China embraces a revolution in genetic testing, seeking answers on destiny and identity

BEIJING — It was from the news of American actress Angelina Jolie’s double mastectomy that Yang Yang learned it would be possible to have her DNA sequenced. A white-collar worker from Chongqing, a major city in southwest China, Yang admired her idol’s decision in 2013 to take her future into her own hands after a genetic test revealed a high risk of breast cancer.

Five years later, Yang has discovered that genetic testing services are not only available to Hollywood stars, but also to the average Chinese citizen. For RMB 299 ($43), she ordered a “Genetic Discovery Kit” from 23Mofang, the largest direct-to-consumer genetics testing company in China, spat into a test tube, and then returned it for analysis.

Two weeks later, Yang’s test results, displayed on a slick mobile phone app, informed her that she was 100 percent Han Chinese, had a high tolerance for alcohol, and had a high risk of gout. “I realized that my knee would hurt every time I drank too much,” said Yang. “So I started to pay more attention to my drinking habits.” Like Jolie, she, too, would take charge of her health.

Customers like 28-year-old Yang — tech-savvy and college-educated young professionals — are driving growing demand for genetic testing in China, 23Mofang’s CEO, Zhou Kun, told STAT. As living standards rise, people are increasingly prioritizing their personal health and livelihood. Health care spending increased more than fourfold in the last decade.

Much of Chinese consumers’ interest in genetic testing though, is rooted in a strong belief that genetics can explain their identity — not only their risk of disease or ancestral origins, but also their personality, their likes and dislikes, and their future. The rhetoric compelling consumers to sequence their genomes sounds like astrology, but with the veneer of science.

The 23Mofang website appeals directly to the Chinese customer’s desire to understand their destiny and identity. “Who am I?” the bold letters at the top of the homepage read. “What special characteristics do I have? What will my future be like?” Below, there is a photo of three hikers looking into the clouds as they trek up a misty mountain, double-helix-shaped halos wafting above their heads. The message of genetic determinism is clear: Their fate is not written in the sky, but encoded in their DNA.

Yang decided to order the 23Mofang kit after coming across a video ad while surfing the Chinese microblogging platform Weibo: A young married couple banter over their taste preferences; the Sichuanese wife likes savory rice cakes while her Northern-born husband prefers them sweet. They each buy a kit to find out what other genetic differences the test might yield.

Customers “are particularly interested in how their genes might inform their day-to-day lifestyle choices, like their exercise routines, skin care regimes or diet habits,” said Zhou. The company offers a broad range of tests, including for genes linked to one’s tendency to sweat, hypertension risk, pain tolerance, and long-term memory capacity. In response to high customer interest, it is even adding a test that it says shows whether a user is prone to mosquito bites.

“I wanted to be able to more objectively understand my own body through numbers and data,” said Samantha Wang, 29, who works in finance in Wuhan, in central China. “And I found that the information was definitely helpful. For example, the results said that I metabolize caffeine slowly, and so since then, I’ve tried to lower my caffeine intake.”

23Mofang is the largest of more than a hundred companies in China currently offering genetic testing services to consumers, with Shenzhen-based WeGene and Beijing-based Novogene and 360°Gene also big players. When 23Mofang launched in 2015, it sold 1,500 testing kits. This year, with the largest gene database in the country, it has already sold 156,000. Shipments of DNA sequencing machines to China from American company Illumina rose by 42 percent last year.

Chinese users are also fascinated by their ancestral and genealogical origins. In contrast to the United States, a 300-year-old nation comprised of immigrants, China has a history of 5,000 years, and over 92 percent of the population is Han.

“Our customers are particularly interested in their ethnic roots,” said Zhou. “Are their ancestors from the south? The north? Part of the Yao ethnicity? Do they have Tibetan blood?” Sometimes, people will even use their kits to confirm royal or famous lineage.

Many Chinese millennials, who grew up as only children before the country’s one-child policy was relaxed, are also interested in uncovering extended family ties. In a 23Mofang advertisement, Huang Jiawei, a young man who grew up as an only child, yearns for a big family. Through the 23Mofang test, he discovers a whole set of distant relatives, and the advertisement ends with all of them gathering for a hot-pot dinner reunion. “It’s like I discovered a whole new family,” Huang says, beaming into the camera.

Another factor driving the rising demand for genomics testing is the willingness of Chinese consumers to embrace the novel technology, and pay for it out of pocket. “In China, like in many emerging markets, you have the benefit of jumping quickly to the newest technology because of a lack of existing alternatives,” said Mirza Cifric, CEO of Veritas Genetics, a Boston-area-based DNA sequencing company that offers services in China. Its business there “is approximately doubling year over year,” he said.

Cifric said it is easier to persuade doctors in China to adopt cutting-edge technologies than it is in America, where there is a more “established point of view around genetics, and a more paternalistic relationship between physicians and individuals.”

With the cost of DNA sequencing coming down, the tests have become affordable for the average Chinese family. It cost $3.8 billion to sequence the first human genome, completed 15 years ago. Today, it would cost under $1,000. Tests for a limited set of genes, like most of the products sold to consumers, cost even less. (23Mofang now sells its kit for less than one-third its price three years ago.)

The ubiquity of social media and e-commerce in China has helped genetic testing companies rapidly build awareness. Chinese consumers often purchase their products online and share them with their networks on social media platforms like WeChat and Weibo. “After I did the test, I’ve recommended the service to maybe 15 or so friends, family members, old classmates and colleagues who have all bought the kit and tried it, too,” said Wang.

23Mofang markets its tests almost entirely through social media. The company, for example, enlisted Papi Jiang, an influential internet celebrity and blogger who boasts nearly 28 million followers on Weibo, to promote its tests. In a sponsored video, she used the 23Mofang kit and discovered that she is 3 percent Dai (an ethnic group from southwest China).

A development to watch for in genomics, particularly in China, is the sequencing of babies, said Cifric. In the next five years, “the goal is to have every single newborn have their genome sequenced at birth, but have the interpretation of the data focused on early-onset disease, just things that happen in the first five to 10 years of life, information that might save their life,” said Cifric. “This is something that we are building a strong presence in China.”

Veritas is introducing a new product called myBabyGenome in China, currently in its pilot phase. It decodes the complete genomes of newborns for $1,500, providing a report on 950 serious early- and later-life disease risks, 200 genes connected to drug reactions, and more than 100 physical traits a child is likely to have. In a nation where anxious Chinese parents will look for any means to shape their children’s future and give them advantages in life, newborn sequencing will most likely become a must-have product.

Yang does not have children yet, but when she does, she said she will definitely have their genomes sequenced. “The earlier in life we do one, the more chance that we have in changing our habits,” she said. “And changing our fate.”