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

Biogen’s Alzheimer’s drug reached approval despite weak clinical evidence and unanimous rejection by the FDA advisory panel, after Biogen highlighted a high-dose subgroup with 23% slower decline. The FDA approved it at roughly $56,000 a year; three advisers resigned, while Biogen gained about $20 billion in market value within five days.

The drug debate exposed a deeper incentive problem: Friedberg said Medicare Part B effectively ties physicians’ compensation to the price of administered drugs through a 6% payment. He argued that when neither patients nor doctors bear the full cost, marginally effective treatments can proliferate while healthcare spending keeps rising.

Remote work produced at least one concrete productivity gain: Metromile’s Tempe customer-service and claims operation reported higher output per employee after going fully remote. Calacanis separately said his daily and weekly Slack reporting system made contribution levels obvious; two employees quit after he introduced it, and both proved to be among the lowest performers.

Calacanis said a housing company in his portfolio was being flooded with affordable-housing opportunities, to the point that choosing projects had become the problem. He said factory-built modular construction could remove six months to a year from building time, leaving local approvals and regulation as the main constraint.

The tax discussion identified the practical advantage of extreme wealth: owners can borrow against appreciating assets instead of selling them and triggering taxable gains. Chamath added that investment-related borrowing can make interest deductible and argued that cheap leverage lets already-wealthy investors compound capital in ways people without substantial collateral cannot easily replicate.

Chamath drew a firm information boundary when the hosts pressed him about reports that Richard Branson might race Jeff Bezos into space. As Virgin Galactic’s chairman, he acknowledged his role but refused to comment on anything not public, an unusually clear glimpse of where podcast conversation stopped and board-level information began.

Friedberg ended with a speculative but specific cloning pathway: reprogram an ordinary body cell into a pluripotent stem cell, convert it into an egg cell, then induce development without fertilization. He stressed that the crucial developmental step had not been demonstrated in mammals and presented human cloning on this route as a possible future trajectory, not an achieved technology.