E35: Biogen's controversial Alzheimer's drug approval, the billionaire space race, Bitcoin & more
Jason Calacanis (host), David Sacks (host), Jason Calacanis (host), David Friedberg (host), Chamath Palihapitiya (host), Narrator, Narrator, Narrator
In this episode of All-In Podcast, featuring Jason Calacanis and David Sacks, E35: Biogen's controversial Alzheimer's drug approval, the billionaire space race, Bitcoin & more explores alzheimer’s drug uproar, billionaire space race, and economic fault lines This All-In Podcast episode spans Biogen’s controversial Alzheimer’s drug approval, the billionaire-led private space race, post-pandemic work-from-home battles, the housing and inflation crunch, and tax fairness debates. The besties unpack how weak efficacy but strong financial incentives shaped the aducanumab decision and what it reveals about FDA, Medicare, and pharma. They then dive into Bezos vs. Branson vs. SpaceX as a test case for public–private innovation, before shifting to remote work, commercial real estate, and structural problems in housing supply and inflation. The conversation closes with IRS tax leaks, wealth creation mechanics, meritocracy vs. diversity fights, China’s 9-9-6 work culture, and the social psychology behind Bitcoin maximalism.
Alzheimer’s drug uproar, billionaire space race, and economic fault lines
This All-In Podcast episode spans Biogen’s controversial Alzheimer’s drug approval, the billionaire-led private space race, post-pandemic work-from-home battles, the housing and inflation crunch, and tax fairness debates. The besties unpack how weak efficacy but strong financial incentives shaped the aducanumab decision and what it reveals about FDA, Medicare, and pharma. They then dive into Bezos vs. Branson vs. SpaceX as a test case for public–private innovation, before shifting to remote work, commercial real estate, and structural problems in housing supply and inflation. The conversation closes with IRS tax leaks, wealth creation mechanics, meritocracy vs. diversity fights, China’s 9-9-6 work culture, and the social psychology behind Bitcoin maximalism.
Key Takeaways
Aducanumab’s approval exposes tension between scientific rigor, hope, and market incentives.
The FDA overrode a unanimous advisory panel that found the data inconclusive; safety is good but efficacy is modest and contested, yet approval creates a potential $100B market that may spur further Alzheimer’s innovation.
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Misaligned healthcare incentives drive up costs even when drug manufacturing is cheap.
The monoclonal antibody reportedly costs around $5 to make per dose yet is priced at ~$56,000 per year, with Medicare Part B paying and physicians getting a 6% ‘spread,’ creating powerful economic pressure to prescribe marginally effective drugs.
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Using approvals to ‘create markets’ can accelerate R&D but risks precedent creep.
The hosts argue the FDA may be repeating its Duchenne muscular dystrophy playbook—sanctioning a weak-evidence drug to catalyze industry investment—raising questions about whether regulators should double as market-makers.
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The private space race illustrates how government contracting can outperform government-run R&D.
NASA’s shift to buying launch services from SpaceX and others, rather than building everything internally, has cut costs, increased launch cadence, and catalyzed a broader commercial space ecosystem, while also raising real military and geopolitical stakes in orbit.
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Hybrid and remote work amplify management, onboarding, and performance-measurement challenges.
Large companies face difficulty supervising thousands of employees they barely see, while startups are leaning into fully distributed models; simple process hacks like daily/weekly Slack check-ins can sharply clarify who’s actually producing.
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Housing pain is primarily a supply and policy problem, not just a rate problem.
NIMBY zoning, regulatory friction, and now institutional home-buying are constraining supply and pushing out first-time buyers; the hosts argue that loosening building restrictions and embracing modular construction matter more than one-off subsidies or blaming hedge funds.
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Public anger at ‘tax-avoiding billionaires’ often confuses unrealized gains with income.
The ProPublica IRS leak showcases how the very wealthy live off loans against appreciated assets and deduct interest, but the panel stresses that under current rules tax is due at realization; they criticize narrative framings that ignore this and point to deeper structural inequities like limited access to homeownership, private investing, and quality education.
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Notable Quotes
““If you have a well-structured safety study that says that these things are not harmful to humans, then… we should probably be in the business of getting more drugs approved faster.””
— Chamath Palihapitiya
““The FDA could approve 100 drugs tomorrow, and then what happens to the economics of healthcare if everyone’s allowed to charge any price they want for any care if it has even the slightest range of efficacy?””
— David Friedberg
““This is privatization for the win… Instead of having the government doing all the R&D, you let the private sector do it and NASA contracts with them to deliver the product.””
— David Sacks
““When you lock people out of homeownership, you’re essentially ripping away 60 to 70 percent of how they’re ever going to make real wealth.””
— Chamath Palihapitiya
““We are screaming at each other about things that none of us really understand without taking the time to understand each other. Meanwhile, China is 9-9-6.””
— Chamath Palihapitiya
Questions Answered in This Episode
Should regulators ever explicitly use drug approvals to ‘manufacture’ markets and spur investment, or does that inevitably compromise scientific standards?
This All-In Podcast episode spans Biogen’s controversial Alzheimer’s drug approval, the billionaire-led private space race, post-pandemic work-from-home battles, the housing and inflation crunch, and tax fairness debates. ...
Get the full analysis with uListen AI
How could Medicare, the FDA, and Congress be restructured so that safety, efficacy, and pricing incentives are aligned instead of working at cross-purposes?
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What concrete policies would actually increase housing supply and homeownership opportunities without simply inflating prices further or over-subsidizing demand?
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Is there a fair way to tax unrealized gains—or implement a wealth tax—without distorting investment, crushing non-elite asset holders, or creating massive administrative complexity?
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In the long run, will fully distributed workforces and Slack-centric organizations outperform traditional co-located ones, or will onboarding, culture, and innovation suffer in ways we don’t yet see?
Get the full analysis with uListen AI
Transcript Preview
(laughs)
Like, Jacob-
Sorry.
... could you get any closer to the camera? I mean, your face is, like, right up in it.
(laughs) We can see your bloodshot eyes.
Oh, God.
I mean, it- it's really unbelievable. (laughs)
9:00 AM start time's-
(laughs) .
... a little rough on Jacob. A little rough on Jacob.
That's true. I want my second cup of coffee already.
(laughs) This is- this is a lifestyle choice we may regret.
I'm going all in. Don't let your winners ride.
Rain Man, David Sachs.
I'm going all in. And I said- We open source it to the fans and they've just gone crazy with it. USI. Love you at night. Queen of Quinoa. I'm going all in.
Hey, everybody. Hey, everybody. Welcome to another episode of The All In Podcast. It's Saturday morning. It's ridiculously early, but we're taping the show because one of the besties happens to have left the continent with us from, uh, an undisclosed location, Chamath Palihapitiya. Are you in a wine cellar or-
(laughs)
... in catacombs? Uh, wh-
I am in. I am in... Look at it. Wait for it, wait for it. Wow. D- Were you able to see that or no?
No.
What was it?
Are you in the c- Are you in the cathedral somewhere?
You mean the ceiling of your room?
(laughs)
The sky walks on the ceiling. It's incredible. So, you paid for the four walls and now you can afford the roof.
Yeah, okay, hold on, hold on.
Fantastic. Congrats.
Okay, hold on. I'll do a little, I'll do a little, uh... Let's see if you can just see outside and get a sense of the view. Oh, you can't. Oh, no. It's hard.
We can, we can. Just, uh, pause for a second.
Oh, yeah. There it is. There's the-
Oh. Whoa, bestie lifestyle happening. They're just gotta hold it for a second and then the light will do the thing.
Oh, no, that's my architect. Hold on.
(laughs)
I'm going to-
Look at this. Wow. Hmm.
... go out here.
This is some-
I love how the- I love how the house is already built and he's still paying the architect.
Yeah. He's like, "Uh, do me a favor. This came out great, but-
Yeah.
... can you rip down these four rooms and then just start over?" (laughs) All right. Well, we lost, uh, bestie C as he walks around his castle in some European country.
Welcome to Lifestyles-
(laughs)
... of the Rich and Famous.
What time is it there for you?
Well, it's, uh, six in the afternoon. Six in the evening. I- I was in London last week, and holy mackerel, the weather... If you wanna see climate change, spend some time in Europe, because literally day over day, uh, London on the first day I landed was, call it 24 degrees Celsius, so whatever that is, 80, 78 maybe. Beautiful. Literally the next day, it was 62 and raining. And it just kept bouncing back and forth. It is the weirdest thing. And if you're in Europe right now, you- you just see some of the craziest weather patterns literally day over day, massive thunder showers, then, you know, it's completely normal. I mean, no wonder everybody here takes, uh, climate change so seriously. You actually feel it every day.
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