E35: Biogen's controversial Alzheimer's drug approval, the billionaire space race, Bitcoin & more

Biogen's Alzheimer's Drug (Aducanumab) Approval

• The FDA approved Biogen's drug Aducanumab on Monday, marking the first new Alzheimer's treatment in nearly two decades.
• The drug is a monoclonal antibody designed to bind to and clear amyloid plaque from the brain, though it is not a cure and does not reverse disease progression.
• Three members of the FDA advisory panel resigned after voting unanimously against approval, citing the drug's modest efficacy.
• Biogen reported a 23% reduction in disease progression for the highest-dosage group, a data slice the FDA accepted despite conflicting results in other cognitive tests.
• The drug carries a list price of approximately $55,000 to $56,000 annually, equating to roughly $4,800 per monthly injection.
• Manufacturing costs are estimated at roughly $5 per dose, raising significant questions about the markup and the sustainability of current pharmaceutical pricing models.
• Medicare Part B covers the drug but includes a 6% kickback for physicians on the price, creating a financial incentive for doctors to prescribe it.
• Chamath Palihapitiya argues the FDA's approval may be a strategic move to create a $100 billion market, incentivizing other biotech firms to innovate and eventually produce more effective treatments.
• David Friedberg notes the FDA's lack of a public, plain-English explanation for overruling the advisory panel's unanimous recommendation against the drug.
• Jason Calacanis suggests that while the drug's efficacy is inconclusive, it should be allowed for patients with terminal prognoses to test, with the option for the FDA to revoke approval later based on real-world performance.
• The discussion highlights a structural disconnect between the FDA's regulatory role and CMS/Medicare's pricing/incentive structures, which Congress has failed to holistically fix.

Jeff Bezos and the Commercial Space Race

• Jeff Bezos announced his intention to fly on Blue Origin's suborbital rocket on July 20, 2021, with Mark Bezos and a third passenger.
• Spaceflight tickets for the flight were auctioned at up to $4.8 million, with Blue Origin having conducted over 120 flights, two of which resulted in accidents historically.
• Chamath Palihapitiya predicts Bezos will transition to running Blue Origin full-time after the flight, viewing it as his ultimate passion project.
• Jason Calacanis warns of the risks of early manned flights, suggesting a virtual reality simulation would be a safer alternative to risking a life for a stunt.
• Richard Branson has announced plans to fly on Virgin Galactic before Bezos, escalating a "space race" between the two billionaires.
• The panel attributes the rapid advancement in private spaceflight to U.S. government contract incentives (e.g., SpaceX contracts) that de-risked R&D for private companies.
• David Sax and Chamath emphasize the strategic necessity of U.S. dominance in space to counter military threats from China and Russia, particularly regarding satellite security and high-ground warfare.
• Military applications discussed include "tungsten rods" dropped from space capable of delivering kinetic strikes at Mach 35, as well as the potential for space-based nuclear threats.
• Chamath argues that the lack of regulatory burden in the current space phase is critical, warning that excessive regulation could stifle innovation similar to what occurred in nuclear energy and housing.

Remote Work and Corporate Policy Shifts

• Major tech companies have diverged in their return-to-work mandates: Apple and Google require three days in-office, Amazon requires two, while Twitter allows permanent remote work and Facebook is moving toward hybrid models.
• David Sax criticizes the culture of petitions and "snowflake" behavior at companies like Apple, where employees attempt to dictate corporate policy, arguing this reflects a management failure to supervise remote employees effectively.
• Chamath notes that while remote work benefits high performers, it allows low performers to hide; he proposes a lightweight "SOD/EOD" (Start of Day/End of Day) Slack reporting system to track productivity.
• Salesforce announced a pivot to become a "Slack-centric" company, aiming to make its platform the central hub for distributed workforces.
• The panel observes a crisis in commercial real estate, citing 16 million square feet of vacant office space in San Francisco alone.
• Jason Calacanis argues that the inability to build new housing is the root cause of the housing crisis, driven by NIMBYism and red tape rather than a lack of capital or demand.
• The group discusses the societal implications of hedge funds buying up residential housing, noting a populist backlash across the political spectrum while calling for regulatory reform to allow modular home construction.

Wealth Inequality, Taxation, and Political Discourse

• ProPublica released leaked IRS tax records of 3,000 wealthy Americans, revealing instances where billionaires like Jeff Bezos paid zero federal income tax or received tax credits despite massive wealth gains.
• The panel explains that wealthy individuals often avoid income tax by borrowing against their equity (margin loans) rather than selling assets, a strategy made tax-advantaged by deductible interest payments.
• Chamath and Jason argue that the narrative shift toward taxing "wealth" rather than "income" is gaining traction but ignores the liquidity and risk inherent in holding unliquidated assets.
• The discussion touches on the "Great Reconciliation" of American society, suggesting that free healthcare, universal housing construction, and free trade schools are necessary to restore upward mobility.
• David Sax and Chamath critique the current political culture of "toxicity" and performative activism, noting that corporations like Snowflake face backlash for prioritizing meritocracy over diversity rhetoric.
• Frank Slootman, CEO of Snowflake, apologized after comments implying diversity and meritocracy are mutually exclusive, which the panel views as evidence of CEOs' fear of public backlash.
• The group draws a parallel between domestic political paralysis and the strategic threat posed by China's "996" work culture (9 a.m. to 9 p.m., 6 days a week), arguing the U.S. must foster its own innovation ecosystem to compete.

Bitcoin Maximalism and Cultural Nihilism

• The Bitcoin conference in Miami exhibited "Bitcoin Toxicity," where maximalists aggressively attacked critics and demanded acceptance of Bitcoin as the only valid currency.
• Jason Calacanis compares this behavior to "Fight Club" nihilism, where frustrated young men channel their dissatisfaction into rigid, cult-like adherence to new ideologies.
• Chamath argues that the solution to this societal unhappiness is not UBI or withdrawal, but purpose-driven creation and the opportunity to build "great things."
• The group notes that the "iPhone" era required Steve Jobs' physical presence and intense collaboration, which remote work may fail to replicate, potentially impacting future product innovation.
• David Sax suggests that the current cultural climate forces people to choose between being "useful" or "virtuous," stifling honest debate on complex issues like nuclear energy and school choice.