How pharma lost America
Throughout history, before a regime's downfall, it's the subtle undercurrents— microaggressions that seed skepticism, the gradual loss of trust, and the build up of quiet resistance that ultimately erode foundations, revealing the hollow core within seemingly permanent institutions.
Take the downfall of the Roman Empire, it wasn't sudden, but a centuries-long dissolution masked by the pretense of continuity. The pharmaceutical faces a similar fate today.
Rome's promise was permanence.
Ours is authority.
The Roman Empire didn't collapse from barbarians storming the gates. Its fall was etched in slow decay, invisible until the damage became permanent. Political legitimacy rotted from within through the "crisis of the third century" - 26 emperors in 49 years, most assassinated or overthrown. The imperial throne became a death sentence rather than divine right.
Economic trust dissipated as emperors silently devalued the currency year after year. Silver content in coins dropped from 90% to below 5%. The people's money became worthless tokens while elites hoarded real wealth.
Social cohesion fractured when citizenship - once sacred and exclusive - was mass-distributed to anyone who could pay taxes.
By the time visible threats appeared at Rome's borders, the empire was already hollow.
The pharmaceutical industry now faces its own arc of decay, marked by a documented erosion of public trust spanning six decades.
Yes, this system has made extraordinary advances: vaccines that eradicated smallpox and nearly eliminated polio; treatments for HIV that turned a death sentence into a chronic condition; and therapies that have dramatically improved outcomes for cardiovascular disease, various cancers, and numerous other conditions. Life expectancy in developed nations increased by nearly 30 years during the 20th century, with pharmaceutical innovations playing a huge role.
Yet beneath these massive achievements, institutional priorities many times diverged from public needs.
The 1962 Thalidomide crisis marked the first significant breach of public confidence. A sedative marketed as safe for pregnant women caused severe birth defects globally. Public outrage framed pharma as profit-driven rather than patient centric - a perception that data would increasingly support.
During the 1970s and 1980s, pharmaceutical lobbying budgets grew 400%, securing patent extensions and less regulation. The gap between rhetoric and reality widened. Patient rights movements emerged in response, demanding transparency from a regulatory system increasingly influenced by those it regulated.
The 1990s brought tangible evidence of systemic issues through litigation. Fen-Phen's link to heart valve damage resulted in a $3.75 billion settlement. TAP Pharmaceuticals paid $875 million for bribing doctors to prescribe Lupron for unapproved uses. Off-label marketing, meaning marketing drugs for unapproved uses, increased sales by 20-30% for drugs like Neurontin.
The public's economic relationship with pharmaceuticals shifted dramatically. Trust in the industry further declined as pricing became disconnected from both production costs and patient care. Like Rome's currency losing silver content, many pharmaceuticals increasingly extracted value while delivering diminishing returns.
The opioid crisis exposed how thoroughly this system had been compromised. Purdue Pharma paid $635 million for misleading marketing about OxyContin's addiction risks, fueling a crisis with $78.5 billion in annual societal costs. The opioid crisis, like Rome's collapse, revealed how an already weakened system finally cracked under pressure.
Antitrust violations further revealed the industry's priorities. 'Pay-for-delay' maneuvers, where brand-name firms paid generic drug makers to delay the release of cheaper versions, cost consumers $40 billion annually by 2019.
GlaxoSmithKline's $3 billion settlement in 2012 demonstrated the industry's willingness to promote drugs like Paxil and Wellbutrin for unapproved uses despite known risks.
The economic consequences were measurable. Drug prices rose 68% faster than inflation between 2008 and 2018, while industry profits averaged 15-20%. The divergence between value provided and price charged became difficult to justify.
By the 2020s, the regulatory system itself reflected questionable practices. User fees, which are fees paid by pharmaceutical companies to cover the FDA's drug-review costs, meant 45% of the FDA's budget came from the industry it regulated.
Despite demands for data transparency, 50% of clinical studies remained unpublished.
The COVID-19 pandemic briefly restored some public confidence, with pharmaceutical approval ratings rising to 62% in 2021 due to vaccine development. This goodwill quickly dissipated as familiar patterns reemerged, with ratings falling to 34% by 2024.
With public perception of pharmaceuticals at historic lows, the alternative health movements that had been brewing beneath the surface for decades have now erupted into full-fledged social phenomenons. In the political context, this crystallized when Robert F. Kennedy Jr. entered Trump's orbit. Kennedy, who pursued presidential candidacy and built his platform partly around health freedom and pharmaceutical industry reform, represented a growing segment of Americans questioning established medical paradigms.
What Rome and modern pharmaceuticals share is the psychology of institutional decline—the tendency of systems to maintain appearances long after their foundations have eroded. The public continues participating not from belief but from perceived lack of alternatives.
Ezra Klein noted in his recent podcast that attention - not money - governs our economic and political systems. This attention functions as the primary currency that unlocks persuasion, fundraising, and organizing capacity. It is the essential gateway to all other political resources in an ecosystem where the boundaries between media, commerce, and politics dissolve into a single attention marketplace.
It was precisely this attention economy that MAHA successfully navigated. In this landscape, the pharmaceutical industry's credibility collapse created fertile ground for disruption. In an era where 72% of Americans distrust institutions, the MAHA movement gained traction by tapping into institutional skepticism already embedded in public consciousness, their messaging aligned with values that resonated across various demographics.
The movement is positioned at the precise intersection of market readiness, public skepticism, and cultural momentum. It connected with a segment already disillusioned by conventional medicine, turning a niche subculture into a force capable of influencing policy.
This pattern mirrors what we've seen in market disruptions across sectors. Airbnb surfaced during the 2008 financial collapse when economic necessity changed both supply and demand behaviors. Blockchain tech gained traction exactly when trust in financial institutions plummeted. Legacy technology companies were outmaneuvered by competitors who saw through the psychological shifts driving market behaviors.
The sharpest investors understand that timing is everything - zeroing in on ventures that engender at the exact moment when public sentiment turns against incumbents but before alternative systems fully materialize.
This phenomenon plays into the broader health landscape. Having attended countless health conferences across the United States, I've observed how the longevity sector increasingly attracts people across political spectrums. These spaces reveal complex conversations where traditional affiliations blur, replaced by interests in health optimization, anti-aging research development, and institutional dialogue. The vocabulary once exclusive to alternative health communities now permeates mainstream wellness discussions, signaling a broader cultural transformation beyond any single movement.
What makes these movements, including MAHA, interesting from an economic and marketing perspective is not their novelty, but their synthesis. They've responded to six decades of public distrust with messaging that reflects values shared across demographic groups. Public sentiment around these movements is naturally divided, with support or opposition often hinging on specific policy details. This essay, however, is only an observational reflection on the psychological patterns that accompany change—examining shifts in public sentiment, trust, and attention through the lens of market timing and cultural momentum, rather than any specific stance.
When future historians examine our era, they'll likely observe not how suddenly things changed, but how long the pretense of proper function persisted despite mounting evidence to the contrary.