of yourself.
So even though you're super valuable, it's kind of, you know, it's kind of all encased in this hard, hard shell. So at the end of the day, scientific communication, I think is the key. And when people are thinking about going out and, um, potentially, uh, Looking for jobs in industry and interviewing for jobs in industry.
Scientific communication is going to be one of the big things that I'm looking for. How do you show up in that interview? Are you able to concisely communicate something very important? That's what I'm looking at.
Kevin Folta: You know, music to my ears. I, and, and, and the thing is, I'm teaching a science communication course this fall for graduate students, just a one hour, you know, once a week we get together and talk about some principles that really emphasize how communication occurs and how we do it through disparate [00:52:00] Disciplines and how scientists to scientists is very different from scientists to public and or scientists to legislator.
And those kinds of conduits, no one ever teaches us that. And I got lucky because I have a background in communication. So I do this, but then I have a university that fights me and says, this isn't your job. And I think it's exactly my job. And so it's, it's really, um, it shows that we need to have a greater change at the university level, and maybe it's starting to happen where you're seeing more and more emphasis on science communication, but I think we're still way behind.
Alicia Zhou: Yeah, absolutely. I mean, I think this is one of those things. I feel like if, if you could take kind of the principles of science communication, a elevator pitch kind of VC startup, like Y Combinator kind of thing, where it's like, let's lock a bunch of people in a room and like figure out if they can pitch their company within five minutes to a board of whatever, like investors.
You should do a similar thing with, with PhD students in their theses, right? Like you invested five plus years into writing a dissertation about a [00:53:00] topic that you are now the world's expert in. Can you communicate to somebody who is not a world expert in your area concisely within five to 10 minutes?
Why what you did in your thesis is important. Like if you can't, did you really do anything that important? ?
Kevin Folta: Well, and can you do it while they're looking at their smartphone? Yes. And why they're thinking about what's for lunch and for, you know, and, and against all their biases. It, it's a real hard nut to crack, but it's something that there's good tools to do it with.
And we can create change in people by having the right approach. And even the really recalcitrant folks, um, I sell at a farmer's market every Saturday morning and I'm a biotechnology guy. And so you can imagine, you know, I'm kind of the, you know, the, uh, uh, the, the dark sheep there. Um, but I, but it, it. Is something that we can make great inroads by just the strategy we adopt.
Well, we should, Joe, this has been fantastic. Is there a place that people can look online if they want to learn more about maybe you or the [00:54:00] company?
Alicia Zhou: Yeah, absolutely. To learn more about color, you can go to our website. It's pretty easy to remember www. color. com. Um, but yeah, if folks are interested in learning more about me or, um, what it is to jump from academia into industry, they can come find me on Twitter.
Um, my handle is a Y underscore Joe. Um, and. And you can also find me on LinkedIn, um, as well. And people can always DM me. I'm always happy to chat, especially folks who are thinking about going to the next step in their career. I'm always happy to chat.
Kevin Folta: Oh, that's really wonderful. That's really great. And I should emphasize that at Twitter, that's at a Y Z H O U.
Yes, that's correct. All right. Very good. Yeah. That, that, all right. Well, thank you so much for joining me. This was really fantastic. And I hope as time goes on and as things evolve and as things change in the landscape of the medicine or in medicine or the company, get back together with me here and let's talk about the new successes.
Alicia Zhou: Absolutely. Thank you so much for
Kevin Folta: having me. And for all the listeners, thank you again for listening to another episode of Talking Biotech. [00:55:00] This is another application of biotechnology and how medicine will be run in the future. And for those of you who are listening who either need a career change or maybe you're thinking about the career of the future, I think this is a great place to target.
So practice those communication skills. Join me on the podcast. The invitation stands, you know, this is, this is your medium too. So work with me to interview other folks and build your communication skills. This is a talking biotech podcast. Thank you for listening. And we'll talk to you again next week.