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

**David Sacks** (0:01)
You get any closer to the camera, I mean, your face is like right up in it.

**David Friedberg** (0:05)
We can see your bloodshot eyes.

**Chamath Palihapitiya** (0:07)
It's really unbelievable.

**David Friedberg** (0:08)
start time.

**Jason Calacanis** (0:09)
It's a little rough by Jacob.

**David Sacks** (0:13)
That's true. I want my second cup of coffee already.

**Jason Calacanis** (0:15)
This is a lifestyle choice we may regret.
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 an undisclosed location, Chamath Palihapitiya.
Are you in a wine cellar or in catacombs?

**Chamath Palihapitiya** (0:58)
I am in.
I am in. Look at it. Wait for it. Wait for it.

**David Friedberg** (1:01)
Wow.

**Chamath Palihapitiya** (1:02)
Were you able to see that or no?

**David Friedberg** (1:05)
No.

**Jason Calacanis** (1:06)
Are you in the cathedral somewhere?

**David Friedberg** (1:08)
You mean the ceiling of your room?

**Jason Calacanis** (1:10)
It's incredible. You paid for the four walls and now you can afford the roof.

**David Friedberg** (1:16)
Okay, hold on.

**Chamath Palihapitiya** (1:17)
I'll do a little, let's see if you can just see outside and get a sense of the view. Oh, you can't. Oh, no. We can't. We can't.

**Jason Calacanis** (1:24)
Just pause for a second.
Oh, bestie lifestyle happening there. Just got to hold it for a second and then-

**Chamath Palihapitiya** (1:29)
Well, no, that's my architect. Look at this.

**David Friedberg** (1:35)
I love how the house is already built and he's still paying the architect.

**David Sacks** (1:38)
Yeah.

**Jason Calacanis** (1:38)
He's like, do me a favor. This came out great, but can you rip down these four rooms and then just start over?
Well, we lost Bestie C as he walks around his castle in some European country.

**David Sacks** (1:48)
Welcome to Lifestyles of the Rich and Famous.

**Jason Calacanis** (1:51)
What time is it there for you?

**Chamath Palihapitiya** (1:53)
Well, it's 6 in the afternoon, 6 in the evening. I was in London last week and holy mackerel.
The weather, if you want to see climate change, spend some time in Europe because literally day over day, 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 just see some of the craziest weather patterns, literally day over day, massive thundershowers, then it's completely normal. I mean, no wonder everybody here takes climate change so seriously, you actually feel it every day.

**Jason Calacanis** (2:38)
And with us as well, David Sacks is here, the Rain Man himself tearing up the Twitter. We've been off for two weeks, so there's a lot to cover. And of course, the queen of quinoa, chairman of the production board, David Friedberg. Right off the bat, I think we got to go science and get the Friedberg ratio up from the get.
Biogen has an Alzheimer's drug that on Monday, the FDA approved. It's the first new treatment for Alzheimer's in almost two decades.
And Biogen's drug is not a cure for Alzheimer's. And Friedberg will get into that. It does not reverse the disease's progression, but it does mitigate it. Gets it getting worse. Very strange moment in time. The FDA's advisory panel, three members of it have quit because they didn't want to approve this drug because it had such a modest efficacy.

**Chamath Palihapitiya** (3:28)
Three quit, but unanimous vote against approval.

**Jason Calacanis** (3:32)
Right. So unanimous vote against, then three quit. And this is, I think, out of 10 or 11 individuals. So this is truly significant. The drug is going to cost $55,000. It still requires brain scans and all this kind of stuff. But it's hope for people suffering.
And so the FDA approved it.
Friedberg, tell us on a science basis what we're seeing here. Is what's happening in journalism and social media now happening in science? Or is this some other search for truth or some other issue?

**David Friedberg** (4:03)
The Biogen drug that was approved this week is called aducanumab. Remember, any drug that ends with MAB, M-A-B, means monoclonal antibody. So it's an antibody.
Antibodies, as we've talked about in the past, are proteins that can be made by our immune system and proteins that bind to a specific target that then tells your immune system to clear that target out of your body. So that's what monoclonal antibodies do.