Jun 13, 2021 · 1h 35m · allin
E35: Biogen's controversial Alzheimer's drug approval, the billionaire space race, Bitcoin & more
Chamath Palihapitiya · 25m spoken Jason Calacanis · 22m spoken David Sacks · 20m spoken David Friedberg · 18m spoken
0:00 / 0:00
▶ Watch on YouTube →
gold bands on the timeline = statements, start to end. Hover to read, click to jump. CC turns on captions
In Episode 35 of the All-In Podcast, hosts Jason Calacanis, Chamath Palihapitiya, David Sacks, and David Friedberg analyze the FDA's controversial approval of Biogen's Alzheimer's drug, Jeff Bezos's upcoming spaceflight, remote work corporate policy debates, and leaked IRS billionaire tax records. Through spirited debate, the hosts evaluate regulatory incentives, housing inflation, corporate meritocracy, and global technological competition with China.
How this conversation actually went
Every chapter scored 0–10 on four independent dynamics. Hover any point for the reasoning behind the score. The hosts hold 99.4% of the talking time here. How this is scored →
The hosts as informed peer 6.7 Guest teaching 3.2 Guest disagreement 4.3 The hosts pushing back 4.6
speaking balance: gold is the hosts, purple is the guest (3 minute bins)
Sharpest disagreement ▶ 35:32 Space Military Dominance vs Bea Arthur Mockery
Sacks forcefully insists on the high-ground military imperative of space weaponry while Chamath openly ridicules him and Jason as elderly sitcom characters.
Hardest push from the hosts ▶ 28:03 Friedberg Rejects Historical Probability FallacyFriedberg strictly rejects Jason's effort to calculate future rocket safety from historical failure rates of previous iteration machines.
Biggest teaching moment ▶ 4:03 Friedberg Explains Monoclonal Antibodies and Plaque RemovalFriedberg delivers a masterclass on monoclonal antibodies, clearing amyloid plaque, and the technical reasons Biogen's initial trial data was re-evaluated.
The host holds their own ▶ 15:19 Chamath Reveals Medicare Part B 6% Kickback IncentiveChamath demonstrates deep systemic market knowledge by exposing how Medicare Part B awards physicians a 6% commission on administered drug prices.
the scores for every segment, with the reasoning behind each
| Chapter | Topic | The hosts as informed peer | Guest teaching | Guest disagreement | The hosts pushing back | Why |
|---|---|---|---|---|---|---|
| Pre-Show Banter and Camera Setup | 1 | 1 | 2 | 1 | Light pre-show banter as Chamath shows off his European vacation ceiling and scenery while Sacks and Jason joke about Jacob's early start time. | |
| Biogen's Controversial Alzheimer's Drug FDA Approval and Science Breakdown | 8 | 5 | 2 | 3 | Friedberg delivers a comprehensive scientific breakdown of Biogen's Alzheimer's monoclonal antibody drug aducanumab, trial data slicing, and pricing dynamics. | |
| Market Dynamics, Alzheimer's Demographics, and FDA Precedents | 8 | 4 | 2 | 3 | Chamath outlines Alzheimer's demographic distributions, historical market failure patterns, insider trading history, and FDA precedent under Janet Woodcock. | |
| Medicare Part B Kickbacks, Systemic Incentives, and Free-Market Debates | 7 | 3 | 4 | 5 | Chamath reveals the 6% physician kickback incentive embedded in Medicare Part B, prompting Friedberg to challenge the systemic economic inflation created by such approvals. | |
| Free-Market Drug Approval, Terminal Prognosis, and Economic Value | 6 | 2 | 3 | 4 | Sacks argues from a free-market perspective that terminal patients with nothing to lose should have access to inconclusive drugs as an informal stage four trial. | |
| Regulatory Trade-offs, Healthcare Cost Inflation, and Market Innovation | 7 | 3 | 4 | 5 | Friedberg highlights the macroeconomic danger of healthcare cost inflation when approvals are granted without pricing discipline in a partially socialized model. | |
| Jeff Bezos's Spaceflight Announcement and Fatality Risk Analysis | 6 | 6 | 4 | 5 | Jason attempts to calculate fatality risk from historical test flight failures, but Friedberg pushes back sharply against applying historical probabilities to modified deterministic systems. | |
| Billionaire Ego, Suborbital Flights, and Richard Branson's Counter-Launch | 5 | 2 | 5 | 4 | Sacks takes a contrarian stance calling Bezos's spaceflight a dangerous brain fart and suggests putting a VR headset on a dummy instead. | |
| Government Space Incentives, Military Strategy, and Geopolitical Competition | 7 | 3 | 7 | 7 | A heated clash occurs when Sacks and Jason argue for military space dominance and tungsten rod kinetic weapons while Chamath openly mocks their hawkish rhetoric. | |
| Government R&D Funding, Industrial Policy, and Clean Energy Debates | 7 | 2 | 4 | 4 | Friedberg explains how heavy regulatory burdens killed nuclear energy development, drawing contrasts with government contract incentives in space and clean technology. | |
| COVID Reopening Milestones and Corporate Work-From-Home Conflicts | 7 | 2 | 6 | 5 | Sacks criticizes Apple employee petitions regarding WFH policies, claiming management constantly caves to employee mobs and that WFH enables low performers to hide. | |
| Hybrid Meeting Faux Pas, Tech Campus Perks, and Career Growth | 6 | 3 | 4 | 5 | Friedberg reminisces about lavish perks at Google during its private days, while Sacks argues that campus perks offered zero career skill building. | |
| Evaluating Remote Work Policies and Workplace Productivity | 7 | 4 | 4 | 5 | Sacks favors regional company hubs, whereas Friedberg shares Metromile data proving employee productivity increased after shifting fully remote. | |
| Salesforce's Slack-First Strategy and Office Vacancy Rates | 8 | 3 | 5 | 5 | Sacks praises Marc Benioff's marketing strategy around Slack, then forcefully attacks NIMBYism and California's proposal to subsidize first-time homebuyer down payments. | |
| ProPublica IRS Tax Leak and Systemic Tax Reform Debates | 8 | 4 | 5 | 5 | Friedberg and Sacks clarify that wealth accumulation is unrealized stock gains rather than taxable income, while Chamath breaks down margin loan interest deductions. | |
| Crypto Maximalism, Fight Club Nihilism, and Corporate Purpose | 7 | 4 | 6 | 6 | Jason critiques Bitcoin maximalist toxicity at the Miami conference, prompting Sacks to defend crypto subcultures and quote Fight Club to explain social frustration. | |
| Corporate Meritocracy, Cancel Culture, and Global Competition with China | 8 | 3 | 6 | 6 | Chamath warns that US culture wars pale in comparison to China's intense 996 work ethic, while Sacks notes that Frank Slootman's forced apology shows CEOs are afraid to express true opinions. |
Statements from this episode (41)
Chamath: Volatile European weather explains high regional concern over climate change
“No wonder everybody here takes climate change so seriously, you actually feel it every day.”
Chamath: FDA advisory panel voted unanimously against Biogen's Alzheimer's drug
“Three quit, but unanimous vote against approval.”
Friedberg: Antibody therapy costs $5 to make while Biogen charges $56,000
“It costs roughly five dollars to make antibody therapy, just to be clear. So when you make them five bucks roughly is the cost, and they're charging 56,000 dollars for this treatment.”
Chamath: Every prior Alzheimer's drug submitted to the FDA failed
“Every single Alzheimer's drug that's ever gone through the FDA has been rejected and has failed.”
Chamath: Medicare Part B pays physicians a 6 percent drug markup
“Under a Medicare Part B plan, a physician gets a six percent kickback of the price of the drug.”
Sacks: FDA should conditionally approve terminal disease drugs as Phase 4 trials
“These people have nothing to lose, and so I would let the drug through, I think, and then watch how it performs over the next couple of years. They could always revoke the approval in two years, you know. In other words, almost consider the usage of the drug o…”
Friedberg: Drug pricing is calculated from long-term healthcare system cost savings
“Pricing is typically done based on the long term cost benefit of the of the drug of the to the paying system. So, you know, they'll take a look at like, hey, here's how much we're going to benefit people or benefit the paying system. Therefore, we can charge X…”
Chamath predicts Biogen's drug approval will incentivize faster and cheaper competitors
“I think it stands to reason that a lot of people will look at the increase in Biogen's market cap and the profits that Biogen can make over the next 10 or 15 years and say, I will attack that and do that cheaper, faster, better.”
Friedberg predicts easier drug approvals will accelerate healthcare inflation
“We are going to see this proliferation of approvals that end up costing all of us so much that the inflation that we've already experienced in terms of paying costs for healthcare continues to climb.”
Calacanis states Biogen gained $20B in market cap within five days of FDA approval
“They added twenty billion dollars in market cap in the five days since you know, this announcement happened.”
Calacanis: 5% to 10% of Blue Origin test flights would have been fatal
“Blue Urgent's done 20 some odd flights, two of which went south and probably would have existed resulted in death. So I think five to 10% of Blue Urgent's fight flights would have killed.”
Calacanis: SpaceX had two accidents in 120-plus flights, zero in six years
“Two of the 120 plus flights that SpaceX have done, but none in the last six years have had an accident.”
Friedberg predicts Jeff Bezos will announce he is becoming Blue Origin CEO
“My prediction is Bezos is going to come back, and he's going to announce that he's going to be the CEO of Blue Origin.”
Friedberg predicts Amazon will operate as a monopoly for decades
“He's got the world's greatest money machine ever. It's a flywheel. It'll run as a monopoly for decades.”
Sacks calls Jeff Bezos's spaceflight decision a foolish idea enabled by sycophants
“Quite frankly, I think this is a brain fart that the people around him are telling him smells like perfume and they should be telling him, dude, what are you thinking?”
Sacks: The government is not good at research and development
“Instead of having the government doing all the R&D, and the government is good at some things, but R&D is not one of them.”
Chamath: Space is too vast for any nation or entity to own
“It's too vast, it's effectively infinite, you can't own it, ok?”
Calacanis: Russia and China have 100-year plans to dominate humanity
“They have a hundred year plans to dominate humanity, and they are willing to put millions of people into concentration camps.”
Sacks: Future military artillery will be space-based
“Look, the future artillery is going to be from space.”
Sacks: Nuclear energy expansion is unrealistic due to local NIMBYism
“Nobody, nobody wants nuclear. There's a huge NIMBY problem with nuclear, right? Which is who really wants a nuclear power plant in their backyard? I mean, not gonna happen. I don't think it's realistic.”
Friedberg: Geothermal capacity equals 100 billion years of current energy consumption
“Geothermal capacity is still like a hundred billion years based on our current consumption rate.”
Sacks: Most Craft Ventures portfolio companies are remote or distributed
“Most of my portfolio companies are now working from home or fully distributed.”
Sacks: Remote work improves top workers but lets weak ones hide
“I think that work from home makes the best employees better, but it allows the worst employees to hide.”
Sacks: Tech giants fear remote work hides thousands of unproductive employees
“And I think what this really comes down to is a fear on the part of Apple and Google and Facebook. They've got thousands of employees who aren't really working and are going to be able to completely hide.”
Chamath: Remote work won't reach full potential until onboarding is solved
“And until you do that, I'm not sure that work from home will be as effective as it can be, because I think you'll just get a lot of people that, that languish a little bit as they switch jobs.”
Chamath: Remote work will lower commercial real estate utilization, not destroy it
“On your point of commercial real estate, Jake, I actually think it just brings the utilization down, but I'm not sure it destroys it because I think people need the physical plant.”
Chamath: Flex workspace providers like WeWork will benefit from hybrid work trends
“Now, maybe over time they'll get much smarter about getting smaller spaces and having flex spaces. So like things like we work do better because then you use that for overflow space or that's how you actually have a primary outfit.”
Friedberg: Metromile's per-employee productivity increased after going fully remote
“At Metro Mile, we have a big customer service and claim center in Tempe, Arizona. And we have gone fully remote since the pandemic and productivity per unit per, per employee's gone up.”
Jason Calacanis: San Francisco has 16M sq ft of vacant office space
“It's sixteen million of square feet of vacant office space now spread across San Francisco.”
Chamath predicts recent U.S. inflation surge is a temporary head fake
“I think this whole inflation thing is a head fake.”
Sacks: Populist left and right will unite against hedge fund home purchases
“So I think you're going to see a unanimity on the populace left and right in reaction to these hedge funds.”
Chamath: Homeownership drives 60 to 70 percent of average American wealth creation
“The other really terrible thing about home ownership is that it is where the preponderance of wealth creation for average Americans comes from. And so when you lock people out of home ownership, you're essentially ripping away. 60 to 70% of how they're ever go…”
Calacanis: US will force tax return publication and impose a wealth tax
“And so I think the way the United States is going is we're going to force people to publish their tax records. And we're going to force some sort of minimum for people with holdings, aka wealth tax.”
Palihapitiya: AQR study found Warren Buffett ran 20-30% leverage via Geico float
“There's a really great study by AQR, I think is the name of the hedge fund, and they reverse engineered Buffett's returns. And what they saw was that Buffett ran about 20 to 30% levered his entire career. And the way he did that was synthetically by the float …”
Chamath: The iPhone would never have existed without Steve Jobs
“The iPhone would never have happened had it not been for Steve Jobs.”
Sacks: Apple employees would race back if Steve Jobs were alive
“If Steve were still around, those Apple employees would be racing back to the office because they'd be so excited about what they're working on.”
Chamath Palihapitiya: Nuclear power is the fastest path to carbon neutrality
“Because it is the fastest way for us to get to carbon neutral.”
Palihapitiya: Greenpeace is one of the largest opponents of nuclear energy
“The same people who want carbon neutral, i.e. Greenpeace is the one of the largest advocates against nuclear.”
David Sacks: US foreign policy aligns on China, but domestic policy lags
“You're seeing both Democrats and Republicans really get on the same page now about the threat that China represents, but our domestic policy is not realigned around that.”
Friedberg: Science could allow cloning humans from body cells within 20 years
“So in theory, in the next decade or two, we could take any hair cell from our own body, Converted into a stem cell. This is totally sci-fi. By the way, it's not proven. There's no, there's a bunch of discoveries that have been made research that's been done th…”