We're Paying $1 Billion to Fall Behind

Every country makes mistakes. What’s harder to accept is when a country makes them on purpose—or at least knowingly. The United States is currently doing both, making choices that point not sideways, not slower, but backward in ways that could take a generation to undo.

The federal government recently agreed to pay roughly $1 billion to TotalEnergies to abandon offshore wind projects in U.S. waters. Those projects were expected to power more than a million homes. Instead, that capital is being redirected into dirtier, less sustainable oil and gas development. This is not deregulation. It is a deliberate, taxpayer-funded intervention to halt one form of domestic energy production in favor of another.

That alone should give pause. But it's part of a pattern—across energy, science, public health, civil rights, and institutional governance—that suggests the country is pulling away from the very foundations that built its strength. And not by accident.

Science and Research

Energy decisions make headlines. Science policy rarely does. But the consequences of underfunding it outlast any news cycle.

For decades, American leadership has been built on sustained investment in research through institutions like the National Institutes of Health and the National Science Foundation, investments that produced the breakthroughs defining modern life, from cancer therapies to semiconductors. Recent funding constraints and disruptions are already affecting research pipelines. Universities are scaling back. Grants are stalled. Researchers are reconsidering where to build their careers.

This isn't theoretical. It's arithmetic: slow the investment, slow the innovation, lose the ground. China has spent years building out its research capacity. The EU keeps deepening collaborative funding. The U.S. doesn't need to outspend them. But walking away from the table is a different thing entirely.

Public Health

The costs in public health are the most immediate. The United States spent decades creating a system capable of responding to outbreaks, developing vaccines, and protecting population health. It took a long time to build. It’s taking a far shorter amount of time to break.

Recent shifts in vaccine policy and public health messaging are accelerating that erosion. Growing political interference in agencies like HHS, combined with amplified skepticism toward vaccines despite overwhelming scientific consensus, is undermining the institutional confidence that makes public health systems work. Vaccines are one of the most effective tools medicine has ever produced, and the trust behind them took generations to earn.

Eroding confidence in that system doesn't create freedom. It creates a specific kind of vulnerability—the kind that shows up as outbreaks, as misinformation taking hold, as people dying from diseases we know how to prevent. And once that trust is gone, it doesn't come back easily.

Environmental Policy

Not every regulation is worth keeping. Some rules are outdated, some are redundant, and a serious case can be made for trimming them. But that's a different argument from what's actually happening.

Efforts to weaken water protections, emissions standards, and pollutant tracking may reduce compliance costs in the short term. But many of these protections were established after costly failures: industrial contamination, unsafe air, widespread health consequences. Rolling them back doesn't eliminate risk. It shifts it onto communities and future taxpayers. When guardrails are removed, the consequences tend to arrive later and cost more.

Voting Rights and the Press

A country's strength depends on whether people trust the system that governs them. The proposed SAVE Act would require documentary proof of citizenship to register to vote. Noncitizen voting is already exceedingly rare, yet millions of eligible Americans lack ready access to such documentation—rural voters, lower-income individuals, many married women whose legal names differ from their birth certificates. When barriers rise, access falls. Policies that reverse the trajectory toward broader participation reshape who governs and who does not.

The same pressure is bearing down on the press. The First Amendment isn't an abstraction—it's the mechanism by which power gets scrutinized, challenged, and held to account. When the government threatens broadcast licenses, targets specific media organizations through regulatory pressure, and repeatedly labels journalists as enemies of the state, the effect is a press that pulls its punches. A country without independent journalism doesn't become more stable. It becomes less informed, and more easily misled.

The Pattern

Each of these areas can be debated individually. But taken together, they point in the same direction: away from investment in the future, away from scientific expertise, away from broad democratic participation, and away from the independent institutions that hold power accountable. That is not a neutral shift. It is a deliberate one.

And because these systems are connected, the damage doesn’t stay in one place. Weaker research means slower medical breakthroughs and fewer competitive industries. A less trusted public health system means a less healthy, less productive workforce. And when people stop trusting institutions, the effects are harder to trace but impossible to ignore.

It's tempting to view these developments as inevitable, as if they're simply the product of forces too large to name or change. They're not. They are the result of decisions made by elected officials, supported by voters, and enabled by disengagement.

Many Americans supporting these policies are doing so in good faith, responding to legitimate concerns about economic security and eroding trust in government. But good intentions don't guarantee good outcomes. In practice, these policies often work against the very interests they claim to serve—gutting research slows the medical breakthroughs that save lives, weakening public health infrastructure puts families at greater risk, and turning away from future industries shrinks the economy those families depend on.

This isn’t really about left or right. It’s about whether the choices being made actually serve the people they’re supposed to serve.

The United States is not in irreversible decline. It remains one of the most dynamic and capable countries in the world. But direction matters.

Spending $1 billion to shut down offshore wind development is not the defining policy of this era. But it’s a clear signal of what the priorities are—and those priorities reach well beyond energy. Countries don’t usually fall behind all at once. They do it gradually, through decisions that each seem defensible on their own but add up to something much harder to reverse.

That process can be reversed. But it won't reverse itself. It takes attention and engagement—and if left unaddressed, it can last for a generation.

The Dissonance in Pharma DTC Erodes Credibility — and Limits Its Potential

The future of DTC should foster understanding, trust, and improve clinical conversations.

Prescription-drug commercials have been a recognizable part of American TV for nearly 30 years. Their production values have kept up with the rest of the advertising world, and in the costliest broadcast spaces, they now look almost identical to ads for consumer tech, cars, and sports betting. As The New York Times reported, spending on direct-to-consumer drug advertising is rising again, driven by competition in high-profile therapeutic areas – a reminder that DTC advertising is not fading but growing in scope and influence.

I have been writing about DTC pharmaceutical ads for nearly 20 years, and the dissonance – cavorting cartoon characters or people climbing mountains while vital information is voiced over – has remained remarkably consistent. Patients and clinicians often start the clinical conversation inside a narrative that the advertising has already shaped.

DTC advertising is the biggest untapped resource for public health education in the country. The concern isn't about the presence of risk information; it's whether the overall experience helps people understand what those risks mean and how they should affect treatment choices.

An ad for Vanda Pharmaceuticals’ antipsychotic Fanapt highlights this disconnect: a calm voice lists stroke risk, cardiac complications and sudden death while smiling, anime-style characters move through bright, cheerful scenes. The disclosure follows regulations but trivializes the seriousness of the condition and distracts from the importance of the adverse-event information.

Regulators have started to recognize the gap between mere compliance and actual understanding. The FDA’s letter to Novo Nordisk about a TV commercial for oral Wegovy criticized how the ad implied broader emotional and lifestyle benefits than the evidence supports. In another letter concerning a commercial for argenx’s Vyvgart Hytrulo, the agency noted that “attention-grabbing visuals, frequent scene changes and background music” might hinder understanding of the major risk statement. That language matters because it acknowledges that production techniques influence how risk is perceived. However, it stops short of addressing the core creative decision in most branded campaigns – whether the story enhances the safety message or competes with it.

Direct-to-consumer advertising grew rapidly after the FDA relaxed its broadcast guidance in 1997 and finalized the approach in 1999. Drug names became part of everyday conversation. Awareness increased, but public trust in the industry did not follow the same trajectory. The American Medical Association’s 2015 call for a ban on DTC advertising reflected ongoing concerns that brand narratives can influence the clinical encounter before a diagnosis is made. Physicians interviewed by The Times this week described spending valuable visit time recalibrating expectations created by advertising – explaining why a widely promoted therapy may not be suitable or why its risks and benefits are more complicated than the commercial suggests. That debate is unfolding at a time when trust in health institutions remains fragile.

The conversation still tends to frame DTC as a choice between maintaining the current model and eliminating it. But this overlooks a bigger issue. The pharmaceutical industry now controls some of the most influential health-communication platforms in the country – including television, streaming, social media, search, and digital video. How this multi-channel infrastructure is used has huge implications for how patients understand their health.

That reach is most visible during the Super Bowl. In 2024, Pfizer chose not to promote a specific therapy but to “celebrate science” on its 175th anniversary. Instead, the message was muddled and abstract. Pfizer missed an opportunity – not because its creative execution was weak, but because the platform’s power far exceeded the depth of what it chose to say.

That same media moment has also shown what a different objective looks like. Novartis’ Super Bowl LX screening initiatives and Bayer’s heart-health risk campaign used the industry’s most expensive media real estate to encourage early detection and informed action. They are not simply creative templates for branded advertising; the regulatory environment is different. They demonstrate that when education takes priority, storytelling shifts – and viewers leave with knowledge rather than just an impression.

Branded advertising operates within stricter regulatory constraints, but it still makes choices about tone, pacing, and imagery. These choices determine whether safety information is incorporated into the story or hidden beneath it. The issue is not about fair balance. It's whether the surrounding narrative trivializes the disease and distracts from the risks that should influence treatment decisions.

In many product campaigns, the narrative reassures, while the safety information warns. The viewer receives two emotional signals at the same time and must reconcile them. This split may work well for recall, but it weakens the credibility on which long-term brand success now depends.

Eliminating DTC would remove a source of awareness that has encouraged patients to seek care earlier and discuss stigmatized conditions with their physicians. The opportunity is to use it more effectively. A better approach would replace distraction with decision support – focusing on the moments when a patient and clinician weigh options, reassess progress, and adjust the course if a therapy is not suitable. In this model, safety information is not an interruption; it becomes part of the narrative.

This isn't a call for longer risk language or more data on the screen. It's a call for creative alignment. When tone, imagery, and narrative support the medical reality instead of competing with it, the advertising sets the stage for the clinical conversation rather than pre-empting it.

That shift has business implications. The industry has long argued that informed patients achieve better outcomes. In a crowded and scrutinized market, credibility remains one of the few durable advantages for brands. Creative work that distracts from risk might boost short-term recall, but creative approaches that aid decision-making builds trust with patients, clinicians, and regulators.

Direct-to-consumer advertising has become a permanent feature of American culture. Its future credibility will rely more on whether it bridges the gap between marketing and medicine than on disclosure adherence. In a medium where a 30-second story can reach tens of millions, aligning the message with medical truth is no longer optional; it is essential for understanding.