Founder Stories: Sean George, Co-Founder and CEO of Invitae

Well, thanks again and thanks for having me. This is really an honor. In my career, there are oftentimes discussions, people from around the world, people I've worked with kind of scratching their head wondering how to— and formal ambassadors and economic development agencies asking, how do we recreate Silicon Valley? And well, certainly not in its entirety, but certainly a major part of that is Stanford and I think that's going to be hard to replicate. So I think they got to— they'll keep asking that question. It's an honor to be here. I love telling this story to students, people like you. I certainly hope to inspire you, I hope not to scare you. But I think maybe I'll just tell the story from my perspective and I think one of the key things I often tell people is whatever you read about company formation and the mythology of companies starting and whatever you hear about or read about, certainly read about in books, the real story is a lot more nuanced and it's also very much depending on your perspective. So I'll tell you from my perspective what the last 5 years have been about. And I certainly am very interested in any questions you might have when we're done. I'll suggest perhaps some pointers, my learning, where I stand today with everything that's happened and maybe to sum them up, first is if you're going to start a company, if you're going to start a new endeavor, I would offer that it's good to— generally people say it's really good to try something big and disruptive, I think probably on paper and for a lot of reasons that makes a ton of sense and you can go a lot of different directions, but I think one reason to go do something big and disruptive is because it's incredibly difficult to do and the odds of success are so low that if you're going to go do it, you might as well spend all that time and energy and sacrifice doing something that you think is really important. And in hand with that I think is, it's got to be something that you really, really care about internally and I think it's hard to even express maybe my thoughts on this. It's not that you care about it, it's that you can't stop thinking about it. It's that when you wake up in the morning, you see something that is a missed opportunity or something somebody else is missing or you have an attachment or a passion about something that is so great that if it makes sense to kind of start an endeavor, start up a company to try to address it, you care so much about it that you just can't get it out of your head and you're not going to be satisfied until you have made a go at it, because again, that's going to be important too. Maybe another key learning, you'll have ups, you'll have downs, you may win, you may lose. If you want my input, the experience itself is worth it, that alone, it truly is one of those things where the journey is what matters. Not necessarily the outcome, but you will have your highs and your lows and this is where I think that you've got to maybe balance and level and understand on a variety of levels. Luck has a lot to play with it, market externalities, externalities on the competitive landscape, there is a lot that has to do with whether or not you in this new venture would succeed, and for two reasons I think it's important. One is a public service announcement, there's plenty of people that start companies and have great success and then proclaim to the world what a genius they are and how they knew it all along and I summarily reject that mythology that there is kind of one creative force and one person that makes it happen. It takes a team, it takes a team, it takes a group of individuals to do anything worthwhile. I also recommend that to people to make sure to understand, Again, the downside is a very real possibility and I think you should just steel— if you're going to try this kind of thing, you should steel yourself for that outcome and not personalize it. Do your best. If you've got a passion about something, do your best to build something that makes a difference, but a lot can happen and if you end up failing in the process, that's how this works. Pick yourself up, dust yourself off, go find another team to tackle another problem and go do it. And then I think speaking of team, that's maybe the other key lesson that I've learned is the team you start with, the team that joins you, the team that invests in you, it is— my perspective, my two cents on it are that it is very much about the team that you choose to go through this with and should you at any point along the way start experiencing success and building and growing, I think in retrospect I would say all of the energy and we've— we'll get a little bit into it, we've put a lot of energy into our team and how the place works and even to the point where in the early days I thought it might have been a little overkill, certainly since there was a very high likelihood of success we wouldn't be around anymore when the money ran out. But now looking back I actually think every ounce of energy we poured into the way we wanted to work, the way we wanted our team to work, now is— now it's coming back, it's coming back and I'm not only glad we put as much energy as we did, I actually wish we did more. You can't put enough energy into your team and the way the place works. So those are the major learnings. I'll start from the beginning. I was at a company, I was the COO at a company called Navigenics, it was one of the kind of middle, mid-2000s direct-to-consumer genetics plays, a lot of good ideas floating around then. We were basically the physician-oriented, stodgier, less fun version of 23andMe and that was our plan, we were going to go take genetics to the masses, really kind of employee health plans, doctors, whatever. It didn't work, for a lot of reasons it didn't work, business model, timing, don't need to go into it now, but it didn't work, but what I did get at the time from my experience in the industry as in the tools diagnostics technology industry, leading to that, knowing where kind of the microarrays in use at the time, the DNA microarrays kind of were the beginning, the harbinger of what was to come in genetic technologies. At the time, a bunch of sequencing companies had been developing next-generation sequencing technologies that promised to lower the cost of access to the human genome. And while the business that we were trying to build just wasn't working, what I did see bouncing around from medical geneticists' offices to genetics clinics to doctors' offices, talking with genetic counselors, What I did see was the beginning of what we started, and what I saw was, you know, in fact, there are a lot of genetic disorders, there are a lot of genetic diseases, and there are a lot of people impacted by them, and what struck me most is none of the clients that I was talking to were happy about the way it worked. Genetic counselors, medical geneticists, you know, cardiogeneticists, cancer geneticists, you know, even clinicians that were vaguely aware of how genetic testing worked, Nobody was happy. Things were very expensive, very, very long lead times. If you ordered a test, it could take up to half a year to get an answer. Just really kind of almost primitive given where the technology was at the time and was going. But even more importantly, this is where it really came clear to me, a couple of family events, not my personal close family, but kind of, you know, related, related family and friends and their families, you know, a couple events in their lives that had big impact on that family, devastating impact on those families. And then in these clinics, what I would see are not the same families, but equivalent families sitting there with their kids in these clinics. And after kind of knowing the situation with the genetic counselors, certainly talking with some of these families along the way, Understanding, just getting a good feel for the absolute despair that they were going through, seeing in these clinics these kids, I mean, I actually at the time when we started the company, I had just become a relatively new parent and I don't know if any of you, hopefully not, probably not a lot of you parents wait on that one, that's my other piece of advice, life advice, wait to have kids. But you think most parents, most new parents kind of think they have it tough. They don't get to sleep. They have troubles. Seeing these parents with these kids that were not developing, that were not growing, that were having serious, serious problems really put it in perspective for me. These people had problems. I will never have problems, most likely, that these people have. And I think as I kind of went through that experience, that's what then stuck in my head as, this is ridiculous. This is ridiculous that given where the technology is today, these people wait so long for the testing. They can't even get access to testing. The clinicians don't even tell them about the testing because it costs $20,000 to get it and very likely won't give them an answer anyway. That's when it kind of all started coming together. So I kind of, at that point, put it together. I knew where the next generation sequencing technology was going, effectively the cost per base of the human genome was dropping off faster than Moore's Law, which I think— I mean, we all know what Moore's Law did for computing, networking, and everything that has followed. And it was pretty clear about 5 years ago, this is what's going to happen in medicine. This is what's going to happen in genetics. And I'm going to go— we're going to go figure out how to make this work. So we decided— it was myself, couple other people that were working with me at the time, we kind of popped out, decided to go start a company and the idea was, hey, let's build a company that will consolidate the 3,000 to 4,000-some-odd genetic disorders, the test for these 3,000, 4,000 different genetic tests consolidated into one highly efficient industrialized platform production line to consolidate the entire genetic testing industry, drive the price to the floor and make it available to everybody. And that's what we started with and while there was no way at that time I could really know exactly where it was going, I certainly couldn't know that I would be standing here today telling you about it, that's essentially what we are doing. So Invitae, Invitae now, we are— we're basically hell-bent for leather on bringing genetic testing into mainstream medical care, for literally billions of people on the planet. Anybody in the developed healthcare system can benefit from this. I mentioned the 3,000 to 4,000 genetic disorders that I kind of became familiar with many years ago. In fact, it affects possibly up to 10% of any given population. Up to 10% of the population has an inherited genetic disorder. It's just that they're so fragmented, 3,000 to 4,000 of them are spread that any one of them seems small enough. The biggest one, the biggest market, consolidated market by far is the birth breast cancer testing, Myriad does it, et cetera, but there is a long tail of these genetic disorders and so that's what we set out to do and indeed thankfully that's what we're still doing. We went out to raise money, this was end of 2009, not the best year to go out and raise venture capital and in fact it turns out of the— we pitched to more than 110 places, firms, hedge funds, what have you. It turns out half of them didn't have any money. So knowing— seeing where those firms went now, half of them just didn't have any money, the crash had happened, things were rearranging, capital was getting reallocated. So it was a long haul, we pitched to more than 110 really for about a year. It was a fairly tough time actually, that was kind of the first set about 6— maybe 6 to 9 months into it, was the first time I really faced the potential for failure like squarely in the face. The team that we were working with, there were 4 of us, we were kind of self-funding it, we had some space, we got going. We actually started originally in the Tres Agaves tequila tasting room up there in San Francisco. We were there for about a month and a half, one of the co-founders knew the owner, so we holed up there. Then we moved to the QB3 space over in Mission Bay, So we had some space, we got some of the equipment up and running and we were getting going, confident that we were going to raise money, but then after 6 to 9 months, just no after no after no after no, part of the team started shaking loose a little bit, they needed to go get a job, their spouses were like, hey, how long are you going to pursue this crazy dream? That summer right before we got a couple of these firms interested was definitely the first time, certainly in my career, ever that I really stared failure in the face. I'm a fairly confident individual, no one has ever accused me of a lack thereof, but boy, that experience there, that was trying and that's by the way, that's why I think you should do it. I think you should do it just for that experience, it's been invaluable to me. Just facing that failure in the face, pulling these 3 people along, invaluable, invaluable, and really actually frankly prepares you for the next phases of company formation. So we pitched 110, 115 nos, got a couple interested, and finally one of the firms that we had been talking to, we got the A round and got going. I think at the time the idea seemed stupid, the pitch was kind of, hey, this technology curve is happening, there is this big unmet need, we're going to build this engine, this sequencing engine that's going to be able to deliver clinical reports better, faster, cheaper than anybody, consolidate the industry, we're going to go for 50% gross margins, it's going to be an execution play, no intellectual property barrier to entry. At the time, the FDA was rattling sabers about sequencing in LDTs, at the time the gene patents were fully in effect and there was a patent thicket, kind of hovering over every one of these ideas. The idea of building a biotech company with a long-term aspiration of getting to 50% gross margins was completely foreign to any investor in the space and then of course when you're raising money as I hope a lot of you will try to go do, the thing you get asked all the time is what's your differential advantage and if the answer is because we know what we're doing and we're going to work harder than anybody else is not a compelling argument. To somebody who's got a very, very high cost of capital. So it is understandable, it took a while, but we did eventually get some investors that I think, frankly, I think they were at the end of their fund and they just took a flyer on the idea. They said these guys seem crazy enough, we'll just give it to them and see what happens. So we got going. We started hiring the team, started getting going, and one of the very early things that obviously has led led to a lot of the success we've had, constantly seeking out people that had been through it before, people who have done it before. In the fundraising process, I mean, look, I was CEO of a company, I've run large business units, global business units at technology companies, it still was an incredible help to run the pitch by 4 or 5 people that I knew that had raised money before, who had been VCs before, started companies before, So a month, month and a half of that preparation was invaluable. And that's one thing I would say right from the get-go, get people who have done this before, run it by them, run it by them, run it by them, drill it with them, really test your assumptions. Then once we got funded, it was time to start filling out the board and I started reaching out to people I knew, people in the space and I was really interested in getting Randy Scott. Randy Scott had founded Incyte, took them public, Randy Scott had founded Genomic Health, took them public, very, very early player, big player in personalized medicine and I just kept calling him and calling him and calling him and trying everybody I knew that knew him. Finally got on his calendar shortly after we raised the first round, went to talk to him about joining the board and here was a person who after really spending a year and a half talking to just about everybody in the industry, experts on the medical technology investor side alike, basically saying it was a horrible idea. I spent— within 30 seconds of talking with Randy, I can see his facial expression, like he's clear, he gets it. And then he starts talking about, oh, and then this and then this and then— and it was clear that I had found my board members. So we kind of got going there, got Randy on the board, I had another board member come in, kind of an experienced hand in the diagnostic space and I think this is where not just in the company formation, but early days along the way, having experienced people, people who have done it before, people that challenge you on what you're doing, how you're doing it, is invaluable and this is where I can't say enough where I think there's, again, I hear the mythology, myth around companies and again, my perspective is it's quite different. You have an idea of what you want to do, you are the driver, at the time I was the driving force of getting this to happen, but there is no way that we would have made it happen without these individuals banging on the idea, testing the idea, testing assumptions, bringing in their network to test the assumptions further, do channel checks, build models, et cetera. Invaluable, invaluable. Some of the things we definitely fought on, the price point for example was one of them. One of the early kind of founding concepts was we are going to make this as low price as possible and we know one day in the future we'll catch up on the COGS. And again, anybody with any experience in the diagnostic industry will tell you it is really hard to run a low margin business in diagnostics. And we battled on that and we battled on that and that was one thing where I said, where I think I did, we did stick to the founding purpose of the company. And even though there was a lot of early, not fighting, but debate about it, one thing that kind of strikes me which is another really important thing is these individuals shared the same passion that I and the team did. These individuals had the same values as I and the team did. Ultimately when it came down to what is our real model, what are the actual moves we're going to make by way of pricing or offering, it is absolutely essential that all of the people involved share the values, share the core mission. So that kind of goes back to if I can impart one thing on you, really having that core mission, the core, what it is you are trying to accomplish in view, and having everybody on the same page on that makes these things possible. That is the only way we got past those early days kind of testing things out, technology risk, market risk, trying to get clients, all the debates about pricing and offering. The fact that these individuals had so much experience and could really push us as well as the fact that they shared the vision really kind of exit us in what I think kind of the early phases of the company, the first 2 years or so, first, 2 rounds of financing, essential, essential for it. Now the thing is, so while when we started I think a lot of people thought it wasn't such a great idea, things started moving pretty quickly. So when you went to the medical conferences and the clinical conferences, instead of every talk being about how next generation sequencing was 10 years away, 15 years away, kind of the typical technology cycles in our space, would seem, about 2 years into it, it would seem that they were actually moving a lot faster. Acceptance by the clinical community, the prices, actually many of the investors we talked to just looked at our price model and said, you are crazy, costs are not going to come down that fast and indeed actually they were coming down faster. So people were just shocked, even I who had been in the industry a while and kind of think of myself as perhaps an overly optimistic type technology zealot, even I was shocked how fast these things were coming down. And so things really started to move in the industry and really kind of turned our out-of-left-field crazy moonshot of an idea into something that all of a sudden everybody started thinking, actually, that's not such a bad idea. And then you've got all of the industry incumbents thinking that way and you've got all of the 120 investors that you talked to 2.5 years ago thinking, oh yeah, that's a great idea, let's do it. And so people start surrounding around the space, And this was a period of time where we had to start making some decisions and they were really, really tough decisions and I think it's— the way I think about it or the way I would tell you from my perspective is this is kind of the classic big piece, small pie, small piece, big pie kind of thing that a lot of— most entrepreneurs face at some point in time in financing. It's also one of control, right, so I'm running this shop, I've hand-built, hand-selected the team, we are making progress and then at some point, right, again the market starts shifting, everything moves, we knock off the technology risk, we prove it can be done, externalities seem to be going in our favor, FDA basically goes away for a while at the change of administrations, the gene patent thicket that was pretty much assumed to be something that would block our kind of model forever showed signs of cracking. The first case started popping up through the federal court, through the district courts that was challenging patents, subject matter patentability for gene sequences itself and in that period of time, a lot of people started getting interested in the space, a lot of people started getting interested in us, it became clear to us it was turning into an execution play. And at that point then you've got these industry veterans around the table, you're looking at in our kind of business model what matters when it starts turning into an execution play, essentially turns into a footrace and you start asking— you start coming to the realization that you need a lot more capital than you thought you did. If, again, if you really want to go for what it is we wanted to do, if we really wanted to go after all of the families that are currently not able to get this information for their kids, for themselves, we were going to have to spend a lot more money and so that started going into decision-making mode where there were a couple of companies that we had been kind of partnering with that then all of a sudden threw over acquisition offers. In that you're kind of making the decision, well, gosh, we could probably raise another, maybe another $10 million round on our own, but really if we want this to happen, we want to have it at scale, maybe we should tuck into a larger company and just see this through. That's trying as in you've spent the last— you've basically sacrificed the last 2.5 years of your life getting to that point and now the best options in front of you seem to be the ones that remove your control. It's not what you— it's not why you started the company, but again, if— for us, it was very much one of like, look, what matters most is that what we're doing sees the light of day and has impact in the market. And so we seriously entertained a lot of that, or for a while we entertained those bids, did the diligence, had the conversations, soul-searching times to be sure, and then what happened then, Randy, who was on our board, again I think got so excited about it all, he kind of said, okay, yes, we could raise a small round and kind of go it alone, but we're just not going to make it, it's just he amongst most knows you need a lot of capital to make changes in these spaces. The acquisition offers were, yes, that's probably barring our internal round, the best way is to go ahead and be acquired, make it happen, but even then you run the risk that you just get subsumed by a big company and everything that you've tried to build doesn't actually get out there. And so he suggested, hey, how about this instead, I'll lead the C round, I'll bring in a bunch of investors and we'll fund this thing and we'll do it right, we'll go go for the long shot, we'll go for the big win, we'll go all the way and this is going to take $300 million and so let's do that. And it turns out that's the way we went, that was certainly the right call. For his pains, of course, he was going to be CEO instead of me and that's where it all came in, it's like okay, which door do you go through, what are your personal incentives, it all kind of came back to again if you wanted to get— if I wanted to get this done, this team who had joined me wanted to get this done, this was definitely the best way to do it. It meant taking a smaller piece of a bigger pie, it meant giving up control of the company, it meant a lot of things that you, at the time, were tough, but honestly, I mean, looking back, there was no other way to do this, there was no other way to do this, that was the right way to go. And I think that's where I want to, on that point in particular, I today, I talk to a lot of entrepreneurs that are in that tweener phase of the company, they got some funding, they're getting going and they're making these decisions and they know they need the money but it means losing control, they know they need a partner but it means partnering— I would say that is a key point in the— if you're going to start a company, that is going to be a key challenge as you start to succeed. Again, if you want my advice, the best thing to do is do what's right for the mission, Remove yourself from the equation, that's the best way to succeed. I've seen people get all tied up in what their percent ownership is, it's my vision, my company, we're going to do it my way. That's a tough path to continue. For everything that we read about in the public media, how that's the— obviously the one or two of those, the unicorns that make it out and that's the case, that's all we ever read about, but I can assure you the thousands of other companies most of which die on the vine, that is not the way it works. You've got to be willing to sacrifice your own personal ambitions and desires for the mission at hand. So then we— so at that point in time we raised a good-sized C round, certainly more than we'd ever raised in A and B. Things started working, we started adding more teammates and this is where again, this is where the team comes into play. You want to bring in people that then can keep moving the company through the next phases, right, and they're going to be different people than the people you started the company with, they're going to have different skill sets, they're going to come from different backgrounds and in a tight-knit kind of no safety net environment like a startup company, they're going to seem like they're from a different planet to you and much of your team, but it's essential, it's essential that as the company scales and grows you add these people and that's what we did, we started, getting ready to— we had proven commercial success, again the technology risk was peeled off a while back, we had started proving commercial success and now it was time to start building an organization that could really go out and go after it. So there was a period of rapid company building, a lot of different skill sets showing up. The other thing that happened— starts happening at that time, so now we have access to more and more capital, more and more capital is coming in, which then starts opening up the decision set, so kind of up until then, Every month was basically a race against dying as a company. We have 9 more months of cash, we need to prove this, this, and this. We have 6 more months of cash, this and that. We have 3 more months of cash. We have no more cash, our bridge loan takes us 4 more weeks, 6 more weeks, 8 more weeks. Then all of a sudden you've got more money than you ever thought you would have, you've got a bigger team around you, and now the questions get a lot harder in terms of okay, now how do you create value for the next round of investment, or do we need to get going thinking about going public, can we get to breakeven before then, you know, and in that period of time with many more voices around the table, it can get a bit crazy and indeed in our, you know, that middle kind of maybe this is about 2 years ago in our company's history, there were a lot of ideas about a lot of different directions to go, you know, should we go this way, more direct-to-consumer, should we go, you know, absolutely hardcore traditional clinical, should we go somewhere in between, should we just, skip the US and its crazy third-party reimbursement system and go outside of the country. Let's go to Latin America. Let's go somewhere where there's actually a market for this information instead of this bizarre— I call it the regulo-insuro-industrial complex that kind of distorts markets in this country for diagnostics and these technologies. We can talk about it later if you have questions. Maybe we should do that instead. And those again, those are tough times because now you're burning on a monthly basis what you used to spend a year, you've got a lot more people coming in, the culture that you're trying to build from day one gets challenged consistently and there was a period starting at about this time, this stat has continued with us even today at our company, at Invitae today, more than half the company has shown up in the last 6 months, right? So of a company we've been around for 5 years and more than half of our headcount is here 6 months ago and that started about in this period of time, about 2, 2.5 years ago. And what we were trying to do, we were trying to build a different culture, I'll talk a little bit more about it, we were trying to build a different place, a different way of working and of course when you're growing that fast with all these new ideas and all these new people coming in, that comes under serious, serious pressure. And that— so all that's coming together at that time and again to get through that time I just keep— as I think back on it, it keeps coming back to the people around you, you have excellent, smart, passionate people around you, you have very experienced hands around the table, both working with you on the management front and on the investor front, so we started bringing in these blue-chip investors that had been in the space for a while, that had seen a lot, that were long-term investors, That really got us through that time and got us to the point where then it was time to think about— we had now achieved enough commercial success where— and by the way, the markets were hot enough, I mean I think in a down market it would be tough, but we could actually see, hey, we can start raising more and more money, we could even think about getting in the public markets to really continue to accelerate, continue to lower the prices, continue to make this happen. And in the back and forth of all this, that's what we decided to do, we started gearing up to do to do it. Right before that, kind of at the end of that period, we went out to raise kind of our last private round or— the way it works today, there's this kind of— since the JOBS Act, there's a lot more action from what traditionally had been called mezzanine investors or early IPO investors. They also now are investing in kind of basically the last private round of public companies. So we began talking to those firms. Which I would say that really started focusing our attention on what is our story going to be as we go out to access the public markets. And again, our team helped us, the team we had added, we couldn't have done it without them, no way. The investors that we had added along the way, we couldn't have made it happen without them. Interesting little story, we actually went out and did kind of the non-deal roadshow, we were out raising the private round, with the bankers involved, we actually had at one point we were going out to raise $50 million or so, had a lead, we're about to close it and then literally on a Friday afternoon the banker called on a call and just said, oh, sorry guys, lead fell through, big, big, big mutual fund X is starting to wonder what's going on, huge hedge fund Y wants to know where are we, are we going to close soon, Very quickly what looked like a pretty good like let's raise $50 million, it was all coming together, fell apart in a matter of minutes. That was harrowing to say the least. That's a period of you're burning a ton, it's not like back at the first early rounds when you're burning a couple hundred K a month. You have a financing fallout then and maybe everybody sours on the story and all of a sudden you're like going back to the company, firing 100 people, not good, not good at all. But the team rallied, again we've got pros around the table, the team rallied and we ended up actually turning into a major, major win. Very quickly we found another lead which is actually even better than the first lead we had and instead of raising a $50 million round, we ended up closing $120 million D round and I think that's one of those things kind of as I think about that financing itself kind of is a lot of the experience. Now that's a financial effort, but I think same thing has happened on the technology side as we've been working on different ways to look at this sequence information, get it into the clinic, different ways to run the pipeline. A lot of the failures that we've had very, very quickly got turned into wins that were even bigger than the failure we experienced and I think that's— Part of the programming that I would suggest you're going to need to have, you're going to face a lot of adversity. You're going to have a lot of downs with your ups. And you and the team around you, your natural reaction needs to be, OK, now what do we do? How do we fix it? How do we get going? How do we preserve? And again, I keep coming back to in my mind every single one of those kind of circumstances that we hit. Along the way, that is possible when everybody is on the same page and everybody is passionate about the mission and everybody can suspend what it means for them. Oh my God, we're about to bail out of our D round, what's going to happen, what's going to happen to me, what's going to happen next, all these relationships are going to fall apart. Instead, everybody was dead set focused on no, no, no, no, no, this we need to make happen, our clients are loving us, the patients are getting the results, we are going to make this happen, we are going to make it happen, we're going to pull it out. And I think of the D-round financing falling through, a bunch of technology foul-ups along the way that we had, every single one of those when you started, again it's kind of back to when you're facing that failure and then the team rallies around it and the team always rallies around it for the right reasons, not only do I suggest to you that is absolutely critical in building a business that hopefully, again I wouldn't say we're a going concern yet, but looking good so far. You want to build a business to that point, you're going to have to have that and again it comes back to kind of like this is why I'm encouraging you to do it. Those experiences, pulling through with a team for something that is absolutely important that the world needs, even if you don't succeed, even if it does end up in failure, that alone is worth it from my perspective and I can honestly look back and I think I think I can be honest with myself, even in the darkest times along the way the last 5 years, every time we were in a downtime, I still could come into work and remind myself, I would do this again. If we don't close the bridge round, if we don't close the C round, if what I just got, what just came out of the lab yesterday, if that ends up tanking us, I would do it again. Every single one of those times, I could always, I think, I mean it's hard when you're there, but I think honestly looking into myself, I kept coming back with I would still do it again. Even if we fail, crash and burn the next week, I would do it again. And I can tell you now, even if along the way, it's easy to say now we've gone public and we're kind of making a go at it, but I can honestly say I would do it again even if every time along the way there was a chance for failure, even if it happened, I would totally do it again. Let's see, so kind of, so then along the way we're having commercial success, this was really kind of, we had only been commercial for about 9 months, almost a year at that time, we had brought in Chief Commercial Officer, really built the team up, but still a really small effort, but we were making great traction, so we decided after the D round to immediately go and load up again and access the public markets and this I think kind of all along the way I had been receiving from the very, very beginning with no money and no space all the way up until that point in time, I'd received plenty of advice from a lot of people about fundraising and what I would offer to you is the following, I think kind of there are two flavors of advice for entrepreneurs on fundraising and one I think if I may vastly overgeneralize, one comes from fairly wealthy people that don't have to work and think very deep thoughts about the optimal way to raise money and build companies, and the other comes from people that aren't independently wealthy and have to use other people's money and just want to get something done. And I would say that the levels of advice go something like, on this side is kind of like the big piece, small pie is better, you want to optimize every stage of value creation and only take so much dilution along the way, and if you have cash, make sure to increase the value before you raise more cash, And on the other side is the simple advice of take as much money as you can when you can because you never know what's going to happen tomorrow. And I just got to tell you, again, one man's perspective, that is the voice to listen to. And even right after the D-round, we had just raised $120 million and the very next question was, hey, I think we can get to the public markets, let's do it. Let's do it right now while we can because this is going to take a lot of money and if we want to ensure success, that's what we're going to do. And so we did, so we got geared up, we went into— in our industry there is a big conference at the beginning of the year, the JPMorgan Healthcare Biotech and Healthcare Conference, kind of went into that having just announced, okay, we're going to go do it, kicked off the roadshows and then the great thing about the roadshows is we had just raised $120 million, so we've been out talking to all these firms and a lot of them had just come in and then we We got some more interested, closed the round, closed the IPO in mid-February and took the company public, came back to the company, had a big party and I'll admit it was entirely surreal, the whole thing. On the one hand it's been the longest 5 years of my life, I think I've aged 20 in those 5 years, on the other hand it just seems like yesterday we were literally in that Tres Agave's tequila tasting room, kind of like, oh, this could possibly work, maybe not. How long do you have? I don't know, how long do you have? Well, let's keep trying, let's see if we can go. It really has been surreal. And again, I think reflecting on it— well, and the first thing I would tell you too is right now it's actually the way we view it, it's kind of just the beginning. We're making a great ramp commercially. Our value proposition is really selling. Again, it's kind of like, hey, you're you're currently ordering and paying for these genetic tests that are very expensive and slow, why not come to us and have them be very, very fast and better and much, much cheaper? It's an easy sell, mostly, but it's really early days. It's a big market, it's a complex market, like I mentioned, the payer system is difficult, there's a lot of challenges ahead of us, but it would seem, certainly from my part, I think from my perspective, Where we are now is maybe a— I wouldn't label it success, but it's kind of like— for me, it's all of the people that came and joined, all of the people that took massive career risk on what we were trying to do, minimally it looks good on their resume now. Hey, that company went public, I think, yeah, that's great. Minimally it is some kind of like, hey, okay, this is working well enough where there's enough people interested, they're willing to invest in the idea. And what I think is most interesting is in these big funds, these big hedge funds, these investors, what was really satisfying to me, and this again comes back to this concept that I'd love for you to take away about the mission, the best thing was— so there's one woman that runs this massive, massive fund, very big important fund in Boston, and to come in and be prepared for the pitch and the questions and everything and to basically to have her kind of go, you guys have made my day. I have been looking for something in healthcare like this for years and I don't know why anybody gets it. If the technology is falling, prices are falling off the map, why isn't the care getting cheaper? Why isn't it getting better? Why aren't patients getting this? And it's kind of like, you know, to have someone like that in your corner, which by the way, a lot of our investors are exactly the same way, you know, Again, it makes it all worth it, it makes it all better and I think we're genuinely at the point now where even if we do fail, prices in the industry have come down since we came on the scene, turnaround times have come down since we came on the scene, there is no question anymore whether or not people will do genetic panels or gene tests or whatever, that question is now settled, it is now a race, anybody who needs genetic testing test, we'll get one much, much faster. And I think not just because of us. Again, there are a lot of industry participants that are taking part in this. But in a large part because we stuck it out there and said this is the way the future is going to be. These things are going to be cheap and available. The margins are going to be low. And it's going to be a real consumer market for this kind of thing. In a sense, we have succeeded no matter what happens at this point. And of course, now the game is to to make it successful going forward. So maybe one last thing and then we can go to questions. I think the point that I mentioned is obviously I've been kind of pointing out this mission that the burning desire to do something has got to be front and center. Again, for all the sacrifices you're going to make to make it happen and for all the chances of failure, you've got to have it mean something and then even in the success, I can assure you the success has nothing to do with money or going public or anything. The success is, like I mentioned, the people you're interacting with saying this is awesome, this is an idea, thank you for making it happening. We now are kind of doing some work with some advocacy groups and we just recently had one of these advocacy group heads, her family has been affected and to sit down and have her just kind of pour out her heart and say, I can't believe this and this and this and we need this and we need this and it's a crime that this doesn't happen and just to say, we got it, we're doing it, yes, next year, yes, the price— that is where the success really feels like success. None of the other stuff feels any different than when I was at my old job or when we were starting or when it was clear it was possible we were going to fail. It's what you're doing that matters the most. The team that you build is what matters the most and then I had mentioned that we— that I felt it was really important to pay attention to how you're building the team and how you're running it. So this is kind of— well, I think it's interesting. So we started the company and again it was a bunch of technology people and we were really excited and excitable and going to change the world. The other thing is it kind of crossed my mind, we had all worked at many places, I had run fairly large units at companies before and it kind of came, hey, while we're out trying to do this, why don't we also try to create a company that we actually like working at? Why don't we try to build a company where people enjoy coming to work every day and build a company where maybe if we do possibly one day have success and grow to be a 10,000-person company, it actually is not your typical big slow company, let's try to do that. And it was kind of a personal desire that a lot of the— all of the co-founders shared to do that. It was also a rational desire, I think, kind of as I sat back at the time and certainly as I think today, an observation about the world, kind of lately, technology cycles are getting really, really, really fast. Workforces are getting very, very distributed. Competition is popping up. I mean, yes, I think it's going to be hard to recreate Silicon Valley, but boy, there is a lot of global talent pouring into— basically think of it as entrepreneurial capacity on just about any industry you can think of, and I can see it happening, and so kind of, One of the other ideas is not only like why not build a place that's really great to work at that we would like to work at that people don't run around basically afraid of their bosses all the time, why don't we build a company that can actually innovate at scale because I actually think this is going to be important. If we're going to have to stay on these technology cycles, if we're going to have to stay bleeding edge and access global talent, it's going to have to work differently than most companies work today. So we tried some things early on. We actually didn't have an org chart. Until 120 people. We didn't have any titles at all, we still don't have titles, we now have SEC mandated titles but internally we don't have titles that convey rank or entitlement or whatever, they're very functional practical titles. We built a— one of the first things that I did when we got the A round, no, this was maybe when Randy joined the board, when we built the board, we built this little survey system where the team would basically do 360 reviews of each other and especially me and then that would get published to the board and kind of the team could basically either with their name attached or anonymously rate me and how we were doing and where we were going and was it working. And that system has actually evolved over time and now we actually have it in full play. We don't have peer reviews at the end of the year, anybody who's a manager we really want them just focusing on execution and mentoring and getting things done and we have a separate group which is our talent ops group and we have this system that we've built, that is essentially like a statistical interpersonal kind of basically a performance evaluation survey that's completely 360. We gather many, many, many, many data points throughout the year and are especially interested in how I'm doing, how Randy is doing, how the leads are doing, and so it's completely upside down of kind of how most companies kind of do personnel reviews, who's doing what, who gets paid paid what, who gets opportunities, who doesn't. We've implemented a lot of unusual features into the way we operate to preserve some of that early, early kind of nimble— the ability to be nimble, the ability to challenge, the ability to chase ideas. And I think like I said, we spent a lot of time on it in the early days and I felt at the time this was probably too too much and now though that we're getting to 250 people with half the company hasn't been here more than 6 months, I am really, really glad we spent as much time doing that because I've actually really been delighted to see some of the core cultural elements that certainly I like about our company and we think are going to be important for the company have not only survived, they're starting to bake in and people are really starting to grab onto them as one of the major reasons they like to work there. Work here and honestly if we hadn't paid as much attention to it early on, it wouldn't have happened. We would have faced what I talked to many, many entrepreneurs about, many, many founders about is that the tragedy of seeing this great thing and as you achieve success, it starts getting away from you, which again to an extent it will and that's good, but then seeing the culture go and seeing the bureaucracy set in and the fire go away, For me, again, I would— as you're starting a company, I exhort you to pay a lot of attention to the type of people you're bringing in and how you intend to operate and manage those people over time. So that's kind of a view from start to finish, that's my personal perspective of what has gone on at Invitae the last 5 years. Let's do a few Q&As. Yeah, like I said, I'd love to grab questions from anybody. Oftentimes your questions are much more interesting than what I have to say. So yeah. Did you, in the last 5 years, did you have any big pivots or was it just a linear execution? No, we knew what we were doing from day one and never— no. Yes, of course, yes, and I think this is universal and anybody I've talked to that has have done this, you pivot at some point. Early on it was very much, in large part because of capital constraints, it was going to be kind of a B2B type play. We were going to build the technology engine and then basically offer it as a B2B play to LabCorp and Quest and Myriad and these other players and enable them to lower the prices and expand the menus. When Randy started getting involved, when the market started shifting our direction, it became clear this is happening fast and it's going to be much more of a footrace, that's when we decided, that's when one major pivot was okay, we're going to go all the way, all the way to the clinician, all the way to the patient, build a brand in the space and build the whole thing soup to nuts, which of course was going to take 10 times more capital than the B2B play, but that was a major pivot and that's also what increased the complexity of the company, increased the size of the company. That was a major pivot. We— in that period I mentioned about 2.5 years ago, we were seriously considering going full-blown kind of— I wouldn't say non-medical, but really pushing the bounds of the kind of our position, our relationship vis-à-vis the current medical establishment 2.5 years ago, we were really kind of debating which way to go and we were pretty close or I'd seriously entertaining maybe we needed to go around it, started gearing up to do so, but then kind of quickly pivoted back and said, no, let's stick to our guns. The only way this is going to be impactful for those families and those kids in those waiting rooms in any near— anytime in the near future is to get the medical community going on it, serve their needs as well as the patient's needs, and get going. So, so kind of I'd say those are the 2 major big kind of one certain pivot and one that was an almost pivot that we quickly pivoted back. Yeah, absolutely. Yep. It sounds like one of the key factors of success is the grit you had and the determination. So my question is, is that based on just your natural innate ability or is it— do you have techniques to kind of keep going after maybe so many nos that you initially got? If you want to repeat the question. Oh, sorry. I think the question was kind of like, sounds like it takes a lot of grit and determination. Are you just insane or was that some kind of choice you made along the way? Is that the basic— I think those who work with me probably think it's a little of the former. But I'm not sure, I think a lot of things in life come down to choice and will, so you know, if you really want to do it and you decide you're going to do it, then it's just a matter of sheer will. And yes, yes, to do it you're going to be— your will will be tested. Actually the whole fundraising process, someone mentioned it to me at the time and now it makes total sense, it's a bizarre way that people go about raising money, But someone once said actually it's a pretty good test for the next— the years to come and actually now it totally makes sense to me. Getting kicked in the teeth all the time, telling you it's a bad idea, getting strung along by VCs that have no interest in investing in you at all, that's actually a pretty good testing ground. You can do that for a year or so, you just might be able to then build a company and grow it. Yeah, inborn or learned, I don't— I don't know, but I prefer to think of it as if you find something that you really care about and you choose to go try to address it, try to make that difference, yeah, you've got to make some choices. You will have to make sacrifices. I'm also not a believer in you can have it all. You want to go do something like this, you build a company, you better simplify your life because you aren't going to have a whole lot of time. You better figure out what's important, focus on that, and then make it happen. And yeah, you're going to have to work through a lot. To see it through and face a lot of self-doubt and face a lot of challenges. But again, that's kind of the awesome thing about it, that you don't often get an opportunity to really do that. John, thank you so much. We've got to move on.